Is it me or is it you?

            For the first time this week, I’ll admit that I had some difficulty with the reading for this week, which focused on the idea that Botswana has not seen a drop in HIV incidence, in spite its aggressive ARV program, because education campaigns were too “Western” in their nature. My discussion of the reading will be very brief in this entry, simply because I feel that I haven’t completely grasped the concepts at hand as of yet. Hopefully, after the in-class discussion today, I will have a better understanding of the material. I plan to post another blog entry post-discussion. That should be a bit more insightful.

For now, I’m just going to summarize the a few issues presented in this week’s readings. Many scholars believe that these education campaigns, which were often in English, and were based on education campaigns in the U.S. and Europe, did not have the intended widespread effects, because these initiatives did not properly account for Botswana’s culture and value systems.

            Prior to the advent of modern medicine, for centuries the Tswana people have gone to “witch doctors” and other “healers” to cure their illnesses. These healers are still widely consulted today, and many are well-respected in their communities. One of the foundations of this alternative medicine is that all ills in one’s life can be traced back to a clear source in that person’s life—often the illness or suffering of the patient is considered to be a function of that individual mistreating someone else. For example, a healer may attribute an individual’s bad headaches to his or her jealousy of a colleague. Many scholars contend that the education campaigns put forth in Botswana, simply state that the cause for HIV is unknown, and this is problematic because it is culturally not sound. Another major contention by the scholars in the readings for this week is that topics about sex, such as condoms, are taboo in public forum in Botswana, and that HIV campaigns that bring such issues to the forefront are difficult for people to accept.

            While I understand how campaigns put forth in Setswana would be more effective than those in English, I am not sure what these scholars believe these campaigns should say. Of course every culture and every group has its own system for interpreting the suffering that befalls it, but I don’t understand how else a campaign for HIV awareness and education can be made.

            Perhaps, my personal bias as a pre-med student, and as someone who strongly values scientific inquiry is clouding my judgement here, but I feel that these scholarly articles are marginalizing the Tswana culture. In essence, it seems like these scholars don’t think the Tswana people can handle the cold, hard facts about HIV. As a future doctor, I believe it will be my responsibility to arm my patient’s with as much knowledge about their health as possible—even if I have to bring up topics that are uncomfortable or admit to the limitations of science. I simply don’t understand how laying down the facts is so problematic.

            Am I the one who’s marginalizing the Tswana culture by putting it to the side? Or is there more merit in the scholarly argument that the Western way of doing things isn’t always right than I am able to see?

Ignorance Isn’t Always Bliss, but Knowledge is Always Power

        

HIV/AIDS is an equal opportunity ailment. It crosses every boundary imaginable to afflict adversity on thousands upon thousands of people from all walks of life while continuing to confound doctors and researchers from around the globe. It is the mystery in medicine, like the one of the HIV/AIDS epidemic, that initially drew me to pursue a career in medicine. As a doctor, I hope to be able to develop the skills necessary to help others lead healthy lives and also to confront the medical maladies that cause so many to suffer.

I seek knowledge so that I will have the power to alleviate the pain of others to the greatest extent possible. My patients will come to me seeking knowledge about their health and how it can be improved. (I guess we’ll see how successful I am at actually convincing people to trust me with their health.)

From Unity Dow and Max Essex’s Saturday is for Funerals, it is clear that knowledge was key in giving the people of Botswana the tools to fight the AIDS epidemic there. Although the incidence and prevalence rates remain high, Botswana is one of the only nations providing anti-retroviral (ARV) medication to all citizens. Such a system ensures that those who are sick will get treatment. Although in certain cases treatment is complicated due to drug resistance, in general the ARV cocktail widely used in Botswana, called HAART is highly effective in prolonging the lives of patients with HIV, and a similar cocktail is also highly effective in combating the transmission of HIV from mother to infant.

The government program of providing ARV medications is accompanied by intensive education and counseling services, so that patients do not only get a second shot at life with an improved bill of health, but they can also understand what having HIV entails and what they must do to protect others from transmission. When just south of Botswana, in South Africa, many leaders, including President Mbeki, many denialists are spreading fallacies about how HIV does not exist and was made up in the West, it is especially remarkable that the government has responded in such a decisive and unified way. South Africa continues to have one of the highest HIV rates in the world, with low quality of treatment. Ignorance and bliss, diametrically opposed.

            This book is an eye-opening account of how Botswana went from a nation where in one year, Unity’s mother attended at least one funeral every week, in which AIDS was often hidden as the cause of the deceased’s death due to stigma, to a land where the epidemic is now spoken of much more openly and where friends and coworkers band together and convince each other to get tested and get treatment.

The bottom line: knowledge about the diesease will help everyone—not just those who are HIV-positive or have a loved one who is. Effective treatment, counseling, and education about prevention is vital to the economy. Instead of losing many of its young adults to HIV/AIDS, Botswana is able to keep those individuals in the workforce longer, reduce the number of orphans (who are unfortunately more fiscally demanding since their parents generally don’t leave much behind to help care for them), and reduce overall costs of healthcare and childcare, by providing ARV drugs. This also ends up creating a more egalitarian societyl.

In 2006, Michael Ganz, an Assistant Professor at the Harvard School of Public Health, released a study that showed society pays $3.2 million to care for an autistic person over his or her life, citing that this was partly due to the loss of productivity created by autistic people who are unable to hold jobs. The point of his study was that early intervention therapies for autism, which are proven to help autistic individuals function at higher cognitive levels as adults, should be instituted and covered by health insurance, which they are currently not. By doing so, Ganz’s work implies that the initial expenses of these therapies will be cost-effective because it will end up being an investment that pays off, allowing society to reap the benefits.

Obviously, autism and AIDS are two vastly different beasts. But, both are lifelong, and until a cure is available, they never go away. Succumbing to them, hurts everyone in the long run. But, knowledge about how to take early action to keep these conditions under control, and taking smart, well-planned action based on that knowledge helps everyone in the long run.

Many other nations struggling with the AIDS epidemic and with other such medical mysteries should perhaps study Botswana’s model. After all, it is following one of the most basic tenets of medicine, straight from the Hippocratic Oath: “First, do no harm.”

Pursuit of Happiness

            On July 4^th, 1776, thirteen Americna colonies unleashed the Declaration of Independence, penned by Thomas Jefferson, to the world, proclaiming that they could no longer bear to be under the thumb of King George’s tyrannical rule, and instead were now an autonomous entity. The most famous idea that came out of this document is, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

            For years to come, “life, liberty, and the pursuit of happiness” would become the cornerstone of what democracy entails for Americans. A sacred ideal. And yet, where does our happiness lie? The American dream—which attracted thousands of foreigners to come here—is for every individual to be able to work with a steady income, start a family, own a home, raise children, help put them through college, and save up enough money for retirement, while also having enough to purchase top-of-the-line cars, appliances, computers, etc. And have a white picket fence, too. But, as recent events have shown, that is simply not economically possible.

            In America, we have applied the basic democratic principles of government to our daily lives, namely the idea that everyone should have and equal say and a right to vote (although we did have trouble making this a reality, we have always claimed to believe in it). Similarly, Americans have extrapolated and said not only should all individuals have the right to have their voices heard in government, but all individuals should have the right to have their voices heard in the economy, as consumers. In our capitalistic view, Americans naïvely believed that if the majority can get what it wants in the political realm, this will also be true in the economic realm. Unfortunately, this is not viable.

            We often say money doesn’t buy happiness. But in America, our pursuit of happiness is strongly linked to economic stability.

            According to the National Poverty Center, in 2009, 14.3 percent of Americans lived in poverty. Thirty-five percent of American children grew up in poverty (http://www.npc.umich.edu/poverty/). According to a study by the University of Maine, the American healthcare system was “by far the most expensive healthcare system in the world” (http://dll.umaine.edu/ble/U.S.%20HCweb.pdf). Similary, the USA is responsible for 46.5% of the world’s military expenditures, according to the Stockholm International Peace Research Institute (http://www.globalissues.org/article/75/world-military-spending). Talk about stark inequalities.

            In America, we have erroneously tied democracy to consumerism. Furthermore, we have spread this belief to other nations, telling others they should also spend in this way. It certainly seems to be the case in Botswana. At present, Botswana’s economy is strong as is its democracy. There is little corruption and large economic growth. It is still working to find ways to fortify its freedoms of speech and press and better include all groups in the political process, since most news reaches citizens by government-controlled radio (“Freedom in the World,” Botswana 2010) and minorities like the Bushmen have little say (“For Some Bushmen, a Homeland Worth the Fight” by Barry Bearak). But, overall, the nation is following in many of America’s footsteps. And the unfortunate result is that it is attempting to fill a pair of shoes that are not the right size.

            A model where democracy creates a society where spending is so rampant can only be successful for as long as the country is economically stable. Botswana doesn’t have the same net worth as the USA, but it is stable. However, if this economy was unstable, democracy would most likely be co-opted for a different, less egalitarian form of government. This is the breeding ground for neo-patrimonialism regimes, a problem that is common in Africa, and is described in “State Formation and Governance in Botswana” by Neil Parsons and James A. Robinson. This is a system in which, in spite of a written Constitution, one ruler is in charge of government, sometimes as a president-for-life, and is above the law. Officials in bureaucratic positions are in place more for the wealth and power those positions accrue, rather than to carry out necessary government functions. Ultimately, this leads to inefficiency and corruption.

In this situation, creating what Max Weber termed a legal-rational government, actually hurts the pocketbooks, and most likely the egos of those in power. In the legal-rational system, power is derived from rules that are written down, applied equally to all, and adjudicated to ensure equal application. Individuals only have power if they hold a political position and their power lasts only as long as they hold that position (Keeping the Republic by Christine Barbour, CQ Press). However, legal-rational authority only works when there is enough to go around, so the commonfolk can earn a decent living, while those in power can continue to lead a cushy lifestyle.

To summarize my ramblings, I conclude by saying, it is high time that Americans and the world redefine what the pursuit of happiness is. The fact of the matter is, no group of people can prosper exponentially when resources are finite. If Botswana’s people wish to have the right to their own pursuit of happiness, then they should heed America’s mistakes and recognize that while economic stability is desirable, it is not the only component of happiness. As Nelson Mandela once said, “Money won’t create success, the freedom to make it will.”

 As Wayne Arnold points out in his New York Times Article “Rethinking the Measure of Growth,” it has become necessary for people in all countries to create a completely transformed vision of prosperity, where the wealth and strength of one’s community comes before the wealth and strength of the individual. If we don’t make a conscious effort to do so, we’re all going to end up unhappy—and our lives and liberties may remain hanging in the balance.

Gandhi said it best: “Earth provides enough to satisfy every man’s need, but not every man’s greed.”

Join Me On An Adventure

I am ecstatic to say that I will be traveling to Botswana as part of Wayne State University's African Democracy Project. About twelve students and four instructors will embark on a two-week journey in March to focus on the topics of Democracy, HIV/AIDS, and Sustainable Development, and how these issues can be compared and contrasted in the local and global contexts. The goal of the trip is to explore the "glocal" connection between Detroit and Botswana, specifically applying concepts and ideas learned about the governance in Botswana to improve the MetroDetroit area.This blog, a required part of the course, will hopefully become a narrative of this experience.


The basics about Botswana (from the CIA World Factbook):

• Geography: Located just North of South Africa
• Climate: Warm winters and hot summers; prone to periodic droughts
• Populations: 2,029,307, with a life expectancy of about 60 years
• People: known as the Batswana
• Language: Setswana
• Religion: Christianity mainly
• Government: Became a representative democracy after gaining independence from England in 1966
• Economy: One of the world's highest growth rates since its independence, considered one of the richest nations in Africa
• Major industry: Diamond Mining
• HIV prevalence rate: Second highest rate in the world, about 24%. Currently Botswana is implementing a new program to make anti-retroviral medication free to all citizens with HIV or AIDS. Many feel that the HIV incidence rate is very similar in Detroit and in Botswana, when accounting for the population differences.
• Major Environmental Problems: Overgrazing, desertification, limited fresh water 

On a final note, I know very little about blogging. My hope is that this blog will become more of a forum, where my classmates, friends, and family can read, write, and share their thoughts on the subjects covered over the course of this class. So, please comment below!