The Global Pulse Journal Blog

This CNN article is from a week ago, and strangely appropriate to this blog. It deals with president Obama’s pledge to not include employ lobbyists to an agency they may have lobbied. Given the current economic crisis, some folks think this is is the right thing to do. Some obvious examples include Wall Street lobbyists working at the Treasury department, and defense contractors working at the Pentagon. However, it may not be the best choice in all cases:

Consider Tom Malinowski. He’s the advocacy director for Human Rights Watch, an expert on genocide and torture. But when it came time for a top human rights job at the State Department, he was turned away.

Why? “Because he lobbied against torture,” says one incredulous administration official. “It’s crazy.”

But the rules are the rules: The ethics code requires that no lobbyist can be hired to work for an agency he may have lobbied.

So, just to clarify: Someone like Malinowski who lobbied against torture and is a widely acknowledged expert on international human rights law is, er, blackballed. More to the point, he was shown the door precisely because he tried to influence Congress on an issue that both he and the administration agree, and care deeply about. (Malinowski won’t comment.)

I think president Obama’s original intent was to avoid conflicts of interest, but can we agree this is a bit extreme? Advocating against torture is not the same as ripping off taxpayers on the behest of a giant insurance company.

The BBC is running an article called Madonna Urged to Rethink Adoption, which you can find here.  Pop star Madonna is planning on adopting a second child from Malawi, a four year old orphan named Mercy James.  What I find interesting is that the NGO Save the Children is arguing against the adoption, because the child may have extended family in Malawi who could care for him.  According to the BBC,
Save the Children spokesman Dominic Nutt told the BBC’s Newshour programme: “For the most part so-called orphans in poor countries tend to have family still available to them, if not actually a parent still living.

“It is vital, we say, that children should not be taken abroad to be looked after but should be cared for in their own environment by their own community, ideally by their own family, particularly their extended family.”

Whether or not you think Madonna, personally, should be adopting a second child from Malawi is a seperate issue.  Save the Children apparently believes that NO CHILD should leave the country if there is any possible way to find someone else to look after them.  Particularly disturbing is the idea that they should stay in their own environment.  Why should a child born into poverty be forced to stay in poverty?  Why is it that an American woman can put her child up for adoption even though her parents, siblings, aunts and uncles are still alive, whereas a Malawian child should only be put up for adoption if he has no remaining relatives?

Americans routinely adopt children from foreign countries, with excellent results.  I don’t think Malawi should be excluded from that opportunity.

The new Prime Minister of Zimbabwe, Morgan Tsvangirai, has announced that the practice of invading white owned farms is, ‘actually illegal.’  He went on to comment that those attempting to occupy farms illegally would be “arrested and face justice in the courts.”  This is a reversal of the policy under President Mugabe who encouraged Zimbabwean war veterans to occupy White owned farms, a policy which has led to the closure of hundreds of farms and the exodus of many White Zimbabwean farmers from the country.  Many cite this policy and the end of commercial agriculture that it brought about as the cause for the collapse in Zimbabweans economy and the hypyer inflation which the country is experiencing.  Zimbabwe was once known as the breadbasket of Africa.  Now, thousands are starving.  Hopefully Prime Minister Tsvangarai’s policy will encourage the reemergence of commerical farms in Zimbabwe, but only time will tell.

Following up on a previous post, the Guardian newspaper, in an explosive article, has compiled “detailed evidence of alleged war crimes committed by Israel during the 23-day offensive in the Gaza Strip earlier this year, involving the use of Palestinian children as human shields and the targeting of medics and hospitals”.

It also has produced 3 documentaries detailing their investigation. Be sure to watch them all:

[youtube:http://www.youtube.com/watch?v=Hy6-FZz69lE]

Part 1 deals with  deals with the allegations of using children as human shields by the Israeli army.

[youtube:http://www.youtube.com/watch?v=H2UuQ8V5DvY&feature=channel]

Part 2 deals with the targeting of medics and medical facilities. According to the World Health Organization, more than half of Gaza’s 27 hospitals and 44 clinics were damaged by Israeli bombs.

[youtube:http://www.youtube.com/watch?v=3ToZTtGOr0k&feature=channel]

Part 3 deals with drones targeting civilians.

In a report from March 23, Physicians for Human Rights Israel mentions:

there was “certainty” that Israel violated international humanitarian law during the three-week war in January, with attacks on medics, damage to medical buildings, indiscriminate attacks on civilians and delays in medical treatment for the injured.

“We have noticed a stark decline in IDF morals concerning the Palestinian population of Gaza, which in reality amounts to a contempt for Palestinian lives,” said Dani Filc, chairman of Physicians for Human Rights Israel. The Guardian gathered testimony on missile attacks by Israeli drones against clearly distinguishable civilian targets. In one case a family of six was killed when a missile hit the courtyard of their house. Israel has not admitted using drones but experts say their optical equipment is good enough to identify individual items of clothing worn by targets. The Geneva convention makes it clear medical staff and hospitals are not legitimate targets and forbids involuntary human shields.“

What happens after the relief services pack up and the foreign volunteers go home?  Today’s article in the New York Times by Neil MacFarquhar writing from Gonaïves is an all-too-rare example of follow-up during the off-season of catastrophe.  Half a year after a succession of hurricanes left hundreds of people dead and Haiti’s desperately fragile infrastructure in tatters, the people of Gonaïves are still struggling to resume normalcy — two-thirds of the city have yet to be repaired — even as they fearfully muster their defenses against future storms.

No other city in Haiti absorbed so much punishment. More than 30 inches of rain fell overnight. The deforested hills, less than 2 percent of them covered by trees, sent the spill-off crashing down into La Quinte River, the wall of water and mud eventually cresting at 15 feet above its banks.

By the time it receded from the city streets, the flood had killed 466 inhabitants; another 235 just disappeared and are presumed dead. Of the city’s 33,000 buildings, 5,441 collapsed and some 22,300 others were damaged. Nationally, damages came to a total of $900 million, or nearly 15 percent of the gross domestic product.

“All it takes is one cloud, and everyone asks me when they will be evacuated,” groused the deputy mayor, Jean-François Adolphe, when asked about the mood here. The City Council tried to develop a plan, he said, but readily admitted it was basically fruitless. The city does not have a place to shelter anyone, not to mention the means to ferry its inhabitants to higher ground.

Earlier this month, UN Secretary-General Ban Ki-Moon and former US President Bill Clinton visited Haiti to meet with President Rene Preval to discuss Haiti’s predicament and the poverty trap affecting its people.  As has been clear for many years, any serious plans for the country’s recovery will have to address not only provision of basic services and securing food supplies, but also long-term job creation and environmental recovery efforts.  Another certainty is that such efforts will require thorough changes in North America’s relationship to Haiti in terms of support and funding; although the UN released a request for $108 million for hurricane recovery in Haiti, less than half of that has been raised.  A high-level donor conference will take place in Washington, DC, later this spring.

More on the hurricanes, Haiti’s future, and a putative new chapter in US-Haiti relations:

UNICEF: Surveying storm preparedness in Gonaives.

Paul Farmer and Brian Concannon: “Change Haiti Can Believe In”

US Conference of Catholic Bishops: Cardinal Francis George urges Obama to grant Temporary Protected Status to Haiti for the next 18 months.

From the Times UK:

The Israeli army has been forced to open an investigation into the conduct of its troops in Gaza after damning testimony from its own front line soldiers revealed the killing of civilians and rules of engagement so lax that one combatant said that they amounted on occasion to “cold-blooded murder”.

The Palestinian Center for Human Rights released the names of 1,417 Gazans that it says were killed in the war, saying that 926 were civilians. The Israeli Government contends that most of those killed were combatants or legitimate targets.

According the article:

The soldiers’ testimonies include accounts of an unarmed old woman being shot at a distance of 100 yards, a woman and her two children being killed after Israeli soldiers ordered them from their house into the line of fire of a sniper and soldiers clearing houses by shooting anyone they encountered on sight.

“That’s the beauty of Gaza. You see a man walking, he doesn’t have to have a weapon, and you can shoot him,” one soldier told Danny Zamir, the head of the Rabin pre-military academy, who asked him why a company commander ordered an elderly woman to be shot.

The BBC has covered this as well.

[youtube:http://www.youtube.com/watch?v=2rPO1v3Uc1c]

To some, “collateral damage” is just a by-product of war, or at least what we tell ourselves in order to somehow justify the loss of innocent civilians. However, what if there is another reason for this violence? What if harming others, in this case Palestinians, is indirectly encouraged? Some Israeli soldiers spoke to Haaretz about their experiences. Even more troubling is an article published 4 days ago, which documents how graduating Israeli soldiers design special shirts to commemorate the occasion.

From the article:

Dead babies, mothers weeping on their children’s graves, a gun aimed at a child and bombed-out mosques – these are a few examples of the images Israel Defense Forces soldiers design these days to print on shirts they order to mark the end of training, or of field duty. The slogans accompanying the drawings are not exactly anemic either: A T-shirt for infantry snipers bears the inscription “Better use Durex,” next to a picture of a dead Palestinian baby, with his weeping mother and a teddy bear beside him. A sharpshooter’s T-shirt from the Givati Brigade’s Shaked battalion shows a pregnant Palestinian woman with a bull’s-eye superimposed on her belly, with the slogan, in English, “1 shot, 2 kills.” A “graduation” shirt for those who have completed another snipers course depicts a Palestinian baby, who grows into a combative boy and then an armed adult, with the inscription, “No matter how it begins, we’ll put an end to it.“ 

There has been a recent renewed focus on HIV prevention methods, especially in developing nations. One such method which, like the female condom (see Global Pulse Blog March 18th), microbicides are a potential method of empowering women to help prevent the spread of the HIV virus.

A March 12th discussion on US National Public Radio explores the continuing debate over the roll of microbicides in the fight against HIV.

In one recent study, presented at the Conference on Retroviruses and Opportunistic Infections in Montreal found results that, while not statistically significant, are believed to be promising especially when the microbicide gel was used consistently. The gel worked to prevent HIV in 30 percent of the women who tried it in this study.

Be sure to check out the entire discussion over this controversial HIV prevention method.

I recently read a very interesting article in the Journal of the American Medical Association (JAMA), which spoke about the correlation between education and health.   The article, ‘Social Policy as Health Policy’, (subscription needed) by Steven Woolf, MD, MPH stated that increasing education levels would do more to improve life expectancy in the US (and, presumably, across the globe) than advances in medical interventions.  One website referenced by the article is the Robert Wood Johnson Foundation’s Education and Health Calculator.  This tool will allow you go see the percent of adults who hold a university degree in every state of the US, or by many counties, to see the mortality rates, and to see how those rates would be affected by higher levels of education.  It’s fun to look at, and an important reminder that health inequalities can begin with inequalities in education.

The coup, which has been a bit more popular throughout Sub-Saharan Africa as of late, has now brought a new government to the people of Madagascar.  The new president is young and a proclaimed reformist, most typically are so only time will tell.  Of the many challenges in establishing a new government, perhaps the greatest is attempting to determine the long-term outlook for a given nation and its people.  Do I think this could put the country in a more precarious position?  Potentially, but maybe not.  Can I be sure of anything?  Not in the slightest.  With that, I will stick to the short-term.

South Korea had lofty aims to cultivate over a million acres of underdeveloped farmland within the Madagascar borders and then ship the produce back to South Korea as a measure of “food security.”  Those plans have been scrapped.  The South Korea proposition had one clear fault: they wanted the land for free.  In fact, this dubious arrangement had prompted condemnation from many outsiders and provided additional impetus for the subsequent coup.   Naturally, the new administration readily cancelled the deal.  This is politically understandable, but I do not believe it is optimal.

Much of Africa, including Madagascar, has an impresive amount of farmland devoid of farming.  A good driver of economic growth and wealth generation (typically increases health) is often the farming industry.  Any country with the right landscape and climate for a particular good(s) can enjoy a healthy export industry, usually to wealthier nations lacking food production (like the Gulf states).  Notwithstanding international trade issues/debates (particularly the Western farm subsidies), it may prove beneficial for Madagascar to put this available land to use, and if needed, use South Korean capital inflows to start the process.  The catch is: make them pay rent.  The arguments (from South Korea) about job creation and such being a payment of sorts are flimsy.  It is difficult to say and especially quantifiy the future effects on Madagascar’s labor market.  However, it would be quite manageable to include this new source of revenue in the country’s fiscal budget (using the money to bolster public health and education programs would not be such a bad idea).  Thus, I think Madagascar should not fold their cards and walk away from the playing table; rather, they should play a better hand.  And if they really are astute, and the land is truly valuable, they may wish to auction the land to all available bidders (tends to drive up prices).

There are a couple excellent entries on the PHR’s Health Rights Advocate blog regarding recent evidence about the participation of American medical professionals in torture.  Scott Allen, MD, writes:

Health professional supervision of torture is one of the gravest affronts to medical ethics and is illegal under both domestic and international anti-torture law. Danner’s disclosure of the ICRC report on detainee treatment in CIA custody is shocking but not suprising. For years evidence has been mounting through news articles, government investigations, and even the statements of Bush Administration officials that health professionals were centrally complicit in the breaking of bodies and minds at the black sites, Abu Ghraib, Guantanamo and elsewhere.

All of this was in the bad old days of WMDs, flag-waving, and Blackwater. . . right?  Not so fast, writes Sara Greenberg.

Something about this really gets under my skin.

As student doctors, we are given so much.  We are given amazing knowledge, the product of an entire history of human civilization and learning about the human body and mind; the time and experience of our mentors; and the unbounded kindness of our patients, who allow us to touch them and to learn from them, even at the risk of harming them by our inexperience or error.  We are given all these things in trust, to use in the remainder of our professional lives to heal and to help.  A medical professional who knowingly uses his or her knowledge to help violate another person’s body and autonomy has broken that trust, and broken it for all of us: past and present and future.

As evidence of medical participation in war crimes continues to accumulate, American medical professionals need to do some serious soul-searching.  I believe this applies to all of us — including those who have never seen the inside of a black site, voted for the Democrats every time, or are still in training — because somehow, our medical system obviously had produced a significant number of physicians who had no problem assisting in torture.  What kind of professional climate was it, that made that possible?  We need to make sure that the next generation of physicians, psychologists, and allied health professionals, are absolutely 100% positively sure, that it is not okay to do this.  We need to talk about it clearly and transparently, so that we may begin to rehabilitate some of that trust.

I leave all you fellow future physicians with this excerpt from a 2006 editorial from Time by Andrew Sullivan:

After a while, you get numb reading these stories. They read like accounts of a South American dictatorship, not an American presidency. But we learn one thing: once you allow the torture of prisoners for any reason, as this President did, the cancer spreads. In the end it spreads to healers as well, and turns them into accomplices to harm.