What would you do?

There is a family that takes care of our compound in Kampala. David* and his wife, Susan*, take care of cleaning our flat, washing our clothes and letting us in and out of the compound gate. They have three children, two boys and one girl, aged 10, 7 and 5. They had two other children, but they died when they were very young.

Recently, David has not been around, and I assumed he had gone to the village as usual to visit relatives and take care of family issues. I discovered only yesterday that he has actually been extremely sick, unable to get out of bed, and that one of his aunts was now living with him and taking care of him.

Today I went in his house to talk to him. He said he had gone to a hospital (not Mulago) several times and was told he has ulcers and cancer that is causing pressure in his abdomen, leaving him in excruciating pain and urinating blood. He needed more money to go back to the hospital, but this morning his mother called, and told him that the family had wasted enough money, that he should come back to the village and they would find another solution. She told him to get on the next available bus, and come to Soroti, in eastern Uganda. The bus ride takes, I believe, somewhere between 6 and 8 hours.

David’s brother had died some time ago, and David had to carry him back to their home. He has been having nightmares every night, and his family seems to believe that his illness is due in part to this traumatic experience. Hence the search for an alternative solution.

I could not tell from his description what exactly he was diagnosed with or how he was diagnosed, and his aunt did not know the name of the treatment he was given. At first he said he wanted to drive back to the hospital, but then at his family’s insistence it was decided that he would get on a bus to Soroti today. He said he was confused, that he didn’t know now what was causing his pain and didn’t know what to do. I wanted to take him back to the hospital, get more medicine, and figure out what was really wrong. I can’t imagine how he will survive the bus ride. He can barely sit up on his own and cannot walk without assistance.

But it is not my decision, however sure I am that going to the hospital in Kampala is a much better idea than getting on a long, hot and bumpy bus ride to Soroti for some alternative treatment. As a student of human biology (my first degree anyway) I of course have much faith in so-called “western” medicine. I know that it will not solve everything or save everyone, but I want to know that he has gotten the best treatment possible and been properly diagnosed at the very least. And I am not sure that he has been.

I am so afraid for him, and for his young family here, but it is not up to me to decide what is best for him. There was nothing I could do but drive David and his aunt to the bus park and hope for the best.

*for privacy’s sake I have changed their names

Who needs electricity? Come on baby, light my fire

Does lack of electricity lead to more sex? Which leads to more babies? This is the argument Uganda Planning Minister (Ministry of Finance), Ephraim Kamuntu, has recently made according to the BBC’s “Uganda Blackouts ‘Fuel Baby Boom'”. Without TV or other entertainment, Ugandans are falling into bed and making babies, leading the country to hold one of the highest population growth rates in the world, or so the story goes.

Meanwhile, in the U.S. condom sales are up, apparently for related reasons. What’s the cheapest form of entertainment? No electricity and no entrance fee required (legally anyway), and it keeps you warm so you can reduce your heating bill! But in these times of financial hardship, U.S. consumers are apparently wary of accidentally ending up with a costly bun in the oven…hence condom purchases…

A few questions though…

In Uganda, sure, it may be dark, but you still have your seven other kids bounding around the house, how much time do you really have to sneak off and procreate some more?

Also, what about the men (and some women) who stay out in bars till 3am? They are there in numbers…I know because I can hear them when the Ntinda hotspots keep me awake at all hours of the night (and morning)…

Most importantly, what about countries with equally poor access to electricity? Why isn’t their population growth rate as high as Uganda’s? India, for example, has a population growth rate of 1.4% (according to the UNDP), and yet nearly 490 million people live without electricity.

Finally, I think population growth will fall only when couples have incentives to have fewer kids, or disincentives to have more kids. While in a taxi yesterday, the driver told me he had 14 children with three women. And wanted 2 more with a different woman. I am sure he makes far less than most couples in the U.S., but there is still no incentive (as he sees it) for him to stop making babies, electricity or no electricity.

Sorry Dr. Kamuntu, your argument falls flat. How many kids do you have by the way?

Why M7 Overestimates Himself

Ok, I don’t understand Museveni’s psychology enough to take a legitimate stab at why he seems to overestimate his own abilities. But a recent article in TIME (by the way, did you know that TIME is an acronym? “The International Magazine of Events”) discussed precisely this issue — namely, why people in powerful positions (from Obama to Putin to M7) tend to overestimate their own capacity.

The article discusses a new study by two Stanford researchers published in Psychological Science. Authors note, “By producing an illusion of personal control, power may cause people to lose touch with reality in ways that lead to overconfident decision-making.”

How does M7 measure up?
Personal control. Check. Losing touch with reality. Check. Overconfident decision-making. Check…

M7 was until recent years hailed the “new breed of African leader.” Just months after coming to power in 1986 he announced, “The main cause of Africa’s crisis is leaders who do not want to leave power. There is no reason why anyone should be president for more than ten years.” And yet here we are, in 2009, with two years until the next presidential election, and his fourth term is already inevitable in the eyes of many. So what happened? Was his personalisation of power inevitable? (see last week’s article in The Independent, “Family Rule in Uganda” , for more info on the subject)

I don’t think an experiment with Stanford students rolling dice can provide any definitive answers to these questions. Nevertheless, I find valuable research on the psychology of power, and why some leaders take their countries to moon while others drive them into the ground. I tend to think that individual agency plays a large role…but of course this is a subject of great debate. Does a leader shape society more than society shapes a leader?

Cabinet Reshuffle: Votes > Performance

I know, this should be obvious. The point of Museveni reshuffling cabinet was not primarily to ensure that the most qualified people become ministers of their respective ministries, but to secure votes for the not-so-distant 2011 presidential election. I know, but does government have to blatantly admit it?

In a recent interview with Uganda’s Independent magazine, the Vice President of Uganda, Professor Gilbert Bukenya gave the following response to the following question:

Q: How do you regard the newly appointed cabinet; is it the best the President would produce?

A: This [cabinet] is a perfect combination which is going to lead us to the next general election with developments that will help us generate more support as the NRM party from the masses. The new cabinet has people whom I think are great performers and this is what the President needs as we move toward the elections in 2011. This does not mean that the previous cabinet did not have performers but I think these are vote winners.

And there you have it. Votes > Performance. No shame, no beating around the bush.

My other favorite part of this interview? In regards to his supposed shenanigans as reported by the Ugandan media:

“What these reports have done to me is denying me a chance to dine and mix with people in open places because during such times stories are made up, actually it’s because of that that I decided to construct gyms and saunas in all my homes so that I work out privately.”

Oh, really? Phew. Gyms and saunas in all your homes? Thank goodness, I was worried.

Who Cares About Cancer?

Cancer is not captivating. Or, at least, in sub-Saharan Africa it doesn’t seem to be when compared with, say HIV/AIDS or malaria. Why is that? Is it the sheer numbers? The assumption that you are more likely to die of a communicable disease before you will ever develop cancer in this region? Or maybe, like global warming, it’s a scary topic that it is easier to put off thinking about until tomorrow. Or the next day…Or the next day…

It seems like a lot of friends of friends are dying or have died from cancer recently in Kampala. On Sanyu FM this morning, a caller asked for advice on how to handle his relationship with a girl who had terminal cancer. While I have long been interested in health and healthcare in Uganda, I have never looked much into cancer prevalence or treatment. I assumed, at any rate, that treatment was prohibitively expensive for most people when available at all. But do we even have accurate figures on who has cancer and where? I went circles around the WHO Uganda site to find any figures. At best they have projections for 2005, based on 2002 burden of disease estimates. Not exactly what you might call up-to-date or very accurate.

I next went to Uganda’s most recent Demographic and Health Survey, from 2006. I was shocked to find that in searching “cancer”, there was a SINGLE result, out of 501 pages! It was a note on reproductive organ cancer made in reference to the Sexual and Reproductive Health Policy Guidelines that had been developed in 1994.

According to WHO’s stats, cervical cancer is the most common form of cancer in women, followed by breast cancer. In men, the most common is prostate cancer, followed by esophageal cancer. Lung cancer is surprisingly low on the list (9th for men, not even ranked for women), given the number of people I see smoking around Kampala (of course this is not indicative of the rest of the country, but still, Kampala-ites are more likely to be diagnosed anyway I would imagine).

Uganda does have a Cancer Institute, which is almost definitely underfunded, understaffed and ill-equipped, though I haven’t done much in-depth investigation of the place. While cancer may not yet be killing as many Ugandans as malaria or diarrheal disease (which primarily affects children), I have a strong suspicion that it is much more prevalent and pernicious than meets the eye. It may not be captivating, but it is killing. More on this to come…

More Moyo, Less Bono!

Smart, sexy, Zambian economist Dambisa Moyo has recently published her first book, Dead Aid: Why Aid is Not Working and How there is Another Way for Africa. When I read her interview in the Feb. 19th issue of the NYT Sunday Magazine, I immediately shot an email to Andrew Mwenda telling him to pick up the pace with his own long awaited book, which will likely make some similar arguments to that of Moyo (though with considerably more Ugandan and Rwandan examples, among other things).

Paul Collier, author of The Bottom Billion and professor of Economics at Oxford, has written a review of Dead Aid in the UK’s Independent. Collier actually taught Moyo at Harvard and Oxford, where she did her studies, and I believe he gives a fair assessment of her work. That said, he seems to disagree with some fundamentals, namely that he doesn’t think cutting aid would solve many problems, because he says, “I doubt that many of Africa’s problems can be attributed to aid.” I am not so sure. Problems may not have started with aid, but many are certainly continuing because of aid….

I can’t wait to get a copy and make my own assessment. In the meantime, Andrew, we are waiting! And watch out, your suits are sharp, but Ms. Moyo looks waaaaay better in heels.

(Source: NYT)

Andrew on Aid (Again)

In his excellent new blog, Aid Watch, William Easterly has posted a video of Andrew Mwenda speaking at a recent conference at NYU. Sadly, my Internet connection is currently too slow to watch it, but I have spent enough time with Andrew at The Independent and around town that I am pretty sure I know what he is saying…essentially that foreign aid makes governments accountable (if at all) to donors instead of their own people, which has damaging consequences for many young and emerging democracies.

I generally agree. In some cases, there is little evidence that governments need to be accountable even to the donors, who seem to keep throwing money at programs and government coffers without following up to see that the money translates into measurable outcomes. Domestic taxes are a good (if obvious) solution. When people are coughing up their hard earned money to pay for public services, for example, they are much more likely to make sure that government actually delivers these services.

Tax collection is not easy, however, especially when the richest businessmen are often top government officials themselves, or have close ties to the government. Studies from the Economic Policy Research Centre in Uganda have found that tax evasion in the country is widespread (an altogether expected finding). I am sure we would be shocked to know the real amount that is owed to the Uganda Revenue Authority. It is also hard to tax the informal sector, which constitutes a large and largely undocumented portion of the economies of many developing countries. Nevertheless, improved tax collection should be a high priority for those looking to create real systems of accountability in countries like Uganda. But who are these people exactly? Politicians? Government officials? The most powerful people in the land? Mmmm, methinks not…

Not the First Lady I wanted in the news

Last week I noted the seemingly unusually frequent news stories related to First (and former First) Ladies around the world. I almost added at the end, “Who’s next, Mugabe’s wife?” Close, as it turns out. But instead it was Susan Tsvangirai, wife of the Prime Minister of Zimbabwe (Morgan Tsvangirai) who died in a car crash in Zimbabwe last Friday, March 6.

There has been some speculation that the crash was not an accident but a malicious attempt to oust the PM, but given the decrepit roads, poor driving and sky high car accident rates in the region, I would not be surprised if the official story (that the driver of the truck that plowed into the Tsvangirai’s car) was true. In any case, it is a great loss and tragedy for the Tsvangirai family (which includes 6 children and two grandchildren).

There have been a number of high profile road traffic deaths in Uganda as well, which has one of the highest road accident/death rates in the region. Yet despite the fact that nearly everyone I know has lost a loved one to the roads, there is little to nothing being done to improve the condition of roads or people’s driving. I don’t understand why. It wouldn’t seem to be a collective action problem, because everyone is suffering and I don’t think one group is disproportionately affected. Perhaps it is a fatalistic mentality when it comes to the roads? I have heard multiple people explain these deaths as “God’s will.” Others have told me they do not wear seatbelts because they would rather be killed than maimed for life.

While I do not consider myself very religious, I do generally understand the “God’s will” sentiment. I do not think it applies here however. It is not God’s will that people within the Ministry of Transportation are not doing their job. It is not God’s will that corruption eats up money meant for road construction so that in the end you have roads that have developed potholes before they are even completed (ahem! Northern Bypass). Submission to incompetence gets you nowhere at best and, evidently, killed at worst.

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