The Academy in the time of Influenza: American medicine and the Great Pandemic

American medicine up until the twentieth century was an unmitigated disaster. Or so argues (quite convincingly) John Barry in his fascinating book, The Great Influenza: The Story of the Deadliest Pandemic in History. The first two sections of the book cover a brief history of American medicine and medical research, and I’ve only just gotten to the outbreak of the pandemic that killed between 20 and 50 million people, according to the best estimates. For comparison’s sake, WWI claimed 16 million lives, and AIDS an estimated 33 million.

Barry highlights a strong link between war and disease, namely, the emergence of epidemics or even pandemics. I’ll return to a discussion of this thesis when I’ve finished the book, but for now, what has been most striking is the utter catastrophe that was American medicine up until relatively recently. While scientists and physicians in Europe, including Robert Koch, Pierre Louis, Louis Pasteur, and John Snow were pioneers in epidemiology, germ theory, and more, the study of medicine in America was stagnant, suggesting the importance of healthy academic and scientific competition on the European continent.

Evidence of the United States’ relative backwardness is abundant. Charles Eliot, who became president of Harvard in 1869, wrote in his first report as president that, “The ignorance and general incompetency of the average graduate of the American medical Schools, at a time when he receives his degree which turns him loose upon the community, is something horrible to contemplate.” When Eliot proposed reforms within Harvard, including examinations (of all things), Professor of Surgery Henry Bigelow, had this to say:

Charles Eliot, Harvard President 1869-1909

“[Eliot] actually proposes to have written examinations for the degree of doctor of medicine. I had to tell him that he knew nothing of the quality of Harvard medical students. More than half of them can hardly write. Of course they can’t pass written examinations…No medical school has thought it proper to risk large existing classes and large receipts by introducing more rigorous standards.”

At the end of the 19th century, Barry reports that American universities had “nearly two hundred endowed chairs of theology and fewer than five in medicine…” showing where both the money and the power lay.  It was ultimately the initiative of a few individuals, combined with big money from illustrious families such as the Hopkins and Rockefellers, that turned the ship around.

The Great Influenza is an excellent read, and fodder for thought not only for those interested in medicine, epidemiology, and virology (guilty as charged), but also for those interested in the academy as an institution – how it evolves or stagnates, and the factors that generate innovation and massive leaps forward in our understanding of the world.

Ugandan politics: history on repeat

2014-03-01 11.15.32

On Saturday, March 1, Ugandan Prime Minister Amama Mbabazi (@AmamaMbabazi) held his occasional tweetup, #askthePM. It was the best attended tweetup to date, with virtually all local media represented. And there was was plenty to discuss.

The primary topics included Uganda’s recently passed Anti-Homosexuality and Anti-Pornography laws, as well as party politics within the ruling party, National Resistance Movement. The Observer has captured much of the verbatim proceedings, so I won’t repeat them here. Instead, I’ll offer some thoughts on what Saturday’s discussion says about the current state of Ugandan politics. In short, we are watching history on repeat.

Recent events and Mbabazi’s comments suggest the younger generation of the NRM – amongst those most active in supporting the Anti-Homosexuality Bill – may be out of step with long-time cadres. Or rather, NRM youngsters (relative term, here) comprise an unwieldy arm that may wittingly or unwittingly push the party, once again, into some awkward contortions.

Mbabazi, like Museveni previously, suggested that he had never supported the Anti-Homosexuality Bill. He thought the new bill was redundant, since homosexuality was effectively banned in the existing penal code, thanks to British colonial laws. Further, unlike many Ugandan politicians (and pastors), Mbabazi said that homosexuality was not “un-African,” and has “always been here.” He contended that in Africa sexuality is a private affair, suggesting it should be left that way, with consenting adults left to do as they please.

Mbabazi’s comments, together with the reassuring statement from longtime NRM cadre and health minister Ruhakana Rugunda that, “All people whether they are sexual orientation as gays or otherwise are at complete liberty to get full treatment and to give full disclosure to their doctors and nurses,” suggest that the older generation of the NRM was caught flat footed by the speed at which the bill moved between December 2013 and February 2014. Younger MPs battling in a fiercely competitive electoral environment with no “historical” basis on which to draw support pulled it instead from populist, if draconian, legislation, and dragged everyone else along for the ride. It did not help that President Obama’s statement may have forced Museveni into a corner from which he had to come out and fight, ultimately signing the bill he had opposed not long before.

Flat-footedness and youthful scheming may have been a running theme for the month of February, and extended to Kyankwanzi, where Youth MP Evelyn Anite brought forward a resolution proposing President Museveni stand unopposed as the party president in 2016. Mbabazi contended that the position of the caucus, for which Anite is the spokesperson, was merely an opinion. But the consequences of this “opinion” cannot be so easily dismissed.  Anite’s proposal harkens back to another made by a young woman MP a decade ago. In 2002, then woman MP for Adjumani, Jessica Eriyo, made a motion to remove term limits at the meeting of the party’s (then, Movement’s) National Executive Council. The motion, like Anite’s proposal, took many by surprise, but its consequences were profound. History has a funny way of repeating itself, many times over in the case of Museveni’s candidacy.

And so here we are. The prime minister, who could have carried the torch, is taking fire, again, and MPs too young to remember any other president angle for his good favor, and their political careers.

Uganda’s Anti-Homosexuality Law

Below is a copy of the text from a piece published in the Washington Post’s Monkey Cage blog:

The rise of morality politics in Africa: Talk is cheap and dangerous, but wins votes

Melina Platas Izama

Ugandan President Yoweri Museveni today signed into law his country’s Anti-Homosexuality Bill. The passage of this bill is part of an emerging trend of morality politics in Africa and beyond, including but not limited to the criminalization of homosexuality. Legislating morality, unlike improving social services like health and education, is nearly costless for politicians. It is also extremely popular. Legislators in Africa struggle to hold onto political power, and the majority of their constituents view them as corrupt, according to Afrobarometer surveys. Electoral pressures, combined with politicians’ poor record of service delivery, make legislating morality an increasingly attractive option. In addition to winning votes, however, laws such as the criminalization of homosexuality can also be used opportunistically against both the public and political opposition.

Uganda’s anti-homosexuality bill, which has been under discussion since 2009, criminalizes homosexuality and provides a punishment of life imprisonment for “aggravated homosexuality.” The law delineates particular same-sex acts as “aggravated homosexuality,” including  sex with a minor or with a person with a disability, or if the offender is an HIV-positive person or a “serial offender,” defined as “a person who has previous convictions of the offence of homosexuality or related offences” (the Anti-Homosexuality Act, 2014: Sections 1 and 3). In the original bill proposed in 2009, “aggravated homosexuality” was punishable by death, and failure to disclose an offense committed by another person was punishable by imprisonment for up to three years. Both of these provisions were removed in the final version of the bill. However, in a news conference held immediately prior to signing the bill today, Museveni seemed unsure of the bill’s contents, asking his aides in the audience whether citizens were required to report on one another.

The anti-homosexuality bill reflects popular sentiment in Uganda, where 90 percent of respondents said that homosexuality was “never justified,” according to the World Values Survey, and 96 percent of respondents said that society should not be accepting of homosexuality, according to the Pew Global Attitudes Project. Uganda is no outlier on the continent. Kim Yi Dionne and Boniface Dulani, using all publicly available data on attitudes toward homosexuality in Africa, found that although higher levels of education, living in urban areas, and lower levels of religiosity were associated with greater support for same-sex rights, the vast majority of Africans oppose homosexuality. Dionne and Dulani point out, however, that the limited data collected on attitudes toward homosexuality in Africa fails to capture the salience of same-sex issues among ordinary Africans.

Uganda’s anti-homosexuality bill reflects trends across the continent in criminalizing (or re-criminalizing, since more than half of remaining “sodomy” laws worldwide are colonial relics) homosexuality. The reasons for the recent spike in anti-gay legislation (not limited to Africa, by the way) are still being debated. Guy Grossman suggests therise in evangelical Christianity and heightened political competition explain the political saliency of LGBT-issues. These bills are undoubtedly politically popular, and thus useful tools for garnering electoral support.

David Bahati, sponsor of Uganda’s anti-homosexuality bill, was one of a handful of parliamentarians to run unopposed in Uganda’s most recent elections in 2011, in a country where competition over parliamentary seats is rising with every election. An average of more than five candidates contested for constituency parliamentary seats in the most recent election, up from less than four in 2006. Around half of the incumbents who ran for reelection were voted out of parliament in 2011. Bahati was subsequently elected vice chairman of the caucus of the ruling party, the National Resistance Movement (NRM).

At the presidential level, backlash and condemnation from Western countries, including the United States, where President Obama issued a statement warning Museveni that signing the bill would “complicate” the United States’ relationship with Uganda, have produced a rally-around-the-flag effect, where even Museveni’s most staunch opponents and a usually critical media have applauded his decision. Some have argued that he is calling Obama’s bluff, leveraging Uganda’s military role in the region. In any case, his signature, appended just weeks after members of his partypassed a resolution in support of his bid for a fifth term in 2016, must be seen in the context of a presidential campaign season that has, for all intents and purposes, already begun.

Recent “moral” legislation extends beyond homosexuality, however, and focusing on the salience of LGBT issues may obscure other arenas in which moral dictates are being employed for political purposes. The signing of the anti-homosexuality bill in Uganda comes just weeks after the signing of the Anti-Pornography Bill, widely reported by local and international media as the “mini-skirt ban,” despite no mention of skirts in the bill itself. Legislating morality may seem odd in a country where more than three quarters of survey respondents believe “some of” or “most of” parliamentarians are corrupt, according to Afrobarometer data, but perhaps it is precisely because of their credibility deficit that politicians are employing moral dictates as a nearly costless alternative to delivering the goods and services that are so badly needed.

In addition to serving as quick and cheap political wins, these laws can also be easily converted into tools for political witch hunts. Ashley Currier demonstrates how leaders of the ruling party in post-colonial Namibia have used political homophobia to stifle dissent. Uganda’s political opposition seems all too quick to forget that opposition leader and former presidential candidate Kizza Besigye was jailed andtaken to court on rape charges (in addition to treason and terrorism) in advance of the 2006 presidential election. The charges against Besigye were eventually dropped, but with Uganda’s new laws come a new arsenal of offenses; offenses that can mark if not jail a political candidate for life.

Apart from the intended consequences of these laws, unintended, if not unforeseeable, consequences are already becoming apparent. In countries where mob justice is a common replacement for weak or non-existent law enforcement, these laws give way to everyday opportunism. Immediately after the passing of the Anti-Pornography Bill, women wearing short skirts in Uganda’s capital city, Kampala, were reportedly attacked, disrobed and robbed. The Uganda Police Force had to issue an immediate warning against perpetrators of these attacks. Although it is too soon to tell whether citizens will also take the new anti-homosexuality law into their own hands, recent events in Nigeria suggest that mob justice against suspected or accused homosexuals may be swift, and potentially deadly.

What to read on South Sudan

South Sudan is in crisis. What’s going on?

Which sentence best describes your current level of knowledge?

I’m not sure where South Sudan is. Here’s a handy map. Now you do! Start here.

 

 

 

 

 

I follow African politics generally, but don’t know much about South Sudan.
Think Africa Press has a good round-up of experts to get you going.

I’ve been following South Sudan for a while now, and am looking for real-time updates on the current crisis.
Then you probably already know this, but Twitter is likely the best source of up-to-date (if not always fact-checked) news. #SouthSudan is a good starting point. Check out the Sudd Institute news and @SuddInstitute, and this terrific list of tweeps compiled by Lesley Warner.

I’m an expert on South Sudan/I’m based in South Sudan. 
Please send me your recommendations.

Scholarships and Fellowships for African Researchers in 2014

There are a number of scholarship and fellowship opportunities for African students and researchers with deadlines in early 2014. I’m compiling a list below (descriptions from respective websites); please feel free to send along others.

EASST 2014 Visiting Scholar Fellowship
What: “The EASST Visiting Scholar Fellowship seeks to equip East African social scientists with the skills needed to carry out rigorous evaluations of economic development programs. Researchers will be based at the University of California Berkeley during either the Fall or Spring semester, and will receive a living stipend, round-trip economy class air travel to Berkeley, CA, and the opportunity to receive a $8,000 research grant to promote impact evaluation at their home institution in East Africa. While at Berkeley, fellows will be able to audit courses, present research, attend seminars, develop curricula and design collaborative research projects.”

Deadline: March 16, 2014
Application portal here.

Washington Fellowship for Young African Leaders
What: “The Washington Fellowship for Young African Leaders is the new flagship program of President Obama’s Young African Leaders Initiative (YALI). President Obama launched YALI in 2010 to support young African leaders as they spur growth and prosperity, strengthen democratic governance, and enhance peace and security across Africa. The Washington Fellowship, which begins in 2014, will bring 500 young leaders to the United States each year for academic coursework and leadership training and will create unique opportunities in Africa for Fellows to put new skills to practical use in leading organizations, communities, and countries.”

Deadline: January 27, 2014
Application website here.

Harvard South Africa Fellowship Program
What: “The Harvard South Africa Fellowship Program (HSAFP) is intended for South Africans who in the past were educationally disadvantaged by law and resource allocation under apartheid. In 1979 Harvard University began awarding these fellowships for a year of study in one or more of its faculties or schools. Harvard funds these fellowships from its own resources. Over the years more than one hundred and forty fellowships have been awarded to South Africans.”

Deadline: March/April 2014 (exact date TBD)
Application website here (still undergoing updates for 2014).

APSA Africa Workshop 2014
What: “The American Political Science Association (APSA) and the Higher Institute of Public Administration (ISAP) are pleased to announce a call for applications from individuals who would like to participate in a workshop on ‘Distributive goods and distributive politics’ in Maputo, Mozambique. The two-week workshop will be held from June 30th to July 11th 2014 at the Higher Institute of Public Administration in Maputo, Mozambique. The organizers, with a grant from the Andrew W. Mellon Foundation, will cover all the costs of participation (including travel, lodging, meals, and materials) for up to 26 qualified applicants. This year’s workshop will be conducted in English.

The Africa Workshops program at the American Political Science Association (APSA) is an ongoing effort to expand the capacity of political science research and teaching in east and west Sub-Saharan Africa. With support from the Andrew W. Mellon Foundation, APSA is undertaking a multi-year program to organize a series of political science workshops throughout Africa and promote the profession of political science across the region. Each year, the program brings brings together approximately 30 scholars from across Africa and the United States for a 2-3 week seminar or short-course that focuses on a substantive theme of interest to political scientists. Driven by a unique syllabus featuring classic and cutting-edge research, each workshop program includes lectures, discussions, topical presentations and debates, guest speakers, peer review sessions, professional development seminars, and local field trips. Participants are required to arrive with and present their own current research, which they will then continue to refine for publication. Through these workshops, participants become an active part of the growing international political science community with increased access to supportive scholarly networks.”

Deadline: March 14, 2014
Online application form here.

MSc in African Studies, University of Oxford
What: “The MSc in African Studies is a three-term, nine-month course designed both as a stand-alone interdisciplinary introduction to current debates about Africa, and as a preparation for doctoral research on Africa. This advanced degree programme provides an excellent foundation for those who wish to expand their knowledge of African Studies, prior to working for NGOs, the civil service, international organizations, and the media, or in other professional capacities.”

“The African Studies Centre is offering full scholarships for the MSc in African Studies for the 2014-2015 academic year.”

Deadlines: January 24, 2014, and March 14, 2014
Admissions website here, scholarships website here.

African Women Public Service Fellows
What: “Wagner announces a call for applications for the African Women Public Service Fellowship, a fellowship program made possible by a donation from the Oprah Winfrey Foundation, which expands the opportunity for African women to prepare for public service in their home countries. As fellows at NYU Wagner, African women study in one of two graduate programs: the two-year Master of Public Administration or the one-year Executive MPA: Concentration on International Public Service Organizations. The awards for either program will support tuition, housing, travel to and from the United States and a small stipend to cover books and miscellaneous expenses. Applicants commit to return to their respective home countries at the conclusion of the program with the goal of assuming a leadership position on the continent where they can meaningfully contribute to the challenges currently confronting Africa.”

Deadline: varies, see application timetable.
Application website here.

Carnegie African Diaspora Fellows Program
What: “The Carnegie African Diaspora Fellows Program (ADF) is a scholar exchange program, offered by IIE in partnership with Quinnipiac University (QU) and funded by a two-year grant from Carnegie Corporation of New York (CCNY). ADF will support 100 short-term faculty exchange fellowships for African-born academics. The program exemplifies CCNY’s enduring commitment to higher education in Africa. IIE will manage and administer the program, including applications, project requests and fellowships. QU will provide strategic direction through Dr. Paul Tiyambe Zeleza and an Advisory Council he will chair.”

Deadline: TBD
Learn how to apply.

Quantitative Methods Training at U-M African Social Research Initiative
What: “The African Social Research Initiative (ASRI) at the University of Michigan seeks applications for up to four visiting scholars to attend courses in social science research methods and analysis at the University of Michigan during the months of June-August 2014. The program is open to academic researchers who are enrolled in or have completed PhD programs in the social sciences and who are from, or reside in, one or more of the following countries: GhanaKenyaLiberiaSouth Africa, and Uganda.
During their time in Ann Arbor, visiting scholars will attend courses offered by two internationally renowned summer training programs at the University of Michigan’s Institute for Social Research (ISR). Applicants who are invited to attend the summer programs may select several options from amongst the four- or eight-week sessions offered.”

Deadline: February 14, 2014
Application details here.

Update: Rachel Strohm has a similar post, Fellowships for African Students.

Malawi: First Thoughts

To understand any place, you have to leave it. It’s only with a comparative perspective that you recognize the significance of things you take for granted on the one hand, or the things you lament daily on the other. That’s how I’ve felt, anyway, during this past year of working on my dissertation, based in Uganda and working briefly in Ghana, Nigeria, Kenya, Burkina Faso, and now, Malawi.

I flew into Kamuzu International Airport in Lilongwe yesterday afternoon. From Kampala it’s a short trip, feeling much like the journey from San Francisco to Chicago, and making intra-continental travel seem easier than it normally does.

There are no immigration forms to fill upon arrival in Lilongwe (at least the day I arrived), but they do check for your Yellow Fever card. How did Yellow Fever, a relatively uncommon disease, become the single most common (only?) vaccination required worldwide? I was thankful I had remembered my aptly colored yellow Yellow Fever card, but others who didn’t have one seemed to get through just fine. While the card is ostensibly a requirement in lots of countries, apart from Malawi I can only ever remember being checked in Nigeria.

At the immigration counter, I was not asked what I would be doing in Malawi, or how long I would be staying. There were no forms to fill out, no visa fees to pay. My fingers were scanned, photo taken, and off I went. I bought a SIM card at the airport, no registration required, and got cash from the ATM. The road from Kamuzu to Lilongwe was practically deserted; a few homes dotted the otherwise empty roadside. The road was smooth, the air hot, the ground dry. I wasn’t sure we had arrived in Lilongwe proper until I started to recognize the names of lodges I had seen in guidebooks. By contrast, coming from Entebbe you may think you’ve reached Kampala, only to find yourself snaking slowly through the city limits an hour later.

The quiet and winding streets of the Lilongwe, lined with trees, remind me of Kigali, as does the relative absence of people. While Kampala, Lagos, Nairobi, and Accra are churning, bustling, and often overwhelming, Lilongwe has a distinctly understated presence.

Uganda’s economy is nearly five times the size of Malawi, Kenya and Ghana about twice that of Uganda, and Nigeria far bigger than all four combined. The largest bill you can get in Malawi $2.50, Uganda, $20, Kenya $11, Nigeria $6, Ghana $23. As you can see, there is no relationship between bill and economy size (or GDP per capita, for that matter), which makes spending and taking out money much easier in Uganda and Ghana than in Malawi or Nigeria. In both Nigeria and Malawi (yes, with my limited experience of one day in the latter),  ATMs appear to be frequently running out of money, and sometimes with very long queues. I’m no economist, but something about tiny bills seems very inefficient. Is there an upside? Any work on the politics of moneymaking, literally?

Finally, although I generally dislike the tradition (requirement?) of adorning the walls of every establishment with presidents’ photos, it is a welcome change to see — for once if not for long — a woman in the frame.

That’s all for today. More comparative musings soon.

Update: Relatedly, though I don’t fully agree: “Africa? Why there’s no such place” h/t to my partner in crime.

Sunday round-up

A few links for your Sunday:

 

Endangered books

IMG_2094
Jinja archives, Jinja, Uganda (2013)

My research of late has explored the responses of Muslim elites and communities to the arrival of missionaries and colonial administrators across Uganda. Sources primarily comprise of missionary accounts, official documents of the colonial administration, manuscripts and books by Ugandan intellectuals and scholars, and work by non-Ugandan anthropologists, most of whom were most active between the 1960s and 1980s.

The best and most detailed accounts tend to be authored by Ugandans, often those who played active roles in shaping the course of the country’s history. Unfortunately, these works are also the most difficult to find. Makerere University Libraries are perhaps the best resource, but you must have university affiliation to use the libraries and you cannot check out or, understandably, copy the books. Thus, many of Uganda’s most precious historical works are quietly locked away from the public.

I’ve identified a class of what I will call “endangered books”. These are books (or theses, etc.) that are now out of print or have never been published, and are virtually impossible to access or acquire without affiliation to a university with a very good library. Many of the authors have passed on, and are not able to lobby for the protection of their hard work. I don’t imagine there is a huge market for many of these books, yet unless steps are taken to republish them, a fire or two is capable of wiping out their existence.

I’m keeping a running list of these works below as I come across them. Hopefully I can convince a publisher to take interest in making sure these treasures do not fall victim to the decay currently facing many archives across Africa (see Jinja archives above). Please feel free to submit your own.

Endangered books:

UGANDA

Y.K. Lubogo. 1960. The History of Busoga. Jinja, Uganda: East Africa Literature Bureau.
Dan Mudoola. 1974. Chiefs and Political Action, The Case of Busoga: 1900-1968. PhD thesis, Makerere University

NIGERIA

Wahab Oladejo Adigun Nasiru. 1977. Islamic Learning Among the Yoruba, 1896-1963. PhD Thesis in the department of Arabic and Islamic Studies, University of Ibadan

Winners and losers in Uganda’s 2013-2014 Budget

BTTB 2013-214

Winners (increased % of budget): Works and Transport, Energy, Public Administration

Losers (decreased total spending): Tourism, Trade and Industry, ICT, Social Development (what is that?), Education

Background to the Budget 2013-2014 available here.

Looks like we are focusing on physical capital at the expense of human capital. Will it pay off?

Health information leads to…cheating!

Well, this is disappointing. A recent study in Uganda supported by Google and the Grameen Foundation, and implemented by Innovations for Poverty Action, has found a way to…increase infidelity.

When provided with information about sexually transmitted diseases via text messaging, cheating among participants more than doubled. Why?

Although the study and its findings have yet to be published, Bloomberg reports:

With the program in Uganda, which began in 2009, infidelity may have risen as women became more aware of the risks of cheating and insisted on going for testing with their husbands, said study author Dean Karlan, an economics professor at Yale University in New Haven, Connecticut. Some men resisted, leading women to deny them sex, which the men then sought from other women, Karlan said.

Basically, it appears that women wanted safer sex, while many men did not.

At first, this struck me as a classic case of unintended consequences, of good intentions paving the proverbial road to hell. However, having finished tearing my hair out (actually, gunning it through Ntinda wondering, what is wrong with these men?!), I realized we have actually learned something important despite the perverse effects of this intervention. Two things, actually. 1) men and women have different preferences regarding safe sex, and 2) women are willing and able to stand up for and protect themselves, at least in Uganda.

Now we need to understand why, faced with the same information as women, men made choices that did not improve their health and did not reduce their risk of contracting a sexually transmitted disease. We also need to find ways to support women to protect themselves and their families.

Looking forward to reading the paper; will update accordingly.

UPDATE: Ungated version of the working paper available here.