HEALTH ISSUES ON THE AFRICAN HORIZON FOR 2015

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As 2014 draws to a close and we review what has happened over this past year, we also look forward to 2015 and all of it challenges. Numerous organisations and commentators have written of the challenges that lie over the horizon for 2015, as regards Global Health. From my own experience of working on the continent I have identified the following challenges for 2015 for Africa.

Some of the issues/challenges overlap and/or influence one another. They do not stand alone, the one can exacerbate the other.

1. Water

Water, on its own, is unlikely to bring down governments, but shortages could threaten food production and energy supply and put additional stress on governments struggling with poverty and social tensions. Water plays a crucial role in accomplishing the continent’s development goals, a large number of countries on the continent still face huge challenges in attempting to achieve the United Nations water-related Millennium Development Goals (MDG)

Africa faces endemic poverty, food insecurity and pervasive underdevelopment, with almost all countries lacking the human, economic and institutional capacities to effectively develop and manage their water resources sustainably. North Africa has 92% coverage and is on track to meet its 94% target before 2015. However, Sub-Saharan Africa experiences a contrasting case with 40% of the 783 million people without access to an improved source of drinking water. This is a serious concern because of the associated massive health burden as many people who lack basic sanitation engage in unsanitary activities like open defecation, solid waste disposal and wastewater disposal. The practice of open defecation is the primary cause of faecal oral transmission of disease with children being the most vulnerable. Hence as I have previously written, this poor sanitisation causes numerous water borne disease and causes diarrhoea leading to dehydration, which is still a major cause of death in children in Sub-Saharan Africa.

“Africa is the fastest urbanizing continent on the planet and the demand for water and sanitation is outstripping supply in cities” Joan Clos, Executive Director of UN-HABITAT

2. Health Care Workers

Africa has faced the emergence of new pandemics and resurgence of old diseases. While Africa has 10% of the world population, it bears 25% of the global disease burden and has only 3% of the global health work force. Of the four million estimated global shortage of health workers one million are immediately required in Africa.

Community Health Workers (CHWs) deliver life-saving health care services where it’s needed most, in poor rural communities. Across the central belt of sub-Saharan Africa, 10 to 20 percent of children die before the age of 5. Maternal death rates are high. Many people suffer unnecessarily from preventable and treatable diseases, from malaria and diarrhoea to TB and HIV/AIDS. Many of the people have little or no access to the most fundamental aspects of primary healthcare. Many countries are struggling to make progress toward the health related MDGs partly because so many people are poor and live in rural areas beyond the reach of primary health care and even CHW’s.

These workers are most effective when supported by a clinically skilled health workforce, and deployed within the context of an appropriately financed primary health care system. With this statement we can already see where the problems lie; as there is a huge lack of skilled medical workers and the necessary infrastructure, which is further compounded by lack of government spending. Furthermore in some regions of the continent CHW’s numbers have been reduced as a result of war, poor political will and Ebola.

3. Ebola

The Ebola crisis, which claimed its first victim in Guinea just over a year ago, is likely to last until the end of 2015, according to the WHO and Peter Piot, a scientist who helped to discover the virus in 1976. The virus is still spreading in Sierra Leone, especially in the north and west.

The economies of West Africa have been severely damaged: people have lost their jobs as a result of Ebola, children have been unable to attend school, there are widespread food shortages, which will be further compounded by the inability to plant crops. The outbreak has done untold damage to health systems in Guinea, Liberia and Sierra Leone. Hundreds of doctors and nurses and CHW’s have died on the front line, and these were countries that could ill afford to lose medical staff; they were severely under staffed to begin with.

Read Laurie Garrett’s latest article: http://foreignpolicy.com/2014/12/24/pushing-ebola-to-the-brink-of-gone-in-liberia-ellen-johnson-sirleaf/

The outcome is bleak, growing political instability could cause a resurgence in Ebola, and the current government could also be weakened by how it is attempting to manage the outbreak.

4. Political Instability

Countries that are politically unstable, will experience problems with raising investment capital, donor organisations also battle to get a foothold in these countries. This will affect their GDP and economic growth, which will filter down to government spending where it is needed most, e.g.: with respect to CHW’s.

Political instability on the continent has also lead to regional conflicts, which will have a negative impact on the incomes of a broad range of households,and led to large declines in expenditures and in consumption of necessary items, notably food. Which in turn leads to malnutrition, poor childhood development and a host of additional health and welfare related issues. Never mind the glaringly obvious problems such as, refugees, death of bread winners etc…

Studies on political instability have found that incomplete democratization, low openness to international trade, and infant mortality are the three strongest predictors of political instability. A question to then consider is how are these three predictors related to each other? And also why, or does the spread of infectious disease lead to political instability?

5. Poverty

Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions globally is rooted in political, social and economic injustices. Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health, which in turn traps communities in poverty. Mechanisms that do not allow poor people to climb out of poverty, notably; the population explosion, malnutrition, disease, and the state of education in developing countries and its inability to reduce poverty or to abet development thereof. These are then further compounded by corruption, the international economy, the influence of wealth in politics, and the causes of political instability and the emergence of dictators.

The new poverty line is defined as living on the equivalent of $1.25 a day. With that measure based on latest data available (2005), 1.4 billion people live on or below that line. Furthermore, almost half the world, over three billion people, live on less than $2.50 a day and at least 80% of humanity lives on less than $10 a day.

Christmas Cornucopia – Twelth Day

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excellent article… absolutely love Bob Dylan, I have also written a blog post about his music as a source of inspiration… thanks for the link via twitter, much appreciated, festive regards, Mike

Thom Hickey's avatarThe Immortal Jukebox

So, at last – the twelfth day of our Sleigh’s journey and it’s Christmas Eve. I hope you have enjoyed the music and reflections on the way here.

I have agonised over the music choices in this series and have a couple of years worth stored up for Christmases to come (you have been warned!). But today’s choices were the first I wrote down and were my inevitable selections for the day before the great Feast.

First, the Keeper of American Song, Bob Dylan, with his inimitable spoken word rendition of Clement Moore’s, ‘The Night Before Christmas’. It is safe to say that Bob’s pronunciation of the word ‘Mouse’ has never been matched in the history of the dramatic arts! Of course, in the process of his more than 50 year career Bob has continually been reinventing himself and in so doing has gloriously renewed American culture.

The clip,above comes…

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THE NEED TO KEEP EBOLA ON THE FRONT PAGES

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I had already started to pen this weeks article when a few headlines/comments/articles caught my eye, forcing me to push it onto the back burner, as I feel this issue is more pertinent and pressing.

A tweet from Laurie Garrett had me concerned. She tweeted; Google News no longer ranks #Ebola in top 20 search items, and even within the health category, only in the Italian and USA news-feeds. This was then followed by a press release from the UN (United Nations’ Ebola Emergency Response Mission – UNMEER) stating that they will miss their December the 1st containment target, due to escalating numbers of cases in Sierra Leone.

The kicker, that then really got me switching my thought train was a press release from the the nonprofit ONE.org (http://www.one.org/us/ebola-tracker/). The Ebola Response Tracker follows the money and shows us the money; i.e.: how much that has been pledged, has made it onto the ground in West Africa to fight the good fight. While the Office for the Coordination of Humanitarian Affairs (OCHA), the UN, and the World Bank have data on the dollar figures associated with each pledge, no one had taken the time to figure out how much of those resources have actually made it to the ground in West Africa.

Erin Hohlfelder, global health policy director at ONE and the brains behind the tracker, says the tracker shows the importance in transparency (and the follow through on ones commitment). “It’s one thing to make a great pledge and commit to doing that, but in the meantime, every day that goes by without these resources is a missed opportunity.”

While progress has been made in the months since these pledges, there is still much work to be done. The USA leads the pack with the highest pledge and disbursement; $572 million of which 72% has made it to the ground in West Africa. Here is a sampling of a few other countries, foundations and institutions: (in no particular order)

Google/Larry Page Family Foundation pledged $25 million – none disbursed yet

Bill & Melinda Gates Foundation $50 million – 27% disbursed

African Development Bank $220 million – 20% disbursed

Paul G. Allen Family Foundation – $100 million 3% disbursed

Silicon Valley Community Foundation $25 million – none disbursed yet

EU $468 million – 17.5% disbursed

China $123 million – 8% disbursed

Australia $36 million – 38% disbursed

Visit their website to check out other countries and follow them on twitter and facebook.

At a press conference last week, Liberian President Ellen Johnson Sirleaf said that the progress her country has made may be damaging. “Our government remains concerned that progress in this battle will lead to complacency on the part of the international community. We must not interpret gains as an outright victory—nothing could be more dangerous.” Complacency must not be allowed to seep in, we need to keep the issues on the front pages. Margaret Chan, director of the World Health Organization, agrees on the complacency front; “We must not forget—Ebola virus is a formidable enemy. Yes, we are seeing some early signals of hope. Cases are stabilizing, we are also seeing some new areas where they are reporting new cases. We must maintain our vigilance. Complacency would be our enemy. And in order to get it to zero, we have been successful in bending the curve a bit, but we need to continue to do more to get to zero.”

The fight is still in the early stages, we must aggressively push to keep Ebola in the news and for more action on the ground. The international response is being outpaced by this epidemic, If more help doesn’t arrive soon, the worst may not be over. Ebola hasn’t simply overwhelmed these health-care systems, it has decimated them. Women in need of support for childbirth have been turned away, leading to an increase in infant morality rates in a region with the some of the highest numbers in the world. Children suffering from malaria or extreme diarrhea are now too often left without medical care, leading to an increase in deaths from dehydration. Life-saving vaccines for those illnesses and others are lying unused in clinics and warehouses, as there are not enough (or any) medical workers to disburse them. Crops are not being planted, food is not making it to the market places!

UNMEER was set up to provide coordination, policy and logistics rather than to treat patients. It needs more resources to halt Ebola as quickly as possible, at present the emphasis is on allocating existing resources in the smartest way, possibly because they are still waiting for more resources/pledges/manpower to make it to the ground in West Africa.

According to October estimates from the World Bank, the epidemic could cost the West African countries affected upward of $32 billion in the next 24 months. What are we waiting for! Every day spent without pledges being delivered on, manpower to hit the ground and the process of rebuilding shattered healthcare services and networks; more people die. Containing Ebola is a constant battle and already we are seeing it cropping up in Mali, where to next?

I will let Anthony Banbury from UNMEER end this weeks blog:

Containing the epidemic still calls for a tremendous increase in resources on the ground. We are far, far away from ending this crisis, there is a long battle ahead of us.

MEDICAL RESEARCH – AN EVIDENCE BASED APPROACH TO GLOBAL HEALTH

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A question posed by Jessica Taaffe on twitter, who is a TWIGH panelist, is my inspiration for this weeks blog. The question posed was: If you were to list three major research gaps for access to medicines what would they be? I posted 2 comments to that statement, the 140 characters per tweet, was not enough to fully weigh into the matter, so I am using this weeks post as a soapbox to expand further.

Firstly you might be asking what does this have to do with global health? In a nutshell, it has a huge impact, access to medicines, is dependent on the research that underpins it, it is the foundation on which medicine that we use stands. How firmly it stands depends on the strength of the research. If the road travelled to arrive at the end product is not evidence based (we will discuss the vagaries of this shortly), we then run the risk of having a flawed product, or even in some cases a product that never sees the light of day, (see my blog on Politics and Medicine).

The two comments I posted to twitter stated that evidence based medicine must be driven by independent clinicians, scientists and medical policy makers. Furthermore I stated that Levels of Evidence A (LOE – A) must be the benchmark. We cannot just be led by the large multinationals (Pharma and Medical Device Industries), they can most certainly push money into research, but the parameters of that research must be in the hands of independent clinicians, shared decision making can and must play a key role. This is a huge challenge but must be addressed, we need to claim back the labs and work alongside the drug and medical device industries

So what is evidence based medicine , why is it important and why do I say the we need to adhere to LOE -A?

Evidence based medicine grew out of critical appraisal, when Gordon Guyatt took over as the director of the internal medicine registry programme at McMaster University. He wanted to change the program so that physicians managed patients based not on what authorities told them to do but on what the evidence showed worked. It then appeared in an article in “The Rational Clinical Examination” series in Journal of the American Medical Association (JAMA) in 1992.

The strength of evidence is assessed by a specific grading system which, in fact, is quite simple. It combines a description of the existence and types of studies supporting a certain recommendation.

-Level of evidence A: recommendation based on evidence from multiple randomized trials or meta-analyses

-Level of evidence B: recommendation based on evidence from a single randomized trial or non-randomized studies

-Level of evidence C: recommendation based on expert opinion, case studies, or standards of care.

So the highest standard to attain is LOE – A, is this always the case? In 2009, a very interesting paper was published in JAMA, assessing the strength of evidence underlying the American College of Cardiology (ACC) and the American Heart Association (AHA) practice guidelines. They were reviewing recommendations to see if they were based on strong levels of evidence (LOE – A) and how much is based on “expert” opinion.

In only 11% of the guidelines published was LOE – A the benchmark, and most of the current guidelines included more than 50% of LOE – C as the standard! The authors correctly concluded that “expert opinion remains a dominant driver of clinical practice, particularly in certain topic areas, highlighting the need for clinical research in these fields”. I am sure if we had to review other areas of medical research we will be in a similar ballpark.

I can cite numerous examples from my own area of speciality where we have used certain drugs for years, with no studies definitely stating that they were beneficial to the patient, but there use was continued because of expert opinion, what drove that expert opinion is open to debate.

The Internet has also allowed incredible access to masses of data and information. However, we must be careful with an overabundance of “unfiltered” data. As history, as clearly shown us, evidence and data do not immediately translate into evidence based practice.

This is where the Cochrane Review stands the test of time, as it enable the practice of evidence-based health care, where health care decisions can be made based on the best available research, which is systematically assessed and summarised in a Cochrane Review. Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.

In closing then, to come back to the original question; what three major research gaps for access to medicines:

  1. Research must be evidence based with LOE-A as the gold standard

  2. Research must be driven by independent clinicians, scientists and medical policy makers

  3. Research needs to be taken back to the labs and institutions who will research what is needed globally.

We would need large NGO’s such as the WHO and the European Research Council (amongst others) to monitor and guide where research needs to be focussed. We need to thank all scientists, inventors, and researchers who are motivated by the need to know, the thrill of discovery,and the desire to make a positive contribution to mankind as a whole and acknowledge the right of people to the common ownership of medicines/vaccines etc. which are basic to their common and individual well being, as to life itself.

As the cognitive linguist George Lakoff puts it, “Empathy is at the heart of real rationality, because it goes to the heart of our values, which are the basis of our sense of justice. Empathy is the reason we have the principles of freedom and fairness, which are necessary components of justice.”

MALNOURISHMENT – A GROWING CONCERN – Food as a Weapon

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The number of hungry people has fallen by over 200-million since 1992, so says the 2014 Hunger Map and a report titled “The State of Food Insecurity in the World: Strengthening the Enabling Environment for Food Security and Nutrition” jointly prepared by World Food Programme (WFP), the Food and Agriculture Organisation (FAO) and the International Fund for Agricultural Development (IFAD).

They go on to say that 805 million people, or one in nine of the world’s population, go to bed hungry each night. But in Sub-Saharan Africa, this is even worse, with one in four people suffering from undernourishment. The report says that sub-Saharan Africa faces the most severe challenges in securing its food; mainly due to sluggish income growth, high poverty rates and poor infrastructure, which hampers physical and distributional access.

It states: “In general, in Africa, there has been insufficient progress towards international hunger targets, especially in the sub-Saharan region,”

The report also says limited progress had been made in improving access to safe drinking-water and providing adequate sanitation facilities, while the region continues to face challenges in improving dietary quality and diversity, particularly for the poor. I did some work in the Southern DRC (based out of Lubumbashi in 2006) and we noted then that dehydration, was the leading cause of death in children under the age of 5. Dehydration as the result of diarrhoea, caused by unsanitary drinking water. For those who survive they are then in turn faced with stunted growth, which is made worse by poor food nourishment.

This report just published confirms that the situation has not changed in the past 8 years, limited progress had been made in improving access to safe drinking-water and providing adequate sanitation facilities. In fact the report notes, that progress has been so poor, that the WFP target of halving the number of undernourished people by 2015, will not be realised.

The report highlights the following to move forward:

1. Sustained political commitment at the highest level
2. Placing food security and nutrition at the top of the political agenda
3. Creating an enabling environment for improving food security and nutrition through adequate investments
4. Better policies, legal frameworks and stakeholder participation
5. Institutional reforms are also needed to promote and sustain progress.

Plus an integrated plan focussing on:

1. Public and private investments to raise agricultural productivity
2. Better access to inputs, land, services, technologies and markets
3. Measures to promote rural development
4. Social protection for the most vulnerable (persons and countries)
5. Including strengthening their resilience to conflicts and natural disasters
6. Specific nutrition programmes, especially to address micro-nutrient deficiencies in mothers and children under five.
As reports go it is a very good piece of work tackling many complex issues and outlining clear broad action plans. As with most reports though, I take issue with their expected outcomes, to broad, not specific and in my opinion, to broad. Its like position papers from government departments or even aid agencies. It does not tackle the problem head stating what is at fault and what needs to be done in clear action plans; to do that will require stepping on toes or worse – maybe even naming names!

Regional conflicts, greedy power hungry warlords all demanding access to food, how it is priced and distributed. This can affect when and if crops are planted, and who gets the produce, and they who sells it. Food can be and is used as a weapon, to control people or even to get votes, Zimbabwe and South Africa are cases in point.

The cost of food is then another key factor, Lester Brown wrote in 2011’s “Food Issue” of the Foreign Policy magazine:

Americans generally spend less than 10% of their income on food, but there are 2 billion people who live in poverty around the globe who spend 50 to 70 percent of their income on food.

A slight increase in the cost of food for these persons could be life or death, and the costs when they do escalate, are beyond the control of the consumer, at times manipulated by external forces, for their own (political or economic) gain.

On a sad and macabre note, Saudi Arabia, South Korea and China ventured beyond their borders in 2008 to grow grain in cheaper regions, such as Ethiopia and Sudan, where, of course, people where starving and did not get any of the planted grain.

So where to from here; I think if we cast our eyes to Burkina Faso, we might see a way out, People Power. The people need to speak and speak loudly in the only way the politicians and regional leaders will listen.

Politics and Medicine

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Politics and Medicine

“Medicine is a social science, and politics is nothing else but medicine on a large scale”—Rudolf Virchow

Politics is defined as “organised human behaviour”, thus we can postulate that Medicine is micro managed organised human behaviour, at times right down to the molecular level. If we examine the Ebola outbreak/s (globally) and how it is being managed on a macro (politics) and micro scale (medicine) we can begin to see the cracks in the system, and hopefully then move to addressing these cracks, before they begin yawning chasms that are not repairable.

The region (Liberia, Sierra Leone and Guinea) has had success (we could add Nigeria and Senegal to the successes) and failures in both areas. Neither is Spain and the USA exempt from this analysis as can be noted from the various press releases (government and medical) over the past few months.

Since the first outbreaks in 1976 (Sudan and The DRC) till the current one in West Africa; care has generally been palliative and symptomatic, questions have often been asked during this period; What of a vaccine and/or other means of treating the infected patients? There was a report in the British Sunday Times (12/10/14), cited a Cambridge University zoologist as saying that “it is quite possible to design a vaccine against this disease” but reported that applications to conduct further research on Ebola were rebuffed because “nobody has been willing to spend the twenty million pounds or so needed to get vaccines through trial and production”. Globally this has been one of the failures of the pharmaceutical companies, and most probably even the WHO, for not pushing harder over the years to get this in motion.

In her 1994 book The Coming Plague: Newly Emerging Diseases in a World Out of Balance Laurie Garrett: warned that there are more than 21 million people on earth “living under conditions ideal for microbial emergence.” Garrett when on to win the Pulitzer Prize in 1996 for reporting on Ebola. In 1995 Joshua Lederberg, the American molecular biologist said: “The world is just one village. Our tolerance of disease in any place is at our own peril. Are we better off today than we were a century ago? In most respects, we’re worse off. We have been neglectful of the microbes, and that is a recurring theme that is coming back to haunt us.”

Jump forward to the 23rd of September 2014, US President Obama issued an unprecedented ‘Presidential Memorandum on civil society  recognising that:

Through civil society, citizens come together to hold their leaders accountable and address challenges that governments cannot tackle alone. Civil society organisations…often drive innovations and develop new ideas and approaches to solve social, economic, and political problems that governments can apply on a larger scale.

If we look at the current crises in West Africa civic leaders are what is missing, hence the inability to track and trace potential infected persons, motivate communities to change risky behaviours (handing of the deceased), agitate with government to create better health care systems, this all adds fuel to the fire of the current epidemic.

Have we listened and learnt as governments, NGO’s and Multinational Pharmacare companies since then?

Despite Medical Advances, Millions Are Dying, this is a banner from 1996, not 2014! from the WHO, which was “declaring a global crisis and warning that no country is safe from infectious diseases, the World Health Organization says in a new report that diseases such as AIDS, Ebola, Hanta, Mad Cow, tuberculosis, etc., killed more than 17 MILLION people worldwide last year”.

As Laurie Garrett wrote in her the closing section of her book, The Coming Plague, “In the end, it seems that American journalist I.F. Stone was right when he said, ‘Either we learn to live together or we die together.’ While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators, and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities. It’s either that or we brace ourselves for the coming plague.”

Time is short.

The Ebola outbreak in West Africa is “unquestionably the most severe acute public health emergency in modern times,” Dr. Margaret Chan, the director general of the World Health Organization, said Monday 20/10/2014). We do seem to be going in circles… circa 1995.. have we learnt nothing from history.

Sooner or later we learn to throw the past away History will teach us nothing Sting – Musician, singer-songwriter

Where have all the people gone, long time passing?

Where have all the people gone, long time ago?

Where have all the people gone?

Gone to graveyards, everyone.
 Oh, when will they ever learn?

Oh, when will they ever learn?

Pete Seeger – American folk singer and activist

Why High-Income Countries Should Help Combat Ebola

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A slight change from my usual postings, but a subject close to my heart and my profession. Here then are my thoughts as to why, globally we should be involved in the West African Ebola outbreak.

As a passionate and committed African, having spent the past 20 years working in various countries on my continent, and having seen the effects of colonisation, globalization, war as a result of minerals and commerce (funded by big western businesses) and how Africa is marginalised via trade and commerce. Never mind the fact that all the ex-French colonies still pay tax to France, even years after independence!!
http://www.siliconafrica.com/france-colonial-tax/
It is also true that Africa’s problems are also created by many corrupt Africa politicians and greedy emerging markets in Africa.

With that as my introduction, then what should we do in the event of disasters, war, famine and in the case of Ebola (disease outbreaks).

As a human race we all live in a global village and we cannot and should not stand by when we see our fellow man/woman suffering; be it in Syria, Ukraine or in this case West Africa (Guinea, Sierra Leone and Liberia). Every effort should be made to help when and how we can, be it with manpower, resources or financial aid.

The entire Southern West Africa region is still emerging from a decades long conflict (partly made infamous by Blood Diamonds) and their are trails ongoing in the Hague re this conflict. One could even argue that western powers (corporate and country) were complicit in this conflict, hence they should now have at least an ethical (if not moral) motivation to get involved. Far to often we stand on the sides and wring our hands at the mess Africa is in and that it never seems to get out of this mess (that in itself is another long missive for another day/thread).

For now the region needs beds (hospitals) and staff to man them, there is a huge shortage of beds. The one thing that this epidemic (as most of them do) has taught us that it is gloves not vaccines that will make the difference. Good basic hygiene, clean water, bleach/chlorine and excellent palliative care in a sterile environment will make a difference. Those who have survived have survived for these reasons.

All of the above needs to sustainable in the medium to long term and the affected countries must be encouraged through means of trade and commerce to make these changes real and lasting. I know this last paragraph sounds pie in the sky, but the rich western countries and corporates (Large Pharma) in this case must commit to push for it to happen not for their end gains and increase in share price (cynical comment re what is motivating large Pharma in this case), but for the good of the region.

People in West Africa will have to alter behaviours, we won’t stop this outbreak solely by building hospitals. There will have to be a change in the way the community deals with the disease. Changing behaviour which is so closely linked to culture, tribe and religion will not happen in the short term. which means that the worst case scenario could come to fruition, which is over 100,000 cases by the 1st of December. (as outlined in some disease modelling programmes!)

Government ministers in the region are also not focussing on the key ways to attempt to manage this outbreak. Shutting down Sierra Leone for 4 days will just push the outbreak underground. Infected persons will go into hiding or even worse; leave the area/region (as some of my sources on the ground have informed me, is already happening!)

We need beds, hospitals and basic supplies. (I must just say a big thank you to the USA for planning to build 170 100 bed hospitals in the region). Beds and hospitals is not being dealt with as urgently as it should be by local governments, they are waiting for outside funders to step in, they must drive the initiative on the ground and mobilise local leaders to work with their villages to manage this outbreak, otherwise the worst case scenarios that are being punted look scary. Both MSF and WHO are pushing for this, but they need local governmental support.

My closing comment is that gloves not drugs (vaccines) will save the day. Basic good clean sanitary medicine and palliative care, aligned with sound symptomatic treatment will save lives, for that we need beds, hospitals, staff and supplies.

Hip or Not?

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http://www.newstatesman.com/culture/2014/09/will-self-awful-cult-talentless-hipster-has-taken-over

Funny, sad, and insightful… how we have trivialised art, culture and to a certain extent life.

For those of us who think retro has a place in society, albeit a small place, and at the right time. The hipster movement seems to thrive on taking it to extremes, and we only have ourselves to blame for their rise to “prominence”, as we have allowed them to trivialise what some of us hold dear.

I never did like extremists (still don’t) be they style, fashion, culture, religion, eco or political ones. Extremists miss out on so much in life with a blinkered approach and sadly the hipsters fall into that category. Life needs balance, one can argue that extremes to the left and right allow balance to hold the middle ground, but even the middle ground has become sullied and grey of late. (in some any areas of life on our planet – a longer topic for another day)

Its not cool to be retro just for the sake of saying look we have made an old shovel into a work of art! That’s not art, any idiot can stick a shovel against a wall… but then I suppose that is what we have lowered the bar too. I do have a penchant for things of a bygone era, but not at the expense of denying myself what technology and the world in all its glory and difference can afford us, we need to be realistic about change and progress and take from a trend, that which is both appropriate and relevant.

Hipsters at times make me think of Clockwork Orange, as the book is set in a future dystopian world and the “hip” language that Alex and his “droogs” (gangmates) speak, plus their love of bowler hats, canes, hark back to a bygone era. I know that is viewing hipsters in extreme, and some might take offence at the comparison, but that is really pushing the boundaries of extremism or being hip.

I think it is the (in my opinion) non balanced view that I find unsettling. The shift away from balance (ying/yang), finding harmony in a discordant world. For it is this which now trivialises the achievements of the great artists, designers, thinkers who have gone before. Yes art (and beauty) is in the eye of the beholder, but maybe the beholder in this case should aspire for art of a more challenging nature than just sticking a shovel against a wall and playing a certain style of music.

If not, then we might be losing the plot, although on the other hand, I think today I will be a shovel artist and tomorrow an avant garde fashion designer… not sure what I will do on the weekend.. maybe a combination of the two.. and shovel s#$t … now that’s hip!

The Beast of Reality

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Various incidents and happenings over the past few months have forced me to be very introspective; the last few weeks have being particularly “interesting” which has had me examining my navel fairly often … this contemplative phase, I am transitioning through, has had me musing on life and all its strange curve balls it manages to throw at one. Being an optimistic person, I have found myself battling to reconcile the rapidly changing circumstances of the past few months. One of the mental activities/mindsets that has kept me going (other than the support, encouragement and belief of my gorgeous wife), is that life is an adventure a never ending journey that we must immerse ourselves in, wallow in, and feast at the table of the banquet of life. Even when the table is set for a simple meal, I believe I must still taste and explore every morsel; even if their are only crumbs .

If we/I do not taste and explore all at my disposal then I run the risk of an unfinished/unfulfilled life, as I have not grasped what is in front of me and savoured it to its fullest. Love is beauty wrapped in the seconds of ones life, if you don’t stop for a minute you might just miss it, and then you might miss out on the next adventure/opportunity. So I am then faced with this dichotomy, of feasting on all that life has to offer and the ever present Beast of Reality. How do we deal with this beast or feed it, so that we can continue to feast at the table of life? This would be the proverbial “Million Dollar Question”?

I have no easy answer/s to that Question, of how to feed the beast and feed at the table of life, as the each of us have our own “Beast of Reality” and we all have to find out what diet it requires. I try to starve the beast and deprive it what it wants (at least what I think it wants from me, ie: to not be able to partake of all that is there to feast upon). I do not avoid the reality of life, in fact I immerse myself in the real world, and all its pain and pleasure, but I starve it by being fully aware of what it does in the world and being aware of how cruel and kind this world can be… I start each day by reading at least 3 newspapers and 2 news magazines (online of course). I think this helps prepare me for what awaits beyond the sanctity of my quiet space (it also stimulates my creativity). Once I have that behind me I can better face the day and then start to enjoy what life has set out on the table for the day. As the beast will not sleep, and has to be faced …eventually, but how we face it and on whose terms and turf, are what we can control. We cannot shut it out from the feast of life, it is always the unwelcome guest at the table, trying to eat more than it should and deprive us of what is ours to enjoy.

This in no way lessens the challenges that I have to face or have been facing, it just helps me to keep perspective on the real world and how I must strive to be drunk on life and long for my/our next adventure.

Things to Live For

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“Poetry, Beauty, Romance, Love – these are what we stay alive for.”

The words of Robin Williams in Dead Poets Society

My thoughts of late have wandered far and wide, but over the past few weeks they have shifted back to a few core questions; the above quote encapsulates some of the answers to the questions that have been spinning in my head. So please bear with me as I unpack this quote in a wider context of what goes in inside my head – be warned it can be a scary place at times, just ask my wife 🙂

Central to my thoughts of late has been inspiration, creativity, stability and harmony; as in how to achieve these aspirations and what path/s I will explore to best find my end goals. I do find inspiration and peace through reading and music, which then inspire me to explore areas of creativity. Strangely though the words (books and poetry) and music that I immerse myself in, do tend to be on the dark side, and through this darkness I find both solace and an opportunity to see light and a future.

I find myself gravitating back to reading the first world war British poets (Owen, Sassoon, Brooke and Rosenburg), why war poetry you might ask? I can relate to their fears, despair and bleakness from my own time in battle, but through this process one begins to understand that even in the depths of despair and the bleakness of the trenches, their is hope. In Wilfred Owen’s last letters to his mother from the front, in 1918, he said that there was no place he would rather be.

Of his work he said:

“My subject is War, and the pity of War. The Poetry is in the pity.”

My work has taken me to black and bleak places on the African continent, so I am always driven to find hope in despair, light in dark and compassion in pain and suffering. I think that is what keeps me sane and focussed on the bigger picture/s in life. It helps me to gain perspective and see the forest and not just the single tree, blocking my path.

Music and poetry form a part of the way I relax and reflect (plus cigars, scotch and bourbon – but that is a tale for another day), that is why I am a huge fan of Bob Dylan.

The poetry of Keats, Milton and Blake (not war poets, they pre-date the first world war some what), also inspire me, and help me to push the boundaries, notably William Blake. He was a revolutionary romantic, he was iconoclastic in his views, notably to the established orders of the day; church and politics. A critical reading of Blake’s “The Marriage of Heaven and Hell” in which the figure represented by the “Devil” is virtually a hero rebelling against an imposter authoritarian deity, clearly highlights Blake’s idiosyncratic views of his feelings towards the established order of his day. (views that I can sympathise with)

“Blake’s theory of contraries was not a belief in opposites but rather a belief that each person reflects the contrary nature of God, and that progression in life is impossible without contraries.”

It also certainly formed part of the revolutionary culture of the period. It was composed between 1790 and 1793, in the period of radical foment and political conflict immediately after the French Revolution. It to then deals with turmoil and man’s search for meaning:

Blake explains that,

“Without Contraries is no progression. Attraction and Repulsion,

Reason and Energy, Love and Hate are necessary to Human existence.

From these contraries spring what the religious call Good & Evil.

Good is the passive that obeys Reason. Evil is the active springing

from Energy.”

For an excellent blending of music (Electronica Folk Black Metal) listen to Ulver’s Themes From William Blake’s The Marriage of Heaven And Hell

http://www.amazon.com/Themes-William-Blakes-Marriage-Heaven/dp/B0000278IT/ref=sr_1_1?ie=UTF8&qid=1408094497&sr=8-1&keywords=ulver+-+Themes+from+William+Blake%27s+The+marriage+of+heaven+and+Hell

I am a huge fan of their music, and their most recent album: War of the Roses -(2011), is a mix of Pink Floyd and Radiohead, how is that for a neo progressive rock band with its roots in Norse Black Metal!

So where does all this lead; how does this bring me closer to Beauty, Romance and Love? and a means to finding my end goals?

I actually do not have an immediate quick answer to the above questions, but what I can say is that by exploring these paths, the mist often clears and I can get to the top of the ridge and see the forest that I thought had me surrounded was in fact just a small copse of 10 or 20 trees.

What is clear for me is where I want to be, the trick is how to get there :).

One of my end games is to actively pursue a path of being a more active writer, than I currently am, and to publish some of my works in the foreseeable future (I have placed time-lines for myself on 2 of my projects). These will bring more harmony to my life, which will in turn make me more balanced (only for awhile, I am a restless soul), this then will positively resonate in my life, bringing more love and peace to my soul and those that I love and hold dear.

Until next time my gentle readers, peace, love and hope to you all.