Showing posts from category From the Wilson Center.
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Yemen Beyond the Headlines: Women’s Health and Well-Being, Foundations of a Fragile State
›Part one of the “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” event, held at the Wilson Center on May 18.
“Ultimately, whether Yemen is able to achieve its goals for social and economic development, will to a large extent depend on its future population growth and size,” said Gary Cook, senior health advisor at the U.S. Agency for International Development, in his opening address on Yemen’s population and development challenges at the Woodrow Wilson Center. [Video Below]
Cook was joined on the opening panel of the all-day conference, “Yemen Behind the Headlines: Population, Health, Natural Resources, and Institutions,” by Dalia Al-Eryani, former project officer for Pathfinder International’s Safe Age of Marriage Project, and T.S. Sunil, professor of sociology at the University of Texas San Antonio, to discuss issues related to population, reproductive health, and child marriage. Drawing speakers and participants form the Middle East, Europe, and the United States, the conference was part of the Wilson Center’s HELPS Project, a multi-year effort to deepen understanding of links among health, environment, livelihoods, population and security.
Yemen’s Population and Development Challenges
Since 1950, the population of Yemen has increased from 4.3 million to 24 million, with an annual population growth rate above three percent, Cook said. High fertility drives Yemen’s rapid population growth, with an average total fertility rate (TFR) of 5.5 births per woman. Rates are even higher in rural areas and among women with limited or no education, he said.
Future population growth will have tremendous impacts on the country’s economy, education, health, and natural resources, said Cook, and “there is a very large gap between the high fertility assumption and the low fertility assumption.”
An additional 1.5 million new people will be added to the labor force and 29 percent less income per person will drop by 29 percent by 2035 if current fertility rates persist, said Cook. Though Yemen has a national population policy that outlines TFR targets of 3.3 in 2025 and 2.1 by 2035, the latest UN Population Division projections suggest these expectations are optimistic. Education and health demands and expenditures will increase greatly, while per capita arable land and water will decrease, exacerbating ongoing land and water scarcity in Yemen.
“We do not have enough local and external resources to address the needs of a rapidly expanding population,” said Cook. “Helping couples who want to limit and space their births will also help the nation,” he added.
Law, Culture, and Child Marriage
“Enforced by law and culture alike,” early marriage in Yemen is common, said Al-Eryani, with over 50 percent of Yemeni women married before they are 17 years old, and 14 percent before they turn 14. Opponents of child marriage argue that children are neither emotionally nor physically ready for marriage and that the practice increases health risks and lowers educational opportunities for girls.
Currently, Yemen has no minimum age for marriage law, and recent attempts to pass such a law have failed, said Al-Eryani. “The practice never really has been questioned.”
“There is a belief that child marriage is a good thing – both for the girl and for the family,” she said. Early marriages are a way to build family honor and tribal ties, and many poor families see opportunity for financial gain in the form of a dowry. “These families see no socially acceptable alternatives for the girl…and all of this is supported by the belief that Islam condones child marriage,” she said.
Through awareness sessions, health fairs, and school plays, the community-based Safe Age of Marriage Project has helped to change social norms around child marriage in two districts in Yemen.
After participating in the program, community members were significantly more likely to believe that delaying marriage gives girls more educational opportunities, empowers them to make decisions, and promotes healthy pregnancy and children, Al-Eryani said. Child marriage was banned in one of the communities, and the marriages of 53 girls and 26 boys were canceled as the result of the project. In the future, she hopes involving more religious and local leaders could further increase the program’s impact.
Youth and “The Reproductive Health Transition”
“When we talk about fertility transition, we only talk about the number of children born,” said Sunil. “A reproductive health transition takes into account not just total fertility rate, but a number of different dimensions.”
Women should have the freedom to decide if, when, and how often to reproduce, said Sunil, through access to safe, effective, affordable, and acceptable family planning methods. They also should have access to quality maternal health care throughout pregnancy and birth, he said.
“It’s a popular belief that Islamic societies with poor and limited resources are not compatible with a reproductive health transition,” said Sunil. “But the onset of a reproductive health transition is underway in Yemen.”
While the transition in Yemen is progressing more slowly than in other countries in the region, many positive trends can be seen among the country’s youth, said Sunil. Trends indicate a drop in fertility rates, especially among younger women; marriage of girls under 15 years old has declined; and contraceptive use among young women age 15 to 24 has increased significantly.
Government and international donor agencies “must capture the growing momentum among the younger cohort” and meet demands for better education, postponement of marriage, and healthcare services, said Sunil. Continued focus on adolescent reproductive health will be the key to achieving the reproductive health transition, he concluded. “From an economic and human perspective, the growing young population in Yemen is potentially a tremendous asset.”
See parts two and three of “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” for more from this Wilson Center event.
Sources: Population Reference Bureau, UNICEF, U.S. Agency for International Development.
Image Credit: “Young girl with her mom – Sanaa,” courtesy of flickr user fveronsei1. -
Inaugural Lee Hamilton Lecture at the Wilson Center
Admiral Mullen: “Security Means More Than Defense”
›Chairman of the Joint Chiefs of Staff Admiral Mike Mullen delivered the inaugural talk in the Lee Hamilton Lecture Series on Civil Discourse and Democracy at the Wilson Center yesterday where he spoke on the importance of “taking the long-view” on U.S. engagement with the world and the changing field of 21st century geopolitics.
Mullen, whose aides, Captain Wayne Porter and Colonel “Puck” Mykleby, wrote the recently launched Mr. Y paper on a new national strategic narrative, echoed many of the same sentiments.
“[The Mr. paper] has some interesting things to say about how we are seeing a shift away from 20th century concepts of power and control to that of promoting strength and influence,” Mullen said. “Frankly, in this small, flatter, and faster world, I think any nation that believes it can, in a very clinical way, control events does so at their own peril.”
“The narrative also happens to share my long-held belief that we must remain engaged internationally if we wish to pursue the world that our children [and] our grandchildren deserve,” he continued:As challenging as engaging others with different views may be, the alternative of abandoning these partners in these regions is far worse. We’ve gone down that road before, and it is one that leads to isolation and resentment, ultimately making our nation less secure as we deceive ourselves into believing that ignoring these challenges will somehow make them go away.
Mullen also agreed with the Mr. Y authors’ view on adopting a more holistic view of national security:
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Until we restore a sense of hope in these challenged regions, we will see again and again that security without prosperity is ultimately unsustainable.Wayne and Puck put it well when they said we must recognize that security means more than defense. And sustaining security requires adaptation and evolution, the leverage of converging interests, and interdependencies. We must accept that competitors are not necessarily adversaries and that a winner does not demand a loser.
The military’s energy initiatives are an important focus as well, Mullen said. “We’re the biggest consumer of energy in the U.S. government…and I don’t think we’ll ever get to a position where that’s not the case, but we certainly ought to recognize that and figure out a way to do it more effectively, efficiently, and at a much reduced cost.”
What we learned in Iraq is “there were too many people getting killed in long convoys,” Mullen said. The Marines were able to adapt to that threat by developing self-contained green cooling kits, and “that’s where we’re headed,” he said. “Our focus on and investments in the green world has taken off.”
“Now it is really mainstream: The service chiefs, combatant commanders, [they] talk about it,” Mullen continued. “There are investments being made, both from an S&T; standpoint – science and technology – as well as research and development.”
Read the transcript in its entirety here for the Chairman’s remarks on the continued importance of the UN, G-20, and NATO; the short-term intractability of challenges in Iran and North Korea; the rise of China; continued American military dominance; the defense budget; and the Arab Spring, which he called the “most significant change afoot in the world today.”
Photo Credit: Chairman of the Joint Chiefs of Staff Admiral Mike Mullen, courtesy of David Hawxhurst/Wilson Center. -
USAID Egypt’s Health and Population Legacy Review
›On May 23 the Middle East Program, ECSP, and the Global Health Initiative of the Woodrow Wilson Center, along with the Global Health Technical Assistance Project, hosted a panel of speakers discussing the past 30 years of the U.S. Agency for International Development’s health and population initiatives in Egypt, as outlined in the new Egypt Health and Population Legacy Review. Geoffrey Dabelko, director of ECSP and coordinator of the Global Health Initiative at the Wilson Center, moderated the event. [Video Below]
Peter McPherson, former administrator of USAID during the Reagan administration, and George Laudato, the administrator’s special assistant for the Middle East, presented on the historical context behind USAID in Egypt and the results of their efforts. McPherson pointed to three lessons that can be drawn from the recent report:- “Big payoffs” require long-term efforts; and
- Economic support for a country can have a dramatic impact; but
- The host country’s commitments and investments are still important.
Motaz Zahran, political counselor for the Embassy of Egypt, noted that USAID efforts were “just one sector of a fruitful partnership” between the United States and Egypt that he hoped would continue. He said the success story outlined by the report was reflective of improvements in coordination and addressing specific goals.
Other panelists outlined the successes of USAID in Egypt as related to their own areas of expertise. Leslie B. Curtin, co-author of the review and an expert in demographics and health outcomes, noted the dramatic improvements in a range of health sectors, in particular the rise in contraceptive prevalence and immunization rates and decrease in both maternal and infant mortality rates.
Nahed Matta, MD, senior maternal and newborn health officer at USAID, focused on improvements to the quality of maternal health, which she said were made possibly through better technology and increased fact-gathering to identify the key factors regarding maternal health trends. Sameh El-Saharty, MD, senior health policy specialist at the World Bank and Health Legacy Review Committee member, credited the increased number of health professionals in Egypt, better information gathering on health systems, and restructured models of health insurance, as successful strategies.
Concluding the session, Amie Batson, deputy assistant administrator for Global Health at USAID, discussed the lessons that other development initiatives can draw from the legacy of USAID efforts in Egypt. She highlighted the importance of country ownership, in which the developing country engages with other institutions and religious and political leaders at both national and local levels, and of policies that fund routine monitoring and evaluation. She also outlined the possibilities of innovation and south-to-south sharing on the local and international scale, referencing inroads made by two recent initiatives: the “MAMA” mobile device program, launched by Secretary Clinton in May 2011 to assist with disseminating maternal health information, and the Saving Lives at Birth initiative, launched by USAID in partnership with several other organizations in March 2011.
Laura Rostad is an intern for the Middle East Program at the Woodrow Wilson Center.
Image Credit: Adapted from cover of the Egypt Health and Population Legacy Review, courtesy of USAID; cover photo courtesy of Leslie Curtin. -
“The Second Front in the War on Terror”
USAID, Muslim Separatists, and Politics in the Southern Philippines
›For some years after the terrorist attacks of 9/11, the existence of violent Muslim separatists on the southern Philippine island of Mindanao gave U.S. officials significant cause for concern. In 2005, for example, the U.S. embassy charge d’affaires to the Philippines, Joseph Mussomeli, told reporters that “certain portions of Mindanao are so lawless, so porous…that you run the risk of it becoming like an Afghanistan situation. Mindanao is almost, forgive the poor religious pun, the new Mecca for terrorism.” During the Bush administration, officials referred to the region as a “second front” in the War on Terror: the region was once seen as a “new Afghanistan” that “threatened to become an epicenter of Al Qaeda.” [Video Below]
Nevertheless, as noted by Wilson Center Fellow Patricio Abinales at an Asia Program event on May 11, U.S. efforts to co-opt and pacify separatist guerrillas have proven remarkably successful in some areas of the islands. Some commentators have highlighted the role of the U.S. military in bringing a relative sense of security to troubled regions, noting that Mindanao presents a “future model for counterinsurgency.” However, Abinales’s research shows the military activities have had little effect, often because troops are stationed far from potential areas of conflict. Instead, it is the civilian side of the American presence that has dampened conflict in the war zones of the southern Philippines.
Abinales specifically explored the factors behind the success of the U.S. Agency for International Development’s (USAID) Growth with Equity in Mindanao (GEM) program in demobilizing and reintegrating 28,000 separatist guerrillas of the Moro National Liberation Front (MNLF), as well as the long-term political consequences of this accomplishment.
“Arms to Farms”
Usually, USAID programs are organized on the basis of grants for specific and limited projects. In contrast, GEM arose as a long-term umbrella organization that oversees the disbursement and management of American funding across a number of long-term projects. Coordinators are trained directly in Mindanao and are encouraged to “go native,” living in the area and becoming part of the community. GEM prioritizes cultural understanding, respect for community leaders, an appreciation of the important role that women play in local societies, and sensitivity to potential divisions within separatist groups and their security concerns vis-à-vis the Philippine government.
There has often been a general tendency for aid organizations to associate the demobilization of warring groups with disarmament. While Philippine officials on Mindanao have sometimes tried this approach, cash-for-guns amnesty schemes have opened up opportunities for corruption and have not been particularly effective. Understanding that one of the major concerns of guerrilla rebels is exploitation by corrupt government officials, GEM established an “Arms to Farms” scheme, whereby Muslim rebels are trained to engage in agriculture, but are not encouraged to put away their weapons. In this way, the program keeps potential guerrillas and Al Qaeda recruits busy with legitimate and peaceful economic activity, while it assuages their concerns about the threat from corrupt government officials, who may otherwise take the fruits of agricultural labor by force.
In fact, Abinales noted that one of the keys to GEM’s success is that the organization has never submitted to the official local authorities, and has largely been allowed a free reign by Manila to conduct its activities on Mindanao. It is precisely because the state has not been successful in delivering welfare regimes which provide stability to the area that GEM is seen as an alternate source of development and security in the region. Moreover, because of GEM’s activities, other American officials are allowed relatively free access, and are even welcomed into areas where the authority of the Philippine government holds no sway. Most of GEM’s activities are conducted with the MNLF, which has maintained its own official treaties and agreements with Manila since the 1970s. However, the American organization is beginning to enter the territory of the Moro Islamic Liberation Front, a splinter group of the MNLF that rejects relations with the national government outright, but one whose leaders are jealous of the development gains the MNLF has made under GEM.
Abinales was quick to point out that although GEM’s activities have been successful, they are tailor-made to specific circumstances. It is therefore difficult to present them as a generalized model that can be applied to other separatist conflicts. Nevertheless, Abinales’s work suggests that government agencies working on counterinsurgency efforts elsewhere might do well to examine the benefits of the flexible civilian approaches to conflict resolution formed with a deep understanding of the concerns of the specific communities involved.
Bryce Wakefield is program associate with the Asia Program at the Woodrow Wilson Center. -
Connections Between Climate and Stability: Lessons From Asia and Africa
›“We, alongside this growing consensus of research institutes, analysts, and security agencies on both sides of the Atlantic, think of climate change as a risk multiplier; as something that will amplify existing social, political, and resource stressors,” said Janani Vivekananda of International Alert, speaking at the Wilson Center on May 10. [Video Below]
Vivekananda, a senior climate policy officer with International Alert’s Peacebuilding Program, was joined by co-presenter Jeffrey Stark, the director of research and studies at the Foundation for Environmental Security and Sustainability (FESS), and discussant Cynthia Brady, senior conflict advisor with USAID’s Office of Conflict Management and Mitigation, to discuss the complex connections between climate change, conflict, stability, and governance.
A Multi-Layered Problem
Climate change and stability represent a “double-headed problem,” said Vivekananda. Climate change, while never the only cause of conflict, can increase its risk in certain contexts. At the same time, “states which are affected by conflict will already have weakened social, economic, and political resilience, which will mean that these states and their governments will find it difficult to address the impacts of climate change on the lives of these communities,” she said.
“In fragile states, the particular challenge is adapting the way we respond to climate change, bearing in mind the specific challenges of operating in a fragile context,” said Vivekananda. Ill-informed intervention programs run the risk of doing more harm than good, she said.
For example, Vivekananda said an agrarian village she visited in Nepal was suffering from an acute water shortage and tried adapting by switching from rice to corn, which is a less water-intensive crop. However, this initiative failed because the villagers lacked the necessary technical knowledge and coordination to make their efforts successful in the long term, and in the short term this effort actually further reduced water supplies and exacerbated deforestation.
“Local responses will only be able to go so far without national-level coordination,” Vivekananda said. What is needed is a “harmony” between so-called “top-down” and “bottom-up” initiatives. “Adapting to these challenges means adapting development assistance,” she said.
“What we’re finding is that the qualities that help a community, or a society, or in fact a government be resilient to climate change are in fact very similar qualities to that which makes a community able to deal with conflict issues without resorting to violence,” said Vivekananda.
No Simple, Surgical Solutions
“The impacts of environmental change and management of natural resources are always embedded in a powerful web of social, economic, political, cultural, and historical factors,” said Stark. “We shouldn’t expect simple, surgical solutions to climate change challenges,” he said.
Uganda and Ethiopia, for example, both have rich pastoralist traditions that are threatened by climate change. Increasing temperatures, drought, infrequent but intense rains, hail, and changes in seasonal patterns are threatening pasture lands and livelihoods.
At the same time, pastoralists are confronting the effects of a rapidly growing population, expanding cultivation, forced migration, shrinking traditional grazing lands, anti-pastoralist attitudes, and ethnic tensions. As a result, “any intervention in relation to climate adaptation – whether for water, or food, or alternative livelihoods – has to be fully understood and explicitly acknowledged as mutually beneficial by all sides,” Stark said. “If it is seen in any way to be favoring one group or another it will just cause conflict, so it is a very difficult and delicate situation.”
Yet, the challenges of climate change, said Stark, can be used “as a way to involve people who feel marginalized, empower their participation…and at the same time address some of the drivers of conflict that exist in the country.”
Case Studies: Addressing the “Missing Middle”
When doing climate change work in fragile states, “you have to think about your do-no-harm parameters,” said Brady. “Where are the opportunities to get additional sustainable development benefit and additional stabilization benefit out of reducing climate change vulnerability?”
More in-depth case studies, such as the work funded by USAID and conducted by FESS in Uganda and Ethiopia, are needed to help fill the “missing middle” between broad, international climate change efforts – like those at the United Nations – and the community level, Brady said.
The information generated from these case studies is being eagerly awaited by USAID’s partners in the Departments of State, Defense, and Treasury, said Brady. “We are all hopeful that there will be some really significant common lessons learned, and that at a minimum, we may draw some common understanding about what climate-sensitive parameters in fragile states might mean.”
Image Credit: “Ethio Somali 1,” courtesy of flickr user aheavens. -
India’s Quest for a Lower Carbon Footprint
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Between 1994 and 2007, India reduced its carbon dioxide emissions by 35 percent. As a result, the country’s emissions per capita now register at just over a ton per year – less than China (nearly five tons) and much less than the United States (18 tons). On May 10, Wilson Center Public Policy Scholar Ajay Shankardiscussed how India made these reductions, and what the nation plans to do to bring them down further in the decades ahead.
According to Shankar, several factors account for the 35 percent reductions. One is market-based, with high costs having discouraged heavy carbon-based energy consumption. India levied a “huge de facto” carbon tax on all commercial and industrial uses of electricity, which led to prices as much as 80 percent higher than the cost of supply. Another reason is legislation: New Delhi passed a robust energy conservation law. The private sector was a major contributor to the reductions; Shankar pointed out that India is now the world’s largest hub for small fuel-efficiency vehicles, as embodied by the Tata Motors corporation’s Nano car.
Shankar acknowledged the need for further carbon reductions. As India’s economic growth continues and its citizens become wealthier, carbon emissions will likely increase as more people buy cars and invest in air conditioning. Accordingly, the country has announced its intention, by 2020, to lower emissions by 20 to 25 percent from 2005 levels. He identified two carbon-reducing “opportunities” for India in the coming decades. One is to make irrigation more energy-efficient through the use of solar energy.
Another opportunity lies in India’s cities, where 300 to 400 million people are expected to flock over the next two to three decades. Urbanization presents a considerable carbon challenge, given the proliferation of carbon-emitting vehicles and AC units envisioned by such migration. Shankar spoke of the need for “smart cities” replete with “green buildings,” parks, and electric vehicles. He argued that India has created these types of cities before – including Chandigarh, the capital of Punjab Province, back in the 1950s.
Shankar stated that solar and nuclear energy constitute the “game-changers” for lessening the country’s carbon emissions. New Delhi hopes to generate 20,000 megawatts of solar capacity by 2020, with projections of grid parity by 2017 – meaning that in just several years, solar power could be as cheap to generate as fossil-fuel-driven electricity. He also underscored the priority New Delhi places on nuclear energy, noting that Prime Minister Manmohan Singh was willing to stake his political survival on the passing of a controversial civil nuclear deal with Washington because of nuclear’s environmental benefits. Shankar insisted that the Indian government will not be deterred by Japan’s recent nuclear crisis.
While Shankar described New Delhi’s 20 to 25 percent reductions goal as “ambitious,” he contended that he is more optimistic than he would have been several years ago about India’s prospects for attaining that objective. India, he concluded, must “rule out no option, and pursue every option intelligently.”
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson Center.
Photo Credit: “Tata nano,” courtesy of flickr user mjaniec. -
Reporting on Global Health: A Conversation With the International Reporting Project Fellows
›“The story is the story, the information is the information, but you can frame it in very different ways,” said freelance journalist Annie Murphy at a roundtable discussion on the current state of global health reporting. Fresh off their five-week assignments, Murphy and three other fellows from the International Reporting Project (IRP) – Jenny Asarnow, Jill Braden Balderas, and Ann S. Kim – spoke at an event at the Woodrow Wilson Center on April 28 about their experiences researching underreported health issues in Haiti, Botswana, Mozambique, and Uganda. [Video Below]
Taking the Temperature of Global Health Reporting
Global health reporting, like many other forms of journalism, has felt the pinch from the global financial crisis, said Balderas, who edited a recent Kaiser Foundation report on the issue, “Taking the Temperature: The Future of Global Health Journalism.” Other challenges that have led to less global health coverage in mainstream media include an increased focus on “hyper-local” news; “story fatigue” from years of HIV/AIDS coverage; greater focus on epidemics and disasters; and the increasing number of advocacy groups starting their own news services.
Placing global health stories is a big challenge, agreed all four panelists. Who will want to run the story? What form – radio, documentary, print, online – will the story take? According to Murphy, some creative thinking may be needed: “It is global health, but that doesn’t mean we always have to frame it in this box of global health. It will be global health no matter what we do, so I think it’s also important for us to feed it into other events and issues that are important.”
(Re)building Maternal Healthcare in Haiti
With the worst maternal and infant mortality rates in the Western Hemisphere, Haiti needs medical providers of all kinds, said Asarnow, but especially skilled birth attendants. The devastating earthquake in 2010 destroyed Haiti’s only midwifery school, located in Port-au-Prince, killing many students and instructors. The school is still struggling to graduate a class of 15 people, she said.
In the rural town of Hinche, located in Haiti’s Central Plateau region, Asarnow frequently visited a public hospital that provided pregnant women with free obstetric care. Yet, she said, “even with free care, there [were] still a lot of barriers for women coming to the hospital to get care.” For example, the family members of expectant mothers had to provide sheets, clothing, food, and a bucket for personal needs. In addition, some women were too poor to afford transportation to and from the hospital.
Most women in Haiti, though, give birth at home with the help of traditional birth attendants, called matrones, Asarnow said. These matrones, popular in rural areas, are not formally educated in midwifery, but the government, along with non-profits such as Midwives for Haiti, have provided the matrones with training in basic health care and emergency situations.
Simply reporting on childbirth turned out to be a challenge, said Asarnow. “It’s hard to get people interested in something that just happens to most women,” she said; other more unusual health problems, such as infectious diseases, tend to garner more interest.
Finding Health Sovereignty in Mozambique
Health sovereignty, explained Murphy, is “the idea that nations have the right to make decisions about health and about how people are going to be treated” – an issue that is particularly pointed in Mozambique, where 50 percent of the national budget and 70 percent of the annual health budget is tied to international aid.
Mozambique, said Murphy, has only 1,000 doctors to serve a population of 22 million. By contrast, the country has an estimated 50,000 traditional healers. As a result, she said, most Mozambicans use traditional healing for at least part of their regular health care.
While researching traditional healers in the northern province of Tete, Murphy investigated a large Brazilian-owned coal mine that had displaced 5,000 local people when it was built. Mining is a major economic activity in Mozambique, yet mining companies are taxed a mere three percent by the government, said Murphy.
Health reporting doesn’t have to only cover traditional health issues, said Murphy. “The environment, natural resources, and how a country earns its money very much have to do with the health of the people who are living there,” she said. “How can you talk about being sovereign and providing health to your citizens if you don’t have the money to do that?”
Treating the Over-Treatment of Malaria in Uganda
“Malaria is quite over-treated” in Uganda, said Balderas. There’s the “idea that if you have a fever, you have malaria.” Consequently, the rate of misdiagnosis can reach alarming rates in some areas, she said.
Balderas said an estimated 50 percent of Ugandans get free treatment through the public sector. However, only donor-funded facilities are equipped with the rapid diagnosis test (or RDT), which takes only 20 minutes to determine the presence of malaria in a blood sample, she said. If these facilities were more widespread, misdiagnoses rates could easily be lowered.
Other challenges to the accurate diagnosis and treatment of malaria include faulty equipment, shortages of electricity and lab technicians, human error, corruption, bureaucratic entanglements, and presumptive diagnoses. For example, sometimes health workers do not know what is causing a patient’s fever, Balderas said, but they prescribe malaria treatments anyway because “they want to be able to give someone a treatment; they want to feel like they’re helping people.”
“There are certainly a ton of issues that relate to health,” Balderas said, such as poverty and corruption. Everyone she interviewed in Uganda – with the exception of government officials – identified the corruption in the country’s drug sector as a key problem.
Helping “Africa” One Small Story at a Time
Inspired by a World Health Organization study, which found “at least a 60 percent reduction in HIV infection among men who were circumcised,” Kim went to Botswana to investigate infant circumcision, a practice that is gaining popularity but is still alien. “I would meet people in the course of my day and they would ask me what I was doing there and I would talk about circumcision. They’d say, ‘Oh, I really want to get my baby circumcised. How do I do that?’” she reported.
The most powerful moment of her trip, said Kim, came when she was researching cervical cancer – the number one cancer among women in Botswana. As she waited with a woman to receive her lab results, Kim asked her if she was nervous. The woman, who was HIV-positive, said, “Yeah, I’m really worried. To me, it would be worse to get cervical cancer than to have HIV.” Even though Botswana is a middle-income country, said Kim, there are far more resources available to treat HIV than cancer.
Kim said that when presenting her work it was important for her to bring in the human element and not just the statistics: “I hope that, in whatever small way, even these small stories will help get issues in various countries on the map, especially in Africa where we tend to think of it as ‘Africa’ and not so much as different countries with different personalities and different situations.”
Sources: Malaria Journal, UNFPA, World Health Organization.
Image Credit: David Hawxhurst/Woodrow Wilson Center. -
A New Security Narrative: What’s America’s Story for the 21st Century?
›We rarely had to question our place in the world during World War II or the Cold War when good guys and bad guys were easier to identify. A clear narrative, whether in the form of opposing Hitler or containing the spread of “The Evil Empire,” fueled our sense of global mission. Sure there were disagreements, but the big picture (and the big enemy) loomed large.
Our sense of realities, large and small, begins with the stories that frame our understanding of the events around us. The fall of the USSR took the wind out of the sails of our mythic sense of purpose. We were still “us,” but we now lacked a “them.”
A security narrative often emerges from our collective sense of threat assessment. It’s not only about what we stand for, but also what we stand against. On that fateful day of September 11, 2001, many believed that we had found the enemy that would provide the story lacking from our national security narrative since the fall of the Soviet empire. But an ill-defined foe lacking a nation-state home has only contributed to our post-Cold War drift. When we ask ourselves why we are committing military might in Libya (or Afghanistan, or Iraq), we’re really asking bigger questions. What is our purpose in the world? What is the story that defines our friends and our foes? And what does that story tell us about when to sit back or step up? When to watch or when to act?
The lack of a storyline also gives those who hate us the opportunity to define us as evil. So it becomes ever more urgent to start the conversation and to provide a non-partisan forum for what is bound to be a difficult deliberation. When Jane Harman left Congress to accept the leadership post at the Wilson Center, she brought her sense that toxic partisanship prevents Congress from addressing the biggest questions facing the nation in a productive and nonpartisan manner. Under her leadership, the Wilson Center has begun the “National Conversation” series to tackle the toughest issues.
The recently held inaugural event showed great promise. Two active military officers, Captain Wayne Porter (USN) and Colonel Mark Mykleby (USMC), writing under the pseudonym, “Mr. Y,” provided the framework for the discussion. Their vision for a new U.S. security story was presented in a white paper titled, “A National Strategic Narrative.” Their stated purpose is to provide a framework through which to view policy decisions well into the 21st century.
The encounter was lively and challenging, sometimes provocative, but always civil. I can summarize the immediate outcome by reporting a consensus that a narrative is missing and needed. It was a good start, but the discussion needs to continue until we reach a national consensus and not just one among five panelists and a moderator. I will not go into great detail in recapping the arguments and ideas presented, but will instead offer a contribution from each participant to whet your appetite.
Anne-Marie Slaughter, Princeton professor and former Director of Policy Planning for the U.S. Department of State began the session with a summary of the white paper, describing the changing nature of power and influence:We were never able to control international events but we had a much better possibility during the Cold War when you essentially had a bipolar world with two principal actors than we do in a world of countless state and non-state actors. Nobody controls anything in the 21st century, indeed it’s just not a very good century to be – it’s not a good time to be a control freak. [Laughter] Whether it’s your e-mail or global events it’s sort of the same problems. What you can do is influence outcomes. So we have to start by saying it’s an open system; you can’t control it but you can build up your credible influence.
Brent Scowcroft, National Security Advisor to two U.S. presidents, provided an historical framework for the discussion:I think we’re facing a historical discontinuity. The Treaty of Westphalia recognized the existence of the nation-state system codified it and so on. That was a replacement for the feudal system where our sovereignty was vague, divided between kings and princes and landowners and religious leaders. It created a new system and I think the epitome of the nation-state system was the 20th century. I think that globalization writ large is changing that system and globalization is eroding national borders. The financial crisis of 2008 showed us we’ve got a global economic system, what happened in one country spread immediately around. It also showed we don’t have a global way to deal with a global economic situation. Now, this force of globalization to me the best way to look at it is akin to the force of industrialization 250 years ago. Industrialization really created the modern nation state with a lot more power over its citizens to deal with issues than the earlier Westphalia state system had. And it brought the state together. It made it more powerful. Globalization is reacting the same way but in the opposite direction. It is diluting the power of the nation state to deal with the important things.
Thomas Friedman, Pulitzer-prize winning columnist for The New York Times, described the difference between virtual and real action:Exxon Mobil, they’re not on Facebook, they’re just in your face. [Laughter] Peabody Coal, they don’t have a chatroom. They’re in the cloakroom of the U.S. Congress with bags of money. So if you want to change the world, you gotta get out of Facebook and into somebody’s face whether that’s in the U.S. Congress or Tahrir Square. You’ll say, why I blogged on it. I blogged on it, really? That’s like firing a mortar into the Milky Way Galaxy, okay. [Laughter] There is a faux sense of activism out there that is really dangerous. The world, your world, may be digital but politics is still analog and we’ve kind of gotten away from that. Egypt changed. Yes, Facebook was hugely important in organizing people, but the fundamental change happened because a million people showed up in Tahrir Square.
Steve Clemons, founder of the American Strategy Program at the New America Foundation, added this thought on the essence of globalization:What globalization really is, is the disruption of cartels. What blogging is, individual blogging is saying is, I’m not gonna wait for The New York Times editor to tell me no any more or [laughter] to say yes three weeks from now. You know, it is the disruption of cartels and that is happening in every sector of society.
Robert Kagan, senior fellow with The Brookings Institution and a former State Department Policy Planning Officer, cautioned against rushing to utopian conclusions about the impact of our new levels of interconnectedness:Let me just give you an example of how even something new doesn’t necessarily change things the way we want them to or the way we expect them to. I’m positive by the way that human nature is not new. So you’re kind of dealing with the same beast, and I use the term advisably, as you’ve been dealing with for millennia. Let’s talk about the fact that everyone can communicate with each other on the internet. You know, when people communicate with each other especially across national boundaries sometimes it makes them grow closer. Sometimes it makes them hate each other more. If you read the Internet in China now it’s hyper nationalistic. Now, you can argue that because that’s where the government channel said and because they don’t let anybody else or anything else or you could say the Internet is a great vehicle for the Chinese people to express their hatred of the Japanese people. It certainly is doing that now. So does that mean the Internet is going to bring nations closer and solve problems? Not necessarily.
Representative Keith Ellison (D-MN), talked about the expectations of youth and how demographics will be a key consideration when defining a narrative:The Middle East is on my mind a lot these days, what it means if you have all these societies where 50 percent of the population is under 18 years old? You know this is – this has big implications. I mean, this is a demographic reality that is going to have vast implications for the United States. So one thing is it’s not going away because lots of these people who are 18 years old, their cohort just moves through. You know, they’re going to be there a long time and they have demands, they’re going to have needs, they’re going to have expectations. You mentioned justice. They expect us to act justly. And I, when people talk about anti-Americanism, for me part of what’s going on is unmet expectations not just ‘we don’t like it.’
For this abbreviated summary of the discussion, I give the final cautionary word to Steve Clemons, who had this to say in response to an audience question about how to begin the process of constructing a new narrative:This is a town of risk-averse institutions, a town of inertia, a town of vested interests. It’s not a town that really embraces the notion of how do you pivot very quickly and rapidly in a different direction. So, fundamentally you need to begin putting out narratives like this.
A transcript and video of the event is available from the Wilson Center and additional coverage can also be found right here on The New Security Beat.
John Milewski is the host of Dialogue Radio and Television at the Woodrow Wilson Center and can also be followed on The Huffington Post or Twitter.
Photo Credit: Adapted from “1989 – Berlin, Germany,” courtesy of flickr user MojoBaer.
