One week of schlepping bags across the Upper Mazaruni area of Guyana’s rainforest, as part of the latest Ve’ahavta medical team, and I’m finally in the Georgetown airport, awaiting my flight home… just in time for whatever Hallowe’en festivities await.

Since internet connectivity was not available in the interior, I saved up my blog posts.  Have at ‘em!

Oct 22

What a charmed life I lead.  Hours ago I was hunched in front of a computer in frigid Toronto, and now I’m… hunched in front of a computer inside a tent in the Amerindian village of Waramadong in the remote interior of Guyana.

Arriving in Georgetown early morning, I hightailed it to Ogle airport to catch a bush plane to Kamarang, which is a remote community near the Venezuela border.  The plane only had two passengers: me and a young man who was transporting a birthday cake. Yes, a birthday cake.

Here’s a pic of the view from my seat on the bush plane, of the rainforest below:

Here’s a pic of the front of the plane’s cockpit.  My mobile’s camera is able to detect the propeller:

There I met up with my contacts who filled both my hands with bottles of Guinness and loaded me onto a dug-out canoe.  So there we were, tipsy on beer, making our way down a jungle river, stopping only to piss.  Weird life.

Over for now.

Oct 23
Jawallah Village

Day 2 of the current expedition to Guyana.  My good friend and strong-like-ox team leader Bekkie departed for Canada today.  We took a long leisurely boat ride to Kamarang village to drop her off at the airstrip before continuing on another two hours to Jawallah.

Last night was sort of interesting.  After traveling for close to 24 hours straight, I bedded down in a palatial tent inside the Waramadong health centre, with my new compatriots fast asleep in adjacent tents.

I was awakened in starts, first by the lovely growl of distant howler monkeys, and then by the less than pleasant cantankerous outbursts of a drunken and profane man, whose voice indicated that he was inside the health centre.  I could hear the snores of my colleagues.  Why weren’t they awakened by this man?

I would drift back to sleep, quite confused, only to be awakened by a long string of very loud four letter words.  I had the presence of mind to reach for my knife, never far from hand.  But being semiconscious and very confused, I never found the wherewithal to get up and investigate.  Was it a dream?  Heck, I’d been in Ottawa earlier that day, and now I was in a tent in the South American jungle, possibly hearing a drunken AmerIndian man wander in our midst.  I was confused and dazed.

In the morning I learned that the drunk had been our boat captain, who was engaged in either an inebriated argument with persons real or imaginary, or having night terrors.  I lean to the former.  A weird first night.

After exhausting ourselves lugging our bags about 200 metres from the boat landing to our tenting location, we relaxed into a delicious swim in the black waters.  (For me, more like a splash than a swim… I can’t bring myself to swim in river waters that are too black to see more than an inch beneath the surface.)

Afterwards, I was overcome with a desperate desire for carbonated pop. A can of coke goes for US$3 here.  A colleague bought me an ice cold sprite, and I cherished it like my firstborn.

The evening ended with us lazily enjoying the full moon reigning over the Kamarang jungle river.  A tropical thunderstorm forced us back to our tents.  A long, hopefully sleep-filled night awaits.

Oct 24
Jawallah village

The village is nestled in a gorgeous section of the interior, with a moonlit river snaking between two banks of somewhat well developed human settlement.  The problem is that, frankly, people suck.  The young men seem perpetually drunk. Sexual assault is highly prevalent. Even the women of our team, usually deemed beyond such unwanted attentions, suffer vile comments and innuendos.  Indeed, one of our doctors witnessed what seems to be a rape attempt within the confines of our very clinic.

I’m afraid to say that my impression of Jawallah, despite its gorgeous children and friendly villagers, is one of drunken louts and sexual predators.

Nonetheless we had a productive clinic today, with about 70 patients seen.  One in particular ate up a fair amount of clinical time: an older man needing a circumcision after suffering an inflamed foreskin.  Not the most pleasant thing to watch.

I find myself strangely worried about some water purification kits I gave out to scores of villagers.  I gave strict instructions for one packet of the agent to be used for 10 litres of water…. but I’m worried that someone might create an over-concentrated batch as drinking water, and end up feeding his children insufficiently diluted bleach!

I think the fears are unfounded.  But I’m a worrier.

Off to sleep now… in a tent on concrete, as a dying generator and howling dogs scorch the background soundscape.

Oct 25
Kamarang

A half day clinic in Jawallah was instructive.  The day began with a house call to a house down the way, where an elderly woman had split her knee open after a bad fall.  Doing triage, I had my joyous fill of wrestling with adorable AmerIndian kids fighting to avoid having their temperatures taken.

I’ll never forget one particularly adorable 2 year old girl with undiagnosed Down’s Syndrome and partial paralysis resulting from a stroke.

Heartbreaking, yes, but as one of our doctors reminded me, each child is –as cliched as this may sound– a source of hope.

We took down our clinic and went off by boat to Kamarang, transporting two patients in the process, one of whom had to be carried the agonizing 60 feet or so of stairs going straight up from the boat landing to the health centre.

And here we are now, camped out in a local guest house.  The rest of the team is bedded down in tents on the guest house grounds.  I opted to pay the $20 for a private room and a bed.  Hey, I’ve got nothing to prove.

Tomorrow, off to Bartica…. and a chance to upload these blog posts!

Oct 27

Bartica

It’s 10:30 pm and I’m drunk off my ass.  We’re toasting the early departure of Dr Louis , a fascinating and hardworking man who easily won my respect and affection.

Today was a profoundly interesting day.  We provided a full day of clinical services to the inmates of the Mazaruni Prison (for long term offenders) and of Sibley Hall (for first time offenders).

The prisoners were uniformly respectful and pleasant.  A brief altercation arose after someone called someone else an “Auntie Man”, but otherwise things went swimmingly.  We saw 110 patients, much more that we would have seen in a community clinic, due to the regimented nature of the prisoner consults.

Some observations…

I don’t ever intend on being in a Third World prison.  Please Zod, never.

Almost everyone had a low back pain complaint.  Our physiotherapist had to see them four at a time.  Increasingly, I am convinced that the fastest growing global health needs are for psychiatric counseling and physiotherapy.

There were many cases of men who thought they had TB, but who just had migraines.

There were many cases of men with headaches and coughs who likely had TB.

There were a great many cases of swollen testicles (a result of undiagnosed STI perhaps) and at least one likely case of testicular cancer.

Language continues to be a barrier in providing services.  Yes, everyone speaks English, but not all English is alike.

I’d like to give more anecdotes, but I don’t think it would be ethical.  Suffice it to say that this visit has been downright fascinating, and certainly justifies my participation in this mission, as I hope to write a paper about it all.

Okay, off to bed.  Tomorrow we provide a clinic to the community of Itaballi then do a call-in TV show.

Oct 30

Toronto

So glad to be back in Canada.  The Customs dude caught me bringing back more rum than  what I am allowed, but let it pass since my mission had been a humanitarian one.  See, kids?  Volunteering pays off!

I didn’t mention than on our last day in the frontier, as we took a boat ride toward the city, we passed a bloated body that had been washed up on the beach.  This is officially the 4th random dead body I’ve seen in my various trips to Guyana.  What is it about this place?

Awaiting my flight to Ottawa now, and a frantic search for a Hallowe’en costume.  I have soooo much work to catch up on, and now I can add getting a TB skin test.  I’m concerned about my exposure, particularly in the Mazaruni prison.

In addition, I have a special treat for my students on Monday.  First they get to see my various bites.  Here’s a pic of my ankle:

Then they get to watch me take my medication for possible intestinal worm infection.  I don’t know that I have worms, but so many of the kids that we saw did have them.  And so many cute little toddlers –whom I was holding while their mothers received treatment– stuck their dirty little hands in my mouth.  There are no toys in my mouth!

Okay, off to get a stiff drink.

Feb 16 – Bethany, Guyana

It is Feb 16 and I’ve been back in Guyana for almost 4 days. As I write this, I am huddled under a mosquito net, recognizing the keyboard keys by the illumination afforded by my headlamp, and sweltering in heat that feels like 35 degrees or so. It is 9pm in Bethany in region 2, and I am presently visiting a clean, organized medical mission run by 7th Day Adventist missionaries. I expected to be sleeping on an open deck, knife clutched for fear of nocturnal aggressive dogs and other such creatures. Instead, the mission has given me a luxurious private bungalow in which to spend the night.

Luxurious is a relative term, of course. This is still mostly rainforest. My bed is shielded by a mosquito net. But all types of creepy crawlies are being drawn to the glow of the computer screen, and the net is now crawling with life. Oh, and there’s a family of frogs living in my toilet bowl. The missionaries call them “surpprise frogs” for the obvious reason. They may regret their choice of abode tomorrow morning when my bean-heavy meal is fully digested. Then they’ll be the ones who are surprised.

Yes, my line of work really is stressful. To greet us in Bethany, the college arranged for their top massage students to give us each a one our relaxation massage. Beneath starlight, nestled in the jungle’s humid embrace and soothed by the otherworldly tweets and chirps of creatures unseen, we had the knots of our muscles expertly pressed away.

The college, by the way, is a training centre for vegetarian Seventh Day Adventist Bible workers who wish to attach medical skills to their missionary work. I have my hesitancies about mixing religion and medicine, but it’s nothing new in the history of humankind, and there is no doubt that these are intelligent, caring people who –religion or no religion– can provide some much needed health relief for the tens of thousands in Guyana who suffer without regular medical care. And there’s also no denying that the college has created a wondrous, peaceful and comfortable home here in the Essequibo region, literally carved out of pure jungle. With all the holiness about, it’s a wonder my unclean self doesn’t burst into flames.

Their vegetarianism is also a boon. Despite my regular bacon fixations, I am mostly a vegetarian myself (mostly!), and prefer to remain strictly so while traveling. Guyana has proven particularly difficult to maintain such a diet, so it’s a fantastic thing to be housed in a compound that produces very creative and healthy vegetarian fare.

This is my umpteenth trek to Guyana, each time with a different mission and purpose, and each time with a different destination. In the morning we travel to the AmerIndian village of Mashabo, where we will explore potential new development projects. Then it’s back to Georgetown to await our Friday morning flight home. A medical team attached to the NGO I’m representing on this trip is presently in the deep interior, near the Venezuelan border; they are returning to Georgetown Friday evening and I’m sad that I won’t be able to meet up with them before leaving.

Our first stop was the frontier town of Bartica, outpost of boatmen and gold miners straggling in from Brazil, Venezuela and all points within Guyana. Here’s an object lesson for those North Americans among you who have never ventured abroad: one night, at dinner with four senior men of Bartica, they turned the conversation, in all seriousness, to the topic of whether one’s first love can truly end. It’s something I’ve seen throughout my journeys, but never in the “West”: men from all walks of life –builders, miners, politicians, labourers– gathering together to discuss the nature of love.

The bugs are spooking me now. Got to turn off the computer!

Feb 17 – Bethany, Guyana

Just returned from a visit to the AmerIndian village of Mashabo, which is home to 400-500 Awarak and Carib Indians, cared for by one overworked health care worker, the very charming and experienced Esther. Our job here is to scope out the community’s appropriateness for a medical intervention. My personal agenda is to determine whether any smaller, low investment but high income, projects can be initiated here. The answer to both questions is yes.

Mashabo is a gorgeous set of wooden homes nestled above a seemingly pristine lake. Like all waters in Guyana, the lake is brown and muddy, but somehow seems cleaner and almost blue from a distance. Esther informed us that ongoing issues include malaria, maternal health problems, chronic pain management, blood counts and contraception needs, all within the NGO’s mandate. Additionally, our visit to the underresourced primary school leads us to conclude that teaching aids, particularly with respect to language and science teaching, are most needed. This, I think, is a potentially cheap and impactive development initiative.

At one point, I went for a walk down one of the trails cut by a tractor (logging is the major industry here). Exotic plants and insects abounded, as well as the ubiquitous rustle in the foliage that was usually a splendid ground-dwelling bird or one of many species of large lizard. This is the jungle, after all.

I spotted another trail, mostly overgrown, that looked to have been cut by machete days earlier. Did I dare? How brave was I? This is, after all, the land of five very prevalent poisonous snake species, killer jaguars, poisonous spiders and a plethora of unnamed biting things that can cause disease, pain and even death. I’ve been to jungles in Guyana, Guatemala, India, Malaysia, Thailand and Uganda before. I’ve tracked wild mountain gorillas through the Congo jungle, bivouaced in a hammock on the Brazilian border to hear the jaguars patrolling, piloted a bamboo raft across a jungle river from Thailand into Burma, and have stared down forest foxes on the steps of remote Mayan ruins being overtaken by the forest. I contemplated the snake-proof gaiters in my pack, the mosquito mask in my back pocket and the hunting knife in my front pocket.

Yes, I dared.

And as I bravely set foot onto this path of new dangers, furtively congratulating myself on my masculine courage, I suddenly jumped back! I was surprised by six barefoot AmerIndian schoolboys, the eldest no more than 7, running happily from out of the “dangerous” path. Each turned to me and politely said in turn, “Good afternoon, sir!”

Yeah, I’m an idiot.

It’s 7pm now and I’m back at the mission. The blazing stars glare down through crystal clear skies, and the oppressive heat sets in for the night. I must awaken at 5:AM to make the boat back to Georgetown. But I go to sleep now with a strange contentment. We heard tonight the members of the mission singing, broken youth who have come here to mend and to find a new way. Christian songs echoing through the jungle, like something out of a Jeremy Irons movie (you know the one). I am not a Christian, but I understand what they do here, and I appreciate it.

Feb 18, Georgetown, Guyana

I awoke at 4:AM to catch a speedboat to the town of Supenaam, where anotherboat would take us to Parika, followed by a drive to Georgetown. In the wee hours, the jungle is dark and silent, save for the constant buzzing of weird insects and the occasional crash of something unknown against a hard surface. I took the time to examine the stars, so brilliant and skewed than what I’m used to in Canada.

I heard another of those mysterious crashes coming from the thickest part of the snaking treeline, and flipped on my headlamp to have a gander. We are below sea level, in a genuine South American jungle. The air is as thick as soup, coarse with raw oxygen spewed forth by the greenery. In front of my lamp, a line of plankton-like objects swam in the air, reminding me that life is everywhere here, even in the breathable air, fully explaining my endless allergic reactions.

Hours of peaceful boat journey back to the “city” were instructive. Passing children –7 or 8 years old– clean and lovely in their pressed school outfits, actually rowed their own boats to school. Children in Canada at that age whine about their electronic toys. Children here perform daily manual labour to earn the right to go to school.

We stop to pick up a mother and her three schoolage kids. One of them has been up all night with diarrhea, so they are heading to the hospital. There is a diarrhea epidemic across the country right now, as a mini-drought has gripped the nation, leading to improper use of stagnant waters. One child spends the boat time brushing his teeth with clean water in a cup, spitting into the myserious brownness of the river. It is a weirdly peaceful sight.

In Georgetown we checked into the Hotel Tower, my 5th time staying here in the last 10 years. Ironically, my father had been a waiter and busboy here 60 years ago. He wouldn’t recognize the place today, with its contemporary discotheque, free wifi and in-house spa. Don’t get me wrong –it’s still a Third World inn, so it’s no Ramada or Continental. But it certainly has changed since my father’s day.

We met briefly with the people who run Food For The Poor, an international NGO that delivers –you guessed it– food for the poor. Then topped off the day with a bit of tourism: a trip to the zoo.

Now, I’d been to the Georgetown zoo several times before, most recently only four days ago! But there’s not much else to do around here. For the equivalent of US$4,two people enjoyed entrance and an alcoholic beverage each. Trust me, booze helps you accept some of the horrors you see in this place. My least favourite is the adult African lion, kept in a concrete cage no bigger than a king-sized bed. The poor beast looked bored and miserable.

Most fiercesome were the harpy eagles and various species of South American owls, each big enough and with talons broad enough to easily pick a human baby from its mother’s arms. The harpy eyed me with malicious intent, until I distracted it by indicating a nearby child: much easier pickings.

Interestingly, there’s a huge fenced in exhibit featuring…. a cow. Yes, a cow. With the cow was a toucan in a cage. A cow and a toucan. I think there’s a Saturday morning cartoon there somewhere.

Further on is the tapir enclosure. A sign above it indicates that this tapir is on loan from the Philadelphia zoo. Why is this interesting? Because I’ve seen tapirs in Guyana before… wandering about, minding their own business. Tapirs are indigenous to Guyana. Why do they need to get one from Philadelphia, of all places?

Weirdest of all were the monkey enclosures. These are large metal cages holding many spider monkeys, howler monkeys, and other breeds I did not identify. The spider monkeys are huge, elegant and sad, with active prehensile tails and faces of red otherworldly delight. They are so bored that they shake the hand of any passing human, possibly writing on their palms in secret monkey script, “Send help!”

But several of the smaller monkey species have figured out how to get out. They treat the cage like a sort of townhouse, coming and going as they please, occasionally visiting other monkey species in their cages. I was concerned about one of them wandering into the anaconda or jaguar enclosure, so I alerted an employee.

“Oh those aren’t our monkeys,” she said. “They come from the outside.”

Really? If there are so many monkeys just kicking about visiting their monkey friends in prison, why do we bother even having a monkey prison?!!!

Clearly, this is not the most progressive zoo in the world. I think the alcohol might have given it away.

Off to dinner now, then a long night of catching up on overdo work. Then back to the cold winter of Canada.

During the first session of every class that I teach at the University of Ottawa, I relate to my students some of my observations from giving a lecture at Jawarlahal Nehru University in New Delhi, India, back in 2007. Essentially, I tell them about how the students at JNU take their education much more seriously than do students in Canadian universities, about how they don’t complain about extra work or the difficulty of classes, but rather appreciate the increasing competitiveness of a globalised economy and therefore the importance of every small iota of knowledge or skills that an educator can provide. This experience is contrasted with some of the complaints I get from some Canadian students, who moan about “too much math” or having to do –gasp!– written assignments or, Zod forbid, write two exams on the same day.

I tell them this in order to bring home the truth, as I see it, that the West is losing the education war, and that we North Americans need to work very hard indeed to match the work ethic of our Asian competitors. After all, I want my students to be as competitive as their Asian brethren, and to be able to work, produce and excel at a global pace.

This sentiment is touched on briefly in Hans Rosling’s famous TEDIndia lecture, in which he states that in his experience students in India study much harder than do students in the West.

I observed a similar trend during my tour of India’s major cities in 2007, where I noticed that every young person with whom I interacted seemed willing and able to sacrifice and to endure great hardship to do his part to push himself, his family and his country to the world’s economic forefront. I’ve seem similar work ethics in other parts of the world –China, Indonesia and Thailand come to mind– but never with the same weird mixture of optimism and desperation.

It’s almost a truism now that a handful of formerly impoverished nations are poised to be the superpowers of the next century. The so-called BRIC nations –Brazil, Russia, India and China– have the world’s fastest growing economies, and are posting expansive economic stats, even during a global recession. Two in particular –India and China– are seen as the great emerging powers of the world. Indeed, it should be noted that in the history of human civilization, the two strongest economies on Earth have always been India’s and China’s, with the exception of the colonial period of the past 200-300 years.

Currently, most US and Canadian foreign policy, with respect to these nations, has focused on China being the likely rival to the USA’s throne of hegemonic dominance. This is reasonable given the overlap between American and Chinese military interests (security of the Formosa Strait and arms deals in Sudan among them), and also because of the current dominance of Chinese products in US markets. Chinese GDP is 7-8 times that of India’s, her per capita GDP six times greater, and her inflation substantially lower. China’s infrastructure, her road quality, civic amenities and electrical grid, for example, are comparable to those of Europe or North America, making for relatively efficient goods production and transportation. And Chinese military power is well proven and disciplined, making China the great regional superpower of Asia.

In the comparison of Chinese and Indian economies, a practice increasingly popular in the parlour rooms of academics, China seems to win according to every traditional metric. But there are qualities that hint at a dramatic shift in coming decades. I would like to respectfully suggest that it will be India, not China, that will take the world’s economy and culture by the collars and shake it till the human race takes note. Assuming that a global economy still exists, and assuming that Climate Change or some other apocalyptic event hasn’t ravaged humanity back to the Stone Age, I predict that the close of the 21st century will see India as the world’s leading nation.

Here are my reasons:

The demographic dividend. China has an age profile comparable to that of Western nations, specifically Canada. In other words, the Chinese are old. As a result, they are heading for the same economic precipice as is the West: in 10-30 years, the number of workers will be fewer than the number of retirees. This is a considerable economic strain. India, on the other hand, is a very young nation. The bulk of its population is just entering the work force.

English. There’s a reason one of the more dynamic industries in China is English language training. They recognize that English is the current global lingua franca and the language of commerce. This will not be changing anytime soon, due to centuries of British then American global dominance. As a result of their colonial past, the elite and mercantile classes of India are already either functional or fluent in English, affording them immediate linguistic entry into the global market. It is not unusual or difficult to find fluent speakers of French, German, Portugese, Russian or any number of important world languages on the streets of India; the same cannot be said of China.

British law. Another dividend of post-colonialism is the inheritance of a relatively functional, reliable and more-or-less fair judicial system, at least to the extent that it needs to be for business purposes. China’s legal system is functional, as well, but individual rulings at the local level are theoretically subject to the whims of the central ruling party. This is relevant to business because trans-border contracts need to have legal heft. An agreement with an Indian firm is guaranteed by the Indian legal system; there is recourse, at least in theory and more-or-less in practice, should a contract go awry.

Politically engaged diaspora. Both nations enjoy large global diasporas which have sought and received commercial success. But the Indian diaspora has gone further by achieving political success. Canada, the USA, the UK, the Caribbean, Africa and beyond… all are seeing elected officials of Indian extraction who, while serving the needs of their electorate, nonetheless maintain a connection to the Motherland. This is serving to accelerate commercial, philosophical, cultural and political connections between India and the world.

Energy profile. Both growing economies are emerging energy hogs. However, China’s model is a factory-based industrial one, depending on coal-fired plants to churn out cheap consumer goods that flood Western markets. India does some of the same, but is known more for its virtual products and human resources –information technology, call centres, medical tourism, etc– all of which have fewer industrial energy demands than does strict manufacturing. The result is that as energy production becomes increasingly prohibitively expensive, the Indian model for wealth generation will become more labile and efficient than the Chinese model. This may be the difference in sustaining Indian growth when the energy crunch really hits hard.

Democracy. It’s somewhat propagandistic to suggest, as the West did during the entirety of the Cold War, that democracy is a prerequisite for national wealth; Singapore proved that assertion to be false. However, history suggests that democracy remains the best political system under which to build a thriving, stable economy. India’s functional democracy, unlike China’s one-party ruling system, is arguably more robust against major perturbations. A revolution, the argument goes, leading to a vitiation of trade deals and dramatic shifts in economic philosophies, is less likely under India’s system than under China’s.

Soft power. Whereas hard power is military brute force and money spent by one nation to affect the behaviour of another, soft power is that exercised to encourage others to become acclimatized and sympathetic –almost desirous– of one’s lifestyle and perspective. There is official, government-funded soft power and unofficial, cultural soft power that flows naturally from a nation’s character and enterprises. Both India and China have pursued the former, by sponsoring cultural exchanges and by investing in development projects and other goodwill gestures abroad. China, perhaps, has been more acutely involved in this activity, especially in regions of specific geopolitical interest, like energy-rich portions of Africa. However, the unofficial kind of soft power is arguably what is more pertinent to assuring a nation’s supremacy atop an increasingly monolithic world economic culture. After all, what has done more to promote US interests abroad, America’s vaunted military supremacy or Coca Cola, Hollywood and Britney Spears?

Chinese cultural soft power has flowed slowly but consistently over the years, bringing kung fu, acupuncture and Chinese cuisine to all parts of the globe. But in recent years we’ve seen the explosion of Indian soft power. The ancient art of yoga is now, ironically, a fast growing multimillion dollar global industry. With it has come Indian styles of meditation and Ayurvedic medicine, all the rage in trendier parts of the West. India is now the centre of the English-language book publishing world, surpassing both the USA and UK in this category, and regularly producing Booker and Pullitzer Prize-winners from her sprawling diaspora.

An increasing global acceptance of vegetarianism as a lifestyle, championed by celebrities and medical authorities alike, is being fueled both by rising food prices and by realizations that meat production is not an environmentally sustainable practice at current global levels. With the increased popularity of vegetarianism has come a gravitation toward the world’s most recognizable vegetarian culture in India. This, too, is a kind of soft power.

Bollywood is, of course, the dreadnought of Indian cultural soft power. Bollywood images of beauty, athleticism, wealth, talent and vivacity are replacing extant world views of Indians as mystics, fakirs and impoverished indigents. The Oscar win of Slumdog Millionaire has permanently cemented the Bollywood ethic into the global mainstream, and with it a growing comfort with doing business with Indians, in all the ways that that phrase suggests. To paraphrase Shashi Tharoor, in today’s world it’s not the country with the biggest guns that wins, but the country who tells the better story; and India is quite adept at telling stories.

The import of cultural soft power is being seen in the rise of Indian educational centres; a few of whom, such as the Indian Institute of Technology, are rivaling the top schools of the USA in quality and name recognition, and are attracting foreign students in increasing numbers. China has some excellent schools, as well, but the global branding of Indian schools is allowing their graduates to leverage those brands in trans-national commerce, by force of name recognition alone, a feat that was once the sole domain of top US and UK colleges.

Both India and China suffer from that great worrisome blight of the Global South: the gaping chasm between rich and poor, both within city centres and between rural and urban poles. In the Chinese case, this has been managed centrally, by establishing specific zones of economic activity. But within those zones, tragedy abounds in the form of child workers and conditions rumoured to be occasionally medieval in their brutality.

In India, the oceans of working poor underwrite the middle class’s rapid accumulation of wealth. In the streets of Mumbai, street-side sellers, sweepers and construction workers sleep in the streets or in temporary slums so that the important work of erecting skyscrapers and servicing the business class will not be slowed by the inconvenience of worker health or happiness. Neither the Chinese or Indian case is a sustainable model for labour rights or popular stability.

Both nations must solve their worker rights issues before economic stability is achieved. Frankly, the nation who can do so first may, quite literally, inherit the world.

This past week I gave my 4th year global health class a brief quiz on current events related to issues in global health and development. They were instructed to monitor major news sources daily since the start of term, with specific attention to stories that might have a direct or cursory connection to global health and development. This might include stories relating to war, politics and economics.

The reason for scheduling the test is that I was concerned that we are doing a disservice to our students by not making their education more relevant to the current state of the world, and by not engendering in them an appreciation for the daily happenings of society. This is particularly important in global health, a subject that changes hourly and that is dependent on an interdisciplinary familiarity with the changing nature of law, politics, science and general knowledge.

The intent is not to punish lack of knowledge, but rather to encourage the valuing of knowledge. Part of the lesson is to be able to asses one’s own level of general knowledge relative to the overall level of knowledge in our society.

Therefore, to provide some hand-waving data for discussing the quality of these questions, I’m doing something I ordinarily would not do. I’m publishing the quiz on this website. You will find the questions below, with the answer key immediately after.

You are, of course, welcome to take the test yourself. I would further encourage you to input your score to an online service by clicking this link:

Please note: this is not a formal academic study, and therefore has not undergone any ethics clearance. These data will not be published, though they will be discussed in my class. If you enter your results, those results will be visible by everyone. Feel free to enter a fake name, if you’d prefer. But I would like you to enter your true profession, if you feel comfortable doing so. It goes without saying that this is a strictly voluntary exercise.

Also, please don’t cheat. This is not a contest.

—–

1. In 2009, the Nobel Peace Prize was controversially awarded to what person?

A. Nelson Mandela
B. George W. Bush
C. Barack Obama
D. Al Gore
E. The Dalai Lama

2. In early November, 2009, the people of Germany noted the 20th anniversary of what?

A. The death of Adolf Hitler
B. The fall of the Berlin Wall
C. The founding of NATO
D. Germany’s entrance into the European Union
E. The assassination of Chancellor Angela Merkel

3. Who is Dr. Abdullah Abdullah?

A. One of the candidates in a recent Presidential election in Afghanistan
B. Head of one of the larger semi-legal organ trafficking rings in India
C. The scientist who led the development of an experimental HIV vaccine in Africa, currently undergoing limited clinical trials
D. Recently appointed Deputy Director General of the World Health Organization
E. Author of a controversial study recently published in The Lancet, about excess deaths in the wake of the US invasion of Iran

4. On November 11, 2009, a joint report by the American Cancer Society and Global Smokefree Partnership was published. The report predicts that cancer deaths due to smoking will double in 12 years in what region or population?

A. The Caribbean
B. China
C. India
D. Africa
E. Aboriginal communities in the Western hemisphere

5. Who is the current Director General of the World Health Organization?

A. Margaret Chan
B. Ban-ki Moon
C. James Orbinski
D. John Baird
E. Aung San Suu Kyi

6. In October, 2009, Desire Munyaneza, the first person to be convicted under Canada’s War Crimes Act, was sentenced to life imprisonment after a court found him guilty of seven charges relating to what?

A. The Rwandan genocide
B. The Sudanese (Darfur) genocide
C. War crimes committed during the Congolese civil war
D. The selling of counterfeit HIV drugs in sub-Saharan Africa
E. War crimes committed during the NATO peacekeeping activities in Somalia

7. In December, 2009, representatives of 192 countries will meet in Copenhagen to discuss what?

A. The on-going humanitarian crisis in Darfur
B. The global threat of terrorism
C. Pandemic influenza
D. Global food production
E. Climate change

8. In November, 2009, this man’s war crimes trial at the World Court in The Hague was postponed till March, 2010, to give his new lawyer time to prepare.

A. George W. Bush
B. Radovan Karadzic
C. Wanderlei Silva
D. Slobodan Milošević
E. Ramush Haradinaj

9. In what year is Canada is scheduled to withdraw the bulk of its troops from Afghanistan?

A. 2010
B. 2011
C. 2012
D. 2013
E. 2014

10. After the May, 2009, conclusion of civil war lasting over two decades, the government of this country has just agreed to release the remaining 136,000 refugees forced to live in government refugee camps.

A. Democratic Republic of Congo
B. Nicaragua
C. Sri Lanka
D. The former Yugoslavia
E. Sudan

—–

Answer key: 1c 2b 3a 4d 5a 6a 7e 8b 9b 10c

Ever read Maximum City? It’s one of the best non-fiction books I’ve read in decades. It’s about life in Bombay (Mumbai). I had the pleasure of meeting its author, Suketu Mehta, a couple of years ago in Ottawa. There, we talked about a scene in the book in which Suketu is given “one hit for free” by the leader of India’s biggest organized crime syndicate. That’s right: he’s got a coupon for one free assassination. When asked to whom the crime lord should turn his attentions, many thoughts in the room flirted with members of the outgoing Bush administration.

(Very important disclaimer, for any members of US security reading this: I advocate violence against no one, not the least of which a sitting US President. So please don’t send scary men with guns, body armour and baseball caps to my door.)

Fast forward to 2009 with Bush gone and the saviour Obama in his place. Much has been expected of Obama and, I must say, the fellow has not quite delivered. This is particularly true for US involvement in global health and development initiatives around the world.

So it was with great interest that I invited superstar epidemiologist Ed Mills to give a guest lecture in my 4th year global health class this past week. I knew Ed would drop the following bombshell on the students, that no one has done more for HIV/AIDS victims in Africa than one George W. Bush. The man is a hero in sub-Saharan Africa. And while Obama has personal, familial, political and racial connections to Africa, the current President has actually dialed back some of Bush’s more impressive accomplishments in the region.

As summarized in this blog post, it was largely through Bush’s PEPFAR program (President’s Emergency Plan for AIDS Relief) that he effected what appears to be widespread positive change. Apparently, after a $15 billion investment, the AIDS mortality rate in 12 of the 15 targeted PEPFAR countries (the other 3 were outside Africa) declined by 10.5% over 5 years.

Even Bob Geldof said of Bush’s commitment to AIDS: “There are no votes in helping the poor of Africa, but Bush did it anyway.”

In the words of Dustin Dehez:

“[George Bush] elevated development assistance to Africa to a serious foreign policy field. Indeed, due to Bush’s Africa policy, development now complements the other two d’s: diplomacy and defence. Under his leadership development assistance has more than doubled from a marginal 10 billion to more than 22 billion. And his anti-AIDS programmes have fostered progress in countering the disease, indeed they are ideal types of how bureaucratic hurdles can be bypassed to make development assistance more effective. Like it or not: In Africa President Bush saved thousands of lives.”

Here is an African voice singing similar praises. How did Bush achieve this feat? Mostly by allowing his investments to focus on ARV (anti-retroviral) access. There are all sorts of barriers to poor HIV stricken people accessing these life-extending drugs, some of them valid and others less so: patent protection driving up drug prices, distribution challenges, lack of trained personnel to dose them accordingly, suspected poor adherence to the drug regimen, poor food quality diminishing the drugs’ ability to be absorbed, the inability to store them long term in a tropical climate, local corruption preventing free and easy access, and so on. PEPFAR funding, it seemed, succeeded to some extent in overcoming these barriers.

But hold on…. is all this praise really well founded? It’s based, after all, on the assumption that declines in AIDS mortality rate have to do with PEPFAR monies. Leaving aside the always present problems with assigning causation, are the mortality data even accurate?

I don’t know. But Mead Over seems to think they are not. As Over details in this article, the mortality data used to pronounce the glories of PEPFAR were based on UNAIDS projections. This is a widely performed and acceptable strategem, since such data are slow to return. However, Over suggests that in this case the data are inappropriate for evaluating PEPFAR success.

Then there are ethical issues with PEPFAR in general. The conditions for receiving PEPFAR money include the inclusion of abstinence as a pillar of prevention and refusal to fund needle-exchange programs. Both conditions were lifted in 2008, but after years of implementation.

In addition, PEPFAR only funded branded drugs, rather than cheaper generic drugs, but started allowing the latter after 2005.

Full criticism of PEPFAR is available here, and an easy to read description of PEPFAR can be accessed here. Obama is continuining the program, but with a few changes.

So what’s the bottom line here? Is George Bush the saviour of Africa? Well, I don’t think it’s wrong to acknowledge that the man seemed to care a fair amount about the plight of HIV victims in Africa, and managed to push through policy directives which, while flawed and beset with ideological caveats, nonetheless managed to improve the lives of tens of thousands of people. For that, he should be applauded.

But let’s not forget that Bush also disassembled many civil liberties domestically, pushed his nation into the deepest debt it has ever seen, started two fruitless wars, invaded a country that posed no threat to him or his people, lied repeatedly to his citizens, and, according to at least one study, is responsible for the deaths of half a million Iraqi children.

Give the devil his due. But let’s not ignore the horns.

In one of my many roles at the University of Ottawa, I’m a faculty advisor to the student run “international development week”, which happens this year from Feb 2-7. Our theme this year is, “Development: A Basic Human Right?”

There’s a whole host of (mostly free) events planned, all of which will be posted on the website at www.sdi-idw.uottawa.ca. The key events, however, are held each evening at 7:30pm in Alumni Auditorium:

• Feb 2: Alex Neve, Secretary General of Amnesty International Canada.
• Feb 3: Maude Barlow, Senior Advisor to the UN on Water
• Feb 4: Lloyd Axworthy, former Minister of Foreign Affairs
• Feb 5: His Excellency S.M. Gavai, High Commissioner of India
• Feb 6: Alexandre Trudeau, Journalist

Please note that Mr Axworthy will speak at the National Art Gallery, and that his event will cost a modicum fee.

The Indian High Commissioner is attending following a personal plea from yours truly, so I really really hope he gets a good turn out. If you’re in town, please come on by!

For more information, contact hpihc@uottawa.ca.

Reclining in the Tower hotel, digesting rum and Chinese food, watching CNN and blogging on my phone.

Today we zipped out to Kaieteur Falls near the Brazilian border. It was my second time, but no less fun. Kaieteur really is a natural wonder of the world.

I just realized that Venezuela is going to the polls soon, as Hugo Chavez bids for an end to term limits and gives credence to American charges of dictatorship. I am reminded of a drunken Amerindian we encountered in Kamarang a few days ago. He was ranting about Chavez’s virtues,
particulary of how Chavez is, in his opinion, the champion of the the oppressed against the Americans and the “white people”.

The big news today, however, is a follow-up from yesterday’s farce. The transportation of the two patients, resulting in a car crash, made page 2 of the newspaper this morning. The article reported that “there were no injuries”, completely missing the point that these two Amerindians, flown in from the bush for medical care, have been doubly traumatized in a world they do not understand.

When one of our number, Bekkie, went to see them at the hospital, she found a pathetic, tiny woman with a bruise on her face and a pain in her chest and no one tending to her needs. Her husband with the hip issue had been more-or-less cared for, but she had been admitted with minimal care.

In fact, she had not been fed in a day, and no one had offered her clothes or a towel. It seems the hospital only feeds you if you have your own plate. So Bekkie bought her a new nighty, a cup and plate, and a towel.

These people are impoverished, traumatized and have no one to care for them. In many ways, it would have been better for them to have stayed in the interior and suffered with their illnesses. As the Amerindians say, people come to the city hospital to die.

I am sadly reminded of the snake bite woman who was flown here and who died of the bite. Her final hours must have been horrific, spent alone and terrified in an unfriendly, dirty and alien place. It would have been better to leave her to die in her village, surrounded by love and care.

This place needs advocates for the poor and remote. Soon.

Greetings from the lobby of the Hotel Tower in Georgetown, Guyana, where I am miraculously able to access free wifi (while mosquitos eat me alive).

What a day.

Last night, I craved rain. So a local taught me a rain summoning chant: “Mike mike musawa!” I repeated it three timesd and the heavens split open to crap down a river of unending rain. In the morning, I washed in the raised and blackened river, as nameless flotsam floated by.

I presented my snake boots to our boat captain as a gift, and was immediately beset with personal requests for more boots from everyone else in the vicinity. One 10 year old girl, who claims she wants to be a scientist, implored me, “You must remember us!”

We left Waramadong on schedule at 7:30 am on an emormous bark canoe. But this time we took with us an old man with a broken hip, who had to be lifted on in a sling, his wife, a woman with a broken arm, another abused woman with human bite marks on her arm, her baby, another woman and her baby who suffers from a strange flaccid paralysis, and a random selection of rivergoers.

Arriving in Karamang at 9:30, we were abashed to find the weather disfavourable for an aerial pickup. We lingered for hours before our two bush planes could land. Most of us, and our bags, left for Georgetown in the first plane. But two (thankfully not me) stayed behind to carry the man with the broken hip into the second plane.

You need to understand that these are remote river folk. None of them had ever been in a car, let alone an airplane, before. And now they were being compelled to fly to the nation’s only city at a time of great medical distress.

Well, most of us arrived in good order and headed to the hotel to wash up. The second plane, however, was delayed 2 hours. Upon arrival, no ambulance was available to take the man with the broken hip to the hospital. Instead a station wagon was found for him and his wife, while the others went on to the hotel in another taxi.

Both vehicles took the same route. But the hotel bound vehicle was stopped because of an accident up ahead… the station wagon had crashed! The man with the broken hip was thrown forward. His wife crashed through the windshield, earning an enormous hematoma on her face. A miscreant from the crowd then attempted to steal their meager belongings. The taxi, too, was totalled, removing the sole source of income for the driver. (There is no real insurance here.) In one brief moment, three lives were altered, possibly permanently.

You also need to understand what a nightmare Georgetown public hospital is. People will attend to your basic medical needs. But no one will ask about your emotional disposition or if you understand the system or if youu have a place to go. There is plenty of tragedy to go around.

Once more I am huddled in my tent in Waramadong village on the Kamarang river, a distant stone’s throw from the Venezuelan border, frantically squishing monstrous and nameless jungle bugs like the big sissy that I am. Outside, a torrential downpour is sending the river into frenzies as gorgeous sheet lightning frames the otherworldly flat mountains near the Venezuelan border.

Today was our last working day in Guyana. Tomorrow morning we are scheduled to pack up our tents and take a motorized canoe downriver to Kamarang, whence a bush plane will fly us the two hours to the capital city Georgetown.

But what an eventful day it has been.

While we are indeed cut off from phones, tv, most radio and all internet, news still travels astonishingly fast. Remember the poor woman who was bitten by a snake? The one whom a colleague and I had to carry up 30 feet of stairs from her canoe to the clinic? She was flown to Georgetown with her worried husband a few days ago. Today we learned that she died there.

My heart goes out to her and her family. The government pays for aboriginals to be flown out for medical care, but not for their return. The impoverished husband is now all alone in the “big” city without people who speak his dialect, facing enormous amounts of racism, and possibly without any way to get himself or his wife’s corpse back home.

We had another snake bite victim right here in Waramadong. But thankfully, after spending a night in the health post (where we have cast our tents), this morning he walked home on his own power.

When I get home, I really must look into some way to get antivenin made and stored locally here.

We also made our final –and biggest– presentation today, this time to 400 high school students. Once again, I pretty much winged it, but it went well. Half way through our condom demonstration, however, we were ordered to move on to another topic!

Which brings us to today’s real drama. In the wee hours, the local principal came knocking with 2 women in tow: one a mother, the other her 13 year old daughter who had been impregnated by an older man. For some weird reason, the mother ran out to fetch the purported father, and a whole little Maury Povich show erupted in our little camp. My kingdom for a paternity kit!

I’m not sure what was resolved, if anything. But the lesson here is that these communities need counselors, community organizers (Gobama!), condoms and a greater intervention by the law.

To bed.

Today was our first full day in Waramadong village, a remote riverbound Amerindian community notable for its gorgeous boarding school of 300-400 high school students who have been shipped in from around the region.

Guess what? We have another snake bite victim: a middle aged man with three fer-de-lance (labarria) bites on his leg. He’s resting in the adjacent room right now.

There’s something idyllic about a place where everyone, young and old, says good morning, good afternoon and good evening, and where children –at least outwardly– are content to be children.

Problem is that there’s a little epidemic of teen sex going on here, which is where we are targeting our message. Enter the great bugaboo of this kind of development work: the community is very religious (Seventh Day Adventists) and are forbidding us from giving out condoms because, “condoms encourage them to have sex.”

People, they’re already having sex! Let’s at least stop them from getting diseases and babies!

Today was punctuated by a surreal meeting with the headmaster and the entire faculty, which lasted well into the blackness of the unlit night, wherein all of their frustrations with the “White man’s world” and development strategies to date came to light. I found myself giving them strange advice: to take control of their situation, to start their own epidemiology projects in order to sue for government support with real data, and to take the initiative in documenting their own heritage, particularly dwindling knowledge around medicinal plants.

But we must acquiesce to their wishes. So tomorrow I will speak to 300 high school kids about condoms… While not providing any.