Africa for Obama

Tuesday 20 January 2009

About 67 million people actually cast a ballot for him but for hundreds of millions more today is a historic day. He may have been voted President of the United States of America only but over here in Tanzania it certainly feels like Barack Obama has been anointed the leader of the united nations of Africa too. I can only imagine what it must be like in neighbouring Kenya but over here the Obama-mania is thick enough to cut with a knife. Everywhere you look you can see Obama bumper stickers, Obama shirts and shawls, and buses decorated with "yes, we can".

It is hard not to be swept away by all the enthusiasm and I too of course recognise the significance of this day. Rather than watch the inauguration ceremony all alone on CNN in my hotel room, I decide to join the crowds in the bar. Although there is still almost an hour to go before the supreme moment, it is already very crowded. I suddenly find myself wedged on a sofa between an American woman and her Tanzanian companion. The three of us each represent a different continent and we each have our own reasons to be excited by this moment but the feeling is equally intense in all of us. Together we watch the moment when Barack Obama is sworn in as the 44th president of the USA. Together we briefly draw our breath when it seems he stumbles over the most momentous words of his life. It is not until the next day—away from the bar clamour—that I learn the mistake was not his but was prompted by the bumbling Chief Justice. It does not matter. All this crowd cares about is that as of this moment Barack Obama is the new president; not just America's but Africa's too.

Healthy world

I must admit I haven't used my constitutional right to vote in a while. I suppose you could say that I have been hiding my voter apathy behind the rather flimsy excuse of living abroad. On top of that, the Dutch political landscape is just so depressing these days with parties such as the ominously titled "Trots op Nederland" (Proud of the Netherlands) and "Partij voor de Vrijheid" (Party for Freedom) that I'd rather run for the hills than participate in this sham. Not the way to go, I know. I'll try to do better in future. You've got to practice what you preach after all, and I'm certainly no stranger to a bit of political preaching. One of my former flatmates once sighed in desperation "Are all you Dutch so political?!".

A lot of my preaching takes places in the international rather than the domestic arena, probably in part the result of my line of work these days. Like so many across the world, I have been keeping a very close eye on the US presidential elections. And like so many outside of the US, I have had no trouble picking my favourite. Of course, healthcare is a topic close to my heart in this election. The American healthcare system represents both some of the best and worst in the world. Top class medicine for some but unattainable for many. In international aid and development on health, the Americans have also imposed an at times rather controversial agenda. It is interesting to see where the candidates stand on these issues. If I hadn't made up my mind already, this article just published in The Lancet might have done it for me:

Obama vs McCain on global health
by: Nellie Bristol
The Lancet (2008), 372:9638, p.521-522

In the run-up to the presidential election, US health care continues to dominate the debate. But where do the candidates stand on global-health issues? Nellie Bristol reviews Obama and McCain's pledges in this area, including their views on HIV/AIDS and international development.

When asked by a reporter last year if he supported the spending of US tax dollars on contraceptives in Africa to slow the spread of HIV/AIDS, John McCain, the Republican US presidential hopeful, seemed unsure and confused. "I haven't thought about it before", he said. "Before I give you an answer, let me think about it a little bit because I never got a question about it before. I don't know if I would use taxpayer money for it."

The scene illustrates what global-health experts say is the key difference between McCain and Democratic contender Barack Obama in the area of global health: that of particular investment in the issue. "Obama has a personal knowledge and interest that is not insignificant", said J Stephen Morrison, executive director of the HIV/AIDS task force and of the Africa programme for the Center for Strategic & International Studies, based in Washington, DC. "He made sure he was smart around the issues of global health." Morrison cited Obama's Kenyan father and his August, 2006, visit to Africa where Obama and his wife Michelle were publicly tested for HIV/AIDS in an attempt to reduce stigma attached to the procedure. "I do not think McCain is indifferent, but I do not think he has the same level of personal knowledge or passion", Morrison said. "[McCain has] said much less both about development issues and global health so it's hard to infer from silence", said Ruth Levine, vice president for programmes and operations and senior fellow at the Center for Global Development (CGD). "It does not feel like a core part of the agenda he would bring in."

That difference is evident in the candidates' campaign literature and in their statements about global health. Although McCain is a vocal supporter of the US global AIDS programme—the President's Emergency Plan for AIDS Relief (PEPFAR)—and has pledged to combat malaria in Africa, his campaign documents are thin on the subject of global health. Meanwhile, Obama's campaign promotes proposals to confront HIV/AIDS globally and has a multiple page list of sweeping reforms in international development. "He is really reading the play book of many of the strongest voices in development and in global health", Levine commented. Obama supports and calls for changes in PEPFAR, including an additional $1 billion over 5 years to fight the epidemic in southeast Asia, India, and eastern Europe. He also calls for increasing the capacity of health systems to deliver HIV/AIDS treatment. In a move likely to cost him support among pharmaceutical manufacturers, Obama also pledges to "break the stranglehold that a few big drug and insurance companies have" on HIV/AIDS drugs. "Obama supports the rights of sovereign nations to access quality-assured low-cost generic medication to meet their pressing public health needs", his campaign literature says.

Although supporting US bilateral HIV/AIDS efforts, Obama also advocates more US funding for multilateral programmes and the Global Fund to Fight AIDS, Tuberculosis and Malaria. US support for the Fund has been a partisan issue; some conservatives are concerned that the organisation does not reflect US policies on issues like sexual abstinence and needle exchange. Obama also pledges US support to meet the UN Millennium Development Goals. In 2005, he cosponsored the International Cooperation to Meet the Millennium Development Goals Act.
Some Americans view the UN suspiciously, and even hostilely, claiming its aim is to usurp US power and channel money to corrupt dictators. The USA is behind in its payments to the organisation and many, including Obama, are pushing for UN reforms. Nonetheless, development experts say his endorsement of the goals and of other multilateral efforts is substantial, indicating a change from the go-it alone strategy now used by the USA. "It is quite a profound departure from what we have seen up to this point", said Levine. "I think it will really bring US development policy into alignment with where Canada and the Europeans have been."

Another key piece of Obama's development platform is his Health Infrastructure 2020 plan. "Barack Obama will take the lead at the G8 working with and leveraging the engagement of the private sector and private philanthropy, to launch…a global effort to work with developing countries to invest in the full range of infrastructure needed to improve and protect both American and global health", campaign documents say. Among issues addressed by the plan is the migration of health-care workers from developing to rich countries. Obama also advances sweeping reforms for US foreign assistance—a move favoured by the development community and some members of Congress. He advocates doubling yearly foreign assistance to $50 billion by 2012 and endorses a $2 billion fund to support primary education globally. He also calls for 100% debt cancellation for the world's heavily indebted poor countries and programmes to advance commerce and democracy in struggling countries.

Add it all up and the dream plan of Obama's development experts costs a substantial amount of money, so much so that some question its feasibility. "It is not entirely clear to me that everyone has done their homework on how this could possibly be paid for in what is sure to be a real food fight around priorities in a tight economy", said CGD's Levine. In addition to fiscal constraints, because he is so engaged with the global development community in the USA, Obama is also likely to be buffeted by the tensions that exist within it, Morrison added. One major point of contention is the degree to which PEPFAR will become the whole of the USA's global-health policy for the foreseeable future. "What he [Obama] has is a very active and divided debate" with one side arguing that PEPFAR has had "hugely distorting impact on development commitment", he said. Those advocates will be "arguing for a rebalancing" against the constituency that believes PEPFAR can be tweaked sufficiently to serve a broader purpose. "I would anticipate that early in an Obama administration you are going to have some serious battles around these issues", Morrison commented.

Nils Daulaire, president of the Global Health Council, although a strong PEPFAR supporter, is among those who think that the USA should widen its focus. "The reality is that HIV/AIDS is a large, but by no means the predominate piece of the global-health puzzle", he said. The Global Health Council and others, he said, are "really focused on getting the next Presidential Administration and the next Congress to look at the larger issues of global-health infrastructure and basic health services and, in particular, bring back attention to the pretty severely neglected areas of maternal and child health and family planning."

Although global-health experts call for increased access to primary health care, specific diseases still tend to attract the most attention from candidates. On Malaria Awareness Day, McCain pledged as President to "end malaria in Africa". He said that the USA will spend $1 billion a year on the disease in the next few years and added, "I call upon the private sector to meet its obligation to serve a cause greater than its self-interest by matching the federal commitment dollar for dollar". Laurie Rubiner, executive director of the Malaria No More Policy Center, said eliminating deaths from malaria in Africa, would cost an estimated $2·2 billion a year over 5 years. The disease currently kills more children in Africa than AIDS and tuberculosis combined, she added. McCain's malaria pledge illustrates his commitment to "soft power" in US foreign policy, Rubiner commented. Another example of that approach is McCain's proposed "League of Democracies", which he refers to as "the core of an international order of peace based on freedom". In explaining the proposal, McCain said, "Our great power does not mean we can do whatever we want whenever we want, nor should we assume we have all the wisdom, knowledge, and resources necessary to succeed". He added: "We need to listen to the views and respect the collective will of our democratic allies."

Experts agree that both candidates support a more collaborative relationship with other countries, which could be a boon for global health generally. "Both Obama and McCain from quite different perspectives have an appreciation for the US in the broader context of the world", said Daulaire. "I think this is the most internationally savvy pair of candidates that we have ever had running for president."

The end of a nightmare

Now that I am back in a place where I can access the internet I quickly checked the news this morning, something I have not been able to do much for the past couple of days as all the TV stations here are in Russian only. What I just saw there has completely made my day and nearly brought tears to my eyes: Ingrid Betancourt - the Colombian politician about whom I have written here repeatedly- has been freed! This is absolutely wonderful news. News that I doubted would ever come. Now that it has, I am delighted to be able to wish her and her family much happiness for the future.

Criminal minds

My office operates an open floor plan. On the busiest of days we have about 12 people sharing that space, yet for all those big brains churning it is usually quiet like a crypt, safe for the sound of fingers rattling on keyboards. I don’t particularly like working in dead silence so I do what a lot of us do: I plug in to the radio. To keep my mind properly confused that is usually Dutch radio; staying in touch with what is going on back in the motherland I guess. Most of what I hear only fleetingly passes through my brain and doesn’t stick but today I heard a Postbus 51 commercial that had me lift those fingers of the keyboard and take notice:

"In the Netherlands we are working together to prevent people from developing terrorist thoughts. See what you can do at Nederlandtegenterrorisme.nl."

Please do me a favour and read that again. Notice anything odd? That is right: it doesn’t warn for terrorist actions; it doesn’t even urge you to be watchful for terrorist activity; it says you should be aware of terrorist thoughts. Welcome to the world of the Orwellian Thought Police. I can just imagine the red phones ringing hot with dutiful citizens reporting their neighbours for saying scary things like Allah Akbar or for buying fertiliser, bleach and a kitchen knife. In addition to a debate over freedom of speech, it now seems we also need a debate about freedom of thought.

I wonder what the logical extension of this is. Under what law would we prosecute people for harbouring terrorist thoughts? Perhaps even more importantly: what exactly IS a terrorist thought? Am I having a terrorist thought wondering what it would take to blow up the White House? Or perhaps if I publicly expressed my sympathy for certain undesirable causes? I am considering putting in an order for the Anarchist's Cookbook just to see what happens.

Would it be a coincidence that this message hits the airwaves just as paranoia is reaching uncharted heights? A penny for your thoughts.

Nothing to fear but fear itself

... the only thing we have to fear is fear itself -- nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

Franklin D. Roosevelt, Inaugural address, 1933

As with many famous quotes this one too has taken on a life of its own to brake free from its context. President Roosevelt uttered these words to persuade the American people that the power to overcome the Great Depression was within them, if only they stopped being paralysed by fear of the Depression. It is essentially the circular reasoning of a self-fulfilling prophecy. If you stop being afraid, that what you are afraid of will go away. Economic theory holds that there is something to be said for Roosevelt's call to confidence. Recession and economic downturn are very much dependent on the mood of the day and much less so on cold, hard facts and figures. The question is if it holds true in other sectors as well.

Michael Moore built an interesting, albeit somewhat oversimplified, case in his award-winning documentary Bowling for Columbine that fear is what is driving American society over the edge: people have guns because they are afraid of people who have guns who are afraid of ... and so on and so on. A self-reinforcing spiral of fear. Fear is also what is gripping the Netherlands these days. Everybody is holding their breath to see what will happen when Geert Wilders' movie Fitna will be released. Nobody really knows yet what this movie is about but it is expected to be a heavy-handed accusation against the Quran and Islam. It is feared that this will incite reactions in the Islamic world similar to that provoked by the Danish cartoons in 2005. There is fear that Dutch embassies in Islamic countries will find themselves under attack, that Dutch business abroad will suffer and that the country itself has a bullseye for terrorist attack painted on its back.

I am not naive. I know there are people out there crazed and outraged enough to cross the line between lawful, proportionate opposition and unlawful, disproportionate action. I lived a mere 5 minute walk away from where Theo van Gogh got his throat slit and had a note pinned to his chest warning Ayaan Hirsi Ali that she would be next. One of my former colleagues was startled to learn she had been teaching chemistry to terror suspect Samir A. shortly before his (second) arrest. All this is very real. Still, I cannot help but wonder if we are building our own self-fulfilling prophecy with this mass hysteria. The message it seems to be sending is that this movie is apparently such a big deal that it calls for a likewise response.

I am a firm believer in freedom of speech so if Wilders wants to make his movie, that is fine by me. I am, on the other hand, also a firm believer in the freedom to ignore that speech. Can't we all just shrug our shoulders over this and agree everybody is entitled to their opinion even if we don't agree? If only we could all stop being so afraid of each other...

Another year goes by

A year ago today I used this blog to draw attention to the kidnapping of Ingrid Betancourt, a Colombian presidential candidate fighting for a better future for her country. One year on she is still being held somewhere in the Colombian jungle. Her campaign manager and friend Clara Rojas was recently released after a much publicised intervention by the Venezuelan president Hugo Chavez. This has sparked renewed hope that Ingrid Betacourt too might be released soon. The truth, however, is that the two women were separated by the FARC a long time ago and nothing is known about the current whereabouts of Betancourt. Footage released some time last year shows her looking gaunt and severely worn down by the now 6 years of captivity she has had to endure but at least it showed she is still alive.

It s difficult to imagine what her family and that of all the other hostages are going through. We can only hope that by the time another year has gone by, Ingrid Betancourt and all the others will have been reunited with their families.

Bush people

I sure did pick an interesting time to be in Ghana! My visit here touches the CAN2008 on one end and George Bush' African Five-Nation Tour on the other. He is scheduled to arrive in Ghana tomorrow for an official state visit. As I think goes without further explanation, I will not be part of the cheering crowds that seem to be following him on this tour so far. Not only has he been messing up the world in a major way, he is now also messing up my schedule!

The emphasis of the Five-Nation Tour is on health care issues in Africa so given the obvious overlap between my job here and his, Mr Bush has been stealing away people from my interview list. I found myself rebuffed this morning by the Director General of one of Ghana's principal Health Services because he was scheduled at a meeting in preparation of the Tour. I still have a long way to go before I take priority over the U.S. President I guess.

One of the main issues under discussion is further support for programmes to fight three of the most destructive diseases in the world, particularly in Africa: tuberculosis, malaria and HIV/AIDS. Bush' own pet project is the PEPFAR, a snappy acronym for the "President's Emergency Plan for AIDS Relief". In itself it is difficult to be against any plan that aims to combat HIV/AIDS. The problem lies, however, in the strategy with which it tries to do so. The Bush Plan is based on the so-called ABC strategy: Abstinence, Be faithful, Condoms. It is a message that rings incredibly naive to me. HIV/AIDS is not a disease of bad morals; it is a serious public health issue that needs a much wider array of weapons to fight it. The reason I am in Ghana is that we are trying to support a programme that will hopefully increase access to essential medicines for those too poor to afford them. Let's hope that message does not get snowed under in the chorus of those that preach abstinence is the way.

Russian Roulette

I know you are all waiting to hear more about my Russia trip. The problem is that so am I. It turns out the whole project is experiencing some serious hiccups and I still haven't had a definitive answer on when I can go. I first need to get a letter of invitation that I will need to apply for a visa. It's all extremely frustrating because even though I know I will be on this project for some time and eventually it will happen, I still have the small matter of a thesis deadline to deal with. The deadline is completely non-negotiable so as I see the weeks pass by without any news from Russia, I am getting more and more squirmish.

Yesterday the British government announced it is expelling four Russian diplomats from the country to put pressure on the Russians to cooperate in the Litvinenko murder case. The Russians have already announced they don't intend to take this lying down and warn this will have "serious consequences". Taken to the extreme, this could even affect the issuing of visas. I really hope this will not interfer with my trip. At least I will be travelling on a Dutch, rather than a British, passport but I still need to get my visa through the Russian embassy here in London.

As a European citizen you tend to take your passport for granted. Dealing with visas is new to me. The only other country I have ever needed to apply for a visa beforehand for was Australia and that you could just do over the internet. I know plenty of people in my circle of friends who aren't so lucky and have found themselves trapped in the slow churning wheels of bureaucracy simply because they are not EU citizens. That burgundy passport really does help to make life easier. I just hope that it will help me out this time as well. Fingers crossed.

Going political, just this one time...

Every once in a while you may read a book that grabs you by the throat; a story that stays with you long after you have put the book down. About three years ago I read such a book. In English it was published under the title “Until death do us part” (published in Dutch as “Woede in mijn hart”) and it is an autobiography written by the Colombian former presidential candidate Ingrid Betancourt. I don’t remember any more why I bought this particular book. I probably just picked it up as part of my regular dose of Waterstone’s, but it has been one of the most powerful stories I have ever read. I must profess my political ignorance as until I read this book I had never heard of Ingrid Betancourt. This is perhaps all the more shameful because at that time she had already been in the hands of the Colombian guerrilla movement FARC for almost two years.

Today, 23 February 2007, it is exactly 5 years ago that Ingrid Betancourt and her campaign manager Clara Rojas were kidnapped. The last proof of life their families received dates back to 2003 when the FARC released a video tape with a powerful speech made by Ingrid Betancourt. Since then there has been nothing to tell whether they are dead or alive.

Those of you who know me know that I don’t really ‘do’ heroes and I certainly am not inclined to any hero worshipping. This woman’s story, however, has deeply moved and inspired me. At serious risk to her own life she tried to take on a deeply corrupt political system to fight for democracy, stability and peace. The Colombian government that came into power shortly after her disappearance has thus far refused talks with the FARC stating they will not negotiate with terrorists. The FARC in turn continues to drag civilians into this armed conflict. At present it is uncertain if and when this conflict will ever be resolved or what the outcome will be for the hundreds of hostages.

I believe the story of Ingrid Betancourt is one worth being told and I strongly urge you to read this book. It provides a detailed insight into the political situation in Colombia in particular and the American politics in the region in general. If you are interested and want to know more, a good place to start is at http://www.betancourt.info/indexEng.htm