Healthcare and ideology really don't belong together

The USA never ceases to amaze me. At this moment, a political battle is playing out in the Supreme Court that essentially pits the political right against Obama's health care plan. The biggest irony is that the 'socialized medicine' against which the right is fighting so hard is based on a conservative plan, proposed in the 1990s by a conservative think tank, and subsequently adopted by at least one conservative governor (Mitt Romney) in his state.

Perhaps history will prove me wrong, but I think this will turn out to be one of the biggest miscalculations of the political right. Inasmuch as "Obamacare" is not perfect, it is a vast improvement over what existed before. It gives more Americans access to affordable health care. Those who have not had the experience of being locked out of every possible insurance plan because they suffer from chronic disease or terminal disease may not realize just how revolutionary this is. The pre-"Obamacare" trend is not sustainable, especially since America has some of the worst health indicators in the industrial world, and these are getting progressively worse. As Americans become sicker, affordable health care is going to become increasingly necessary.

If 'true American values' continue to move towards the right, as they have been doing for the past 50 or so years, then Americans will wake up in a dystopian society some decades from today. Basic health care (including vaccination, prenatal and antenatal care) will be out of reach for the average person. Perhaps only 10% of the population will have access to fresh fruit, vegetables, meat and dairy products. The rest will have to make do on heavily-sugared and salted food products. It sounds very much like the USA is trending towards "third world" status. Those of us from the "third world" who have seen what zero access to affordable health care for the majority of the population means in practical terms know that there's nothing ideal about it. The strangest thing of all is that the American public will have voluntarily taken itself in that direction  because of its ideological investments.

I think the political right would have done better to embrace "Obamacare" as their original idea. After all, it did grow out of a conservative vision for expanded health care coverage. By contrast, a vision originated by the political left would have pushed private insurance companies out of the market and replaced them with a single insurer: the government. Seen from this perspective, many on the left could (and do) argue that "Obamacare" is too huge a compromise by the Obama administration to the right.

If the right had taken credit for "Obamacare" they would have had a more coherent platform to run on. They would have been able to paint "Romneycare," not as a blemish on Romney's record, but as a superior plan to "Obamacare." I have to wonder what lies ahead for American politics and American health care.

The best-thought out piece I have read on the American health care system lately comes from Fareed Zakaria: "Health insurance is for everyone". Its valuable for its comparative assessment of health care and insurance in different national contexts. David Paul's piece on the Supreme Court and the insurance mandate is also a good read.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

Changing our attitudes towards homosexuality

 http://fromthoughtsintowords.blogspot.com/2012/03/changing-our-attitudes-towards.html

When they think about what it means to be gay, many East Africans focus on its physical implications: they think about gay people as those who have physical relationships with members of the same sex. Because sex is a physical act that one chooses to engage in, they figure that one can choose whether or not to be gay. This perspective fails to take into consideration the fact that, for many gay people, being gay precedes the act of sex. To them, being gay means feeling attracted to people of the same sex. Even if they never act on these feelings and choose to live a life of celibacy or one of heterosexuality instead, they know deep down inside that they feel attracted to members of the same sex and that they have felt that way for as long as they have been sexually aware.

I have read narratives by gay people who speak about becoming teenagers and realizing that, unlike their age mates, they felt absolutely no attraction to members of the opposite sex. They grew older and the status quo held: the heterosexual attraction that other people took for granted was never a part of their experience. Instead, they remember their first experience of feeling romantic love for another as involving somebody of the same sex.

I notice that most discussions of homosexuality in the East African media have not evolved beyond the expression of horror or disgust at the possibility that two men or two women can be physically intimate. Very few East African writers set aside the focus on the sexual angle to ask what it is that makes it possible for a man to feel attracted to a man or for a woman to feel attracted to a woman. Very few even ponder over what it is that makes them heterosexual. They just assume that they are heterosexual because that is the natural state of things. They don’t think about the biological and environmental factors that influence their sexuality. Nor do they realize that if a few factors in their lives had been different, they could possibly have been gay.

The truth of the matter is that there is no single definitive factor that makes a person gay or straight. Rather, a variety of factors interact to influence a person’s sexuality. They include genetic heritage, the hormones to which a fetus is exposed while in the womb, the structure of the brain, family influences, birth order and other factors.

Over the years, I have read of studies where it was shown that there were demonstrably distinct differences between people who self-identify as homosexual, and those who self-identify as heterosexual. These include physiological differences, e.g. differences in the sizes of specific parts of the brain, different brain responses to certain chemicals, and different ways of processing certain forms of information. One study I read about in a science magazine a few years ago (unfortunately, I can’t remember which one now) looked into the family structures of gay and straight men. It found that the gay men’s maternal female relatives tended to have more offspring than their paternal female relatives. The conclusion was that the X-chromosome, which was passed to these men by their mothers, was involved in some way. The scientists speculated that this chromosome was carrying genes that increased female fertility and the likelihood that male offspring would be homosexual.

I remember reading another article which indicated that more gay men tended to experience rejection from their fathers than straight men. Gay men also tended to have closer relationships with their mothers than straight men. The conclusions were not clear cut in this one. It could be argued that the fathers rejected their offspring because they sensed that they were somehow different from the norm and that the mothers tried to compensate. It could also be argued that the rejection by the fathers played a role in influencing their sons’ psychosexual development.

I can think of many more studies that focus on different biological and environmental factors, and show them to have some kind of influence on an individual’s sexuality. The conclusion I am bound to draw from all of this is that sexuality is complex, and that there are no easy explanations for the way it manifests in individuals. Thus, being gay or straight is not about simply deciding to feel a certain way.

Given that homosexuality is complex, and is determined by a variety of factors, our attitudes towards it need to change. We are living in the age of information. With access to the internet, many people really have no excuse for holding on to superstitious beliefs about sexuality.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

How cultural norms contribute to malnutrition

This week, I have been reading Richard K'Okul's book, Maternal and Child Health in Kenya. The book explores the different factors that contribute to malnutrition in the community. These range from bad policies to poverty, ignorance and cultural factors that influence maternal nutrition.

One of the factors that I found unnecessary and sad was the cultural norm in Western Kenya, whereby a young married woman is not allowed to cook for her family. Instead, she has to comply with her mother-in-law's wishes. If her mother-in-law doesn't feel like cooking, then even small babies are condemned to remain hungry until she is ready to cook.

To make matters worse, the food cooked may not necessarily be suitable for small children. In parts of Nyanza Province where polygyny is common, it is the senior wives who control the cooking. It is common to see very young women who are married to elderly men carrying small children with kwashiokor. When asked why they can't feed their child better, they give answers like, ' I have not been given food'.

The point of this little story is to point out that  the time has come for Africans to reexamine and restructure their cultures in order to survive. It doesn't matter how many highly educated specialists Africa produces, if we don't take care of the basic anomalies in our family dynamics: Malnutrition, disease and death will remain common among African children. Young African men must therefore play their part in condemning these practices, and African mothers must advocate more for the welfare of their children. Then Africa will take one step closer to joining the global community.

Africa: an impending ecological catastrophe

Much has been written about global warming and the fact that Africa is least responsible for the emission of the associated pollution. Yet Africa remains most vulnerable to the impact of global warming. Rather than remaining silent observers of this issue, Africans can take certain steps to intercede.

 

One of the factors that touches Africa directly, helping to increase its rate of deforestation, is the spread of organisms such as hybrid maize. Hybrid organisms, apart from being less nutritious than native species, tend to dominate the environment by thawarting the growth and propagation of indigenous species. Africans need to rediscover the farming techniques and foods of their forefathers, which were more environment-friendly than those in wide use today. The crops they grew were also more nutritious than the ones we depend on today. Reducing malnutrition in Africa's child population requires that we radically rethink our agricultural practices. In the long term, doing so would force us to improve the quality of leadership on the continent. Currently, we tend to promote exploitative models of leadership, which idealize short-term gain and turn a blind eye to environmental degradation.)

 

One article illustrates my point: In the Democratic Republic of Congo, some chiefs were bribed with bags of sugar in exchange for allowing European transnationals to exploit virgin forests in the region. Whereas the value of the sugar, salt etc was estimated to be US $100, each tree was priced at $4000. This is just one example of the waste that goes on on the continent. Increasingly, Africa's indigenous resources are being exploited for the benefit other people, but Africans get the blame for their depletion. Ignorance, the stigmata of extreme poverty (e.g. childhood malnutrition which interferes with optimum intellectual development) and the despair associated with disease likely all contribute to impairing the judgment of those concerned.

 

This phenomenon is not new. It was apparent when the trans-Atlantic slave trade was at its height. It was also apparent during the era of forced colonial labour. Today, malnourished communities watch as their resources are taken over by those claiming to bring the benefits of globalization to the African village. Africans have a long way to go before they can stem the out-of-control exploitation of the continent's resources. They must wake up and take charge as the custodians of their resources.

References

1. “Alert over food security.” Peter Cummings Thatiah. Sunday, November 6th, 2005. East African Standard.
2. “Vast forests with trees each worth £4,000 sold for a few bags of sugar.” John Vidal. Wednesday, April 11th, 2007. The Guardian.

Let's get real about Africa's burden of malnutrition

In the past, I have received criticism for my work linking malnutrition to underdevelopment and social dysfunctionality. My critics have suggested that, by identifying problems in African society and highlighting the "stigmata of malnutrition," I am giving racists ammunition for their claims that Africans are genetically inferior to other races.

I beg to disagree with my critics. First, race is not a biological category. It is a socially constructed category. I have no essentialist arguments to make about Africans. What I do talk about is nutrition, which can be changed willfully by people who have choices. The point of my intervention is to raise awareness of the kind that will increase the number of nutritional choices available to most people.

No reasonable man or woman would dare to claim that the nutritional needs of most of Africa's children were being met. Conditions such as kwashiorkor, pellagra, rickets and others are commonplace in our communities. Any African who has lived in a community where having one meal a day is a luxury knows that children do not thrive under those circumstances. They do not thrive physically: Their bodies are stunted, and they succumb easily to diseases and parasites. The children do not thrive emotionally either: Hunger does not breed joy, nor is competition for limited resources in the home conducive to cooperation between family members. Families quickly become dysfunctional. They do not thrive intellectually: How can they, when their bodies are ailing and their brains do not receive the nutrients necessary for the growth, development, and optimal function of the brain? Furthermore, they may also be vulnerable to mental disease as teenagers and adults. Remember that mental disease is like any other form of disease: It thrives where there is chronic malnutrition, stress and trauma.

These are the challenges that the majority of Africans (who are poor) must wrestle with as they raise their children. Their children, in turn, grow into adults who are physically and psychologically marked by the deprivations they suffered. They may be small in stature, prone to falling ill, may have failed to reach their full intellectual capacity, and may experience undiagnosed depression and other forms of mental disease. All these factors can be attributed, not to their race, but to chronic lifelong malnutrition and the other difficulties they have endured. Anybody who takes the time to study the experiences of populations the world over that have historically been subjected to similar deprivations will notice similar problems.

Boer residents of British concentration camps in Southern Africa in the early 20th century endured such deprivations. Furthermore, prisoners in the Russian Gulag experienced similar forms of deprivation, as did Jewish people and other European minorities in Nazi-occupied Europe. The Kikuyu families who were put into concentration camps by the British during the so-called Mau Mau Emergency experienced similar deprivation. Those occupants of the Sahel and the Sahara who have lost their livelihoods to drought, and have had to seek refuge at relief centers decade after decade have experienced the same. A quick internet search will reveal that Asia and the Americas have similar stories to tell.

Whether chronic malnutrition results from poverty, natural catastrophes, wars or political repression and marginalization, it deprives entire communities of their potential. Thus, observations about diminished intellectual capacity and physical stamina, and vulnerability to physical and mental illness in such communities are a testament to the long reach of malnutrition. They are not essentialist claims about "the nature of a race."

If the nutritional needs of most of Africa's children were somehow to be met, then there would be no reason for us to be having this conversation. Africa would be a self-sufficient continent, confident in her dealings with itself and the rest of humanity. But we all know that that is not Africa's present reality. A country like Kenya can afford to pay its parliamentarians world class salaries, but the average person in the village or in the urban slums often struggles to get one square meal on to the table daily. The cycles of famine and drought, which have come to define Eastern Africa, are destined to continue, punctuated by emergency cabinet meetings to deliberate the hunger crises.

Educated Africans must take a step beyond their comfort zone. Instead of spending most of their energy trying to deny the deep-seated problems that plague our societies, they should look at the bigger picture. The underdevelopment burden due to malnutrition across sub-Saharan Africa is real. By not accepting that there is a problem, Africa's educated elites become part of the problem; they stand in the path of advocacy for better nutritional health. Once we accept that there is a problem, policy makers can be pressured to diversify agricultural production on the continent. Africa's educated elites need to shed the disdain they hold for the majority of their own people and, instead, start using their skills to offer transformative advocacy and support.

An open letter to the African woman

Dear sisters,

I'm writing this letter because I have lost several nieces to childbirth in the recent past. This problem has been on the rise in my community, despite the fact that modern knowledge and medicine should have minimized it. The same is true for child malnutrition, which is rising, even as our adoption of modern nutritional and medical practices intensifies.

On September 20^th, 2010, Ida Odinga, the wife of Kenya's Prime Minster devoted attention to the issue at the United Nations. Cited here is a Daily Nation article on the meeting: Malnutrition destroys young bodies and minds, harms education and work performance and ultimately damages communities. Nowhere is this more apparent than in Africa. We know the solutions to prevent this cycle, and it is urgent that we, as women and as leaders, set our goals in action.

 The article goes on to state that, “About 60 per cent of the world’s chronically hungry people are women. While undernutrition is a critical human development issue across the globe, it is especially prevalent in Africa, where one in four people suffer from malnutrition and 40 per cent are stunted.”

That these observations are being discussed at such forums is encouraging. However, we must try to understand this issue as a communal problem. Our friends from other continents and regions can only help us effectively if we make the effort to understand the problem ourselves and to develop homegrown solutions for it.  

My dear sisters, I am addressing you because women are often viewed as the custodians of a people’s culture. Empowered women help to build a thriving culture. In turn, a thriving culture helps to create empowered women.

Those of you lucky enough to be reading this have a moral obligation to empower yourselves, as do I. Then the choices we make, which will serve as examples to the majority, will be rooted in knowledge. The first step in empowering ourselves is to read about the subject of malnutrition. We should not assume, as we often do, that we know everything. I am a doctor, but it took me many years to learn what I know about malnutrition.

Heed these words as the fate of future generations may depend on what you know.

Yours respectfully,

Nelly M’mboga.

Contemporary Africa's implication in its own underdevelopment

In early April of 2010, I was hosted at a Public Library for the presentation of my book, A Healthy You: Tame Africa's Child Malnutrition. I was quite surprised at the interest the contents generated: I had assumed the book would primarily interest Africans, but the audience was predominantly American. To cut a long story short,the presentation went well, and gave me fresh food for thought.

One issue that came to the fore during the question and answer session was the poor utilization of quality protein maize (QPM) in the place of ordinary maize to tame childhood malnutrition on the continent. Other developing continents seemed to have made greater use of this resource than Africa. One participant in the audience hinted that the African establishment seemed to enjoy "victimhood." The person speculated that they preferred to exploit the sympathy that poverty, disease, the orphan burden, and violence attracted than to do the hard work that was necessary to undo institutional dependency on foreign aid.

Globally, research on QPM has been ongoing for many years. On the African continent, it is only in Ghana that  community studies have been documented. These studies have shown that Ghanaian children with Kwashiorkor fed on QPM recover. I have thoughtfully compared these with my own casual observations that Western Kenyan children, fed predominantly on a white hybrid maize staple diet continue to suffer from Kwashiorkor. The high infant mortality rate in Wetern Kenya is a crying shame, yet any possible solutions must come down to political will. When political will catches up with the reality on the ground the problem will receive the attention it deserves. The officials concerned with addressing malnutrition nationally then will be well advised to break down the national statistics for disease burden, poverty rates, and child mortality into regional figures. It will be important to identify the communities most afflicted and to apply the most intense programs within them.

Several reasons have been cited for the minimal undertaking of QPM research efforts on the African continent. One of these reasons is that many nations do not have the technical capacity to support such research. However, if Ghana can do it, why can't other African countries do it? Keep in mind that much of the hard scientific work that would facilitate such research has already been done. It seems more likely that the absence of such research efforts is attributable to the absence of coherent national development goals in many African nations. Such goals are rendered impossible because of the degree to which resources are commandeered for ethnic interests rather than national interests.

Leaders focus more on meeting the superficial needs of "their people" so that the tribal voting blocs on which they are dependent can get them back into office during the next political cycle. There really isn't much time or energy left to look into the more profound needs of their communities in the long-term, or to even think about other communities nationally. What this means is that ordinary Africans who want to see Africa change for the better have to learn to do the dirty work themselves, often without government support.

The African culture of poor leadership is bred in our homes. We must start taking responsibility for this culture: If there is something you can do to change Africa for the better, do it now, starting in your home. Don't just complain about "Africa's poor leadership." Leadership should start with you, dear reader. If you can't make the necessary sacrifice, why should you expect that somebody else will? Leadership arises from the people.