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September 4, 2002.Asmarino.Com
Transforming Eritrea from an Authoritarian One-Man Rule to A Stable and Secure Democratic State:
A Strategy of Negotiated Peaceful Revolution
September 18, 2002 will soon be upon us, marking exactly a year since the president of Eritrea openly imposed himself on The State of Eritrea and its people as the undisputed, one-man ruler by imprisoning his former comrades in arms, "The Eritrean 11"-and by completely shutting down the independent free press. This tragic date stands as an historic reminder of a promise betrayed. It underscored a clear lesson for the Eritrean people to never again put their trust in mortal men but in the rule of law.
In essence, September 18, 2001 was no different from all other days when ordinary citizens had been pulled out of their homes and work places by the security forces never to be seen or heard from again. Its relatively heightened significance lies in how the two aforementioned events exposed the magnitude of our national challenge. It was a very pronounced affirmation of the fact no one-not even those who struggled for two-thirds of their lifetime to plant the Eritrean flag-was safe from the reaches of a determined tyrant.
The unfortunate day was also a wake-up call to all Eritreans at home and in the Diaspora to seriously examine the nature and origin of this national betrayal, and to do everything possible to reverse the dangerous situation and lay the foundation to fundamentally and structurally prevent this from ever happening again. It has forced most Eritreans to see things as they really are and in this sense, it has been a constructive challenge. It has penetrated deep into the hearts and minds of all Eritreans demanding a truthful account of our national reality.
A year later, most Eritreans have come to realize that the present national political arrangement is not only unacceptable, but also extremely dangerous for the very survival of the State of Eritrea. Out of this realization and awareness has emerged a sense of collective responsibility transcending all man-made and primordial cleavages in our national politics. Everything humanly possible has to be done to save the nation from implosion.
In spite of diametrically opposed ideological and political perspectives and programs, all Eritrean political forces have an overriding responsibility to assure the people that they are keenly aware of the gravity of our crisis. They promise to work extra hard and go the extra mile to find a creative and constructive solution that will accommodate the diverse political demands without endangering or sacrificing the sovereignty and territorial integrity of the nation.
So, how do we transform such a potentially destructive national crisis into a clearly defined Unifying National Vision (UNV) before it is too late and events override our better judgments? We must address three key questions before we can formulate a clearly defined UNV and the practical action agenda needed to translate it into concrete reality:
How far has the struggle for rule of law and democracy advanced since September 18, 2001-and furthermore, what are the most distinguishing characteristics of this new period?
What overarching grand strategy will best facilitate the transformation of Eritrea into a unified and democratic nation without weakening the State of Eritrea?
What safeguards do we need to incorporate into our national struggle to ensure that external adversaries will not meddle in or take advantage of our internal difficulties to weaken or destroy the newly emerging state?
From Uncritical Support to Independent Civic Society
It has been an extraordinary year by any reasonable standard. Our disappointment has been equaled in depth and intensity to the unrealistic faith we had in a government of men-let alone Eritreans who had a legitimate reason to feel proud and expect much from their government. For the pages of international newspapers were full of extraordinary positive coverage about the immense potential that the newest African State was bringing to the table in the beginning of a new century. So much promise and so much potential was brought to a screeching halt by an authoritarian decision to usurp all political power.
Eritrea was sabotaged from the inside out. Its agenda of liberty, freedom and economic security was deferred. No one in their right mind would have expected events to take the direction and turn they did and the top leadership of the nation to act so irrationally and irresponsibly. The scar from this breach and betrayal will be deeply rooted in our national psyche and will take generations to heal. It will effect the way we perceive, evaluate and construct our political order.
The Eritrean people-who for centuries have had a keen sense of law and justice-were lulled into temporarily putting their faith in politicians rather than in a constitution and the rule of law. This was an honest oversight at best and a-once-in-a-lifetime fit of madness at worse. They put their children's lives and the nation's resources at the disposal of a government that they expected would live up to its promise. There is no shame in the people's being generous and trusting; the shame is in those who abused their genuine trust and generosity-and in those who hi-jacked the nation's agenda, turning it in to a monumental failure to satisfy their lust for power and temporary glory.
A profound and critical lesson has been forced upon us: we must unconditionally accept the fact that a government of men is a dangerous proposition and that unsupervised and unconstrained government is our mortal enemy. The only government worth calling a "good government" is a government of law and not of men. We are humbled by our oversight and the stark reality brought home by our bitter experience. Our blind faith is a thing of the past. We are now born again and ready to assume the joyful burden of self-governance. Those who underestimated the Eritrea's collective character and tenacity and chose to impose their myopic agenda will have to be brought back to their earthly senses and "convinced" to bow to the will of the people.
Democracy begins with self-empowerment and management. It starts by recognizing and affirming sovreignty over one's self. We have in a short period of time moved from being uncritical cheerleaders of an evolving tyrant to sovereign citizens and organizers of a vibrant civil society. This is by far the most important development of the post-September 18, 2001 political reality.
The primary insurance for democracy is the full empowerment of individual citizens. When individual citizens affirm their legal existence on the basis of a well-engineered constitution and a conscientiously crafted rule of law, a nation can weather any crisis and still come out more strengthened through the experience. The only thing that can further fortify and enrich this kind of empowerment is when citizens move one more step forward and formulate civic societies to define, protect and advance their specific interests. Authoritarians despise free and independent civil societies. To a certain extent, some opposition politicians and groups may share the same fear about the nature and potential of civil societies. Anyone who is used to manipulating the people and who has an elitist agenda will quite naturally be intimidated by the emergence of truly independent popular organizations. The reaction of the Eritrean government's representatives towards the newly established political forums is indicative of this endemic fear.
The civic organizations are here to stay. They will have a profound and decisive impact on the national political and social process. They are learning the rules of the game as they go. The ever-increasing machination by the government and its "Amen corner" has not made their progress smooth-but, this will not derail their struggle for the right of free association in particular and democracy in general. The civil societies are moving in the right direction. Their contribution towards the transformation of Eritrea into a democratic nation will be critical and indispensable. All political forces in and out of power have to reconcile themselves with this new reality. Any effort by the government or the opposition to vertically control the civil societies should be vigorously challenged and condemned without the slightest hesitation. To a greater extent, civil societies under an authoritarian system are more critical to creating the conditions for democratic transformation than an established and dogmatically fixated political parties. Without the burden of the agenda of seizing political power, civil societies have more flexibility and adaptability. They are not constrained by ideology or party bureaucracy.
The birth of the independent civil societies is the regeneration of Eritrea. Expanding and consolidating them will be the responsibility of all who wish to see Eritrea transformed into a democratic nation.
An Extremely Dangerous National Crisis, Not A Revolutionary Situation
The other critical post-September 18 Eritrean reality is: What started as an intra-party crisis has evolved to an all engulfing and consuming national crisis. There is not a single segment of the society that has not been directly affected by this ever-expanding political debacle. The present regime seems determined to continue its destructive behavior by positioning its struggle for day-to-day survival as its primary purpose; consequently, the nation's political health is going from bad to worse.
No other African government has worked as hard to destroy the unconditional support and love of its people as the present Eritrean regime has. Thanks to the arrogant and condescending nature of its top leaders, the country has gone from being the most promising to being the most disappointing in a matter of a decade.
The dwindling supporters of the regime cannot even present a coherent interpretation and intellectual defense of the government's decisions and actions. They are exhausted in "defending" the conflicting and incoherent "articulation" of the regime; most of them are withdrawing into silence and indifference. They are learning that there is a limit to just how far one can go to rationalize the actions and policies of a government bent on self-destruction. In a very short time, most of them will move to the territory of the uncommitted democratic reserve force. If the opposition evolves into a visionary agent of non-violent change, this vast reserve force will side with it-ultimately forcing the regime to the table. If not, it will revert back to the authoritarian camp with the first cosmetic reform by the government. Leveraging this growing political force will demand a mastery of political bargaining. Some in this sector will focus on what the opposition is willing to give up in order to come to the table, while others will concentrate on what can be contributed to its agenda to accommodate this new force. It will be an excellent learning process of give-and-take for the national negotiation.
In our effort to challenge the present regime's total control over the life of the nation, we have to be careful on how we read the details of the Eritrean political reality. We should neither underestimate the strength of the authoritarian regime nor overestimate the strength and preparedness of the political opposition to assume leadership.
The correct evaluation and characterization of the gravity of the national crisis will have a direct impact on how we proceed in formulating our day-to-day tactics-and at times, even on how well we design the particular strategy of a specific political organization. At this time, all political groupings have to clearly recognize that as acutely and deeply rooted as our national crisis is, it has not reached the point where the ruling party is about to disintegrate or the regime is on the verge of collapse. In short, there is no revolutionary situation in Eritrea and it will be a while before we can speak of that possibility. There is no dual power center in the Eritrean political landscape. The implication of this reality for old and new organizers is immensely significant. Policies, strategies and tactics have to be adjusted to take this critical summation into account in our effort to correctly and efficiently manage the outcome of the national crisis.
The urgency to "unite" or to coordinate the opposition under a well-defined and realistic platform is not based on expediency or the imminence of the collapse of the regime-not does it depend on the wishes and kindness of individual organizational leaders. It is as basic as the railroad track is to the train. Without the railroad track we will not get to our destination. Without unity we will not have the necessary leverage to force the tyrant to the table.
Equilibrium by Design: The Art of a Managed Political Stalemate
Under an acute national crisis, the role of the opposition is drastically altered. It does not have the luxury of behaving in an anachronistic fashion and getting pleasure out of the failure of the group in power. It must not be so narrowly focused on removing a dictator that it inadvertently contributes to the collapse of a fragile State.
The tactic of opposing "at all costs" and by "any means necessary" has no relevance to the Eritrean reality. Political opposition organizations must avoid the mistake of simplistically assuming that what is "bad" for the ruling party is "good" for "our group" and by extension, for the nation. The only worthwhile and meaningful way to evaluate all transactions is to ask how they will affect and effect the process holistically, and determine what one can do to strengthen the positive and minimize the negative impact. There is wisdom in being content if an event or action ends up strengthening the overall democratic struggle at a marginal cost to one's organization.
Leadership considered in the context of setting an Eritrean agenda starts by correctly grasping the unavoidable strategic implication of such a responsibility. This overriding national responsibility must underline the deliberation of all issues big and small. Political programs and coalitions cannot have lasting significance unless and until they incorporate and reflect this mode of thinking.
We can say that barring "miracles" and an "unexpected change of personality," the new elite who mismanage the nation have no reason to change their direction and style of governance. Their control of the hearts and minds of the people is slowly fading, but their hold on power is becoming more concentrated and potent. The party and the government are convinced that the only way they can govern without a serious challenge is by corrupting a section of the top and middle level leadership of the E.D.F. This new symbiosis has its own implication for the democratic opposition's strategy and tactics.
The composition of the current ruling elite in Eritrea is a strategic alliance between the top party cadres and the military/security hierarchy along with a few intellectuals sprinkled here and there-making it a formidable force to be reckoned with in the near future. The absence of a broadly organized national opposition with a unifying vision adds to their comfort zone. As it stands now, there is nothing on the political horizon to convince or force the Eritrean government to come to the table and negotiate a peaceful transformation of Eritrea into a democratic nation. There is no incentive for the Eritrean government to change its course or adapt a conciliatory view.
For the opposition to assume the government is on the verge of collapse would be an exercise in self-delusion and appeasement. This is a luxury it cannot afford. We have to prepare for a protracted struggle and dig in our heels and build a solid opposition, which has an appreciation for pragmatism and real politics. We have to build powerful and visible economic, social and political leverages to effect a change in the government's behavior.
No matter how brave and determined we are at this point in time, we have not marshaled enough political clout to influence the behavior of the authoritarian regime. As negative as it may sound, this is the stark reality. By the same token, in no way does this imply that the regime is invincible and not headed towards an inevitable showdown with the people. Enough seeds have been planted in the hearts and minds of many within the ruling party and the army to finally tip the scales of balance in favor of creating an Eritrean democracy in the near future.
As the balance of forces stand now, the opposition is strategically strong but tactically weak; and the ruling party is tactically strong, but strategically weak. Viewed from the perspective of national salvation, both extremes are unhealthy and dangerous. How to creatively correct this imbalance without destroying the nation in the process is the crux of the challenge and the primary responsibility of the opposition. Based on this understanding, we have to try introducing into our political discourse the concept of "struggle"-not in the sense of totally overwhelming the adversary, but in terms of weakening it enough so that there is no choice but to accept a negotiated solution to the national impasse. Working to correct the glaring imbalance-and in principle, working to set the political groundwork for a future grand compromise are mutually inclusive. By definition, this strategy puts a sense of national responsibility equal to if not greater than that of the ruling elite in the hands of the opposition's leadership.
The opposition has to coalesce all nationalist and democratic forces and create a political stalemate by design and avoid going for broke and putting the nation through the catharsis of a revolutionary situation. This demands a fundamental transformation-a revolution in our thought process. It presupposes defying our experience and adopting a contrary trait. Accepting the responsibility-even when our best instincts say it is madness to try to influence a significant part of the ruling party members to see eye to eye with us-is going to be as revolutionary as accepting the notion that world is round when everyone else believes it is flat. Ideas accepted and acted upon become strong political and social forces that can move people and nations.
The alternative is war at all cost. The "victor" (if there is such a concept in the context of a civil war) will rule a nation with half of its population in graveyards and the rest carrying visible and invisible scars. We have the moral and political responsibility of formulating a strategy that will not turn Eritrea into a fratricidal battleground.
A Major Change in Strategy: Going for A Negotiated Revolution
It goes without saying that the legitimate demand of the Eritrean people to live in peace is not only directed towards external adversaries who harbor ill will towards the sovereignty and territorial integrity of the new state, but also to all Eritrean political forces in and out of power.
The opposition has a historic responsibility to heed the people's call and make the necessary conceptual and practical adjustments to live up to their wish and desire for a peaceful way to resolve our national crisis. We have to address this paramount issue without any hesitation or delay. Theoretical what ifs and misguided reminders that "this is Africa… peaceful change is not possible" hold no credibility under the present reality. We need to dig deeper and examine the lunacy of the concept of armed struggle and insurgent politics under post-independent Eritrea.
If a segment of the opposition persists with this anachronistic and discredited strategy, a genuine effort has to be made to convince them to abandon this idea and demand accountability for their actions. This responsibility primarily falls upon the shoulders of the card-carrying members of the respective organizations. When and if they fail to persuade the leadership of the organizations this task has to be assumed by the civic organizations.
A strategy which from the outset assumes there will be civil war between Eritreans is not only morally unacceptable but also against the fundamental national interest. We have to make the strategic choice: warfare or non-violence, bullets or words, the battlefield or the table. Groups wielding guns cannot guide the struggle for democracy. The arrogance and shortsightedness of the ruling elite should not be matched by the irresponsibility of an opposition elite. We cannot outlaw death, but we can prevent organized carnage as a political prescription. The responsibility of possibly waging war to unseat the cruel tyrant has not been assigned or mandated to the leadership of the Eritrean opposition. If there are some who have designated themselves as armed guardians of the Eritrean people, not only is it wrong, it is also dangerous to the overall democratic struggle. The dichotomy of armed and unarmed democrats is a political absurdity. If left unchallenged it will turn into an unequal relationship between an armed potential tyrant and a collection of helpless civilian democrats. This has to be tackled head on in the early phases of the opposition's dialogues on the possibility of forming an umbrella organization to unify all political forces struggling for the democratization of Eritrea.
The usefulness of armed struggle ended when Eritrea became an independent state. All internal struggle after independence is political-and by extension, peaceful and protracted. The fact that a power-hungry clique chose to monopolize power has complicated the process, but not changed the fundamental non-violent nature of the political struggle for democratizing Eritrea. The devastating consequences of post-independence civil war are all evident in Angola, Mozambique and The Sudan. All Eritreans who are working to transform the nation into a democratic entity have the added burden of studying the devastating experience of other nation's civil wars to get a general idea of what it entails to go through that particular kind of devastation. This is only to reinforce and highlight the tragic first-hand experience shared by most of the organized opposition's leadership in the Eritrean civil war. The collective lessons learned and the wisdom earned from the first civil war is enough for us to drastically change the strategy of the present struggle for democracy.
The opposition has to make the fundamentally strategic concession of abandoning all insurgent options and concentrate on channeling all of its undivided energy into actualizing a peaceful transformation. With a Peacefully Negotiated Revolution as its over-arching national political strategy, the opposition can proceed on to the "how-to" part of creating the necessary conditions to concretize this strategy.
Massive Organizing: Creating a Vast Social Movement for Political Leverage
The major shift in our overall strategy on how to solve the ever-growing national crisis demands an equivalent shift in our organizing focus and method. A peaceful approach to conflict resolution at the national level demands that the opposition mobilize a broad section of the society and work hard to narrow the constituency base of the ruling party. Such a method creates a political climate that will convince the leadership of the regime and ruling party that it will be in their best interest to join the table and negotiate a new and better political arrangement that will guarantee the nation's stability, and simultaneously usher in a negotiated compromise agenda for the transition to democracy.
The present Eritrean government has proven its mastery of intransigence. It has constantly exhibited an unbelievable level of arrogance and contempt for reasonable requests to solve the national problem peacefully through dialogue and intelligent discourse. The history of G-13 and G-15 proves that the power-hungry elite running the State do see a reason to negotiate their control of power. Their response to all peaceful demands has been to throw citizens in jail. The emerging vocal opposition terrifies the governing elite and its reaction should have been expected. Our disappointment comes from having failed to realize no matter how nationalist the governing party was, it was headed by individuals with no appreciation for democracy and respect for the rule of law. Now that we have been forced to test the bitter truth and have surrendered our illusions, we can deliberately design and create the necessary conditions to push the ruling elite to come to the table. We have to build enough leverage and give birth to a new reality. This can only be done by a massive organizing effort above ground (mostly in the Diaspora) and underground in Eritrea. Every force that can support the struggle for democracy has to be organized, connected and plugged in.
Key to all of this is the expansion and consolidation of the newly emerging civic organizations. Every city and country (outside of Eritrea) where there are Eritreans has to have at least one civic organization (irrespective of the form and the specific structure) dedicated to transforming Eritrea into a democratic nation. The next effort should be to officially link all civil societies in a broad-based federal structure. All ideologies and political beliefs must be reflected within the civil society. It should be the most inclusive organizational form in Eritrean political culture. It must promote the ideals of democracy, constitutional governance and the peaceful transfer of power as matters of principle. It should neither endorse nor attack any organized political group. Its existence is primarily defined in relation to the Eritrean State. It is not in the business of being used by an individual party or group to advance a specific political agenda or program. It will struggle for the rights of the Eritrean people to have their say in their governance.
We should work hard to help organize an independent Eritrean Labor Union free from the control of the governing party's political cadres. We should demand that political control of the labor union, youth organizations, women association, student unions and farmers associations etc. be lifted. If the government fails to listen (no doubt it will) the already organized civil societies should be convinced to push for and aid in constructing parallel independent underground organizations for all sectors of our society.
The former graduates of Asmara University living in the Diaspora should collaborate and lead the struggle to organize the new generation into a formidable independent political block. In short, we have the unenviable responsibility of launching a massive organizing effort to create a new political reality and to leverage this new force into actualizing a political stalemate by design. With a unified leadership, we can then challenge the regime by calling for civil disobedience, a national strike or peaceful demonstrations to drive the point home to the regime that it is time to change the rules of the game.
This transformation will be easily expedited by the fact that over 50% (a conservative estimate) of Eritreans are under the age of 30. This youthful generation has no organic affinity to the ruling regime and party. On the contrary, the majority seem to have developed unrestricted hatred and contempt for the ruling elite. They naturally fall within the camp of democracy. A serious effort must be made to organize this powerful force under the democratic agenda.
The struggle for democracy primarily will be an urban undertaking and this is to the advantage of the political forces that are trying to transform the Eritrea's system. Over one third of Eritreans live in an urban environment. Most have access to radios. With a well-organized and coordinated radio program from the Diaspora Eritreans we can easily reach about half of the population. We can use the radio as a source of alternative information and a means of organizing at the same time. High on the priority list of the opposition should be the organizing of a radio program that will serve as an outlet for the collective opposition. Sectarian and one-party radio programs are if not outright counterproductive, at least helpful for the overall democratic struggle. With a systematic and efficient utilization of the Internet we can build on the positive benefits we have already registered.
The most forgotten and neglected sector of the Eritrean population is the entrepreneur segment. The ruling elite's hatred for the business men and women is only surpassed by its hatred for intellectuals. The total monopoly of commerce and business by the ruling party has turned many entrepreneurs to the opposition camp. Presently, they are unorganized and isolated from the direct struggle for democracy. Employing the right approach and making their specific legitimate interest a part of the democratic agenda (thereby giving them the platform to present their demands) will enhance and expand the rank of the opposition.
The very obvious and critical deficiency that needs immediate attention is the low-level participation of the Eritrean intelligentsia. Strong and direct participation of a committed intelligentsia has always made a difference in other nation's transition to democracy. The pattern may vary, but the contribution is a key ingredient to the advancement of struggle for democracy. This critical sector has to assume its innate responsibility and tip the balance scales decisively in the favor of democracy.
Whatever reservations it may have about the political forces on both sides of the national issue, the intelligentsia cannot stay neutral or indifferent. The stakes are too high for any citizen to stay aloof-let alone the intellectuals from whom much is expected. To strengthen the possibility of a peaceful resolution to our national crisis, the organized intervention of the intelligentsia has to evolve beyond its present level.
By far, the most critical responsibility of the opposition is to search for potential partners from within the ruling party to join the peaceful revolution. One has to sincerely believe that there are elements inside the ruling party who disagree with the general direction of the present national leadership. G-15 cannot be the only reformist wing of the party. Even though at this time the party is under total control of the most anti-democratic forces, other factions or followers of G-15 are bound to surface under the right circumstances.
The clarity of vision, the agenda, and the style and strength of the aggregate opposition will have immense significance for the democratic forces within the ruling party. The more organized and united the opposition becomes and the more willing it is to earnestly address the concerns and interests of the ruling party's democrats, the more likely the ruling party's democrats will be receptive to the possibility of taking control of the party; furthermore, the chances are even greater that they will transform it into a potential partner that can be integral to the process of negotiating the transition towards democratic governance. This indirect leverage will have a decisive impact on the direction of the national agenda. Identifying and connecting with this democratic element is the ultimate link that will help transform the confrontation to a negotiation. Without a cooperative democratic wing within the ruling party, the challenge to peacefully resolve our national crisis will take longer and be more taxing, but certainly not impossible.
Hand in hand with the organizing of each sector must also follow the networking and experience-exchanging aspect of all organizations with the expressed purpose of transforming the political struggle into a vast social movement. It will be possible to create a critical mass strong and powerful enough to "convince" the ruling elite to head to the table.
The Foundation - Safeguarding the Sovereignty and Territorial Integrity of Eritrea
The underlying responsibility of protecting and safeguarding the nation's very existence falls primarily on the regime itself. With all our differences in tact, we have to accept this institutional reality. Whatever political maneuvering the opposition has to do in order to bring the ruling clique to the negotiating table cannot include directly or indirectly endangering the sovereignty and territorial integrity of this new nation. The first rule of the salvation of the nation is established when we recognize this underlining foundation. The critical nature of this responsibility is compounded when the governing regime is reckless and irresponsible.
We should not entertain any illusions that the survival of Eritrea is already assured. A weak and divided Eritrea (with serious internal problems) may encourage ambitious enemies-both near and far-to conspire and take advantage of our predicament. The opposition has a corresponding responsibility (albeit at a secondary level) to make sure it does not send the wrong signal about its commitment to the maintenance and consolidation of the sovereignty of Eritrea. The search for non-violent strategies is based on recognizing this national responsibility, and it imposes a certain limitation on the maneuverings and actions the opposition can undertake in its effort to actualize democracy.
Employing the strategy of a peacefully negotiated revolution gives us a true guarantee that the effort to introduce democratic governance will not be costly in terms of both life and property. Moreover, it will not endanger the very existence of the country. There is no other known shortcut to accomplishing our twin duty than to make a conscious decision to abandon the insane and devastating course of armed struggle. Eritrea is blessed by having wise people and hurt by the presence of a power-hungry elite at the helm of power. If we access all the democratic forces (even those in the ruling party), we will be able to mobilize enough goodwill and political strength to prod the ruling party to the table.
The arrogance and contempt of the ruling clique can be contained in a very short period of time once their followers are convinced the interest of the nation should not be sacrificed for the unbridled ambition and fragile ego of an unrepentant tyrant. The opposition should be humble and truthful enough not to claim exclusiveness in defense of democracy. It has to be open minded enough to the point of accepting the possibility that the most powerful democrats may be just a few inches away from the president, waiting for the right circumstance. There is not a designated shelf reserved only for democrats. You can find them where you least expect them. Eritrea's democrats come in all shapes and manners. They are educated and uneducated, old and young, vocal and silent, extroverted and introverted, etc., etc….as diverse as your imagination can handle. They all love freedom and peace, and hope their country will be safe and secure while everyone is searching for a way out of the quagmire. They are not just demanding a change in government, but also a major shift in philosophy. They are all sick and tired of war and the rumors of war. They will not volunteer their children to another civil war. Nor will their children fight.
Let Us Silence The Guns: Eritrea Needs More Poets and Storytellers
The logic of the zero sum game is archaic and destructive-irrespective of which side wants to play it. The peaceful way can work if we prepare for it as much as we prepare for war. Essential to its success is a clear vision, servant leadership and an unwavering commitment to see it through. The people of South Africa and Poland have shown us the way. To the enlightened and humble leader of the people, the table is mightier than the tank. To those who crave power at any cost, life is just another commodity to bargain with. The peaceful way is not the easy way, for it demands that we sacrifice our inflated egos and humble ourselves for the sake of mothers who gave birth so that one day they may be visited by their grandchildren, and fathers who believe life will not be cruel enough to make them attend their children's funeral. The dead are not lonely…just disappointed by the living who are eager to easily forfeit another individual's life just to impose their will. Peace becomes possible when reasonable men and women refuse to accept the devaluation of human life and demand that graves be saved for older people-and when the young continue with their foolishness, loving and hating life and believing they have infinite tomorrows to perfect love.
When poets and storytellers are the most loved and respected citizens in a nation, there is hope…and there is a future. When guns and death rule the day, a nation is destined to have no youth and no future. Politicians with guns cannot guarantee lasting peace but more blood and fresh seeds for vengeance. To defeat a tyrant without violence, our vision of peace has to be stronger than his guns.
Eritrea needs more poets and storytellers. Let us keep the guns silent so that we can hear their words.
Seyoum Tesfaye
Atlanta, Georgia
AFRICANEWS
Views and news on peace, justice and reconciliation in Africa
August 2002
Kenya: Traditional circumcision a health hazard
By Eric Maino
Throwing Away the Knives:
Historic progress is being made in eradicating female genital cutting (FGC) practices in Kenya
The widely practiced tradition of circumcising boys is now seen as a threat to life. The use of the same circumcision knife to operate on several initiates has increased the chances of transmitting viruses, including HIV.
August is circumcision season in Bukusuland, which covers mainly the Western Kenyan districts of Bungoma and Trans-Nzoia. The circumcision of boys is at the centre-stage of every debate in villages here. Young boys aged between 12 and 14 years are bracing themselves to undergo one of the most respected and popular occasions. "About 8,000 boys from the community are ready for the 'cut'," discloses 70-year-old Masinde Wanyama, a member of a Bukusu council of elders from Naitiri, Bungoma district. "But, unlike the previous years where we used to perform the rite traditionally, most boys, this time round will go to hospital for the operation," he adds.
This new development is a contravention of norms, but Masinde continues to explain: "We have to weigh between culture and survival. There is the AIDS scourge threatening to wipe out the whole generation, we are told that our style of rites passage is one way of transmitting the virus. If we subject our children to risk who will perpetuate our generation?"
The change of culture might make Mango Mukhurarwa, the Bukusu ancestor who bravely brought circumcision to the community, turn in his grave at the caves of Mount Elgon, a volcanic mountain at the border of Kenya and Uganda. He might be feeling disrespected as people fail to embrace his gift to the community.
There is a captivating true story of how the ancestor risked his life by bravely killing a terror serpent (eyabebe) in the early 1800s to qualify for the initiation from the Sabaot ethnic group.
The serpent was unleashing untold mischief in the community by swallowing alive animals and people. Then one day Mukhurarwa, the great hunter who persistently wanted to be circumcised by the Sabaots - the Bukusu had not started circumcision - was challenged to kill the serpent in return for the "cut."
To slice a long story short, Mango, with his sharp machete, accomplished his assignment and was, at 1pm that very day under the fierce tropical sun, circumcised by a woman, as the overjoyed Sabaots ululated and sang praise songs. From then, the Bukusu is said to have possessed the gift of circumcision and have carried on with it diligently for decades.
The Bukusu style of circumcision has been very controversial, dismissed by Christianity and other religions as being wicked. The evening before a boy is to be initiated is packed with action. There is excessive consumption of traditional liquor and hard drugs such as marijuana, as people sing and dance.
"On the eve of the cut," observes 30-year-old John Barasa, a catechist at a local Catholic church in Nzoia village, Lugari district, "apart from consuming the brew prepared under poor hygienic conditions, women socialise freely with men. Even married women commit infidelity on this day because culture allows," he notes sadly.
The repercussion, Barasa discloses, is the increase in AIDS cases, family separations, and early pregnancies, resulting in high dropout rates. In a given season at the village, at least 20-school going girls get pregnant, reveals the catechist, a trend he describes as alarming.
The young boy, who stays in the deep night's cold without wearing a shirt, blows a whistle, and knocks two metal pieces with sisal whiskers at the end (Chinyimba) to rhythmically hit iron bangles worn on the hand. As a test of him withstanding the blade the following morning, he is abused and wiped, while others go an extra mile to place hot iron metal on his toe nails.
As though that is not enough, very early in the morning the initiate is circumcised naked in the presence of the entire society; the knife used for one can be used for even 10 others! "This is hazardous," notes Dr. Dickson Otieno of Namabale Hospital Bungoma district. He adds: "During that process, the same knife is stained with blood. When used on another boy, chances are high that some viruses including HIV, could be easily transmitted."
Otieno says a team of medical experts, assisted by social change crusaders, has been tirelessly traversing the entire community, preaching about the dangers of the circumcision ceremony. He expresses optimism that quite a good number of parents and boys have heeded the call. These efforts have been beefed up by consistent intervention by the Catholic and other churches; many boys opt for hospital circumcision. "There it's safe and in case of any emergency the doctor is ready for assistance," says 45-year-old Simiyu Sitanda, from Namanjalala, Trans-Nzoia district. His 13-year-old boy, Amos Sitanda was operated on at a hospital at the onset of this season.
"I'll never agree to be circumcised in the tradition style," vowed 14-year-old Bethwel Wanjala. "The whole process is out-dated and with the era of AIDS its possible to get infected since only one knife is used for a mass of boys." Wanjala is among 50 other boys from Naitiri village who got a two-day training on the dangers of traditional circumcision. He now educates other boys at Naitiri Primary School where he is a pupil.
Risks of HIV/AIDS aside, sometimes the circumciser may miss the target, endangering the boy's life. Dr. Otieno gets terrified at the thought of this. "In a season we get over 50 cases where the knife has chopped the artery leading to acute bleeding, some cases are mild while others are critical." Sinoko location administrative chief, Tabuka Siakama, also stages a campaign against home circumcision. He has on many occasions at public meetings implored parents and their sons to discard the old tradition. "Culture is nice, but we cannot take chances with a culture that has implications to our health," the chief has been telling his residents.
Boys cut at the hospital have the advantage of wound dressing and medical review by the doctor. Should complications develop, the attending clinical officer is always handy. Many boys consider the hospital operation as being trendy, and very few would actually prefer to go the traditional way. The traditional method, termed as gruesome and full of inhuman and degrading treatment, has attracted the wrath of human rights activists and the intervention of the government. Most government officials working in the region have always beseeched the community to change. Interestingly, the change has never been controversial and there is no strong opposition from traditionalists, as it would have been expected!
A Bukusu boy previously could not be considered a man if he did not pass through the customary ritual. The "uncultured" boy was always sidelined and regarded as a coward. However, for most boys today, the reverse is true: go it the tradition way and you will be called "uncivilized" and "barbaric." Never has modernity raided the African culture the way it has done to the Bukusu's circumcision. In this case, it is for the better.
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AFRICANEWS - Koinonia Media Centre, P.O. Box 21255, Nairobi, Kenya
PeaceLink 2002
http://www.rho.org/html/fgc_overview.htm
AFRICANEWS, June 2002
Kenya: Young woman fights the knife
By Eric Maino
Female genital mutilation (FGM) is still rampant amongst ethnic groups in parts of Kenya. But thanks to the bravery of young women such as Alice Cherop, and the recently passed Children's Act, FGM may become a thing of the past.
As the war on Female Genital Mutilation (FGM) in Kenya continues, matters have turned nasty for Mary Kurgat. Earlier this year, on a sunny February morning, she found herself before an Eldoret magistrate to defend herself from an offence she couldn't believe. Her 17-year-old daughter, Alice Cherop, had filed a case, seeking orders from barring her mother from subjecting her to female circumcision.
At her tender age, Cherop is a brave woman, since she dared to defy traditional norms and seek legal recourse for an abhorrent practice deemed honourable by her Kalenjin community. Which is why Mary found the charge offensive to the extent that she regretted having given birth to Alice.
"It became the talk of the day, and was perceived as an absolute shame and a curse that befell the community," observed Irene Rono, a neighbour who hinted that Cherop would be excommunicated for shaming the elders, family, and community.
Cherop's brothers are said to be baying for her blood, accusing her of being arrogant and disrespectful, something that hasn't escaped the Form One student at Ngeria Girls School.
"I have no plans of going home; there is nothing big [there] apart from contempt," she says. "I prefer school." Well- wishers from Germany who have volunteered to pay the entire secondary education are financing her studies.
Cherop was one of five girls set to undergo the cut in December last year after having narrowly escaped another one in 2000. Two of the five girls were already married women whom tradition dictated must be circumcised to fit into the clan.
But, upon learning her mother's intentions, Cherop sought refuge in a neighbour's house, a house she had never been into. She harboured confidence that her host would not chase her away or betray her.
During the submissions, Cherop requested the court to bar her mother from instituting on her what she described as a "punitive and repugnant act." The magistrate concurred and issued an order restraining Cherop's mother, her agents, associates, and people with like mind from forcing Cherop to undergo FGM.
The ruling depended a lot on the Children's Act, which came into force late last year. The act criminalizes FGM, with Section 13 stating that: "Any person who subjects a girl child to cultural practices like FGM can be send to jail for 12 months if they are convicted by the courts. He or she can also be fined KSh50,000 [US$650]." And Section 14 says: "No person shall subject a child to cultural rites, customs, or traditional practices that are likely to negatively affect the child's life, health and social welfare, dignity, or physical or psychological development."
That is what Cherop feared as she faced the prospect of being subjected to a practice prevalent in Sub-Saharan Africa. Many communities highly grace the passage, saying that FGM attracts a handsome dowry, is a sure way to tame a wife to remain faithful to her husband, and sometimes believed to bring about good luck and respect to the family.
In Kenya, the rite is rampant, with Kisii District having the highest number of cases. About 30,000 girls aged between 12 and 16 years are mutilated every year in the country, according to Mariam Suleiman, FGM Program Co-coordinator for the Centre for Human Rights and Democracy (CHRD), an Eldoret-based NGO. Eldoret is located in the Rift Valley province where the ritual is so rampant.
The side effects, and results of, FGM include: the inability of women to enjoy sex once they mature; complications in childbirth; severe pain while the cut is occurring; and risk of infection with HIV/AIDS, since the same knives are used for many people at the same time and are often unwashed or unsterilised after each use.
Girls undergoing the practice are, in most cases, married off to elderly men of ages equal to their fathers. In fact, Cherop decided to forgo the tradition that her six elder sisters had undergone, after realizing that it was the first step towards an early marriage.
"My mother had already established me a suitor," said Cherop. "I was to be married off immediately after the "cut" and that could bar me from pursuing my studies," said the 10th born in a family of 11. Cherop had finished her primary education in 2000. She dreams of being a lawyer. She has never met the man who was to be her husband and who had already paid the required bride price.
http://www.crlp.org/pub_bo_fgmhand.html
AFRICANEWS, July 2002
Kenya: Self-help groups empower women
By Eric Maino
Women in Kenya are finding that there' strength in numbers: if they pool their resources together in self-help groups of their own creation, they can radically change their lives and the lives of their families and communities.
The air is filled with singing and laughter as 20 members of the Nzoia Muungano Self-Help Group return from the fields of western Kenya. They have just weeded group member Anne Sikolia' one-and-a-half acre maize plantation in Nzoia village, Lugari district.
Tomorrow, the group plans to build a two-roomed mud hut for Veronica Sichangi a widow with four children.
As the adage goes, sticks tied together cannot be easily broken. Perhaps this is what Kenyan women have in mind as they form cooperative groups all across the country to deal with social and economic problems that particularly engulf the rural areas.
One such group is Nzoia Muungano, which started in the mid 1990s and enables its members to progress economically and socially. Twenty-four-year-old Sikolia, a mother of three, is among thousands of women who have benefited from groups such as Nzoia Muungano
"It would have been quite a strenuous task for me,?explains Sikolia. “I would have taken a whole month weeding this piece but now look, it has been done in a day!"
Sikolia is unemployed. Her husband moved to Nairobi, Kenya' capital, five years ago in search of employment, and has never returned. Neither does he send any money, which leaves the family in poverty. "We only managed a meal a day, put on tattered clothes, and lived in dilapidated conditions like refugees," she reveals sadly.
However, she continues to say that since joining the group two years ago, a lot has changed.
She points to a hut that she and her colleagues built, house utensils that group members purchased for her through a revolving fund, and farm inputs that were bought by funds collected from members.
"Before this, I loathed having visitors, and nobody could after all visit a pauper,?she says. “I felt a social outcast but, now, I feel proud welcoming visitors in the compound.?In December, during the harvesting season, the group members will assist her to harvest the crop, she says.
Hellen Chepkorir has many reasons to smile. The 27-year-old mother of five lives a better life than she did five years ago. Chepkorir has managed to send three children to school, feed and dress them, and pay house rent, courtesy of the flourishing charcoal trade of which she is wholesaler at Chukura market in Uasin-Gishu district.
Chepkorir belongs to Chukura Women' Group, which is comprised of small-scale businesswomen. Women in the association contribute Ksh500 (US$6.50) each week; the collection revolves from member to member on a weekly basis.
Chepkorir, like many other married women, used to sit and wait for her husband to fend for the family so that they could eat. Sometimes, her husband could not get anything for up to two days, which meant that family members went to bed without food.
"Then some women approached me to start a self-help group, where we could contribute 100 shillings [US$1.30] to a member to enable her to start a business,?she narrates. “I bought the idea straight away."
At first, she started a vegetable grocery shop with Ksh500 shillings (US$6.50), since the group consisted of only five members. Profits accruing from the group helped her to buy food and meet other financial requirements.
More members joined until they became 12 members. Each member then contributed a weekly sum of Ksh500. Eventually, Chepkorir was able to get a loan of Ksh6,000 (US$78) to start a charcoal business. Today, as a wholesaler, she sells her commodities to retailers.
"It would be difficult, a dream, to raise Sh6000 at once,?says Chepkorir. “But this has enabled me to progress; it is like getting a loan at interest free whose terms are soft.?
Chepkorir says that since her business started doing well, family wrangles have ceased. "I could bitterly quarrel with my husband, accusing him of neglecting the family since he provided very little,?she reveals. “At one time, the marriage was threatening to break, but today, I can supplement his earnings and we live an amicable life."
Forming and joining a self-help group varies from locality to locality. The principle requirement is for a member to know the group' objective, then to be able to pay a membership fee ranging from Ksh200 (US$2.60) to 500 (US$6.50), depending on the economic base of the members.
Under the trees - village women meet with Julia
When I first met the women who call themselves the South Sudanese Women Association (SSWA), I thought of the little song, "It Only Takes a Spark to Get a Fire Going."...
Women' groups are well organised. They have annual elections for leadership posts such as chairperson, treasurer, and secretary. There are by-laws and constitutions that govern most of these groups, to see to it that members stick to the group' objectives.
"Some laws are tough,?explains Lydia Wamboi, chairperson of Kongoni Women' Self-reliance Group in Lugari district. For example, if one defaults on her payment without an explanation, she can be penalised or even expelled from the group, says Wamboi.
"Most groups you see around don’t have offices or assets,?says Wamboi, a mother of six who separated from her husband following family wrangles over poverty. “We operate and meet in members?houses. It is after visiting a member that we can even learn of the problems affecting a colleague."
Wamboi says that discussions during meetings are wide-ranging. "We exchange ideas on our rights, nutrition, child bearing, and discuss among ourselves about the HIV/AIDS pandemic. We converse about the virtue of fidelity and sometimes family planning measures."
These groups have intensified good relationships amongst members, who often view themselves more or less like sisters. "And now we command respect in the community, and even from our husbands," chips in Sylvia Nyongesa.
Nyongesa, a single mother of two, says she has benefited a lot from her group. "One remarkable thing was when we contributed money and I bought a dairy cow. Today, I am able to sell milk, while I reserve some for my two children. Their health has improved a great deal, and I can be able to buy food and clothing from the proceeds. In a month I have a total earning of Sh3000 [US$39], which is far too much from what others are getting in this rural area," she says.
"Women realised, too, that they have energy and skills to improve their lifestyle,?points out Wamboi. “They fetch firewood and water, operate kitchen gardening, cook, wash, and perform other domestic chores that are equally laborious, but hardly earned from it.?
When they first formed these self-help groups, women faced many obstacles, chief among them objections from husbands. At first, married women could be stopped from attending meetings from husbands who accused them of infidelity. Some dropped out of the associations following mounting pressure at home, but those who continued are now being admired.
Ironically, those men who were adamant against their wives joining these groups are enjoying the proceeds from these groups. In some households where men are drunkards, and can’t support the family, it is common to have women assuming the role of breadwinner.
In some places such as Lugari district, the groups are so powerful that they can easily shape the opinion of society. In most cases, during election years, politicians use women groups to gain votes.
Following outstanding successes, the phenomenon of women' self-help groups has compelled many women to form associations. It is the order of the day to belong to a women' group. Weekly contributions and visits are known as merry-go-rounds, as they revolve from one member to another.
The bottom line of every group is to have each member live a better life, where she feels loved and cared for, hence pulling many from lives of solitaire anguish and despair.
Upon learning the importance of social groups, the government has started to encourage women to register their groups with the Ministry of Home Affairs. In Lugari district, there are 3,050 registered groups so far, says district development officer John Kianda.
Kianda further discloses that most of them are very active. He is optimistic that, with some external assistance, the groups can achieve a lot.
Moreover, Kianda is extremely pleased that the groups have become a forum for discussion and the exchange of ideas, which has been lacking for so long. Registering a group he says, costs Ksh300 (US$3.90), and the certificate is renewed every year.
A local community development assistant (CDA) is posted in every village to facilitate the groups into places for discussions and ideas.
Prof. Authur Okwemba of Moi University School of Social Sciences describes the movement as “original,?with the purpose of improving living standards. He adds that, if given financial assistance, most of them can progress well.
Sudan:Nineteen years of the SPLA Politics/war
By Brian Adeba
The Sudan Peoples' Liberation Army (SPLA) came into existence 19 years ago. The occasion of this anniversary affords one to reflect on how far the movement has come and the challenges that still remain in the "New Sudan."
May 16th marks the nineteenth anniversary of the founding of the Sudan Peoples?Liberation Army (SPLA). On that day in 1983, two battalions of the Sudanese army mutinied in the southern town of Bor. By the time a force was said to quell the mutiny, the first bullet in what was to become one of Africa' longest and bloodiest wars had already been fired. The mutineers of battalions 105 and 106 fled to the bush towards the Ethiopian border.
Nineteen years of fighting has taken its deadly toll. An estimated 2.5 million people have lost their lives; four million have been internally displaced, while thousands have been forced into refuge in neighbouring countries. War-induced famine and disease are still a looming threat to the lives of many.
But as the death toll continues to rise every year, so has the Sudan Peoples?Liberation Army (SPLA) been growing. From a band of a few hundred men, today the Sudanese rebels number in the thousands. From controlling a small area along the Ethiopian border, the SPLA is now in five regions of Sudan. Nineteen years have also seen the SPLA transform itself from a classical hit-and-run guerrilla army into a formidable conventional army that has thwarted the efforts of successive Khartoum governments to defeat it militarily.
The strengthening of the SPLA' military clout meant an increase in the area under its control in the three regions of the south, Nuba Mountains, and Southern Blue Nile province. Government control in these areas is limited to a handful of heavily fortified garrison towns.
"The fact that the movement (Sudan Peoples?Liberation Movement, or SPLM) has firmly established itself in these areas is evidence of its military gains," says John Luk Jok, director of the Nairobi-based Centre For Documentation and Advocacy, and editor of the "South Sudan Post."
"It [SPLM] would have done more if there were no problems in the movement," he adds, referring to a 1991 split in the SPLA that generated fighting for the better part of the 1990s. But in January of this year, the splinter group, the Sudan Peoples?Defense Force (SPDF) led by Dr Riak Machar, returned to the SPLA fold after a deal it signed with the government in 1997 went sour.
However, the growth of the SPLA has not been without its hitches. As it became a conventional army, the area under its control grew larger and so did the increase in human rights abuses. Citizens under SPLA control termed it an "occupation army" as rape, plunder, arbitrary arrests, and executions became the order of the day.
In 1994, 11 years after its birth and three years after a devastating split, the SPLA held a convention in the town of Chukudum in Equatoria region to map out the way forward. Among the issues raised by civilians was the wanton abuse of human rights. The convention also mandated the creation of a civil authority that would revive administrative structures, which had collapsed as a result of the war. The Chukudum convention is considered a watershed in improving things in the SPLA.
"It [the human rights situation] has improved a great deal, but there is need to strengthen the institutions for the protection of human rights, for instance the police and judiciary," argues Jok.
Today, the SPLA is talking of "peace through development" in the areas it controls, arguing that while it pursues the option of a negotiated political settlement with Khartoum, it should start socio-economic development of the "New Sudan" (a term it uses for areas under its control) and provide social services to the civil population.
"Peace through development," argues Jok, "is a show of confidence and consolidation of the gains achieved so far. A liberation movement that does not have confidence can’t do that!" Jok further says some countries are now providing development assistance - rather than emergency support - to the civil authority of the New Sudan (CANS).
Two years ago, the SPLA introduced a controversial document that forced the more than 45 international non-government organisations working in areas under its control to shift efforts away from providing emergency relief to setting up development-orientated projects. Since 1989, an estimated US$2 billion has been used for emergency relief in areas under SPLA control.
"Half of this amount would have had significant developmental impact on the livelihood of the people of the New Sudan, if it were (sic) utilized in the development of the economy," says a booklet titled "Peace through Development: Perspectives and Prospects." The booklet, issued two years ago, is basically a blueprint of the SPLA' objectives of development.
More recently, while on a trip to the United States in March, SPLA leader John Garang said that the movement would soon launch its own currency, to be known as the New Sudan Pound. The SPLA also envisages the creation of a central bank soon.
While all of these developments show that the SPLA is becoming more and more sovereign, the challenges still remain daunting. These challenges include creating a monetary system that will harmonize the four currencies in circulation in areas under its control, maintaining and sustaining the military gains achieved so far, and developing the required infrastructure.
Meanwhile, the Khartoum government has been replenishing its war machine. In April, Khartoum' Minister for Defense, Bakri Hassan Saleh, went on an arms shopping trip to Russia. In a deal analysts say is worth between US$200 to 300 million, Khartoum plans to modernize its Russian-made armoury acquired in the 1970s and 1980s. It plans to buy 12 state-of-the-art Mig29 fighter planes.
Says Dr. Cirino Hiteng Ofuho, an assistant professor of International Relations and Politics at the United States International University in Nairobi and adjunct lecturer at the Institute of Diplomacy and International Studies, University of Nairobi: "This is indeed worrying. There are only two countries in Africa, Egypt and South Africa, which have these planes!"
Analysts say oil revenues, which have been on the rise in the last three years, have enabled Khartoum to afford the expensive planes. According to Ofuho, although the areas surrounding the oilfields remain the "most active fronts," this has not prevented Khartoum from trying to consolidate its troops in northern Bahr el Ghazel, which has been the scene of serious fighting in areas around the SPLA-controlled towns of Gogrial and Tonj in recent months. These are areas that have been a foothold for the SPLA, and its proximity to the oilfields has been a major source of worry to Khartoum.
Ofuho says the recent upsurge in fighting in these areas is because Khartoum has moved troops from the Nuba Mountains. "Khartoum is taking advantage of the ceasefire in the Nuba Mountains and is sending troops to Bahr el Ghazel," he argues. Thanks to the oil money, Khartoum is now spending an estimated US$1 million per day on its army. Analysts say it fancies itself as a regional force because of its growing military strength.
But as the SPLA struggles to sustain its military gains and at the same time fend off the advances of a stronger enemy, its diplomatic front needs to be strengthened, as Khartoum is constantly on the lobby in the region using oil as bait. At the start of the war, the SPLA' diplomacy was not effective and mainly limited to countries of socialist leanings. "Diplomacy was weak mainly because of a lack of resources. The immediate threat, which was the military front, took all the resources," says Ofuho.
But now, says Ofuho, the SPLA has realized the importance of diplomacy and has stepped up its efforts on this front lately. The pressures that have brought this diplomacy about are the issues of child soldiers, oil, and internally displaced people. After nineteen years of fighting, the SPLA can boast of friends sympathetic to its cause in East Africa and the Horn. These countries are Uganda, Kenya, Ethiopia, and Eritrea. But internal political changes in these countries have the potential of changing this situation. The Ethiopian-Eritrean conflict was a good example.
Last year in Uganda, the opposition made a point of Museveni' alleged support for the SPLA, which became an election issue. Had the opposition won the elections, this would have affected the SPLA adversely. In Kenya, President Daniel arap Moi is expected to step down at the end of the year. Although he has not officially named and groomed a successor, among the four men expected to succeed him is Minister of Energy Raila Omolo Odinga. Odinga raised public outcry last year when he announced that Kenya would start buying oil from Sudan, which he argued is cheaper. There is no saying what a man like this would do if he becomes president.
However, Moi has said he will remain chairman of the ruling party Kenya Africa National Union after he steps down as president. For a man who wields enormous political influence in Kenya, this might be a consolation to the SPLA. But it would be unwise to bank on this. Change, any type of it, is always a possibility.
On a peaceful settlement to the conflict, both the SPLA and Khartoum are still haggling over the points that form the basis of the IGAD-led negotiations. The issues of self-determination, separation of religion and state, and the interim period remain as contentious as they were seven years ago when the IGAD talks were first launched.
How can one sum up the SPLA after nineteen years of fighting? "The SPLA has grown into a formidable opposition to governments in Khartoum," says Ofuho. "It has also emerged into an alternative system, but it can not afford to be complacent."
http://www.peacelink.it/wajibu/3_issue/p3.html
Wajibu: A Journal of Social & Religious Concern
Volume 13 No. 2 (1998)
Education for all Education for life
Basic education is for all
F.X. Gichuru
When the term basic education is used, certain classes of people think it is for others, not for themselves. The truth, however, is that everyone, a professor included, needs basic education. I mention professors to represent a class of people who have gone to school, who have read many books and have come out with many skills. Yet they could be lacking in basic education. The misunderstanding of basic education arose from the fact that during the 1950s even authoritative institutions like Unesco considered basic education mainly to cover the early primary school cycle. In the 1970s development theory focused on basic needs and therefore the need arose for defining the content of this type of need. In the Conference of Ministers and those responsible for education in the Eastern and Southern Africa Region, basic education was defined as the "minimum provision of knowledge, attitudes, values, and experiences which should be made [available] for every individual and [should be] common to all. It should be aimed at enabling each individual to develop his or her own potentialities, creativity, and critical mind, both for his or her own fulfillment and happiness and for serving as a useful citizen and producer for the development of the community to which he or she belongs"(1) When, by 1980, the achievement of this "minimum package" through the normal school system became unrealistic, the world began to think of basic education through all the available means and in the shortest time possible. This was the subject of the WCEFA (World Conference on Education for All) which took place in Jomtien, Thailand, from March 5-9, 1990. The year 2000 was defined as the target date for achieving EFA as defined.
During the preparations for the conference, we asked the question: "What kind of education should necessarily be given to all people and how?" We went on to note that this education must be an ideal acceptable to all, and it must be easy and practical to dispense.(2) Defining it has always been a problem. During the 1950s, UNESCO referred to it as Fundamental Education (FE), in the 1960's as Universal Primary Education (UPE) and since the 1970s, as Basic Education (BE).
Attempts to actualize FE led to the definition and promotion of UPE. But the process of implementing UPE turned to be illusory due to high costs of formal schooling. The difficulty resulted especially from the institutional and structured nature of the school. In the 1970s evidence of this unrealistic approach led to the definition of the Basic Needs Strategy in the resolution of human problems. Provision of BE was seen as an approach to satisfy education as a basic need.
BE was defined by the Regional Conference held in Kenyatta University, Nairobi, in 1974, as the "minimum package".(3) The BE, according to this definition, would be common to all educated men and women. But experience has shown that up till today not many people understand or value this type of education. Formal education has continued to be the attractive model due to the obvious positive implications.
However, in the 1980s universal formal education at the primary level proved illusory. This phenomenon has been observed worldwide. In one sense therefore, the world population is losing confidence in education and the consequences tend to be dramatic. The 1980s, when education suffered a general decline all over the world, were described as a decade of lost opportunities. This is why the WCEFA was seen as necessary at that point in time.(4) But the situation has remained the same in the 1990s. Even on the eve of the 20th century BE continues to suffer due to wars, natural disasters, political and economic policies of countries and the policies of multilateral agencies such as the World Bank and the International Monetary Fund.
Due to the SAPs (Structural Adjustment Programmes) introduced by these institutions, public expenditures on education were reduced, the teachers' salaries being targets in the first place. A good example of this is Kenya by the beginning of 1998. In another article I raised issues underlining the challenge on governments, NGOs, organizations, and communities all over the world, especially Africa, regarding commitment to EFA. The issues touched on relevance, feasibility, replicability, and sustainability of EFA. The fears that I expressed in that article were justified when we look at what has happened on the eve of the new millennium.(5)
The theme of the WCEFA focused on "meeting basic learning needs", a big correlation having been observed between the ruling concept of BE and the proposed concept of EFA: Meeting Basic Learning Needs. What was new in this concept? Perhaps nothing, only that the new strategy would require being more explicit about the nature of BE, how to measure its achievement, and how to attractively reward it. This was the challenge that experts had to face to and resolve.(6)
We then pondered a little over the nature of the expected EFA. First of all, we did not assume that a detailed package of Basic Education (BE) could be applied universally. The content of BE had to be defined within transcultural guidelines, leaving room for specific applications in different settings. We underlined that the principles of BE must be universal. For example, we may take the following to be some of the universal principles that we referred to:
Literacy: Being able to read and write should be a universally desirable value. However, the medium of this literacy can be in any form, for example in any alphabet, depending on the requirements of a given culture.
- Functionality of literacy: This principle refers to the usefulness of literacy to the individual and the community concerned. We refer to this as applicability of reading and writing, or functional literacy. Again, this principle would traverse all cultures and stand as a permanent imperative for BE.
- Self-confidence: This is critical as a principle of BE. Self-confidence would make the individual put trust in his or her abilities to confront problems courageously and set out to look for their solutions, no matter how or when solutions are possible. The BE must make individuals self-reliant and able to develop their collective environment(s). That requirement of training for self-confidence from the earliest stages of life again is valid across all cultures.
- Spirit of Co-operation: Once again, a basically educated person must have the need and strength of co-operating with others. A person who does not see the need for positive interpersonal relationships would be lacking an essential attribute of basic education. I suppose there is no need to say that the principle of co-operation is universally desirable, irrespective of the cultural differences of different communities.
- Appreciation of work and desire to be industrious: Positive value of work should be a universal principle of education. The feeling, or the reasoning, that would promote the idea of "more income and rewards for less work" should be discouraged. Expecting to earn a lot out of little work, or for the least demanding work, should be a mark of a very uneducated person. This actually is the spirit behind corruption and theft that we witness in our society. Industriousness then should be an attribute of an educated person or community. All cultures accept the principle of hard work as a positive value to be promoted in the BE.
- Need for Recreation: We refer to this as an imperative of BE because certain people tend to downplay the need for recreation. The best function of the human organism is guaranteed when the individual is refreshed. Methods of refreshing the human organism are diverse and vary according to different cultures. The important fact is that the body and mind of the person should not be allowed to degenerate due to over-use or neglect. That must be a universal, transcultural principle of BE.
We summarised the principles stated above by referring to three imperatives that we attribute to an integrally educated person: the mind or the brains of the human being must have certain knowledge and skills for survival; the spirit of the human being must value the need for positive interpersonal relationships; and the body of the human being must be kept active and refreshed enough to avoid degeneration due to overuse or lack of use. This is what I called "Tripolar Education".(7)
Discussing the process of EFA, we outlined how to achieve the six universal principles of EFA, as outlined above. The achievement of the first principle, literacy, is usually the ambition of most aspects of modern education. A little enlarged, this covers the sharpening of human intellectual capacities; in other words, the improvement of the cognitive domain. Most schools attempt to do this. For that reason, the only thing we may wish to say here is that in all communities, centres of learning, however simple, are necessary.
In these centres, learning resources are made available for the assistance of learners. Teachers are required to guide the learners to achieve learning in the easiest and most efficient manner possible. The difference between what we proposed and what is usually available is that the learning resources must be simple and accessible to all. That of course requires strict supervision but this is feasible.
The achievement of the second principle, application of literacy, can easily be attained if teachers will always try, in a creative way, to relate to real life all knowledge that is to be learnt. In other words, the content of literacy must be about what is happening to the learner in daily life. For example, in a pastoral community, numbers must be linked to the animals, counting for instance. Learning geometry must be related to the building of houses or other useful structures. As soon as a learner has learnt anything, circumstances must compel him/her to apply the knowledge immediately.
The third principle, self-confidence, is perhaps what has been most ignored or discouraged by traditional formal education. Undemocratic situations, where a ruler is unsure of himself, have tended to discourage the development of self-confidence and creativity in individuals. This, in consequence, has hindered the development of self-reliance. Self-confidence is trust in one's own strength and resources. This principle helps individuals to surmount most difficulties. Self-confidence must therefore be developed in individuals from the earliest stages of life. Children must be allowed to do things by themselves, with assistance only where necessary; most simple problems and challenges must be allowed to be solved by them. This process of solving one's own problems must be developed into a way of life for all individuals, from the earliest stages in life. Are there adults who have not acquired this attribute? If there are, they need this type of BE.
Developing the above principle of self-confidence must not contradict the fourth principle, the spirit of co-operation. When they co-operate in projects, people are able to do great things: unity is strength. If you teach people to co-operate, you have taught them to liberate themselves because then there is nothing they cannot do. As children are taught to be self-reliant, they must be made aware that this will best happen in a united community effort to solve global community problems. Children must of necessity be made to learn that they live in a community and they must be made to co-operate with the rest of the community for their own individual good. If there are adults who cannot co-operate with others, then they need BE.
The fifth principle, appreciation of work and desire to be industrious, is a very positive value for education. From the earliest stages children must be made to love work because it produces the fruits of daily life. The more the children work in any project, the more they should be rewarded/reinforced by the teacher. Laziness should be a contemptible attribute and should be socially reprimanded by collective scorn. By the time the children are adults they should have a positive attitude for work and a negative one for laziness.
The sixth principle, the need for recreation, can be achieved through both knowledge and practice. Children and adults should know why they need recreation; otherwise, a habit will not be cultivated. The human organism needs periods of refreshment when, either through physical exercises or though changes of activities, body functions are recreated and a feeling of well-being restored. Physical exercises strengthen the muscles, relax the joints, and irrigate the body tissues through an increased flow of nutrients in oxygenated blood; toxins are removed from the tissues as the increased flow of wastes are removed. Body functions are, consequently, better activated after recreation.(8) All people, as a matter of education, must be accustomed to recreation. Sometimes, professors, or other professionals neglect this. What is their attitude on physical education? Did their physical education end with primary school? How can they describe their life routine? Sleep, wake-up, enter the car, drive to work, sit behind a desk till evening, then get into the car, drive back home, sit comfortably on the sofa, eat and sleep, to start the cycle again, every day, every week, every year? Do they engage in regular physical exercises? If not , they are rotting physically and deteriorating very fast. They need BE.
The above six principles can be regrouped into three domains: cognitive, affective, and psycho-motor. As we said earlier, these are the three imperatives attributable to an integrally educated person. This is the type of EFA we need to aim at as we execute it.(9)
Looking at the actual WCEFA held in Jomtien, Thailand, the concrete goals were expressed as follows:
- To improve primary education and make it so widely available that at least 80% of 14-year-old boys and girls world-wide will be able to equal or surpass a nationally defined level of learning.
- To cut adult illiteracy rate to half its 1990 level, and achieve parity between male and female literacy rates.
- To provide more educational opportunities to meet the diverse needs of youth and adults, including literacy programmes, skills training and specialized education on such topics as health, nutrition, safe water, child care and family life.(10)
These goals were good but did not explicitly articulate my scheme of integrated education for all, including the youth and adults. If I became more rigorous in the analysis of the goals, I could do some intellectual gymnastics and fit them into my scheme. But the achievement of these goals by the year 2000 appears dim. The value of the WCEFA should, however, be seen to extend far beyond 2000. Jomtien aimed at forging a global commitment for Basic Education and at mobilizing worldwide support and resources for achieving these goals. The strategy that was proposed in the New Vision was meant:
- To uphold the primacy of learning achievement over school attendance, ensuring that children really master basic knowledge, acquire the tools of literacy and learn how to think.
- To promote a broader vision whereby learning is not reduced to formal schooling; where the ultimate end of learning takes precedence over financial and material means.
- To include all programmes (formal or informal; for children or for adults) - all channels, and all educational institutions, are now seen as part and parcel of BE, provided they contribute to effective learning achievement.
Rather than uphold the monopoly of formal schooling, the WCEFA encouraged a broad and diversified spectrum of BE programmes for children and adults.(11) Basic Education was thus made the responsibility of society as a whole rather than of the Ministry of Education alone. An alliance of social forces, mobilised for the purpose of BE was seen to be more likely to furnish the resources, fresh impulses and commitment which EFA was envisaged to require, something more than the formal system of schools, teachers, and ministry of education officials would ever be able to accomplish. The responsibility of national leaders was seen to be important and fitting in view of putting together this alliance for education, giving leadership to the alliance and sustaining its work over time.(12) We do underline that the BE efforts must touch on everyone, making sure that all people get basically educated on the three sides, in the scheme I described above as "Tripolar Education".
Notes
1. World Declaration on Education for All: Meeting Basic Learning Needs, Jomtien, Thailand, March 5-9, 1990.
2. Cf. Comments of Dr. Wadi Haddad, the Executive Secretary to the Interagency Commission for the WCEFA, in the Report of African Regional meeting on WCEFA held at UNESCO/BREDA, Dakar, 22-23 June, 1989, par. 2.
3. See Definition in Note 1 above. UNESCO/UNICEF Co-operative Programme, Nairobi, 1974.
4. "Today, education faces a global crisis" (see the release of sponsors): UNDP, UNICEF, UNESCO. The World Bank, World Conference on Education for All - Meeting Basic Learning Needs, p.1; see also Annex 2 of the executive Director's circular, 15/5/89, p. 11: (i) What are the aims of the World Conference? (ii) Why this initiative now? (iii)- What is the scope of education for all? See also Dieter Berstecher, "Basic education for all: a vital concern" in Basic education forum, Vol. 1, May 1992, pp. 1-3.
5. See Gichuru, F.X., "Which way education for all?" in Basic education forum, Vol. 1, May 1992, pp. 5-7.
6. Cf. Gichuru,. F.X. "The concept of EFA", in BERC Supplement, Vol. 2, September 1989, p. 4.
7. Cf. Gichuru, F.X. "The nature of EFA" in BERC Supplement, Vol. 4, November, 1989.
8. The Kenya Minister of Education, Hon. Kalonzo Musyoka, warned schools on neglecting physical education as a subject in the primary schools. He emphasized that physical education is vital for the development of the total person. See Daily Nation, June 15, 1998, p. 5.
9. Cf. Gichuru, F.X., "The process of EFA", in BERC Supplement, Vol. 5, December 1989, p. 2-3.
10. Cf. World Conference on Education for All, op. cit., Jomtien 1990.
11. See Dieter Berstecher, "Basic education for all: a vital concern" in:Basic education forum, Vol. 1, May 1992, pp. 1-3. Many efforts are being made to achieve this ambition. See, for example, Unesco, Education, innovation and information, March 1996, International Bureau of Education, Geneva. Also see Unesco, Sources, Special Issue, No. 72: Unesco in 1996-97, "Joining Forces for the 21st Century"; The Unesco Courier, April, 1996, "Education for the 21st Century: Learning to Learn."
12. Berstecher, Ibid.., p.3. By 1998 it appears that national leaders have not been able to do this due to competing demands of politics and economy.
Published Quarterly by DR. GERALD J. WANJOHI
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http://www.theatlantic.com/issues/97aug/malaria.htm
The Atlantic Monthly; August, 1997
Malaria kills roughly twice as many people worldwide as AIDS, drugs no longer work against some strains, and mosquitoes in diverse parts of the United States now carry the disease. Why aren't we doing more to fight it?
by Ellen Ruppel Shell
DEPENDING on one's perspective, the struggle to gain dominion over malaria can be seen either as a primer of the possible in infectious-disease control or as classic tragedy. All but obliterated in the developed world half a century ago, and suppressed in the Third World in the 1950s and 1960s, malaria has since returned in full force to North Africa, India, Southeast Asia, China, South America, and the Caribbean. Worldwide incidence of the disease has quadrupled in the past five years, and resistance to available drugs for prevention and treatment is growing rapidly. Nearly 40 percent of the world's population lives in regions where malaria is endemic, and millions more live in areas that are encountering the disease for the first time in decades. Europe has had outbreaks, and in the United States 1,000 to 1,200 cases annually have been reported in recent years. But the Centers for Disease Control and Prevention estimates that cases reported in the United States represent only about half the actual incidence. Every year approximately seven million American tourists and business people spend time in regions where malaria is endemic, as do military personnel and foreign visitors to the United States, and it is likely that thousands arrive here with malaria parasites in their bodies. As a consequence, locally transmitted malaria, absent from the United States for roughly thirty years, has returned. Since 1988 locally transmitted malaria has appeared in California, Texas, Michigan, Florida, New Jersey, and New York City. Anopheles mosquitoes -- members of the genus that carries malaria parasites -- are common almost everywhere in the United States and, for that matter, in most populated regions of the world.
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Nonetheless, the United States has shown little interest in the problem. Malaria is transferable in blood, yet it is not screened for in the American blood supply. The country's Anopheles mosquito population has gone unmonitored for more than fifty years. "We just don't know the potential for transmission," says John Beier, a professor of tropical medicine at Tulane University. Temperature and humidity may well be among the most important factors in the rate of spread of the disease, yet we have only a vague notion of what effect, if any, climate change will have on malaria transmission -- if, for example, global warming can be expected to bring malaria and other mosquito-borne diseases north from Mexico. Most Americans seem to think the disease has been eradicated or, at worst, is confined to the tropics. In fact there are few places on earth that cannot sustain a malaria epidemic.
Dyann Wirth, a professor of tropical medicine at the Harvard School of Public Health, insists that Americans must stop thinking of malaria as purely a Third World disorder. "The official CDC line is that widespread malaria in the United States is unlikely," she told me recently. "But we could have mini-epidemics, established pockets of disease that would be very expensive to control." Vector-borne diseases -- diseases that are transmitted by way of a third organism, such as the mosquito -- have a much higher reproductive rate than other diseases and pass through a population much more quickly. "Each case of AIDS," Wirth says, "passes along, on average, two to ten additional cases of AIDS. A case of malaria can result in as many as a hundred more cases of malaria. So the multiplier effect is quite substantial." And in this era of tight government budgets there is ample reason to worry that erosion of our public-health infrastructure and the denial of affordable health care to recent immigrants and the poor will encourage the spread of malaria in the United States.
Last year Vice President Albert Gore told an audience at the National Council for International Health that emerging infectious disease was "one of the most significant health and security challenges facing the global community," and announced a policy on infectious-disease control that directed the United States to "work with other nations and international organizations to establish a global infectious-disease surveillance-and-response system." But his statement did not mention funding, and the war on emerging disease it proposes is well beyond the current means of any government research or health agency.
Although the U.S. government is the world's single largest supporter of malaria research, we spend relatively little on the problem -- roughly $40 million annually, most of it administered by the Department of Defense, the U.S. Agency for International Development, and the National Institute of Allergy and Infectious Disease. The Defense Department seeks to protect the U.S. military from acquiring malaria abroad, and focuses on short-term efforts to benefit soldiers. USAID is controversial among scientists, who complain that the agency has spread itself too thin, hiring consultants who, as one infectious-disease expert put it, "know a lot about economics but not a damn thing about disease." Since USAID funding takes into account particular strategic and political interests of the United States, malaria in Africa is for the most part not a priority. And NIAID, an organization with unquestioned scientific expertise, devotes less than one percent of its budget to malaria -- far too little to sustain a strong research base. The CDC also has a role to play. Stephen Morse, a virologist at the Columbia University School of Public Health, says, "The CDC is critical for world control of this disease, yet it's operating on a shoestring." Daniel Colley, who directs the Division of Parasitic Diseases at the CDC, agrees. "Most people assume that we're capable of doing considerably more than we can," he says. "The public-health challenges of malaria are enormous, and we're limited by manpower, time, and financing in our ability to tackle many critical tasks. In relation to the magnitude of the problem, support for research and control of tropical diseases is minimal in this country. Compounding this situation, parasitology has faded from the curriculum of many medical schools in the United States, so although in a global environment the medical community should know about this problem, it largely doesn't."
The international funding picture is equally dismal -- one scientist describes the total infectious-disease budget of the World Health Organization as "at best slightly larger than the budget of a major teaching hospital in Boston." Roughly $85 million a year of public-sector funds is spent internationally on malaria -- only about two cents for every reported case of the disease. As one adage has it, "Money is not a problem in malaria research, because, basically, there is no money." Stephen Morse warns that the lack of international attention to the disease amounts to sheer recklessness. "We have been trafficking in microbes -- albeit accidentally -- for a long time, and many of us are worried about our eroding infectious-disease surveillance-and-response capabilities," he says. "Internationally, funding is tenuous and in great need of improvement."
Still, sporadic attempts have been made to coordinate international efforts at controlling the disease. I witnessed one such effort, an international conference on malaria sponsored by the National Institutes of Health, the British Medical Research Council, and the French Institut Pasteur. It was a by-invitation-only affair held in a luxury resort hotel on the ocean about ten miles from Dakar. The President of Senegal, His Excellency Abdou Diouf, presided over the opening ceremonies, attended by a colorfully garbed entourage of ministers and ambassadors. President Diouf expressed his gratitude to the scientists for coming, and spoke gravely of malaria as one of the most terrible problems facing his nation, Africa, and indeed the world. Then he and his retinue left to a flutter of applause, and the session took on a Tower of Babel quality. Western scientists spoke of vaccine and drug development, of biotechnology, of manipulating and transplanting genes. African scientists spoke of a dearth of medical supplies and a lack of basic infrastructure, of bad roads and no refrigeration and a treatment population that thinks malaria comes from the sun. The one thing all parties seemed to agree on was that medical science has dismally failed to get a grip on the disease.
DEADLY, CAGEY, AND RESILIENT
MALARIA is caused by infection with the Plasmodium genus of protozoan parasite. More than a hundred species of this parasite exist, capable of infecting reptiles, birds, rodents, and primates. Four species infect human beings, the most common being P. vivax and P. falciparum. The most pernicious is P. falciparum. It is not unheard of for an African child to go to school in the morning and die of falciparum infection in the afternoon. Understanding this adds perspective to the public obsession with other fast-acting microbes, such as so-called "flesh-eating" bacteria and the Ebola virus. The 1995 Ebola outbreak in Zaire that inspired Hollywood and transfixed the world caused approximately 250 deaths over a period of six months. More than twenty times that many Africans die every day of malaria.
Malaria parasites have spent centuries adapting to life in the human body, and as a result have grown cagey. Unlike human immunodeficiency virus, or HIV, which both infects and is transmitted by human beings, malaria parasites keep their delivery system separate from their food supply -- they do not shoot the messenger. The parasites are transmitted to human beings through the saliva of the female mosquito, which is so efficient at this task that it is sometimes described as a flying syringe. Once injected, the parasites quickly retreat to the liver, where they mature and multiply. It is not until they re-emerge in the bloodstream and invade the blood cells that symptoms appear. By this time the parasites have reproduced thousands of times. They thrash about, popping blood cells, clogging blood vessels, debilitating their host, and in some cases killing within hours.
Like HIV and tuberculosis, malaria does not elicit what is called a complete immune response in human beings: we can be infected with these microbes repeatedly, or carry them for any amount of time, without developing a full resistance to them. Nor do we develop a protective immune response to these diseases, as we do for such infections as polio, measles, and smallpox. Whatever immune reaction we develop appears to occur deep in the cell, and is devilishly difficult to elicit.
"HIV, TB, and malaria are among the most important infectious agents in the world," says Harold Varmus, the director of the National Institutes of Health. "There are no effective vaccines against them, and all have the same property of establishing chronic infection without an effective immune response." Malaria is perhaps the toughest of all, because, as a parasite, it has far more genetic material than a virus or a bacterium has. Never yet has a vaccine been proved successful against a parasite, and malaria is a particularly difficult target for a vaccine, because in each of the several stages it goes through, it has the opportunity to take hold in the host.
Because it is so deadly, the malaria parasite has wielded surprising influence over the way human beings have evolved. Sickle-cell anemia, an excruciating and usually fatal genetically transmitted blood disorder, offers the most dramatic example. Historically, victims of sickle-cell disease, who have inherited the sickle-cell gene from both parents, were generally sick much of their lives and tended to die young, often before they had the opportunity to bear children. This should doom sickle-cell in terms of natural selection, which by definition selects for characteristics that ensure that an organism will live long enough to reproduce itself. But the sickle-cell trait, which occurs in people who get the gene from just one parent, is not lethal, and in fact confers partial protection against malaria. People who have the sickle-cell trait may get sick with malaria, but they are unlikely to die of it. In some parts of Africa a quarter of the population has the sickle-cell trait -- an almost incredibly high proportion considering that a double dose of the gene is fatal. The evolutionary fact that human beings have taken on a lethal blood disorder in exchange for partial protection against malaria shows the unprecedented power of the disease.
Malaria inspires such fear that forty years ago the World Health Organization targeted it for global eradication. The United States spent heavily on the campaign, in 1958 committing $23 million a year for five years to the WHO program. Worldwide investment in the project ran into the hundreds of millions of dollars, with some Third World countries kicking in 30 to 50 percent of their health-care budgets. The main thrust of the effort was the spraying of powerful, long-lived insecticides into the interior walls of homes. Workers tramped through villages in North Africa and Asia with spray guns loaded with DDT. The target was the Anopheles gambiae mosquito, which carried P. falciparum.
Hut after hut was sprayed, and untold legions of A. gambiae were ambushed. Malaria rates went down, and hopes for public health soared. But the optimism was short-lived. It soon became clear that spraying was most effective in areas that were only marginally malarious -- areas such as Egypt and southern Europe, where the parasite had only a slippery hold. Meanwhile, for complex reasons, mosquitoes where malaria was solidly endemic started showing resistance to the insecticides.
In 1969 the Global Eradication of Malaria Program was replaced with a global malaria-control strategy. But in 1975 reported malaria incidence was far higher than what it had been fifteen years earlier. Harold Varmus, of the NIH, recalls the impact in India as particularly dramatic. "When I was working there in 1966, I saw almost no malaria," he says. "But when I returned in 1988, there was a raging epidemic. This made a real impression on me. We thought we'd licked malaria in India, but of course we were terribly wrong."
The WHO now estimates that malaria kills as many as 2.7 million people worldwide each year (roughly twice as many as AIDS), and that it sickens as many as half a billion. Children infected repeatedly with malaria over a period of about five years generally develop a partial resistance that allows them to carry the parasite in their blood without getting deathly or even overtly ill. Adults develop this partial immunity too, in somewhat less time. But this does not mean that they can no longer be infected; it means only that their bodies have learned to keep the symptoms in check. Malaria parasites have a voracious appetite and in just a few hours can suck as much as a quarter pound of hemoglobin out of the red blood cells of an infected human being. Hundreds of millions of African children and adults are chronically infected with malaria, and are anemic much of the time. Bernard Nahlen, a physician who is studying malaria in Kenya, told me that one in twenty children in the villages surrounding his clinic are so anemic that were their blood tested in the United States, they would be rushed to a hospital for emergency transfusions. Another American physician in Kenya, Patrick Duffy, says that when he has treated Africans with drugs to clear their blood temporarily of malaria parasites, the patients report feeling as they have never felt before -- that is to say, well.
SOLUTIONS THAT AREN'T
IN the main road leaving Dakar through the savanna of western Senegal traffic thins and the landscape thickens with sorghum, melon, and peanut farms. Manioc sprouts in bushy clumps, and nomadic herders thread flocks of bony goats and long-horned cattle through clumps of mango and baobab trees. Lamine Diawara, a physician, an entomologist, and a commander in the Senegalese army, pulls our pickup truck over to ask directions from a group of people selling oranges by the side of the road. One of them, a man of about twenty in a tattered knee-length tunic and a headdress, swings first a canvas sack of peanuts and then himself into the bed of the pickup. Diawara shrugs and drives on. The truck he has borrowed to make the journey is finicky and slow; we pass horse-drawn carts but no cars. Dignified in his sharply pressed military uniform, Diawara is uncomfortable with silence, and his voice is soft but urgent. Since morning he has spoken of almost nothing but malaria. "Westerners think only of HIV," he tells me. "HIV is horrible, of course. But it is malaria that keeps Africa down."
Diawara is taking me to a village where he often comes to observe and treat patients. The village is a cluster of thatched huts some distance off the main road, on a dirt track that dissolves into a grassy path. Here most of the women have infants slung on their backs, as do some girls who appear to be as young as five. Young men relax in the shade while their wives pound sorghum and sort seeds. The children crowd Diawara, who strides off to seek the elders, five of whom emerge beaming from one of the huts, hands outstretched in greeting. Speaking in Woloff, Diawara asks permission to show me around, and they volunteer to serve as guides. I ask if they have been ill lately. The head elder nods, and says he has suffered from malaria four times this season. The others indicate that they, too, have been afflicted. We visit the village clinic, a cement-block hut hung with posters promoting "safe love" in English and Arabic. Inside there are no medical supplies, no equipment, and no lights. There are no medical personnel; a teenager trained in recognizing malaria symptoms comes in from time to time to hand out anti-malaria medications. This is the best that can be hoped for in rural areas, because anti-malaria drugs are costly; often there is no money for them. Another problem is that malaria is diagnosed not by its symptoms, which are ambiguous, but by checking for parasites in the blood, which requires a microscope. There probably isn't a microscope within miles of this place. When fever strikes in Africa, it is often assumed to be malaria, and if drugs are available, they are simply administered. A child may die of measles or meningitis while being treated for malaria.
I ask for a look inside a home and the head elder takes me to his. The single room is clean and cool, and a tightly made double bed fills most of the floor space. The only other object is a billowing mosquito net, whose corners are tucked neatly around the bedposts. Bed nets impregnated with insecticide are widely touted as a cheap and easy way to prevent malaria in the tropics. Many articles and even a book have been written advocating the use of bed nets, and the WHO devotes considerable space on its Web site to the health benefits of nets. I ask the elder if he uses his. He untucks the net, poses beneath it, and asks that I take his photo. Yes, he says, he uses the net. But still he gets malaria. He loses about two or three weeks a year to the disease. He says he is tired much of the time. The other elders nod, smiling. They, too, they say, are tired.
"Nets might help, but they will not cure the problem," Diawara tells me later. We are back in the truck en route to the nearby city of Thiès. "Bed nets reduce exposure, but they cannot stop it. Not all mosquitoes bite people in bed." I ask Diawara if he uses a net, and he says he doesn't. Nor, he presumes, does the elder who posed, or any of the people we just met in the village. "The elder wanted to show respect to a Westerner," he says. "The West brought the nets. But people here do not believe that they work, and most of us do not use them. Nets keep out the breeze, and this is a very hot country."
I learned another reason that mosquito nets are unlikely to solve Africa's malaria problem from Jean-François Trape, a French physician and malaria expert on the staff of the Laboratoire de Paludologie, in Dakar. Since the early nineties Trape has studied malaria transmission in two Senegalese villages, each about four hours' drive from Dakar. One of the villages, Dielmo, has a stream running through it, where Anopheles mosquitoes breed year-round. Malaria there is rampant, and children are never without parasites in their blood. The other village, Ndiop, has high malaria transmission only during the rainy season, which lasts about four months. Dielmo residents, exposed to an average of 200 infectious mosquito bites a year, experience an average of forty-three attacks of malaria from birth to age sixty. Ndiop residents, who get roughly ten infectious bites a year, average sixty-two malaria attacks. Trape explains this apparent paradox by pointing out that the villagers of Dielmo are more likely to have the bulk of their attacks during childhood, thereby boosting their resistance to the disease. Their bodies come to an uneasy truce with malaria, in which constant infection weakens but does not kill them. Trape argues that providing people with bed nets to ward off malaria in areas where it is highly endemic may in fact increase their risk of dying from the disease, by reducing but not eliminating their exposure. The gambiae mosquito can transmit the malaria parasite in a single bite. If the transmission rate is reduced to fewer than two attacks a year, a person may lose his or her partial resistance to the disease between bouts. Therefore, Trape told me, in areas where malaria transmission is reduced but not eliminated, adults get sicker and older children die at only a slightly later age than do their counterparts where the rate of transmission is higher. "I have two children, and I can tell you, as they get older, you invest in them more," Trape said. "In African culture people prepare for the death of an infant but not a ten-year-old. The nets in many cases simply delay the inevitable."
HIÈS is Senegal's second largest city, after Dakar, but by Western standards it's a village with sprawl. The center is small enough to cover on foot in about an hour, and most of the traffic is human. Goats and chickens poke through the streets, and children stare and wave. Diawara takes me to the Service de Lutte Anti-Parasitaire, which he directs. It is housed in a barrackslike brick structure surrounding an open courtyard where women sit, fanning flies away from buckets of fish. These are technicians' wives, who live here with their children while their husbands do fieldwork. Although Diawara has a wife and four sons in Dakar, he spends most weeknights here, sleeping on a bench in his office. The office is equipped with a computer that collapses from heat exhaustion each summer. A broken air-conditioner lurks near the ceiling. There are no screens on the doors or glass in the windows, but there is a giant-sized can of bug spray. On the wall is a map of Senegal, bristling with straight pins. The pins designate areas where mosquitoes have been trapped, dissected, and examined for parasites. From the dates on the pins I learn that Senegal has been trapping and dissecting mosquitoes for about thirty-five years. Given that most of the country is swarming with parasite-carrying insects, the point of this exercise eludes me.
Diawara introduces me to his head technician, a small, neatly made man of about sixty in a stained lab coat, who bows and pulls out tray after tray of mosquitoes. The mosquitoes were snared by the men I noticed lounging in the shade in the village we visited that morning. The men are paid three dollars a session to sit with their pants legs rolled up. Their exposed legs and feet are mosquito bait (malarious mosquitoes have a preference for the lower extremities). When a mosquito alights, the man traps it in a small glass vial. In the rainy season, when transmission is fiercest, a man can trap as many as 300 mosquitoes in an eight-hour shift. Up to one percent of these carry the falciparum parasite in their salivary glands.
Diawara sweeps a plastic cover from a microscope, slips in a slide, and focuses expertly to show me falciparum in action. What appears under the microscope at this moment looks relatively benign: the malaria parasite is stained a cheery red against the dimmer red of the infected cell. But I have seen greatly enlarged photographs of malaria parasites pouring from the ghostly white hulks of dead blood cells, like soldiers fleeing a scorched-earth spree, and the sight is frightening. Fierce and sometimes fatal anemia is only one consequence of such an attack. The parasite can alter human blood cells so that they adhere to blood vessels; in the case of cerebral malaria the infected cells can occlude capillaries to the brain.
I saw children with cerebral malaria in clinics near Dakar. In one clinic I visited, every child admitted was being treated for it. The head physician there, Mouhaumadou Fall, who is also the chief of pediatrics at the University of Dakar's medical school, explained that it was "pediatric strategy to always treat for malaria, even without proof." The children with full-blown cerebral malaria looked terrible. Their eyes were unfocused under half-closed lids, and they lay absolutely still. Scientists aren't sure, but they believe that cerebral malaria causes brain damage in about 10 percent of cases, and it is estimated that another 10 to 50 percent of cases result in death. But the disease is treatable if caught early enough. One fifteen-month-old at the clinic who just days before had undergone treatment was so lively that his mother joked about stuffing him into her pocket for safekeeping.
For complex reasons, women who have acquired partial resistance to malaria lose it during their first pregnancy, and tend to get very ill with the disease. They are more likely than the uninfected to die in childbirth, and there's about a 40 percent chance that the baby will have a low birth weight. Malaria can damage the brain and other vital organs, and cause heart failure, respiratory distress, kidney failure, bleeding disorders, and any number of other systemic breakdowns. A study recently conducted in Gambia suggests that almost any estimate of malaria deaths woefully understates the impact of the disease, because the control of malaria seems to bring about a radical reduction in mortality from all causes. The implication is that infection with the parasite greatly increases susceptibility to other infections and to malnutrition. Some scientists have gone so far as to cite malaria as a contributor in half of all childhood deaths in Africa.
Mamadou Kasse, the medical editor of Senegal's largest newspaper, Le Soleil, told me that Africans assume that the West considers malaria a necessary evil. "Malaria keeps Africa down, and down is where the rest of the world wants us to be," he said. "If this was a disease of the West, it would be gone." Kasse is not alone in his belief. Several Western scientists told me matter-of-factly that population control, not disease control, is USAID's central mission in Africa. As one scientist told me in a confidential tone, "I'd rather die of malaria than of starvation."
Indeed, many Westerners assume that infectious diseases like malaria, tuberculosis, and AIDS are simply the price that the Third World must pay for its population problem. But Jonathan Mayer, a medical geographer at the University of Washington, argues that just the opposite is true -- that in effect poor health exacerbates overpopulation. "It's fundamental in demographic transition theory that higher death rates lead to higher birth rates," he says. "Lots of kids die of malaria before age five, which means that people will have lots more kids to make sure some stay alive. As an economy becomes more developed, improved public-health measures do lead to a temporary increase in population: at first the birth rate stays stable and the death rate goes down. But in as little as twenty years the birth rate goes down as well. That's what happened in the United States and Europe during the latter part of the nineteenth century. We got rid of malaria here, and a whole lot of other infectious diseases, but we don't suffer from overpopulation."
BAD AIR
This unclear how long malaria parasites have infected human beings, but there is no doubt that the disease is an ancient scourge. Medical historians believe that it appeared with the introduction of agriculture, when the human population grew large enough to serve as a reliable reservoir for malaria parasites. The Chinese canon of medicine, the Nei Ching, which dates from about 2700 B.C., discusses the telltale symptoms of high fever and an enlarged spleen, and in their writings Aristotle, Homer, and Socrates describe cases of malaria. Hippocrates was the first to associate malaria incidence with proximity to stagnant water. The term mal'aria was coined in the sixteenth century by Italians, who insisted that the disease traveled by air. The medical microbiologist Robert Desowitz wrote in his outspoken review of infectious disease, The Malaria Capers (1991), that malaria was of particular interest to the English during Victorian times -- no surprise, given that at least a third of the hospital beds in their colonies were occupied by victims of the disease. The English carried P. vivax with them to Jamestown, and imported falciparum along with slaves from Africa. In this country malaria thrived in particular in port cities like Boston and New York, and in the South. A Scottish settler described his bouts with the disease thus: "I am now & then troubled with ye fever & ague wch. Is a very violent distemper here. . . . This place is only good for doctors & ministers." Malaria was among the most common reasons for hospitalization during the Civil War, with the two sides reporting more than 1.2 million cases between them.
Precisely a hundred years ago the British physician Ronald Ross proved that malaria is carried not by air or water but by mosquitoes -- a discovery for which Ross was awarded a Nobel Prize. The fact that mosquitoes were involved made the disease all the more frightening, because water could be purified but mosquitoes could not. Malaria was all but gone from the northern United States by the turn of the century, but it maintained a stranglehold on the South. In her forthcoming monograph "Water Won't Run Uphill: The New Deal and Malaria Control in the American South," Margaret Humphreys, a physician and medical historian at Duke University, compares the American South of the early 1900s to today's developing countries, with their colonial infrastructures, weak local governments, and pockets of extreme poverty where both health care and sanitation are minimal. Estimates vary, but there were certainly millions of cases of malaria a year in the South in the mid-1930s. In 1936 the Works Progress Administration hired 36,000 men to drain three million acres of swamp. After that initial push the WPA continued its work on a much smaller scale through 1942, when the Malaria Control in War Areas agency (the predecessor of the Centers for Disease Control) was formed. Soon thereafter the Public Health Service launched an eight-year, $50 million malaria-control program.
The program was an extension of the war effort -- the idea was to protect soldiers, and only incidentally civilians. The U.S. government had previous experience attacking malaria in the field: one of the most successful anti-disease campaigns of all time was waged in the Panama Canal Zone, where in 1904-1906 U.S. military engineers and "sanitary police" worked tirelessly to drain swamps and thereby vastly reduce the area of mosquito-breeding sites. This time the goal was to create a malaria-free zone around every military installation in the United States. American pharmacologists developed the anti-malaria drugs primaquine and chloroquine as an alternative to quinine, which at the time was being hoarded by the Japanese. Mosquitoes, officially dubbed "Public Enemy No. 1" by the Public Health Service, were pelted with insecticide bombs concocted by the Army. And DDT, itself a product of the war effort, was sprayed inside millions of American homes. (No matter that American mosquitoes seem to prefer the great outdoors.) The campaign appeared to pay off, and in 1953 America declared victory over Plasmodium.
But Humphreys argues convincingly that this victory was not so much a triumph as a happy accident. She reminds us that the digging of ditches was a WPA make-work project, not a systematic effort to clean up malaria-ridden swamps, and quotes a malariologist who wrote at the time that "too often in the past, drainage ditches have been dug up hill, so to speak, by workers with no knowledge of engineering practices. Likewise, ditchdigging specialists have drained areas of little or no importance in malaria control." In the United States malaria had retreated from all but a few locales by 1942, the year the Public Health Service launched its anti-malaria campaign. Even in swampy New Orleans a malaria case that turned up in the early 1940s was rare enough to attract a crowd of curious medical students. Humphreys holds that the abrupt decline of malaria in the late 1930s came as a consequence not of ditchdigging and spraying but of the migration of vast numbers of people away from the swamps to the cities.
"It was prosperity, not massive public-health efforts, that caused the decline of malaria in the United States," Humphreys says. "That's something that's not terribly easy to duplicate in the developing world. History tells us that we can't generalize at all from the American experience. The truth is, we still don't know how to control malaria."
For the most part infectious-disease experts have come to agree that what seemed to work in the United States half a century ago will not work in the Third World today. In the tropics mosquitoes breed not just in swamps and ponds but everywhere -- in upturned soda bottles, discarded automobile tires, and animal footprints. Even if African nations had the money to drain swamps, doing so would not be enough. Large-scale spraying for mosquitoes is equally impractical in most areas, and even small-scale spraying is problematic. "Rachel Carson's legacy is not entirely positive," says Robert Gwadz, a malaria researcher at the NIH. "DDT is one of the more benign pesticides known." It is certainly among the cheapest. But it is banned or heavily restricted in most African nations, as in the United States, and the alternatives, pyrethroid insecticides, are expensive.
Even if insecticides were magically made available free to all, they would probably fail to solve the global malaria problem. The same chemicals that are used in small amounts to combat malaria are used in large amounts to keep bugs away from crops, a practice encouraged by the demands of agribusiness. Resistance to insecticides is growing rapidly, because insects have tremendous exposure to the chemicals and hence ample opportunity to develop protective tactics.
MALARIA FIGHTS BACK
EQUALLY troubling is the ability of the malaria parasite to develop resistance to drugs. Malaria has for centuries been a treatable disease. Quinine, an anti-malaria compound that is extracted from the bark of the South American cinchona tree, is one of the oldest effective pharmaceuticals in existence. Amazon Indians introduced Jesuit missionaries to the miraculous properties of the substance, and the Jesuits brought it home to Europe in the seventeenth century -- thereby, legend has it, saving the lives of many a malaria-stricken cardinal, and perhaps even a Pope or two. This so-called "Jesuit powder" is still useful in the treatment of acute falciparum malaria. But it is expensive and short-acting, has side effects ranging from dizziness to deafness, and fails to prevent relapses. Chloroquine, developed during the Second World War, killed malaria parasites and had none of the drawbacks of quinine, but resistance to it has spread throughout the world. A relatively new drug, mefloquine, a synthetic analogue of quinine, is expensive and is losing its effectiveness in many regions. U.S. doctors prescribe these drugs and others to prevent and treat malaria of various kinds.
Qinghaosu, a drug made from Artemisia annua, a cousin of wormwood which grows wild in fields and thickets across China, and a favorite of natural healers the world over, is showing the strain of overuse as well. Practitioners of traditional Chinese medicine have used qinghaosu to treat fevers for something like 2,000 years, though whether in its natural form it actually kills the malaria parasite is unclear. Like quinine, qinghaosu fails to prevent relapses of the disease, and may be neurotoxic. Gary Posner, who is the Scowe Professor of Chemistry at Johns Hopkins University, and his co-workers have synthesized a simplified version of the substance that Posner thinks may overcome these problems, but he has yet to find a drug company willing to develop it. "We have been contacted by several biotechnology companies," Posner says, "but the first question they ask is, 'Have you got a product yet?' Of course we don't. Taking this compound from the lab to the market would take from six to ten years and cost several hundred million dollars. You can't do it in a university laboratory."
Linda Nolan, a biochemist at the University of Massachusett s at Amherst, who has studied anti-parasitic plants in South America and elsewhere, argues that once a parasite has developed resistance to a drug, it is a fairly short step from there to resisting the entire class to which the drug belongs. This is why, she believes, chloroquine, mefloquine, and other drugs closely related to quinine are sinking fast. "What is needed is an entirely new class of drugs," she says. "You have to look everywhere -- in the sea, in the soil. You don't know until you look where you might find something that works." Richard Levins, the John Rock Professor of Population Science at the Harvard School of Public Health, agrees that we would do well to look to plants for insights into how to develop permanent resistance to pathogens. Plants use a spectrum of strategies to deal with predators, he says, and they never presume they have a problem licked. But scientists are also looking for ways to overcome drug resistance that don't involve lengthy trial-and-error procedures with wild plants.
A few years ago the Harvard researcher Dyann Wirth identified a protein on the membrane of the malaria parasite which helps to explain why the parasite develops resistance so quickly. The protein works like a nightclub bouncer, hustling undesirable anti-malaria drugs away from the interior of the cell. This mechanism, sometimes described as a protein "pump," is also found on the surface of cancer cells that do not respond to chemotherapy. In the case of malaria, the pump has a terrifying aspect, in that it allows the parasite to resist drugs it has never before encountered. Any drug that remotely resembles a drug the parasite "knows" to be unfriendly is, as one scientist put it, "spit out rather than sucked in."
"Unless you can reverse this pump mechanism, you are going to encounter resistance pretty consistently," Wirth says. "Right now we're trying to find a way around it." But some human cells contain similar pump mechanisms that fulfill such critical functions as preventing material in the bloodstream from going directly into the brain. What is needed, Wirth says, is a drug that works only on the malaria-parasite pump. "To find this we'd have to screen hundreds of thousands of compounds, and that requires the cooperation of a major drug company," she says. "Unfortunately, no major drug company in the world is involved in the research to develop new anti-malarials."
The dearth of new anti-malaria drugs has recently taken on a particularly urgent significance. The Thai-Cambodian border region harbors a variety of malaria that responds to no known drug. This densely forested territory has in the past decade or so been invaded by gem miners in search of rubies and emeralds, soldiers, and Cambodian refugees fleeing the Khmer Rouge. Virtually all these people come down with malaria, regardless of the precautions they take, and get very sick. Many of the refugees do not have access to medical care; some get well, and some die. But the miners try drug after drug, in an attempt to stay on their feet long enough to make their fortune before going home. This has encouraged the parasites to develop resistance, and this multi-drug-resistant malaria has spread from the border deep into Thailand and Cambodia, and as far as India, Bangladesh, and Nepal.
"Thailand has been the site where drug resistance gets its start," Dyann Wirth says. "In regions of high transmission there is resistance to all of the registered anti-malaria drugs except Artemisia, which has been recently introduced. There is evidence of multiple-resistant parasites in these regions."
Brazil is another cradle of drug resistance. Unlike Thailand, which has long been losing the battle against malaria, Brazil had greatly reduced incidence of the disease in the 1960s. But malaria returned in the 1980s, in a strain that is highly drug-resistant. Wirth told me of a town in the Amazon forest where the risk of getting malaria over the course of a year is virtually 100 percent. Gold miners here dig holes in the ground, pump them full of water, concentrate whatever gold they find with mercury, and sift through the resulting sludge. The mercury is terribly dangerous -- and so are the mosquitoes that breed in the muddy water. The Brazilian government is eager to develop this area, and offers land as a lure. Most takers come from coastal regions, and have never before been exposed to jungle malaria strains. Like the miners in Thailand, they get deathly ill. Their only recourse is mefloquine, but that may be simply a temporary solution. Mefloquine resistance was quick to develop in Thailand, and Wirth and her colleagues are grimly curious to see whether it develops just as quickly under similar conditions in Brazil.
At the conference in Dakar scientists exuded what I was told was an unusual level of optimism that the control of malaria, though not imminent, was at least possible. This hopefulness was inspired by the announcement of several new drug strategies and, more to the point, the development of a new anti-malaria vaccine. It is not the first vaccine to have been attempted; given the mercurial nature of the malaria parasite and the ubiquity of the mosquito that carries it, a vaccine is now widely considered the only realistic hope for gaining control of the disease. In a report titled "Vaccines Against Malaria: Hope in a Gathering Storm," published last year, a committee from the Institute of Medicine, a research organization chartered by the National Academy of Sciences, wrote, "Widespread application of a vaccine that can prevent the illness and death of malaria could be one of the most important advances in medicine, with the potential for improving the lives of hundreds of millions of people." It has not gone unnoticed by scientists that discovery of such a vaccine is the stuff of which Nobel Prizes are made, and competition in the field is fierce.
In the late 1980s Manuel Elkin Patarroyo, a flamboyant and charismatic Colombian immunologist, garnered headlines when he announced that he had developed a malaria vaccine, SPf66, that in a trial had protected monkeys and, to a lesser degree, Colombian soldiers from infection. A second trial in Colombia proved equally promising, and Patarroyo became a folk hero in South America, Asia, Africa, and even Europe, which showered him with praise and awards. But more recent field tests in Gambia and Thailand were disappointing. In Gambia the vaccine offered almost no protection, and in Thailand subjects given the vaccine seemed to have a slightly higher risk of contracting malaria than subjects given a control. Patarroyo, who donated the license for SPf66 to the WHO in 1995, remains adamant that his vaccine is effective. Howard Engers, the manager of the steering committee on vaccines for malaria at the WHO, told me that the agency is reserving judgment until the results of yet another trial, in Tanzania, are complete. He cautioned that the WHO is not sponsoring the Tanzanian trial, implying that it may be less reliable than earlier tests, but then hastened -- a bit nervously, I thought -- to pay his respects to Patarroyo. "Irrespective of the final outcome of SPf66," Engers said, "or of Dr. Patarroyo's apparently promising second-generation vaccines, it is clear that he and his collaborators have had a major impact on the malaria-vaccine-development field over the past ten years or so."
Not all scientists are impressed. At the meeting in Dakar several grumbled that what they saw as Patarroyo's grandstanding had in fact set the field back, by encouraging the erroneous idea that malaria had been cured. "After his announcement, the field crashed, because many governments assumed that the problem had been solved," says Carole Long, a malaria specialist in the Department of Microbiology and Immunology at Allegheny University of Health Sciences. Others hinted that WHO support of Patarroyo was due as much to intimidation as to the agency's faith in his science. Several mentioned Patarroyo's habit of accusing his detractors of being jealous racists resentful of a Third World upstart rising above his station.
"Patarroyo is a very talented, unique individual, but he's under very strong pressure and he tends to personalize things," says W. Ripley Ballou, the acting director of the Division of Communicable Diseases at the Walter Reed Army Institute of Research, who was involved in the test of SPf66 in Thailand. "Here's a guy on his own, with no FDA, no drug company, working out of an attic of an aging building, and he comes up with a vaccine that seems to protect thirty percent of people who get it. So then he builds a beautiful facility, puts a huge amount of money into a detailed characterization of his product, and puts it out there for others to test. And it turns out that in two really good trials SPf66 simply does not work. The devil is in the details."
Ballou has devoted the better part of his career to mucking around in the details of malaria-vaccine development. In January, The New England Journal of Medicine announced results from a vaccine trial that he and his group at Walter Reed designed in conjunction with scientists from the pharmaceutical company SmithKline Beecham. Volunteers were paid $600 to be injected with either the vaccine or a control, feasted on by malaria-carrying mosquitoes, and observed in a nearby hotel, where after seven days' incubation their blood was checked daily for parasites. Seven volunteers got the active vaccine, and the blood of only one contained malaria parasites -- evidence enough, Ballou says, to warrant a field test of the vaccine in Gambia. It got under way this past March.
But not even Ballou believes that the vaccine will prevent all children from getting malaria in Gambia, a densely forested sliver of West Africa floating in mangrove swamps and saline marshes. Gambia is where SPf66 and a long line of other vaccine candidates have met their Waterloo. The SmithKline vaccine was designed to counter a particular strain of malaria, not the mishmash of strains that occur in the wild. And it's not at all certain that the vaccine will stand up to repeated challenges: the volunteers at Walter Reed were infected once, but children in Gambia are infected up to three or four times a night. "This is an enormous human and scientific challenge," Ballou says. "Of course I hope it works, but I will be very happy if it fails and we understand why. This problem is really bigger than ourselves." Traditional vaccinology has depended almost entirely on making better antigens, on boosting the body's natural immune response. But in malaria the human immune response is incomplete and jagged.
"We've protected hundreds of thousands of mice against malaria, but we haven't learned to transfer that model to humans," Dyann Wirth says. "This may be a system where animal models don't teach us what's important for human disease." Richard Levins, of Harvard, says that by focusing on vaccines we are taking too narrow an approach. "Pathogens evolve; they learn how to hide in the central nervous system to avoid attack by vaccines. They change their surface chemistry regularly so that the vaccine cannot recognize them. And vaccines work only if they are used consistently. If the system breaks down, if there is a war or social unrest, vaccine programs fall apart."
Lamine Diawara also advocates a more nuanced approach, one that would contain malaria region by region, until it retreats into the background of everyday life in the tropics. "Malaria is our environment; it is part of what we are," he says. "To control it we must take care not to disturb the equilibrium, to respect the local ecology and customs, to work with human behavior as well as with science." Diawara believes that education would do much to stem the tide of the disease -- as would public-health measures such as the drainage of standing water and the judicious use of insecticides and drugs.
Pedro Alonso, a physician and an epidemiologist at the University of Barcelona, who oversaw the first SPf66 trials in Africa, explained to me how malaria was wiped out in Spain with just such a low-key approach. The Spanish Civil War, in 1936-1939, somehow prompted a resurgence of malaria in his country, and it hung on stubbornly into the 1950s. Pesticides were tried and they helped, but not enough. The Spanish stood back and reassessed the situation -- why this resurgence of malaria after war? What had been disrupted? They couldn't be sure what, but something had increased the mosquito population. The trick was to reverse the process. They stocked their ponds and lakes with gambusia, a fish that eats mosquito larvae. "Now Spain has an enormous number of gambusia," Alonso said, laughing, "but almost no malaria."
China's Hunan province, too, has beaten back malaria: its caseload fell from nearly a million in 1985 to 68,500 in 1993. No new drugs or vaccines were used; rather, a mixture of strategies was employed. Swamps were selectively drained, and malaria cases were quickly treated with both traditional and Western medicines.
But in the West early success in controlling infectious disease has bred arrogance and a belief in whopping big solutions -- vaccines and antibiotics that wipe out rather than contain. We know successful pathogens to be highly evolved and clever creatures, but we bluster about, attacking them as though they were the dumb, plodding aggressors that perhaps we ourselves are. When a microbe mutates around our onslaught, we go off in search of a bigger weapon with which to blast it. But like all re-emerging diseases, malaria has managed not only to dodge the bullets but also to turn the revolver back on us. Our attacks have made the parasite not weaker and less certain but more virulent. Controlling this disease requires vigilance, patience, and, to a certain degree, sacrifice -- there are places we might have to avoid. There are tradeoffs to be made, but so far we've shown ourselves reluctant to make them. Scientists pursue their quest for an effective vaccine or a more powerful drug while treasure hunters of another kind in Thailand and Brazil help the disease find a new foothold. Whether the scientific adventures will eventually pay off is uncertain, but for now there's no question that a price is being paid. Malaria, an ancient disease, a controllable disease, is spreading.
Links
Ten Africa Countries Lower Taxes to Prevent Malaria.
http://www.basics.org/new/jtb/v1/ten.html
Malaria's New Deadly Toll.
http://www.speakeasy.org/wfp/40/malaria.html
Malaria and the Red Cell.
http://sickle.bwh.harvard.edu/malaria_sickle.html
http://csmeh.mc.duke.edu/publications.html
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The Atlantic Monthly; August, 1997
Finance & Development: A quarterly magazine of the IMF September 1998, Volume 35, Number 3
Public Spending on Human Development
Sanjeev Gupta, Benedict Clements, and Erwin Tiongson
Social indicators are improving in many developing countries as public spending on education and health increases. But a greater share of investment in human capital should be channeled toward primary education and preventive health care.
PUBLIC spending on education and health, because of its positive effects on the formation of human capital, can boost economic growth while promoting equity and reducing poverty. How productive and beneficial spending on education and health is, however, depends on how funds are allocated within these sectors.
Compiling the data
The analysis of trends in public spending on education and health in developing and transition countries, and of the effectiveness of such spending in fostering human development, has been hampered by the lack of comprehensive data covering a large number of countries. For its internal use, the IMF has compiled consistent cross-country data on education and health spending for a sample of 118 developing and transition countries, 66 of which are implementing or have implemented IMF-supported structural adjustment programs. Of the 66, 32 are low-income countries with programs under the IMF's Enhanced Structural Adjustment Facility (ESAF).
Cross-country comparisons of government spending on education and health must be made with caution. What is covered by the data may vary from country to country, and data on local government spending are rarely available. Much of the available information on the sectoral composition of expenditures is not consistent with the best available estimates of total spending on education and health. In addition, the fact that data on social spending exclude private sector outlays-which are substantial in many countries-needs to be kept in view when interpreting the relationship between government social spending and social indicators.
Data from a sample of 118 developing and transition countries (see box) show that, since the mid-1980s, real per capita spending on education and health has increased, on average, in developing countries, but decreased in the transition economies. Comparable increases can be observed for countries that had IMF-supported adjustment programs during the same period. However, a relatively high percentage of public spending is allocated to tertiary education (post-secondary and university level) and curative health care. Thus, there is scope for improving social outcomes by changing the composition of public expenditures.
General patterns
In the latest year for which data are available for our sample (1996 in most cases), public expenditures on education averaged about 4 percent of GDP and 14 percent of total government spending (Chart 1). While there was little variation across regions, there was considerable variation from country to country: the standard deviation from the mean was about 2 percent of GDP. Health expenditures were lower than education expenditures (about 2 percent of GDP), with greater variation from region to region and somewhat higher fluctuations from country to country (the standard deviation was 1.6 percent of GDP) relative to the mean.
On average, education and health spending has been increasing in the 118 countries as a group, as a share both of GDP and of total government spending (Chart 2). Real per capita spending on education and health rose by 0.7 percent and 1.3 percent a year, respectively. These real spending figures, which are calculated on the basis of each country's GDP deflator, provide proxies for the volume of education and health services. (Specific deflators for the education and health sectors, based on a breakdown of social spending into wage and nonwage components, are not available.)
Spending on education and health as a share of GDP increased in most regions but declined in the transition countries. There were large increases in real per capita social outlays in Asia and Latin America and the Caribbean, while sub-Saharan Africa and the transition countries experienced either moderate increases or decreases (Chart 3). However, social spending as a share of total government expenditures rose in all regions.
Countries with IMF-supported programs
In our sample, countries with IMF-supported programs experienced comparable and, by some measures, sharper increases in public spending on education and health. Increases in spending in low-income countries with programs supported by the IMF's Enhanced Structural Adjustment Facility (ESAF) cannot be attributed solely to foreign loans and grants, which have remained constant, as a share of GDP, since the onset of IMF-supported programs.
Education. Comparing the latest year for which data are available and the year immediately preceding the adoption of an IMF program (a period averaging 8 years), education spending rose as a share of GDP on average in the 66 countries with IMF-supported programs. Though modest, spending increases in these countries were comparable to the average increases for the 118 developing and transition economies as a group. And, because they occurred during the implementation of adjustment programs, which often require fiscal consolidation to restore internal and external balance, these small changes represented proportionally larger increases in education spending as a share of total spending (Chart 4). Real per capita spending has also increased, on average, in the 66 countries.
Changes in education spending in the 66 countries with programs varied substantially from region to region: real per capita outlays increased in Asia and Latin America and the Caribbean but fell in sub-Saharan Africa and the transition countries. The drop in real per capita outlays in sub-Saharan Africa reflects reduced education spending in some CFA franc zone countries following the 1994 devaluation of the CFA franc; however, these spending cuts were due to a drop in real wages for teachers and the departure of expatriate teachers, and do not necessarily indicate a decline in the provision of education sservices. The decline in spending in the transition countries may reflect not only falling government revenues but also some convergence toward other regions' levels of spending on education, since the transition countries generally had much higher preprogram spending averages to begin with.
Health. A similar analysis of health spending indicates that outlays rose in the sample as a whole, both as a share of GDP and as a share of total government expenditures. Health spending as a share of GDP rose everywhere except Asia and the transition countries. The decline in Asia owes more to rapid economic growth in the region than to a reduction in real spending. The sharp decline in health spending in transition countries, however, mirrored the decline in total government spending in these countries and has evoked concern about the impact of cutbacks on the poor's access to health care and the health status of the population in general. Not surprisingly, real per capita outlays on health increased everywhere (with especially sharp increases in Asia) except the transition countries.
Social indicators in program countries
There is a growing consensus that human development and the well-being of the poor should be measured through the monitoring of selected social indicators. Toward this end, the Organization for Economic Cooperation and Development, the United Nations, and the World Bank, together with developing countries, have identified a core set of indicators, including some in the areas of education and health. Caution must be exercised in analyzing changes in these and other indicators, because of limited data and of changes over time in the methodologies used. Furthermore, social indicators are influenced by a host of factors other than government expenditures, including household income, general economic conditions, improvements in health technology, and the activities of nongovernmental organizations and other private sector service providers. In addition, the efficiency of spending and the degree to which spending is targeted to needy groups also have an impact on social indicators. Notwithstanding these caveats, it appears that increases in public spending on education and health in countries with IMF-supported programs have coincided with sizable improvements in education and health indicators (see table).
Selected social indicators in countries with IMF-supported programs, 1986961
(Annual percent improvement; number of countries in parentheses)
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Sources: UNESCO and World Bank databases.
Note: The total number of countries is larger than the sum of the regions because of the exclusion of regions with small samples. Differences in the rates of improvement across indicators may reflect rounding errors, differences in sample sizes, or differences in the methodologies used (for example, survey methods versus models).
1 Based on program countries for which spending and social indicators data are available. For some indicators, countries with internal strife were excluded.
2 Some countries were excluded because large changes relative to a small preprogram base would have yielded unrepresentatively large percentage changes over a short period.
The illiteracy rate, for example, fell 2.4 percent a year, on average, in the 66 countries with IMF-supported programs. Gross enrollment rates in primary and secondary schools rose in the 66 countries as a group and increased even more rapidly in ESAF countries. Increases in female enrollment rates in secondary schools were particularly sharp. Net enrollment rates also increased, on average. The repeater rate at the primary level and the percentage of students who stayed in school through the fourth grade (proxies for the quality of education and educational attainment) improved, although the repeater rate at the secondary level showed less improvement.
A number of health indicators, including life expectancy and infant mortality rates, also improved. Access to health care and immunization rates in the 66 countries with IMF-supported programs increased by more than 4.5 percent and 6 percent a year, respectively; improvements in these indicators were even more impressive in the ESAF countries. However, the percentage of births attended by trained health personnel declined, and progress in reducing maternal mortality rates varied considerably across countries and regions.
The ESAF countries enjoyed higher rates of improvement on many social indicators than the 66 program countries as a group; this may reflect some catch-up by lower-income countries. Likewise, regional variations in performance may also be partially attributable to preprogram differences. The transition countries, for example, had high rates of school enrollment and low repeater rates before they embarked on IMF-supported reform programs. Other regional differences do not appear to have a simple link to preprogram conditions, however; for example, sub-Saharan Africa has experienced more modest improvements in life expectancy and infant mortality than other regions, while Asia has achieved above-average improvements in education and health indicators.
In the transition countries with IMF-supported programs, falling public spending appears to have had a negative impact on most education indicators. Key health indicators also declined in some of these countries, but improved, on average, in the group as a whole. This may reflect improvements in the efficiency of public spending and/or increased spending by the private sector.
Intrasectoral spending patterns
An analysis of data shows that, while spending on education and health has increased and social indicators have improved, a substantial share of such spending is still allocated to tertiary education and curative health, subsectors with relatively lower rates of social return that disproportionately benefit higher-income groups.
Education. The social rates of return on investment in education are measured by the full cost and benefit (both public and private) to a society of providing education. Studies have consistently confirmed that, in general, the social rates of return are highest for primary education, followed by secondary and tertiary education.
In the latest year for which data were available, the average share of education spending allocated to tertiary education in 46 countries in our sample was 21.2 percent (Chart 5, top panel). The transition economies, followed by sub-Saharan Africa, allocated the largest share of education spending to tertiary education. While it is difficult to establish appropriate spending levels for different types of education, the Asian countries in our sample devoted a relatively lower share of their education budgets to tertiary education. This may be one reason why Asian countries with IMF-supported programs have experienced some of the sharpest improvements in education indicators.
Health. Preventive care is often the most cost-effective type of health intervention for improving the health status of the poor. Government spending on health, however, goes disproportionately to the nonpoor in the form of high-cost public hospital care and not to preventive care. Our sample of 33 countries (Chart 5, bottom panel) reveals that almost two-thirds of health spending is absorbed by curative care. (Since figures on curative spending as a share of health outlays are hard to come by, expenditures on hospitals and medical equipment served as a proxy.) Countries in sub-Saharan Africa, on average, allocated the largest share of their health spending to curative health. This may partly explain why the sub-Saharan African countries with IMF-supported programs have experienced more modest improvements in life expectancy and infant mortality than other program countries.
Conclusion
Recent data on public spending on education and health suggest that real per capita expenditures for education and health have been increasing in developing countries, on average, but declining in transition economies. Increases in public spending on education and health in countries with IMF-supported programs have been comparable and sometimes larger than in other countries, despite the fiscal consolidation often required by adjustment programs. These increases have been accompanied by tangible improvements in social indicators. But a sizable portion of public spending on education and health is devoted to higher education and curative health services. Thus, in a number of countries, increases in spending for primary education and preventive health can ensure that the benefits of social spending are distributed more equitably while accelerating human development.