Under Five Mortality Rate

Under Five Mortality Rate
June, 2010

I remember the panicked look on her older brother’s face as he rushed into the hospital, cradling his unconscious sister in his arms. “Me sistah noh well. We need hep.” he said in Krio, the local language of Sierra Leone, and placed her on the small exam table that we had in triage- the area under the landing in the Ola During Children’s Hospital in Freetown. Her head flopped back like that of a rag doll. After confirming she had a pulse, I scooped her up in my arms, carefully supporting her head, and weaved through the crowd blocking the route to the ER. As I burst through the doors, I scanned the room for an empty bed while calling for a doctor’s help. As I lay her down and grabbed a pulse oximeter from a nearby nurse, I noticed her breathing becoming increasingly shallow. I took her vitals but she barely had a pulse. And then she stopped breathing. The doctor barked at me to get a resuscitator. Holding the bag, I pumped oxygen into her lungs and the doctor pressed down on her chest. Perhaps my eyes were trying to fool my brain, but I could have sworn that I saw her take one last breath. But instead of her pulse rising, a white substance came oozing out of her nose and mouth. Another attempt to revive her yielded similar results. The doctor shook his head sadly and called time of death before moving on to the next patient, a little boy who was convulsing as a result of untreated (and what would be fatal) malaria.

I was left standing next to the girl, my hands shaking, willing myself not to burst into tears.   

In that moment, I wanted nothing more than to go home, lay in my bed, put my head in my pillow and cry. I wanted to buy the next ticket back to New York and to never look back, to forget everything I had learned, to erase the face of that little girl from my mind and to block out the sadness that was overwhelming me. I wanted to undo everything-to rewind to that day when I was nine and had so proudly and confidently announced that I was to become the Secretary-General of the United Nations. I wanted to take back the summer of 2002 in Tajikistan and Uzbekistan, the teaching job in Rwanda, the memories of the orphanage in Vietnam. I wanted to unlearn everything I knew about development and the economics of growth that persisted in reminding me that change would be slow. I wanted to purge myself of all the dinner conversations with the heads of UN agencies in Sierra Leone and with NGO workers I had befriended. I wanted to free my mind of the debates I had entangled myself in about the very merits of the sector that seemed to have long ago sucked me in.

Instead I turned away from the bed and away from the girl and slowly walked out of the ER, past the nurses hurrying about with syringes and bandages and oxygen tubes, through the throng of hysterical parents, down the concrete ramp and back to the cramped and ill equipped triage to resume my duties. Eventually the girl’s parents came; the sobbing mother had the colorful cloth with her that I knew would act as a shroud and indeed later, the father emerged with a little bundle.

Returning to New York and suddenly being surrounded by running water, reliable electricity, paved roads, fire trucks and the expectation that, bar some freak accident, we’d survive to celebrate our 40th birthdays, was jarring. I had a hard time in the dark, from which the forms of the youngest victims of the decrepit healthcare system emerged and I wasn’t entirely comfortable with absolute silence when the heartbroken wails of parents echoed in my brain. Colorful curtains forced images of the makeshift coffins from the deep recesses of my mind straight into my vision and intruding my thoughts and sensibilities.

But sitting in class at New York University, where I went at the time, and wandering around Washington Square Park seemed foreign and empty. My classmates were thrilled to be at NYU, titillated to take advantage of the sudden freedom that college offered and anxious for classes. I wouldn’t describe myself as jaded nor would I assert that somehow college wasn’t new and exciting for me too; it was. But the life I had left behind in Sierra Leone wouldn’t let me return to the life that I had lived in New York. Even more than my previous exposures to the developing world, Sierra Leone left me with the unwavering feeling that I would never be able to rest easy while idle.

The metrics of development aren’t merely statistics- I know what an under-5 mortality of 192 feels like. 

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COINs & Nigeria (Part I)

COINs & Nigeria

May, 2013

When I tell people that I started my trip this summer in Nigeria, I’m met with a mix of reactions. Some people express jealousy at my having had the opportunity but most people express disbelief and concern that I was given permission and took the opportunity to visit the strife ridden country. And given the news coming out of Nigeria, I can understand this. Today’s Google news hits for the search term ‘Nigeria,’ barring sports and Big Brother news, turns up the following dismal headlines: “Nigerian army says kills 150 insurgents, loses 16 troops,” Archbishop Ignatius Kattey freed by Nigerian kidnappers,” and “Nigeria's Boko Haram unrest: Scores killed in Borno state.”

This May, three states within Nigeria, Borno Yobe and Adamawa, were declared to be in a state of emergency by President Goodluck Jonathon and in June, were added to the United State’s ‘Do Not Travel’ list, around when I left Nigeria. Two years ago, almost to the day I left South Africa to come home, the United Nations building in Abuja, where I spent most of my time, was bombed, killing at least 21 people. In March 2012, 12 public schools were set ablaze during the night, robbing 10,000 students of their education. Almost weekly since 2011, bombs go off in churches, schools or police stations in northeastern Nigeria.

The perpetrators of these attacks are a group known as Boko Haram, whose insurgency has killed an estimated 3,600 people since 2009 when their militant activities began after operating peacefully for a number of years prior. Little is known for sure about Boko Haram, their intentions and their membership. They are infamous for their persistent and bloody attacks in northern Nigeria and claim to be fighting against corrupt, false and irredeemable Muslims who they accuse of having corrupted the country. They claim to be fighting for a “pure” sharia law run northern Nigeria. The attack on the United Nations was an outlier on the group’s normal hit list, which focuses on soft targets like schools, churches and police stations. A public outcry forced the President Goodluck to launch an offensive against the group that has been characterized by a lack of access to the media resulting in a near media blackout, by military reports of “successes” and by brutal and counterproductive raids of Boko Haram camps and villages. Extrajudicial executions have bred fear among ordinary people living in Boko Haram strongholds and have pushed people to support the organization even as they continue to carry out bloody attacks.

The ‘war’ waged by and against Boko Haram is sadly not the only outbreak of conflict that Nigeria has seen recently. Plateau state has seen outbreaks of bloody clashes since democracy in 1999, riots have broken out in the urban centers of Kaduna and Kano, for decades there was conflict in Bauchi and, the oil-rich Niger Delta has been the stage for ongoing conflict for years. And of course, nobody can forget Nigerian-Biafran War. ‘Experts’ in the media often reduce these conflicts down to religious battles between the Muslim and Christian populations that reside side-by-side in Nigeria. A closer examination, however, reveals intense and high-stakes fights for control over different parts of the government. Violence can often be traced to one group seizing control of an element of the government over other groups in the ethnically diverse country. Given the system of patronage, control over the government means control over much of the resources.

Conflict happens for a reason. Only desperate people commit acts of heinous violence or protect the perpetrators, like what we are seeing in the news coming from Nigeria. Poverty, a sense of terrible injustice and great inequality can lead to the despair that will make people turn to organizations like Boko Haram. What the USA should have learned about efficient and humane counterinsurgency in Afghanistan, the Nigerian government should learn now in Nigeria. It isn’t about going into destitute villages and rooting out insurgents at the expense of the “hearts and minds” of the local population. Violence, no matter how swift and effective, will, at best, do nothing (to a certain extent, there’s always someone to replace that insurgent you’ve just killed) and, at worst, exacerbate an already tragic and violent situation, as we are seeing now. Instead, answers need to come by looking at what is driving the violence. I do not believe that anywhere near the majority of people who provide cover for Boko Haram want what Boko Haram claims to be fighting for. We need to begin addressing the real issues that are fueling conflict – ranging from corrupt government policies, high levels of inequality, rampant poverty and a lack of hope among the people.

An insurgency is, by definition, “an organized rebellion aimed at overthrowing a constituted government through the use of subversion and armed conflict.” Counterinsurgency (COIN) is then the type of nonconventional warfare that aims to combat an insurgency. Traditionally, COIN comes in two flavors: enemy-centric and population-centric. Briefly, enemy-centric COIN is only a shade different from convention warfare and focuses on combating the enemy and worrying about the ‘other stuff’ later. Population-centric COIN focuses on control over the population and environment involved. Modern COIN often falls somewhere in between, employing a little of both with an emphasis on “reading the insurgency.” What defines COIN against conventional warfare is not just the type of enemy but also the type of response. An insurgency is (usually) not looking to expel an organized army or invade a distant country for resources. It seeks to overthrow and replace an existing government by subverting existing institutions and turning the population over to their side. Counterinsurgency, therefore, needs to eradicate this enemy while maintaining control over the population. One of the major challenges of counterinsurgency is differentiating between the enemy and the population and knowing who to target with what kinds of offensive tactics.

Counterinsurgency, like insurgency, also isn’t a new. It has a colonial past, dating back to the 1ate 1840’s and the French in North Africa. But my interest doesn’t lie in its past so much as it does in its post colonial future and what is considered by some to be the “counter-insurgency era”.

Counterinsurgencies today are taking place all over the world – though many governments refuse to use the word because of its connotation and linkages to a long, arduous, “boots on the ground” battle. Afghanistan and Iraq aside, we are witnessing insurgencies in places like Syria, Mali, Somalia, the Philippines and most recently in Egypt. I would also argue that what we are seeing in northern Nigeria is in fact an insurgency and therefore what needs to happen there, and what is not happening there now, is a counterinsurgency technique.

While well read, I am not fluent in counterinsurgency and I don’t know exactly what a counterinsurgency should look like in Nigeria. But I feel confident in saying that what is going on now and the tactics employed by the Nigerian army are not in line with what should be going on. Working with, not against, the population, building up reliable and efficient institutions, working to alleviate poverty and other underlying causes of discontent and finally, ending the senseless violence against the population would be one place to start. The Nigerian government needs to rethink its strategy against Boko Haram quickly before we see an escalation and spread of the violence.

This isn’t an easy task. But its also the only sustainable solution to a conflict that has already taken too many lives. I want to go back to Nigeria, soon. I want to be able to visit the north without an armed guard. And I don’t think the current trajectory will enable that.

This is arguably one of the more political, if not even controversial, pieces I have posted on my blog. I implore you, if you’re reading this and you disagree to write a comment challenging me. If you prefer privacy, email me. This is a topic that I feel strongly about and I welcome a conversation about it.

As mentioned, this is also Part I of this topic. I look forward to some (more) feedback before I proceed to begin to draft Part II, which will be much more focused on COIN in Nigeria specifically.

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The Deserted Island

The Deserted Island

September, 2013

Walking through the streets of Isla de Mozambique feels like walking through a museum that hasn’t been curated or cared for in years. The houses look like they should be beginning to crumble yet they stand defiant, proud and strong in the face of years of neglect. Hugging the island are beaches, graced by white sand, unspoiled and ungroomed, and blue water, warmed by the sun. Connecting one end, where you can find the grandiose abandoned houses of the Portuguese, to the other, where most of the Mozambicans live in shacks with tin roofs, are dirt roads flanked by concrete sidewalks, varying in quality and the number of potholes. There are a few modern fixtures, including a nightclub and a cell phone store, but most of the island seems to be from a different era.

Isla de Mozambique was originally an island held a Bantu tribe. In 900 AD it was occupied first by Arabs, looking to set up trading posts and then by Portuguese, for whom it was a key trading post en route to India. Following a prosperous period marked by economic expansion and architectural development, including the building of mighty fortresses that remain today, Isla fell into decline in the 17^th century. But as the demand for slaves across the world grew in the second half of the 18^th century, so did Isla’s economy. When the capital of Mozambique, a colony at the time, was shifted to Maputo (where it remains today) the economy again slowed down. But what truly brought Isla down to its knees was the sudden evacuation of Portuguese, many of whom identified themselves as Mozambican at the time, at the time of independence. In 1975, FRELIMO, in what Wikipedia has coined “an act of vengeance”, ordered all Portuguese to evacuate the country within 24 hours with only 20 kgs (44lbs) of belongings. Houses were locked up and abandoned and many seem to remain untouched from that day.

To me though, Isla de Mozambique was a soft bed at the end of a long journey, a cold drink after a rough day or a refreshing dip in the ocean after toiling in the sun. It was, in a word, paradise. I wake up early, when the sun wasn’t yet too hot, and go sit on the roof of the hostel and read a book with my coffee and cigarettes. The sun kisses my bare arms and legs and my eyes begin to get heavy and the words in my books turn to cloudy drops of ink and eventually and inevitably, I doze off. 

In my sleep, I find myself walking through Isla in its many high points. The houses, splendid in their size and architectural design, tower above me, not like NYC skyscrapers in their steel casings and sharp corners, but more kind and soft. The hustle and bustle of the streets is full of energy and vibrancy. The parks are teeming with children, holding hands, skipping and singing, as kids can only do in dreams. I walk along the carefully manicured streets and under the shadowy protection of trees but the further I get away from the houses, the more the scenery changes. Suddenly, I find myself at the tip of the island where the fortresses are. They seem to be flexing their muscles with their high walls and circling guards but I’m not the threat. They face outwards at the sea, keeping an eye out for intruders. I turn and slowly wander away from the fortresses and the stone houses and the transformation is immediately obvious. No longer is the street teaming with Portuguese dressed in elegant summer clothes bristling with excitement at the debutante ball tomorrow, but instead its crowded with Mozambican men carrying recently caught fish, kids playing with homemade toys and women headed in the opposite direction, on their way to work in the houses of the rich. Where the houses were once stone, they are now straw. It isn’t a depressing scene per se but there is a tangible difference from earlier.

When I eventually rouse myself from sleep, it’s time to explore the depths of the island and to go for a swim in the Indian Ocean. The heat has gotten intense now but the weather is dry and there’s a light breeze. This isn’t the NYC heat that makes your clothes cling to you and your hair stick to your forehead within minutes. Instead it’s a pleasant heat. Granted, it’s the winter here and I can’t imagine how hot it gets in the summer but for now, its bearable and even enjoyable.

The first few days, the streets were usually pretty empty, save for a few kids fooling around and some stray dogs. The dogs were particular fun to watch. They had their block that they guarded so that if you wandered onto it, you would immediately be surrounded by barking dogs. But they kept their distance and never got close enough to feel properly threatening. All bark and no bite.

The best walk was to the old fortresses. I only saw the outside of the fort and didn’t venture inside but there was still enough to see and take in. It seems the fortresses from my daydream have aged quite a bit, albeit very well. Restoration efforts are being undertaken to preserve this UNESCO World Heritage Site and you can begin to see the patchwork on the outer parts. Indeed here more so than anywhere else, the restoration efforts seem to not be disturbing the beauty of the original architecture. In fact, one amazing thing about Isla is that in all of its years of development and decay, the same building techniques, the same materials and the same principles were unwavering stuck to, giving the island a sense of unity through time.

Finally I reach the dock, strip down to my bathing suit, carefully climb down the stairs and dive in.
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Zen and the Art of Public Transport

Zen and the Art of Public Transport
September, 2013

I’m on a bus again. But this time I have two seats to myself, there’s semi-functioning wifi and AC, and the driver is certainly not drunk. How different this experience will be from my last few bus rides! In the past four months, you see, I’ve spent hours on buses. But not luxurious coaches like the MegaBus I’m sitting on right now. They’ve ranged from bicycles to motorcycles to automobiles acting as buses, to minivans to actual full sized (though not fully operational) coaches. I’ve stood for 6 hours on one ride (in the aisle precariously balancing my bag between my legs and clutching the bar above me as hard as my broken thumb can stand), been squeezed into a passenger car with five others in the back seat (we ended up driving through puddles so deep that the tires just spun futilely in place) and sat/sslept (impatiently) for 36 hours in a coach (we drove first for 10 hours with many bathroom and food breaks, then waited for the military convey to resume, in the dead of night in a town on the precipice of disaster before resuming the drive for another 16 hours). Yet I don’t mourn the time spent on these various forms of public transportation, for that is at the end what they all boil down to, but instead value the things that I learned while trapped in these different rolling death traps (which I say because car accidents are the leading cause of expat injury and death in Africa).

You are probably wondering: My, what on earth could you learn from sitting on a bus/car/motorcycle/minivan/bicycle for 1-36 hours with your legs cramped up in the minimal leg room, your neck sore from the bumps/humps/pot holes in the paved/unpaved road and with your stuff safely/unsafely stored in the small area above your head/by your feet/in the weird open trailer in the back/on your back?

There is an art to gainful use of time on public transport and it is tied into ones ability to people watch (while staying upright). I think I gleamed more about the cultures of the different places I visited from the way people interacted with each other and with us than I could have in any other casual way. For example, in Mozambique, I learned from sitting on the bus that the authority is suspicious of tourists. As we were entering the line to wait for the military convey to take us through Mozambique, a soldier came aboard the bus to do a glance over the passengars. Presumably, his job was to check for suspicious people, firearms or other menacing looking things that might cause ire in an area striken by a sudden bout of rebel activity and violence. Instead, he instantly spotted us, sitting looking beleaguered, hungry and tired, and made a be-line for the back where we sat, me curled up into the fetal position with my legs tucked into the crevasse in between the seats and James folded over his Kindle pouring over the Stephen King series that has caught his attention. He asked us, in Portuguese, for our passports in a voice that sounded as beleaguered, hungry and tired as we looked. If you’ve never heard Mozambiquean Portuguese, imagine someone with a strong Russian accent bantering in Spanish. Finding us unable to understand/respond quickly enough, he gruffly indicated to us to show him our papers. He took the documents and leafed through this rapidly, not looking for anything in particular but wanting to make it look like he was. Unlike the police in Nampula, who demanded of us our papers three times in the span of our fifteen minute walk from the bus depot to the hostel, he didn’t turn to our visa to ensure that we were legal. He returned them to us and walked off the bus. There was no rifling through the bags to check for RENAMO paraphernalia or looking into our eyes to detect a rebellious spirit. He just wanted to make the motions, it seemed, of making us feel as unwelcome, a feeling that we found in all the authority figures in Mozambique though in none of its people.

On the bike ride from the Malawian border to Milange, on the Mozambiquean side, I learned that everyone likes to fleece tourists, even when they turn out to be kind and reasonable people. We arrived at the border, coated in bus and grime from the previous ride in a minibus in Malawi, and eager to get through the border security and into a lodge where we could take our first showers post our ride to Mulanje, our hike up (and down) Mt. Mulanje and the trip to the border (a total of four days), only to find that the visa for Mozambique was a whooping hundred USD or 2,175 meticais (a notably lesser sum). We needed to go to the atm in the next town, on the Mozambique side, to withdraw enough cash to buy our way into the next country. The only people offering rides were two friendly looking men on bicycles. In desperation, we didn’t negotiate a price before mounting and beginning the slow cycle into town on the back of the two men’s bikes (we had to leave the thired comrade at the border as insurance). In town we were greeted by a political rally on the right and signs welcoming the president high above. Our judgment clouded by the haze of exhaustion and the desire to finally see the real color of our hair (mine was now a light copper color from the dust), we did not pay heed to the warning that something in our plan was about to go badly wrong. Only later, after we had visited the first guest house to the manager telling us it was full, the second to find the manager indicating that it was fully booked and the third to manager just chuckling at our request, did we realize that we were in trouble. The president’s men had stolen our cleanish beds and showers. Still, our bicycle taxi men followed us, determined to stick with us till we found a place to lay our weary heads and wet our dry mouths (showers were no longer a priority). Ultimately, they suggested an idea so wild, so crazy, so local that it might just work. Our final stop was the chapa (mozambiquean for minibus) depot. Here we bravely walked up to the first chapa and asked if we might sleep in his van for the night and then leave with him in the morning. He agreed to the plan and we bought our tickets and lay down our bags. We paid our taxi men and, after three hours of back and forth and searching, they left us to our own devices. Only later did we learn that we had paid them about ten times what we should have. (We also didn’t end up sleeping in the vans as we were saved by a PeaceCorps angel who found us and gave us a bed for the night!)

In Botswana, I learned getting lost in a combi (Botswanan word for the very same minibuses) could lead to a great night out. We had had every intention of making it the movies for a calm night in. But we were running late so, without checking with the driver thoroughly as to his direction, we hopped into a combi, dutifully paid the three pula per person fee and sat back (and squished in). Only about twenty minutes later did we realize that we were not headed in the right direction anymore. Another ten minutes later, we hoped off, not knowing where we were but not too worried about it either. In the distance we saw the neon glow of a bar sign and headed in that direction, like moths to a flame, to discover a karaoke bar – a successful night.

I learned about the culture of sharing from sitting on the bus and watching food be passed around from the window, where it was purchased, by the lucky window seat owner, to the center, where the purchased stood, followed by the commission free passing of money back to the window and finished off with the sharing of food between the purchased and the others.

But I think that the most prevalent lesson I learned was luxury of personal space. Who needs to be able to stand up straight, sit on your own seat or breath unobstructed anyway?
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