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Better dead than deflowered

Better to contract HIV/AIDS than to spill his seed in a condom. Or so espouses the Catholic Church. Their opposition to contraception has contributed to millions of deaths worldwide (not to mention millions of unwanted babies). Latin America, home to 1.1 billion Catholics and 1.7 million people with HIV/AIDS is just one example. The region recorded 410,000 new cases in 2006, up from 320,000 new cases in 2004. Alberto Stella, UNAIDS coordinator for Honduras, Nicaragua and Costa Rica, considered why:

"In Latin America the use of the condom has been demonized, but if it was used during relations I guarantee the [HIV] epidemic would be eliminated in the region. ... The fact that young people become sexually active between the ages of 15 and 19 without any sexual education contributes to the spread of the virus, and evidence shows that abstinence does not work."

The Catholic News Agency, in reporting the news, insinuated that Alberto Stella put the blame on the Catholic Church to avoid admitting "the failure of the UN to stop the disease." So who's right in this blame game? To dissect: Two position underlie the Catholic view: (1) that abstinence is best, and (2) that 'abstinence education' can effectively teach people to be abstinent. The second claim is patently false. Numerous studies demonstrate that 'abstinence education' (I'm not relinquishing the scare quotes) isn't actually educating people. The first claim, by contrast, is ideological, and I won't dispute it. People have many views of the good life. The burden of liberalism is to construct a society where alternate views can flourish. So I respect that some people want to wait till marriage to breach that physical intimacy. But at risk of shedding my liberalism, I have no tolerance for those who impose their view on others (under threat of eternal damnation, of course) at the cost of real human lives. I will defend anybody's right to be wrong, but not to do wrong.

Note: previous post on religion's pernicious effect on women's health.

Like winners

My team lost our ultimate frisbee game last night. Final score: 15-13. But we came back from a 8-3 deficit to score 10 points in the second half while they scored only 7. At one point, it was tied 13-13! So, strangely enough, the winners felt like losers and the losers felt like winners.

Something frustrating: One of my teammates doesn't seem to realize how terrible a player she is. She routinely positions herself at the back of the stack, making her responsible for the first cut. But she can't beat her defender and just ends up clogging the lane. And she can't catch very well. Three times I saw the disc float beautifully into her hands - and then bounce off and onto the ground. Even if she does catch it, she can't throw it. What never ceases to surprise me, some six weeks into the season, is how oblivious she is to her own ineptitude. She picks up the disc on a turnover instead of leaving it to a more experienced player. I've sometimes heard, as inspirational advice: What would you try to accomplish if you were blind to your limitations? But at least on the frisbee field, that seems like lousy advice. My guess is that her mistakes singlehandedly cost our team three or four points, i.e., the game itself.

Still, I love this game of ultimate, even when we lose.

Lest I leave on a sour note, let me add: I have a tremendous job that I love. It's a constant stream of research requests, complemented by all sorts of lectures (next month on Abu Ghraib and medical ethics), advocacy talks (last week on single-payer health care), and even poetry readings (this morning, former US poet laureate Donald Hall). I'm headed south to DC tonight for the annual conference of 'bioethics professionals,' so to speak. I'll be staying with my folks, catching up with old friends, and living large. So this page will be quiet for a week.

Global warming and genocide

Check out this powerful ad, titled "You're Making a Killing in Darfur," from the Save Darfur Coalition, a fantastic and hard-working organization that sends me too much email.



The big news this week is that Al Gore (pictured) and the U.N. Intergovernmental Panel on Climate Change, headed by Rajendra Pachauri (pictured below) have been awarded the Nobel Prize for Peace. The Nobel choice is a reminder of how rouge leaders can manipulate ecological deprivation to foment ethnic tension. Climate change, which can bring droughts and shift agricultural lands, will augment the risk of conflict, disease, and starvation in some countries. The 2007 Nobel committee may have anticipated that some would ask why a peace prize should attend to climate change. In their press release, they explain: "Extensive climate changes may alter and threaten the living conditions of much of mankind. They may induce large-scale migration and lead to greater competition for the earth's resources. Such changes will place particularly heavy burdens on the world's most vulnerable countries. There may be increased danger of violent conflicts and wars, within and between states."

UN Secretary-General Ban Ki Moon, following the lead of Kofi Annan before him, highlighted the link between climate change and Darfur in a Washington Post op-ed this summer, writing:

Almost invariably, we discuss Darfur in a convenient military and political shorthand -- an ethnic conflict pitting Arab militias against black rebels and farmers. Look to its roots, though, and you discover a more complex dynamic. Amid the diverse social and political causes, the Darfur conflict began as an ecological crisis, arising at least in part from climate change. Two decades ago, the rains in southern Sudan began to fail. According to U.N. statistics, average precipitation has declined some 40 percent since the early 1980s. Scientists at first considered this to be an unfortunate quirk of nature. But subsequent investigation found that it coincided with a rise in temperatures of the Indian Ocean, disrupting seasonal monsoons. This suggests that the drying of sub-Saharan Africa derives, to some degree, from man-made global warming.

As Ban Ki Moon notes, violence in Somalia, the Ivory Coast, and Burkina Faso, also "grows from a similarly volatile mix of food and water insecurity." Those problems can be traced, in part, to our own habits of consumption. The point of the Save Darfur ad, clearly, is that our actions in monetary investments can underwrite genocide in Sudan. Less appreciated though no less true is that our national ignoble disregard for the perils of climate change can have the same effect.

In a crooked line

I woke up to this song a few days ago. Maybe one day when I’m more settled, I’ll dismiss the song as the cliched musings of a predictable twenty-something. But as I lay there that moment, it was just profound.

Closer To Fine, by the Indigo Girls (music video here)

I'm trying to tell you something about my life
Maybe give me insight between black and white
The best thing you've ever done for me
Is to help me take my life less seriously, it's only life after all

Well darkness has a hunger that's insatiable
And lightness has a call that's hard to hear
I wrap my fear around me like a blanket
I sailed my ship of safety till I sank it, I'm crawling on your shore.

I went to the doctor, I went to the mountains
I looked to the children, I drank from the fountain
There's more than one answer to these questions
pointing me in a crooked line
The less I seek my source for some definitive
The closer I am to fine.

I went to see the doctor of philosophy
With a poster of Rasputin and a beard down to his knee
He never did marry or see a B-grade movie
He graded my performance, he said he could see through me
I spent four years prostrate to the higher mind, got my paper
And I was free.

Fortune cookies from hell

A few days after the NYT ran a story on fortune cookies with "downbeat advice," I got one myself. My department ordered Chinese food for lunch today (yes, I know I live well).

My fortune read:

"Solid gains are possible today, but with a headache."

Another faculty member (who works in an ethics department no less) received:

"Before asking 'Am I doing things right?', ask yourself, 'Am I doing the right thing?'"

My health policy professor opened his cookie to find:

"You need to control your emotions. Keep them under wraps."

In bed?

Anyone have a favorite fortune?

Medical tourists

It's October now and students are deep into the grind. The midterms are rolling in. It’s been a few months since many of the medical students returned from their summers abroad in various developing countries – Kenya, Guatemala, El Salvador – but people are still sharing notes. I've been cynical about these trips. Three-week, or even two-month, visits are utterly unsustainable. They don't offer much to the host community and seem little more than a chance for medical students to gawk at global poverty. Sure, students may come back with greater "awareness" or "appreciation" of their privileged place in the world, but who really does that serve?

So how do these medical student missions work? Just days after finishing their first year of medical school, students run off to poor countries to perform procedures they wouldn't be able to perform on American patients. One student recently wrote to the PIH listserv to endorse a particular volunteer organization: "I have had several friends who have traveled to South Africa and India to work at medical clinics that are so underfunded and in need of help, that within a couple of weeks they were assisting in procedures, administering medication, and doing whatever needed doing. " As if that were a good thing! First-year medical students don't know anything about medicine, except perhaps a rudimentary physical exam. Second-year medical students don't know much more. Yet that doesn't stop them from practicing medicine abroad (with emphasis on "practicing").

I think many students who go abroad recognize these concerns. It may even add to the guilt they already feel as "healthy, educated, middle-class medical student[s] from the United States." They assuage this guilt by telling themselves that if they weren't "serving" these people, no one would. Or say that their own inexperienced care is better than no care at all. That may or may not be true. Clinical errors aren't the only potential pitfalls. As representatives of their nationalities, students must be careful to avoid mistakes that can precipitate a breakdown in trust or fuel resentment against the more legitimate older Western doctors. And above all, everyone must guard against subverting the local public health sector and pillaging its resources. When Paul Farmer spoke at my campus last month, someone asked him: "What if there is no functioning public sector?" Farmer corrected him: "There is always a public sector. Find it."

I don't really think these medical missions do as much good as they're purported to do. Of course, the intentions of the participants are good. I don't doubt that these students are eager to reduce global poverty or to take a stand for human rights. But I think these 'do-gooders' should be more honest about who's really gaining from these experiences. Some of these 'doctors without borders' are really no more than doctors without qualifications - medical tourists as much as medical trainees. Indeed, one article promoting international "service" concludes by noting: "What is acquired frequently outweighs what is given if a person is open and intent on gaining new insights and strategies." Great, I am loathe to think, another way of feeding off the world's poor.

Hotel Rwanda

On Sunday I saw Hotel Rwanda. The movie recounts how Paul Rusesabagina courageously sheltered 1268 Tutsi and Hutu refugees at the Milles Collines Hotel in Kigali during the 1994 Rwandan genocide. For the last few years, the movie’s been on both my must-see list and my must-avoid list. I don’t handle films about genocide very well. But a friend watched it with me and that made it easier. I didn’t find the movie as powerful as I thought I would. I was told I’d be bawling tears. I wasn’t.

Warning: Spoilers follow.

I appreciated the honest portrayal of Paul Rusesabagina (played by Don Cheadle) as a reluctant hero. He was at first more interested in the hotel’s reputation – “it must not become a refugee camp!” – than in saving lives, although I understand that the hotel’s stature was a major reason why the Hutus held off. So his leadership, though clumsy and hesitant, was smart. Still, I was annoyed that Paul Rusesabagina didn’t offer refuge to others, say for example, the families of his Tutsi hotel staff. Did he really expect them to work on the lush hotel grounds while their families and friends were slaughtered in the streets? The movie doesn’t say. In fact, there's a lot the movie doesn't say; many details are left unclear: the source of the radio messages, the relationship between the Hutu army and the Interahamwe militia, the progress of the Tutsi rebels, the apathy of the Western powers, and at one point, how the Belgium owner of the hotel manages to stall a bloodthirsty Hutu death squad by phoning the French prime minister.

Early on, before the genocide gathers horrifying momentum, Paul Rusesabagina and his wife Tatiana watch through a crack as the Hutu militia abducts their Tutsi neighbor. That night, lying in bed, Tatiana begs her husband to use his influence to intervene. “Victor was a good neighbor,” she pleads. Paul demurs, telling her: “All day long I work to please this officer, that diplomat, some tourist to store up favors so if there is a time when we need help I have powerful people I can call upon.” Titiana isn't satisfied. Paul continues: “He is not family. Family is all that matters. … Trust my good judgment.” The look on his face suggests that later, he will change his mind.

He doesn’t really. In the movie's final scene, Paul and Titiana - photographs in their hands - search frantically among the faces at the displaced children's camp for their two lost nieces, both under the age of ten. "Have you seen these two?" Faces and faces and faces. And then there they are! The music is joyous, a family reunited! Tatiana and Paul lift the two kids into their arms over scores of sad orphaned children. I was startled. How callous to wave around those children in front of their peers! Is that the lasting message of this film about the horror of genocide? Family first?

Blood escapades

Another post on my saga with blood donation:

Instead of donating through my workplace, I donated yesterday at the Red Cross blood center. Apparently, my blood is cytomegalovirus (CMV) negative, meaning I don’t have a virus that “nearly everyone” has. CMV is not a serious virus. The vast majority of carriers never know they have it. But, for those with compromised immune systems, e.g., premature babies and cancer patients, CMV can be quite serious. Rather than expose them to the virus in a blood transfusion, the Red Cross and hospitals solicit CMV negative donors specifically for these patients. For that, I had to go directly to the blood bank. (Plus, I’m now in a raffle for a free I-Phone.)

At the blood bank, I asked if I could give a double-donation through apheresis. I would be able to help more people, and it would extend the wait time till the next donation from 56 days to 112. It all seems very efficient to me. Apheresis takes more time than a regular donation, but physiologically, it's easier on the donor. I've done it before. The little old lady behind the desk replied, “Well, do you meet the requirements? You have to be at least 150 and 5’1.”

I stared at her. Did she think I was standing on a stool? She, meanwhile, stared blankly at me.

“Uh, I meet the requirements,” I finally said.

But it turns out I couldn’t do apheresis because the necessary staff members were out.

They escorted me to a small room for the pre-donation interview. My interviewer told me that to speed up the process, donors may now answer the questions on a computer themselves.

“But then you can’t ask me all those awkward questions about my sex life,” I said.

“You should see it when the nuns come,” he tells me jovially. “Try asking a nun those personal questions: ‘Have you ever had sex with a man who’s had sex with a man?’”

We laugh. I can just imagine the nuns crossing themselves.

Leila Khaled, Hijacker

I accidentally saw the documentary Leila Khaled, Hijacker, directed by Lina Makboul, at the Syracuse Human Rights Film Festival last night. I meant to arrive for a different film, Shake Hands with the Devil: The Journey of Roméo Dallaire, but the festival organizers switched the schedule after it was printed. I hate when they do that. I stayed anyway. Makboul’s film is a biographical account of Leila Khaled, a Palestinian woman born in Haifa in 1944, who hijacked a plane twenty-four years later for the violent secular leftwing organization, the Popular Front for the Liberation of Palestine. No one died in the hijacking, though people could have. Khaled now lives in Amman, Jordan, where the filmmaker Lina Makboul – a Palestinian raised in Sweden – interviewed her. The film is 58 minutes long; if it were any longer, I’d say it’s not worth it.

The film has a few inaccuracies – like stating (twice) that the massacre of Deir Yassin was carried out by the Stern Gang without mentioning the Irgun and the Palmach. She quotes one Palestinian claiming that “hundreds” were killed on that hilltop and then quotes an Israeli saying the number was 20-40. The inference is that the Israeli is propagandizing, while in truth, they both are. Israeli and Palestinian academics agree that the number slaughtered at Deir Yassin stands between 107 and 120. Also, the documentary states the Palestinians fled their homes in 1948 because they feared other massacres. It doesn’t mention that the conquering Zionist forces sometimes forced Palestinians to migrate or that Palestinian leaders sometimes encouraged them to do so in order to make room for their own invading armies. But these historical slights are fairly insignificant.

The film’s thesis, I would say, is that the difference between ‘terrorist’ and ‘freedom fighter’ is subtle and perhaps non-existent, and depends more on historical memory (particularly who’s remembering) than on anything else. Against the backdrop of a waving Israeli flag, Makboul narrates, “Isn’t terrorism always wrong? Maybe it’s okay to be a terrorist… if you win.” In the last scene of the film, Makboul asks Leila Khaled whether she thought, as she prepared to hijack the plane in 1969 (and another plane the next year) that the hijackings might give the Palestinians a bad reputation. Khaled thinks for a few seconds, and then the credits start to roll.

Makboul answered questions after the showing, so someone asked, What did Khaled say? Did she realize she might mar the Palestinians' reputation? Makboul said Khaled answered, “No.”

Most of the questions were pretty idiotic, like, “how do you think your personality changed as you made this film?” The soft-spoken Makboul skirted around the questions, sometimes just declining to answer. The largely student audience asked repeatedly whether Makboul thought Khaled was a terrorist, and Makboul answered repeatedly that she wanted the audience to decide (finally she admitted she didn’t think so). One student asked why Makboul would bother to show this film at a place with so many Jews. I took the microphone next and told him that that was precisely the point. I also asked about how a young woman like Khaled held up in a rather patriarchal movement. A Palestinian in the audience felt it was necessary to publicly condemn suicide bombings “because we should be alive to claim the homeland,” as if that were the reason suicide missions were wrong. What about the 2002 Hebrew University bombing, where the bomber didn't die? Ugh.

In one scene, Makboul asks Khaled if there’s anything she’d like to say to the captain of the plane she hijacked, whom Makboul also interviews. “Why would I?” she says. “His answers don’t interest me.” Looking back on this century-old conflict, it’s clear that the Zionists have failed because they’ve thought only of themselves. The Palestinians, evidently, are no better.

Reincarnation

In your next life, what kind of animal would you be?

That was a topic at dinner last night. (Yes, I have wonderful friends.)

I said I'd be a moose. Years ago on a family trip to the Rockies (or maybe it was the Grand Tetons), we saw a moose from our white-water raft. It was gorgeous, and for some reason, though I haven't thought about that moose in ages, it came back to me last night. Why a moose? For one, they aren't factory farmed the way other animals are. And more than that, I have the sense that moose (yes, that's the plural) don't interact much with human populations. If I were an animal, I wouldn't want to bother with humans in my next life. How cruel they can be.

Fresh in my mind was a squirrel that lost its life just the previous day. I saw the whole episode unfold as I biked down the street: the furry beast jogging and then, sensing danger, darting across the road. "NO!" I called out, but to no avail. Its brittle bones crackled under the car tires, reverberating in my ears, death before my eyes. It's been two days since the massacre, but its body still rests on the pavement, ever flatter by the day. Sorry little guy.

I would not want to be a squirrel.

What if I could be a human again? I'm leaning yes. One friend at the table, who'd like to be a koala bear or maybe a sloth in her next life, suggested that she'd probably need a break.

What would you be?