On giving a damn

Over half of US prisoners report a mental health concern, and nearly one in five suffers from a serious mental illness like schizophrenia or bipolar disorder. Nearly three quarters of those have a co-occuring substance abuse problem. In my work life, I advocate for proper reentry planning for this vulnerable population who have, unjustly, been caught up in our incarceration epidemic.

I am not mentally ill, or criminal justice-involved, or suffering from substance abuse. So I can't actually empathize. Why then do I bother? Don't we live in a world in which we all, myself certainly included, value others according to how well they advance our own individual projects?

It's been a few years, but I decided to break out Martha Nussbaum's Upheavals of Thought. According to her “theory of compassion,” we act compassionately for others (1) when we see they've suffered a terrible misfortune, (2) when we judge that misfortune to be undeserved, and (3) when they occupy an important place in our scheme of goals (321). That third element of compassion, what Nussbaum calls the “eudaimonistic judgment” (meaning: human flourishing), requires seeing others' wellbeing as important to our own. It's a capacity worth cultivating.

Empathy, interestingly, doesn't get a spot in her threefold equation. The concept has received a lot of attention since Obama listed it as a requirement for the next Supreme Court justice. Aristotle included it in his own threefold theory of compassion. He put a “judgment of similar possibility” (316), where one considers oneself susceptible to a similar misfortune, in the (3) spot.

Nussbaum replaced it in part because empathy doesn't seem to drive some compassionate behavior. It doesn't explain why those who can't imagine themselves as beggars still give. But that's not to jettison empathy entirely. Nussbaum calls it an “epistemological aid.” She gives the example of a Nazi officer who refused to participate in a mass shooting “because there were children among the Jews ... and at the time I myself was a father of three children.” She says empathy is “not necessary, but usually very important” (321) and “does important moral work by extending the boundaries of that which we can imagine” (388). That was my experience, tutoring in a prison.

What's most important, though, is that I see my own flourishing as connected to the flourishing of others. Their misfortune becomes my misfortune and their success my success. So I don't need to imagine myself in the place of a prisoner to lend a hand. Some might criticize this self-referential theory of compassion as ultimately self-serving. But as Søren Kierkegaard wrote in Works of Love, the injunction to “love thy neighbor as thyself” means you have to love yourself first. Hence the eudamonistic judgment, incorporating others' wellbeing into our own scheme of goals.

I don't think it's just something individuals have or don't have. It's there to be cultivated.

Know your activists

Friend Jen took me out to the hip, vegan-friendly Strong Hearts Cafe in Syracuse a couple weeks ago. Check out their milkshake menu below - with shakes named for famous activists. I had the Harriet Tubman (vanilla, maple, Oreo) in honor of Upstate New York, where she settled in 1859. Jen had the Roberto Clemente (peanut butter, Oreo). Clemente, the Baseball Hall of Fame's first Latino, died in an airplane accident in 1972 intending to deliver aid to earthquake victims in Nicaragua. He arranged and then boarded the flight himself to make sure the aid reached the victims. The previous three flights had been intercepted by the corrupt Somoza government.

Do you know all these activists? I've got to spend some more time on Wikipedia!

Click on the photo for a larger size.


My dad and I visited Harriet Tubman's home in Auburn, NY, last August. I took these photos:

My two philanthropic cents

NGOs are hurting this year. If you can give, please do.

Every year, I pledge to give at least one percent of my salary, or several hundred dollars, to charitable causes. That's the minimum (and giving to politicians doesn't count). Then over the course of the year, as I learn about various organizations, I distribute that money. I find it easier to disperse money already allocated than to decide each time to give - which would require reviewing my finances, rising above my stinginess, etc.

I donated to the following organizations in 2008. Consider giving to them also.

I supported some causes simply because I believe in them:

Ohio Justice & Policy Center: This NGO, my own, is a public interest law office that advocates (and when necessary, litigates) to reform the strapped public defender system, to eliminate racial disparities in the criminal justice system, to improve the discharge process for mentally ill prisoners, and to protect access to and quality of health care within Ohio prisons, among other projects. We also offer free clinics to aid former offenders with their legal needs (expungements, child support, etc.) and help facilitate their successful re-entry into society.

The Sentencing Project: The DC-based policy-advocacy organization works for a "fair and effective criminal justice system by promoting reforms in sentencing law and practice, alternatives to incarceration, and the removal of barriers to success faced by people with felony convictions."

Doctors Without Borders: Winner of the 1999 Noble Peace Prize, Médecins Sans Frontières is a "medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, natural or man-made disasters, or exclusion from health care in more than 70 countries." Not only does it operate hospitals and clinics (performing surgeries, vaccinating people, feeding malnourished children, etc.), it also has a strong advocacy arm.

Local Cincinnati NGOs: the Drop-Inn Center (homeless shelter), Over-the-Rhine Community Housing, Greater Cincinnati Coalition for the Homeless, Planned Parenthood Southwest Ohio, and the local affiliate of the National Alliance for the Mentally Ill - all venerable organizations.

For other donations, I trust the judgment of friends, many of whom devote their energy to found or run NGOs themselves. So I supported a community library in Zambia, a computer project in Bolivia, a medical clinic in Sikoro Mali funded by the Mali Health Organizing Project, and Project Muso, also in Mali and founded by friends Ari and Jess several years ago. Project Muso facilitates a women’s peer education program to improve literacy and health skills. It also works with the town of Yirimadjo to run a community-based malaria treatment program, which launched this past September to the tune of four hundred community members who gathered in support.

I also gave to JT's organization, San Francisco's Coalition on Homelessness. Another friend hiked the Appalachian Trail to raise money to fight Scleroderma, and two others joined races to support the Cystic Fibrosis Foundation and the Leukemia & Lymphoma Society.

That rounds out the list. It was a hefty one this year. (Last year's is here.)

What organizations do you give to? Which would you recommend?

I love the world

I've been repeating to myself a saying from civil rights leader and Baptist minister Howard Thurman: “Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.” I've had to repeat it to myself lately because I've become rather calculating, thinking: What the world needs is people who do useful things for other people. I imagine these competing motivations will eventually find an equilibrium.

In the meantime, here's something to recall that there are many paths to goodness:

On not applying to graduate school

I have a wonderful job that I am leaving. As the days get warmer and the buds bloom, I sometimes wonder why. But I am confident about this decision. Leave the job. It doesn’t pose the same challenges it once did. Spend time away from a computer. Interact with real people, and by real people, I mean poor people. That’s why graduate school doesn’t make sense. I know my study habits; I know that soon as I’m enrolled as a student, I’ll return to the 2 am nights and 8 am mornings and consume a thousand pages a week, trying to get the most bang for my tuition buck. I may land back in academia someday, but I need to experience something else first. You can see from this background why grad school feels like same-old, same-old right now.

Tutoring at the prison really affected me. So did, to a lesser extent, stories. Here's Tracy Kidder, returning in 1969 after a rather boring year in Vietnam, from his memoir, My Detachment:

"I tried to remember the last time I'd feared for my physical safety, Maybe over six months before, on the night when some sappers got into the base camp. But they'd gone after the brigade staff and had managed only to blow a few holes... I realized I'd never been in real danger, and I had a feeling that I was going to regret it" (177).

I also think of John Steinbeck’s 1936 book, In Dubious Battle. In the book, Jim joins a workers’ movement to fight California landowners to provide better wages for their apple-pickers. Here Jim’s talking to Mac, a party veteran, about why he’s joining the effort.

“No, I’m trying to tell you. I’d never known any hope or peacefulness, and I was hungry for it. I probably knew more about so-called radical movements than any of those men. I’d read more, but they have the thing I wanted, and they’d got it by working.”

Mac said sharply, “Well, you typed a few letters tonight. Do you feel any better?”

Jim sat down again. “I liked doing it, Mac,” he said softly. “I don’t know why. It seemed like a good thing to be doing. It seemed to have some meaning. Nothing I ever did before had any meaning. It was all just a mess. I don’t think I resented the fact that someone profited from the mess, but I did hate being in the rat-cage” (21).

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.

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.

Tax-exempting the rich

Lots of organizations present their tax-exempt status as if that were proof of a good cause. But what does it really mean? It means donors get a tax break. When I give money to charity and report doing so to the IRS, I thereby don't give my money to the government. Sometimes this rule makes sense, such as when I want to give money to an organization that doesn't receive government funding. But most of the time it doesn't make sense. My alma mater, for example constantly solicits for donations. But in taking a tax-exemption on gifts to Brown, donors are in effect taking money that would have gone to the government. And the government needs the money far more than Brown does, especially because social programs are the first to get cut in a crunch. Let me say it outright: Donations to universities, cultural institutions for the rich (say, Carnegie Hall), and religious institutions (say, the Catholic Church) should not be tax-exempt.

How much money does the government lose? I don't have those numbers right now. The NYT (which doesn't cite the numbers either, though it should) presents data from the Center for Philanthropy at Indiana University: "For every three dollars they [rich philanthropists] give away, the federal government typically gives up a dollar or more in tax revenue, because of the charitable tax deduction and by not collecting estate taxes." So we're talking billions of dollars.

First caveat: Some people worry that the government would squander the money (Iraq War, cough cough) instead of say, using it to expand health insurance coverage (which is what John Edwards would do with heavier taxes on the rich). So in that case, it may be better to let rich people themselves decide where to direct their money. But we have to question whether the decisions of the rich are any better than the government's. Rich people tend to give their money to art museums and concert halls, not to the local soup kitchen. NYT: "[L]ess than 10 percent of the money Americans give to charity addresses basic human needs, like sheltering the homeless, feeding the hungry and caring for the indigent sick." Not only that, but the "wealthiest typically devote an even smaller portion of their giving to such causes than everyone else."

Second caveat: Is citizen action as good as I make it sound? Take the example of the Bill and Melinda Gates Foundation. Last year, its philanthropic donations were directed primarily to public health projects in developing countries. "Valuable as that may be," opined the NYT reporter, "it also meant that the American public effectively underwrote several billion dollars worth of foreign aid by private individuals, even though poll after poll shows Americans are at best ambivalent about using tax dollars in such assistance." Yikes! Better leave the money in Bill Gates' hands!

Or at least that was my first reaction. Then I realized that it's just a reporter's (shameful) attempt to stir controversy. "Valuable as that may be," she writes. How cynical! "Poll after poll," she continues. I doubt that, and she doesn't back it up. Americans give just .16% of our GDP to international aid, and as far as I've seen, most people think that's too little. (Norway gives .87%.) And since when are the government's spending priorities decided by opinion polls? But let's suppose that they are. Pretend that the majority of Americans really don't want that money going to global health causes or to places where the life expectancy is less than 35 years old. Where would they send that money instead? If recent polls are correct, then at least 64% of Americans would use it to insure the 47 million uninsured people in this country (2.2 million more than there were in 2005). Covering America's uninsured is still better than covering the university's golf team.

In short, tax exemptions come at a cost. And the poor are paying it.

Design for the other 90%

In NYC last weekend, two friends and I saw Design for the Other 90%, an exhibit at the Cooper Hewitt Museum. The exhibit showcases equipment and machinery specifically developed for the global poor who lack access to electricity, building materials, clean water, etc. It's a small exhibit with roughly 30 items, on display through September 23. Because of the exhibit's size (it took just an hour to walk through), I'd say it's not worth the $12 ($9 for students) ticket price. I'm not even sure any of that money goes toward projects in the developing world. So save your money and read about these incredible items in the International Herald Tribune or the New York Times.

We're beginning to close the "10-90 gap" in medical research, which I've written about before, where 90 percent of funds go toward just 10 percent of the world's burden of disease. In design, the disparity is similar, seeing how 90% of world's population can't use the products sold at IKEA. So, kudos to this exhibit for bringing together the teams that are fighting this imbalance.

Picture-taking was allowed, so here's what we saw:


The LifeStraw (above) was by far my favorite. It's a water purification device used in Ghana, Nigeria, Pakistan and Uganda that removes particles to reduce the risk of infection by waterborne diseases such as cholera, diarrhea, dysentery and typhoid. So brilliant and yet so simple.

I also really liked the Q-Drum (below), an easily roll-able container that can hold 75 liters of water.


If you're in India, Nepal, Zambia, or Zimbabwe, look out for this drip irrigation system (below). It reduces water use by 30-70 percent while increasing yields by more than 50 percent. It can used for many kinds of products that come out of the earth, including fruits, vegetables, maize, wheat, and cotton. Also in the irrigation category, the exhibit included a "Super MoneyMaker Pump" (catchy name, eh?). Used in dozens of African countries, it can direct water without fuel or electricity and can irrigate a two-acre area in eight hours (which I assume is pretty good).

Pathologies of Power Preview

Expect a review of Paul Farmer's Pathologies of Power, forthcoming. I wrote previously about Tracy Kidder's Mountains Beyond Mountains, a journalistic biography of Farmer. Farmer's own writing, of course, discusses global health inequalities in greater depth. If I were to sum up the main thesis of this book, I'd quote Amartya Sen, whom Farmer himself quotes (8). The difference is that Farmer would replace "development" with "health."

“Development requires the removal of major sources of unfreedom: poverty as well as tyranny, poor economic opportunities as well as systemic social deprivation, neglect of public facilities as well as intolerance or over-activity of repressive states.” [Amartya Sen, Development as Freedom, New York: Knopf, 1999, pages 3-4.]

The other difference is that Farmer writes with a bit of a zing, fuming at one point:

“Does being human confer a right to survive?” (211).

I can't feel your pain, but...

I've been reading the heart-wrenching blog kept by Will Okun and Leana Wen, the two young people traveling through Rwanda and Congo with New York Times columnist Nick Kristof. In his latest post from the conflict-ridden Congo, Will Okun writes about fear:

"Imagine living in a rural community where your daughter could be raped, or even sodomized, by soldiers every time she leaves home. Recently, Nick Kristof asked a village leader to speak with a woman who had been raped, and the line continued to grow and grow at a sickening rate. Imagine living in a rural community where you do not grow crops to feed your family, because the soldiers will simply eat all the fruits of your labor anyway. Imagine hiding the fact that you have a job, because the soldiers will ransack your house first. Imagine leaving your village and home with your family in the dark of night for places unknown, because the soldiers’ violence devours everything in its path."

Fear is a paralyzing emotion like no other. Human beings across the world experience it - in Iraq, in Gaza, in Chicago. Despite its ubiquity - it can, after all, affect anyone - it actually affects very few. The problem is: Those who don't experience it hardly know it exists. Empathy is a weak mobilizer. True to the golden rule, we still begin sentences with "Imagine yourself..." and "How would like it if..." But the new plan is simply to shock the conscience. Will Okun explains: "Sadly, it is not enough for a human woman to live in squalor, to be malnourished, to be uneducated, to have no access to clean water or health care. This is not news. Only when she is raped, her children dead and her family killed in war, then we will finally take heed and demand intervention."

It's just not effective to implore people to imagine themselves as susceptible to other people's misfortunes. To help a beggar, I don't need to imagine myself in his or her place. Frankly, I can't. Instead, I need to attach that person's good to my own - what Martha Nussbaum calls the "eudaimonistic judgment." Acting compassionately has three necessary parts, she says. I act compassionately (a) when I see that the other has suffered a terrible misfortune, (b) when I judge it to be undeserved, and (c) when the other an important place in my scheme of goals.

Empathy is an "epistemological aid," to be sure. But alone, it's not so impressive. Those without fear won't - can't - experience empathy. That's okay, though, because there's no need to imagine what it is demonstrably real. Empathy should take a backseat. In its place: interconnectedness.

It's a small small world

In the last post, "Dithering on climate change," I focused on China and hardly mentioned the dithering of the United States. In his column the next day, "Repression by China, and by Us," Nick Kristof did something similar. He discussed the plight of a woman who's been beaten and jailed by China for seeking little more than workman's compensation. Toward the end, he named Sami al-Hajj, the Al Jazeera cameraman whom the U.S. has imprisoned at Guantánamo for the last five years, despite no evidence that al-Hajj has done anything wrong or unlawful.

So one might wonder: What business does an American have condemning China?

Though Kristof raises the question by adjuring Bush to "give America back its moral authority to speak up for human rights," he doesn't discuss it - at least not here. But the inference is clear: The U.S. is its own rogue state, denying rights to 'illegal combatants' and secretly detaining them at hell-holes (ahem, 'facilities') like Gitmo and Abu Ghraib. It's reasonable to ask whether Americans - with our own government's obstinate disregard for global warming - can seriously rebuke China for ignoring the perils of a changing climate. Has the U.S. really surrendered its 'moral authority'?

Whether we retain moral authority or not, Americans are at least perceived to have lost it. In this age of 'identity politics' where people and their arguments are considered inseparable, I exude hypocrisy when I meddle in international affairs, even if I downplay my citizenship. As it's been said before: Remove the log from thine own eye first. Yet the alternative perspective - that I should stand idly by - is just as absurd. I am not my government. Why? One might say that I can't be held responsible for all the havoc my government wreaks. And yes, that's important. But the United States, on some level, is a "government for the people, by the people." In a real democracy, it doesn't make sense to say "I voted for the other guy." My participation in civil society - from protest rallies to blogging - implies my consent to be governed. You see, the reason "I am not my government," is not simply because I oppose its policies but because I am more than its citizen.

It became real in June 2005, on the Red Sea coast of Egypt, of all places. Friends and I were lucky enough to happen upon a birthday party for a Israeli girl in her mid-twenties. We drummed and danced till late, then lounged around on cushy beach chairs in the night and got to talking.

"What do you think of Israel?" she asked.

"Not bad," I replied in Hebrew, casually.

"Be'emet," she said, "what do you really think?"

I paused. A good five seconds passed. She had a look that could only be answered sincerely.

So I said - bluntly baldly - "Your country was born in sin."

For all her sincerity, she was suddenly (though I suppose unsurprisingly) sour.

"And what about yours?" she said.

So we argued - as if sin were the only way a state could be born, as if I as an American lacked the standing to criticize her country for a crime my country had itself committed a few centuries earlier, as if it were somehow unfair to hold Israel to account so long as the U.S. got away with it.

It was romantic in a way - an argument in the night, shifting between languages, between countries, across continents, passionate and heated with the fire crackling and then simmering, debating until our eyes drooped and the beach quieted, the rustle from Red Sea beside us. It was tragic, too - another group of young people inventing clever hakuna matata justifications to excuse the sins of their fathers - anything to save themselves from the awful, disorienting recognition that their identities - as Americans, as Israelis - existed because another identity was destroyed.

I spent nearly eight months in Israel/Palestine in 2005. It was then that I started thinking of myself as "an international" and not just or even primarily as an American. Sure, my passport bears the seal of the United States - but in the end, it's just a passport and not a way of thinking. To be a global citizen is not to be stateless but rather state-ful. In a small, globalized world, one must value not only the 'state of the union,' but also the state of the world. With human rights abuses as with global warming, we can no longer subsist - if we ever did - on "mind your own business" diplomacy.

The social justice sisterhood

I'm part of an advisory group for a new 'global health office' at the medical school. The office will help med students make contacts abroad and will sponsor a lecture series on issues such as refugees, sex trafficking, HIV/AIDS, and migrant labor. The group - which includes both students and professors - met a week ago. Of the 12 people around the conference table, 2 of us were men.

This imbalance isn't exceptional. My public health courses in college were brimming with women; they outnumbered the men 10 to 1. I didn't complain much. I'd joke that I studied public health for romantic reasons. Plus, it was quite exciting to bring diversity to a group - which as a white male I don't often get to do - though it meant I was often looked upon as a curious XY specimen. But the imbalance always bothered me. Really, where were all the men? I don't have any studies about it, just anecdotal evidence. In Providence, I spent a week with a Brown program exploring issues of homelessness and affordable housing - with 25 women and 5 men. In Syracuse, I've been tutoring through the city's literacy corps, a group that teaches adults how to read and write. In my training class of 17 people, 3 were men. I tell ya, it sure is hard to be a man in this world...

So when did social justice work become an old girls network? Here's a hypothesis:

In both developed and developing countries, women disproportionately suffer from economic and social inequalities. In the United States, women earn 77 cents to a man's dollar, occupy fewer CEO positions, can't take time from work to breastfeed, and may even get kicked off a plane for it. Sexual violence, meanwhile, is as frequent as it is perverse. A 2007 study published in last month's Journal of American College Health found that only 2 percent of victims of sexual or physical abuse (that's 1 in 50!) contacted the police. Many women don't report such abuse because they feel ashamed or embarrassed or somehow at fault or because they see the abuse as an isolated incident and not as part of a larger epidemic. We evidently have a fairly vacuous sense of sexual violence.

Inequalities in developing countries also disproportionately affect women. Complications from pregnancy kill half a million women a year. It's safer to donate a liver lobe in New York than to give birth in Afghanistan. In some African countries, women can't insist on condoms or refuse sex and may contract HIV from their husbands. In Muslim countries, no man is killed for raping a women, but women are sometimes killed for 'losing their honor' - or otherwise beaten. On the economic front, we know that the whole family benefits when women achieve financial independence. In fact, UNICEF's 2007 State of the World's Children Report went as far as to say that expanding women's opportunities in South Asia would save 13.4 million children from malnutrition.

I would bet that the pervasiveness of women's victimization - and women's awareness of it - is a key reason why women disproportionately gravitate toward work in public health and social justice. Perhaps women seek to rectify injustice because they tend to bear the brunt of it. Another idea is that women - because they have been marginalized - have great sympathy for fellow sufferers. Both help explain why women greatly outnumber men in public health - a field with a very wide social justice purview - but don't outnumber men in medicine. I also bet (though I have no stats) that female medical students are more likely to see their medical training as part of an overall effort to promote social and economic opportunity and reform 'the system.' The radical conclusion, of course, is that if medical schools want to foster social justice, they should admit more women.

That, anyway, is my preferred explanation. An alternate explanation maintains that women are simply more caring than men - an explanation that's always smacked of reductionism to me and begs the very question it purports to answer: why are women (supposedly) more caring?

Mountains Beyond Mountains: The Dismount

Intro

Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World shook me like few books do. Kidder, a Pulitzer Prize-winning journalist, follows Farmer through his daily routine, from Haiti to Peru to Paris to Russia to Boston, while telling the story of Farmer’s childhood, his first love, his medical school years, his years a maverick at the World Health Organization, and later as a leader. As a person, doctor, advocate, and reformer, Dr. Paul Farmer is utterly captivating – in short, he’s a mensch, but not the kind of mensch you'd want to marry.

We meet Paul at a young age and watch him grow through his various nicknames, P.J., Pel, Dokte, and so on. The central concepts in Farmer’s life also have nicknames, and I spent the week after I read Mountains Beyond Mountains talking in PIH-speak (the lingo of the organization he co-founded, Partners in Health). Having an “H of G” (a hermeneutic of generosity) means interpreting people’s intentions in a favorable light (215); “Love, ID” (infectious disease) is a shorthand response to the rather complacent TBMIs, the transnational bureaucrats managing inequality (216);“the poor” and if not that, “the soon dead” is Farmer’s preferred term for the world’s destitute populations (100); WLs (white liberals) are people who moralize that “things aren’t that black and white” as a way of obscuring AMCs (areas of moral clarity) which, if fully recognized, would compel these WLs to radically alter their lavish lifestyles (101).

I've been that “white liberal.” It's the person content to have the right ideas without necessarily the right actions; the person more enamored by the idea of justice than the work of justice. I am, I admit, more enthused by philosophical discussions of “human rights” than by the logistics of providing the “[c]lean water and health care and school and food and tin roofs and cement floors” that Farmer takes as a “set of basics that people must have as birthrights” (91). In the spirit of academia, I have learned to “problematize” the world but not to fix it – as if the life expectancy in Haiti (53 for men, 56 for women) were merely a moral conundrum and not, firstly, a moral outrage.

Between sitting in the dirt with his patients, lobbying at the WHO, working to lower prices for TB drugs, and shuttling from Boston to Haiti to Moscow to Peru to Paris, Farmer somehow manages to write academic works that are regularly reviewed in major medical journals. Between site visits, he gives presentations like the 2005 Tanner Lectures (PDF) at the University of Utah. I heard a version of that lecture when he spoke at Brown in 2006. Even though he arrived two hours late, six hundred students sat in a six hundred seat auditorium and waited. I did too.

I appreciate Farmer’s stance toward academia. He not only educates, but agitates as well. As a result, he succeeds as an academic where many others have fallen short. He sees academia not as a vain pursuit to enhance knowledge for its own sake, but as a forum for activism, for developing a plan to improve people’s lives. Indeed, one should always approach academia with caution, lest one succumb to its potential faults: “the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy” (195). As an aspiring academic (sometimes), I take that message to heart.

Mountains Beyond Mountains has its imperfections, minor as they are. The eccentricities of Farmer’s childhood are a bit overblown. It’s true that most people don’t grow up on a boat – too poor to afford a real house – but most have equally good stories to tell. Also, in some of Kidder’s exchanges with Farmer, I got the sense that Farmer was performing, i.e., that he was working too hard to shape a persona. Now there’s nothing terribly wrong with that. Malcolm X dictated his whole autobiography that way. But it sometimes compromised the aura of unrehearsed spontaneity that made this book so much fun to read. Take, for example, when Farmer tells Kidder: “I’m not truly humble. I’m trying to be humble” (289). But these are faults with the book, not with Farmer.

Can I find faults with Farmer? Before answering that question, I should ask why I even asked it. In reading this book, I felt as Ophelia Dahl – Farmer’s early love and now the long-time executive director of Partners in Health – did when this young man she just met seemed to do everything to perfection. Once in Haiti with young Paul, she set her alarm clock for five to beat out her companion. But she woke to the sound of his voice anyway. “I just want to do something better than him,” she thought. “For a moment.” I felt similarly sometimes. As a result, I am perhaps exceedingly eager to find faults with this giant, critiquing his work with moral scrutiny he doesn’t deserve. The question, I realized, was not: “Does Farmer have faults?” but rather, “Can I find any?”

I recognize that’s unfair. And I recognize that I’m just some joe with a blog and a dubious claim to moral authority. So you will have to take my comments accordingly.

Inequality

I was uncomfortable with his Robin Hood mentality; that is, the ease with which he can take from the rich to give to poor. When Farmer began to equip the laboratory of Cange’s clinic, he consulted a booklet from the World Health Organization that offered tips for planners working from modest resources. It recommended, for instance, that planners use a homemade solar-powered microscope to cut costs. Farmer tossed out the booklet. Kidder writes: “The first microscope in Cange was a real one, which he stole from Harvard Medical School. ‘Redistributive justice,’ he’d later say. ‘We were just helping them not go to hell’” (90).

I feel uncomfortable with it, but “uncomfortable” in the sense of choosing between evils. I suspect, though without terrific evidence right now, that first-world affluence is in large part responsible for the continued impoverishment of the third world, in ways often unacknowledged because the causality is indirect and mitigated by geography. There is a third world because there’s a first world. So when Farmer steals, it’s possible to construe this theft as some sort of “just redistribution,” even though the people of Haiti never owned that microscope in the first place. I also recognize that part of Farmer’s appeal – part of his heroism, even – is his willingness to f*ck the system. It’s a system both complicit and complacent in acting like poor people dying at middle age were a normal occurrence. To the extent that Farmer’s Robin Hood mentality makes us reconsider the legitimacy of the current world order, it becomes less blameworthy.

To put it another way, it’s still wrong for the food bank to steal your car.

To a Robin Hood, one reason why it’s acceptable to steal from the rich to give to the poor is because the poor gain more from the theft than the rich lose by the loss. So the theft increases overall well-being, even if some people are less happy as a result. I can’t help but think that Paul Farmer is in part motivated by this rationale: the observation that so much good can be done at little cost to the rich. Kidder writes upon their arrival in Paris: “As we entered the city proper, the great dove-colored epicurean city, he murmured something about how much could be done in Haiti if only he could get his hands on the money that the first world spent on pet grooming” (210).

Now, in brief sketch (with apologies), there are two major positions in ethics. Deontologists value principles above all, while utilitarians seek to maximize over well-being, even at the expense of individual freedoms and luxuries. Deontologists tend to fault utilitarians for failing to respect differences between people; utilitarians tend to fault deontologists for obscuring issues of fairness. In truth, we’re all both deontologists and utilitarians. I believe, for example, that what’s mine is mine, what’s yours is yours, and that people are entitled to spend their money however they choose. At the same time, though, I believe there’s something wrong with being very well-off when others are dirt-poor. Or put another way: There is something wrong (though it’s not clear what) with spending five dollars on a beer while another person dies for lack of a five-dollar bed-net.

Paul Farmer doesn’t deeply differentiate between persons. Anyone’s suffering is his suffering, and in fact, the suffering of us all. That’s a virtue, I think, especially in inspiring his donors to fund start-up medical clinics in the poorest areas of the world. His care for others is contagious. Nor does Farmer differentiate between persons with respect to himself. He returned to work shortly after coming down with a near-fatal case of Hepatitis A. He told Tracy Kidder, “The problem is, if I don’t work this hard, someone will die who doesn’t have to. That sounds megalomaniacal. I wouldn’t have said that to you before I’d taken you to Haiti and you had seen that it was manifestly true” (191). If Farmer had some superpower ability to restructure the world, he would divert the wealth of the affluent to those who need it to survive. He’d do it, I think, even if it made people in the first world worse off. I wonder how far he’d go, and I wonder how far I’d go.

At the beginning of this post, I called Farmer a mensch but not the kind of mensch you’d want you to marry. His devotion to improving the health prospects of the world’s poor means that he rarely sleeps and that he sees his wife and daughter every few months for a day (or at least that’s the sense I get from the book). Patients before family. Most people would carve out a larger space for family. It’s obvious that personal relationships pose special obligations that sometimes conflict with principles of impartiality and fairness. So I visit my friends when they are sick, but don’t visit people I don’t know. Though I donate to humanitarian relief, I probably spend more money visiting friends. It may be selfish, but I think I’d want to see my spouse more than once every few months.

I don’t mean to imply that Farmer is somehow acting wrongly in his personal life. I only want to note that Farmer has a different conception of his personal commitments than many other people have of their own. There is room for pluralism here, I think. In any case, the question of “love versus justice” has been hotly debated in the feminist literature under the code word, “the ethics of care.” Any person who starts a family will face these questions someday.

Incision

An incision is a surgical cut to reach the underlying cause of injury or disease. I use it here to signify a theoretical cut through surface level explanations for why the poor bear the bulk of the global burden of disease. A person who dies of cholera, typhoid fever, or dysentery hasn’t really died of the illness itself, but of shoddy municipal water systems that transmit waterborne bacterial diseases. Though a doctor, Farmer echoes my sense that economic well-being is the best medicine. He pays homage to the social determinants of health, maintaining that “the great burdens of disease in Cange were just a symptom of a general deprivation” (Kidder’s words, 91).

At a meeting of the World Health Organization where Partners in Health (PIH) was lobbying for resources to treat multidrug resistrant tuberculosis, many skeptics said that the funds simply didn’t exist. One PIH-er responded, “I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way” (162). PIH-ers see the public health mantra – that “resources are limited” – as a clever way of absolving oneself of responsibility for the poor. In Farmer’s view, it was uttered “without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti” (Kidder’s words, 175). Farmer’s broader view of poverty investigates why resources were limited – not just to work within the constraints, but to work to remove the constraints themselves.

Improving the social context is pivotal to public health, so I'm glad Farmer draws attention to dollars and cents and other less sexy aspects of health care like nutrition and access. If health care workers are really going to be the “natural attorneys of the poor,” as Farmer believes, they will have to learn not only to cure disease but also to prevent it. Prevention has never been the glory of medicine, but preventative efforts will have to expand in developing countries. Doctors will play an important part, I think, but development workers and public health officials – people without M.D.’s stamped after their names – will make equally great and perhaps greater contributions. For those of us with no health care skills and no plan to acquire them (i.e., me), pay attention.

Inadequacy

It is a feature of hero-ness that we expect things from heroes that we don’t expect from ourselves. That is, after all, why they are heroes: because they go “above and beyond.” We expect even more when they adjure us to reform our lifestyles. Responding to Peter Singer’s admonition to live cheaply and give the rest to the needy, many of my classmates found reason to attack Singer himself, ad hominem. “I bet he doesn’t live in a shack,” one of my classmates snarled. The same thing happens with Farmer. Kidder writes that “at some point … I realized that I’d become inclined to hold Farmer to a higher standard than I did most people, including myself” (153). Yet Farmer seems quite capable of meeting our expectations: he does live in a shack, if he lives anywhere at all.

Farmer tells Kidder: “‘When others write about people who live on the edge, who challenge their comfortable lives – and it has happened to me – they usually do it in a way that allows a reader a way out. You could render generosity into pathology, commitment into obsession. That’s all in the repertory of someone who wants to put the reader at ease rather than conveying the truth in a compelling manner’” (207).

I did want Farmer to leave me “a way out,” some assertion like, “Yeah, I’m really insane; no reasonable person would do this kind of work.” Of course that never comes. I doubt I was the only person to finish this book feeling terribly inadequate. Kidder quotes Farmer’s friend and PIH-cofounder Jim Yong Kim as saying, “Paul has a gift for making people feel guilty” (212). Farmer’s activities, from tending at the bedsides of patients to seeing them in prison to lobbying at the WHO, produced a jealousy in me that I hadn’t felt since my interactions with the rare peacemakers in Israel/Palestine who could converse fluently in both Arabic and Hebrew. It angered me because it requires skills I will never acquire and made me a coward by comparison.

On reflection though, my jealousy fizzled. Jealousy focuses on the self, as if improving my own well-being were the purpose of my volunteer work. Jealousy’s not one of the seven deadly sins for nothing. Yet jealousy, with its many vices, also has a certain usefulness: to the extent it overlaps with self-interest, it can inspire social action. I started volunteering in the prison system mostly to fight the injustice of “criminal justice,” but also out of curiosity. Curiosity is obviously different from jealousy, but self-interest is evident in both. Social activists, after all, are people, too.

I can imagine telling my grandchildren years from now that it was at this point in my life, after reading books on injustice, including Kidder’s book, that I decided I would lead a life whose luxuries wouldn’t drive me insane. Farmer, too, seems to have felt a similar motivation. Kidder notes that Farmer’s fanaticism (that’s my word) “freed him from the efforts that many people make to find refuge and distinction from their pasts, and from the mass of their fellow human beings” (219). We say, genuinely I think, that our primary purpose is to improve the lives of others. But another purpose, ancillary and usually hidden, is to avoid the “uneasiness that some of the fortunate feel about their place in the world.” Farmer isn’t so superhuman as to transcend it. Kidder says it’s “the thing he once told me he designed his life to avoid” (Kidder’s words, 295).

Inspiration

Certain images from the book stay with me: A young Farmer diving through bullets to take wounded Haitians to the hospital, popping up from Haiti just in time for his med school exams in Boston, crying when a patient miscarries, sitting on a patient’s bed at Brigham’s, carrying bundles of gifts through the Miami airport, writing AIDS and Accusation from a rocky Haitian hilltop. I imagine it sometimes like the hilltop in Be’er Sheva that I used to climb at twilight: a place to reflect on the city, away from the city. These are images of work, yet they return at night. They are images of a man, yet they exemplify an idea.

I wasn’t as inspired as the book cover said I’d be, but Mountains Beyond Mountains affected me in a different way. I’d say that I am more agitated than inspired. I am agitated by questions about our obligations to far-away others - people dying of diseases I’ve never heard of. I am frustrated because I want to help but I’m not sure how. I am anxious about conveniently blurring their interests – whatever those may be – with my own. So for now, I'm going to do the one thing I know best: read more. I purchased Farmer’s most recent book, Pathologies of Power: Health, Human Rights, and the New War on the Poor. Perhaps I should have bought Infections and Inequalities, a book Farmer published in 1999, when he wasn’t receiving hundreds of emails a day. He may have had more time to invest in book-writing then – though something tells me: no, probably not.

Easter Eggs & Cluster Bombs

Today's Washington Post has a story about the annual White House Easter Egg Roll ("Kids Go on White House Easter Egg Hunt"). I wasn't expecting to find anything to marvel at (don't ask why I was reading the article), but I was pleasantly surprised.

The reporter noted:

"Across from the White House, meanwhile, a handful of activists at Lafayette Park hunted for brightly colored tennis balls in an alternative 'Easter cluster bomb hunt,' intended to dramatize the fact that many areas of the globe, such as South Lebanon, are not safe for children because of persistent fighting and unexploded munitions."

Well done, unidentified activists.

In summer 2006, Israel dropped cluster bombs on Southern Lebanon while fighting Hezbollah. Cluster bombs lack precision and can fall over a wide area. Not all of them explode on impact and can explode months later to the touch of farmers, random passerbys, or children who discover and play with the toy-like bombs. As many as a million unexploded bombs now litter Southern Lebanon. According to the United Nations Mine Action Service, 30 people have died and 191 have been injured since the war ended. If killing civilians in peace time is a human rights violation, then I don't see how the use of cluster bombs can be an acceptable act of war. Recent news suggests that Israel's use of the cluster bombs may have violated an arms pact it made with the United States. But so what? The United States shouldn't have been dealing in cluster bombs in the first place. There's hope, though: As reported in March, it is now a crime in Belgium to invest in cluster-bomb-producing companies.

Update (12/24/2007): Big surprise. Israel's own "investigators determined Israel's use of cluster bombs was a ''concrete military necessity'' and did not violate international humanitarian law. Lebanese officials accused the army of covering up war crimes." See story here.

Why the preferential option?

Borrowed from Catholic liberation theology and developed most recently by Paul Farmer, a "preferential option for the poor" says that we owe special consideration to the voiceless and powerless, or in the words of the Bible, to the widow and orphan. The idea is frequently cited and rarely denied. Why then, I wonder, does it have so little actual currency? Can it so easily become pious verbiage repeated on Church mornings and "social action days" but otherwise ignored?

Maybe the rich don't see the poor from their perch of affluence. That's certainly part of it. The poor are rendered invisible by social and geographic distance, their dire situation compounded by lack of political clout. But that doesn't explain the inaction of the many people - the "white liberals" of the American middle class - who do know, however suppressed the information may be - about the pitiful life prospects of the global poor, or even the poor in adjacent neighborhoods. So if it's not the invisibility of the poor that obstructs their social mobility and health access, then what is it?

It's a policy objection, at least at first. It begins by saying that the health care pie is only so big, so those who may deserve access sometimes have to do without. Why? Because in times of scarcity, there is no "right" to health care. And yes, that's true: No one has an immediate right to something that is scarce. Then, they say, it's not morally wrong to deny people something which they were never owed in the first place. Without a right to health care, there's no responsibility to provide it. In such situations, the needy must use their own resources to achieve their goals. The upshot of the argument, then, is that the idea of a "preferential option" disintegrates in a free market system. Thus "white liberals" can bemoan the situation of the poor but feel no duty to ameliorate it.

The response to this clever footwork, while historically complex, is morally straightforward. With an eye to the history of development, it examines the evolution of the current world order. It assesses the effects of our economic exploitation and colonization of the "third world" - both in the present day and in centuries past. With this broader perspective in mind, the moral basis for the preferential option is much stronger. Now, when "rights" fail us, responsibilities won't. I know this assertion breaks somewhat with the rights-based discourse of the day, but I don't think it makes sense to subsume the question of "the good" - be it health or happiness or something else - into a framework of "human rights." To promote a preferential option for the poor - even when resources are few - we must see their need not as a matter of rights, but as a matter of justice.

In global health, money talks

Where moral outrage over the 10/90 gap fails, money succeeds.

The 10/90 gap refers to the expenditure of biomedical research funds, where 90% of research dollars focuses on 10% of the global burden of disease. Some skeptics have argued that the 'alleged' 10/90 gap unfairly criticizes the biomedical industry, claiming that disease in lower-income countries is caused mostly by poverty, not by distorted priorities of the industry. The International Policy Network is perhaps the leading proponent of this view, holding that deaths in these countries stem from poor nutrition and improper sanitation, not from lack of research attention. They say that effective treatments do exist; they're just not getting to the population. Poking around online, I'm seeing that this issue of the 10/90 gap is exceedingly complicated. We could debate whether the imbalance is really 10/90, but let it suffice to say that pharmaceuticals' profit-making ambitions distort their research priorities in favor of projects likely to generate profit, not projects likely to save the most lives.

So I was pleased to see this morning that the UK, along with several other countries, is setting up a 1.5 billion dollar fund to produce the needed vaccines. As the BBC reports, this "Advance Market Commitment" will contract with pharmaceuticals and developing nations and pledge to purchase the needed vaccines once they are produced, thus giving pharmaceuticals a financial incentive to reset their priorities. Brilliant.

It's true that sometimes the problem isn't the existence of treatments but access to them. But it's also true that existing vaccines for various diseases, including pneumococcal disease and tuberculosis, can be tailored and bolstered to work more effectively. To claim simply that "the real problem is poverty" and not the research budget, is to commit an either/or fallacy.

In any case, this fund is excellent news.

Global warming, global ethics

The earth is heating, and it's happening as a result of excessive human emissions of greenhouse gases. Due to rising amounts of carbon dioxide and methane in the atmosphere, we're in peril or will soon be. Hurricanes will move farther away from the equator and endanger previously safe areas, sea levels will rise, and tropical diseases - once confined to certain warm climates - will spread. It all sounds a bit apocalyptic, and when I talk about global warming I want to reach for my copy of the Book of Revelations, but that's the truth. The scientific evidence is indisputable.

The issue received news coverage last week when the Intergovernmental Panel on Climate Change concluded (for the fourth time) that global warming had a human cause. Public awareness is growing, partially thanks to conserve-energy campaigns and commercials like the one below, produced by fightglobalwarming.com. So far, it's received a fraction of the attention of the Super Bowl commercials, but it puts them to shame.



The ethics seem simple. The argument goes something like (1) global warming is bad, and therefore, (2) holy shit, we're screwed, unless we do something about it. But ethical complications quickly arise, especially we when realize that to halt global warming, we must drastically alter our carbon usage and lifestyle, including the food we eat and the cars we drive. Yet if the "tragedy of the commons" ever applies, it applies to the ultimate common resource: the atmosphere. With free, unrestricted access to fill the globe with carbon emissions, the United States (along with other countries) has exploited this finite resource nearly to its limit.

Let us suppose that I have an ethical duty to not harm others (I know, a very bold claim, indeed). Interpreting this principle is usually straightforward (i.e., "Eli, don't fight with your sister!"). But this conception of harm has been outmoded. When I contribute to carbon emissions by leaving the air conditioner running, I haven't committed a specific harm against a particular individual. The impact of my actions won't surface for years, and when it does, it will be veiled by the huge number of people who have collectively caused, to be precise, the lakes to dry up, mosquitoes to proliferate, and hurricanes to multiply. Can I, as an individual, bear moral responsibility for a harm committed by millions of people going about their daily business? Do we need to revise our conception of harm?

Finally, questions of distribution. The United States has 5% of the global population but generates 30% of carbon emissions. Since the developed nations committed the majority of the damage, should they be responsible for the repair? Should it matter that they didn't know about global warming when they committed the harm? Should it matter that the U.S. economy, built on carbon emissions, has benefited other countries? Yesterday, China declared that the wealthier, developed countries - the historical polluters - should bear primary responsibility for the clean-up. In general, the established ethical principle of "you broke it, you fix it" makes sense. And I hope that international pressure can persuade the U.S. to take action. But it's still sad to see such thriftiness and jockeying when, to appeal to the Book of Revelations, the day of reckoning is nearly upon us.

Eating cookies with eyes wide shut

I usually consider it silly (at best) or deceptive (at worst) when patients decline to know their diagnoses. I mean, isn't more information, more clarity, always better? Then last night, as I snarfed down a box of cookies, I realized that at least this one time, I consciously evaded the nutrition facts. I didn't want to know.

Some folks working in philosophy debate whether there's "a right not to know." I mean, say you could know the day of your death. Would you want to know it? I wouldn't. What if you could know definitively whether there was a god. I bet many people would decline, backing up their choice with some poetic bullshit about "faith." Still, if that's what they want... Everybody has his or her own box of cookies.

But how strong is this supposed "right" to remain ignorant? If you're a sexually active person, is there a right not to know your HIV status? And when it comes time to reproduce (for those who choose to), is it okay to avoid learning whether you carry the gene for Huntington's? Is there a right not to know about social ills? About global warming? About genocide in Darfur? Forrest Gump notwithstanding, is life really like a box of cookies?

"Never again," again, again.

Here's my obligatory post on Darfur.

The predominate vibe among the disconcerted masses is one of helplessness.

So many people, young and old, are agitated from reading Nicholas Kristof's interviews with survivors. We're eager to do something - something besides "raising awareness" and showing documentaries on college campuses. I mean, no one ever stopped raping and burning because some college kids told 'em to.

It's easy to blame our government. George Bush chose Iraq over Darfur. But then it seems too easy. If it's really all about George Bush, then we'd have to admit that we're powerless citizens, and that is something we won't accept. So we send emails, write checks, post on blogs, and imagine a better world.

My brother and some of his Wesleyan peeps organized a ten-day protest at the Sudanese Embassy last January. Holding signs like "Beep to end the genocide," we succeeded to get a lot of cars to honk their horns. A year later, the genocide continues. But at least we managed to annoy the Sudanese officials.

No other thoughts (or whining) for the moment.