Hunger: Bread for the World

Of faith-based organizations, none really does the job fighting hunger that Bread for the World does. These guys are so good, they were recommended by the very secular professor of my Econ and Hunger course -- that's got to mean something.

BftW works on a number of levels, local to international, primarily on food policy. What I really like about them is their focus on policy change at the national level. You can read here their policy statements on the different hunger-related issues the US government works on, both domestically and internationally. They work on lobbying legislators and organize letter writing campaigns, including letters to editors of various media outlets. Really, their goal is to educate and inform, in hopes that that will lead to change in our society. It's a worthy goal, and a good group.

You mean that resistance might just be in the population?

Granted, this is from a meat industry website, so they're not going to be too critical:

Study finds antibiotic resistance in poultry even when antibiotics were not used

By Alicia Karapetian on 3/8/2007 for Meatingplace.com

A surprising finding by a team of University of Georgia scientists suggests that curbing the use of antibiotics on poultry farms will do little, if anything, to reduce rates of antibiotic-resistant bacteria that have the potential to threaten human health.

Dr. Margie Lee, professor in the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antibiotic-free farms, and even those raised under pristine laboratory conditions, have high levels of bacteria that are resistant to common antibiotics. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs.

"The resistances don't necessarily come from antibiotic use in the birds that we eat," Lee said, "so banning antibiotic use on the farm isn't going to help. You have to put in some work before that."

Lee and her team sampled droppings from more than 140,000 birds under four different conditions:

• 1. commercial flocks that had been given antibiotics;
• 2. commercial flocks that had not been given antibiotics;
• 3. flocks raised in a lab that had been given antibiotics;
• 4. flocks raised in a lab that had not been given antibiotics.

The researchers examined levels of antibiotic resistance in normal intestinal bacteria that do not cause human illness and, in a companion study published in May in the same journal, also examined levels of drug-resistant campylobacter bacteria, a common foodborne cause of diarrhea, cramping and abdominal pain.

The meat industry is often blamed for all antibiotic resistance, but that really is rather unfair; it's possible that animals are picking up resistant strains from people who don't think it's necessary to finish their course of antibiotics when their infection clears up. But that's just my bias.

Hunger: USAID

There are a lot of governmental agencies that deal with hunger issues (at least one for every high-income country), so I'll look at what my own government is doing; specifically, what USAID is doing, specifically in Africa.

The US government works domestically and internationally on hunger issues, but only USAID is dedicated specifically to development. (If you were wondering how to pronounce it, you're supposed to spell it out: U-S-A-I-D.) In Africa, USAID is working on a presidential initiative to end hunger, partnering with the African Union (AU) and individual countries, as well as with other development institutions.

First, USAID is encouraging US scientists, universities, and companies to provide technical expertise. While this has been known to be badly planned (large dams with no maintenance plans, anyone?), the premise is good; the important thing is to be sure that the "experts" are listening to the people they're helping. It's not a good idea to provide something that people don't want and expect them to care for it and pay for upkeep, especially people on the edge.

Second, USAID is trying to build the private sector in many countries, arguing that ending rural poverty will end much of the hunger problems in Africa. While it is true that these programs are much needed (roads and transport for agricultural goods are essential), my cynical side says the US will benefit from more markets being opened. Still, better infrastructure is a good thing.

Last, USAID talks of trying to break the poverty cycle that keeps people in food insecurity, throwing around words like "sustainable" and "integrated". Laudable goals, all, but I'd need to get into specifics to judge how well they're doing, and, frankly, I have enough research to do right now, between class and writing a thesis.

I'm sorry if this seems a little more judgemental than my previous organizational posts. I do tend to be harsher towards government programs because they so often have an agenda beyond ending hunger. Morality and politics don't really seem to intersect often enough for me to trust organizations that claim to marry them . . .

Subsidies, revisited

Yes, they're still in the farm bill:

India, E.U. urge U.S. to cut farm subsidies for Doha Round success

By John Gregerson on 3/7/2007 for Meatingplace.com

India and the European Union want the United States to cut its farm subsidies to ensure success for the Doha Round of World Trade Organization talks, according to Indian news wires. "I am a bit disappointed to see the new U.S. farm bill. There is no change in treatment of two important sectors, sugar and dairying," European Commissioner for Agriculture Mariann Fischer Boel told reporters. "These sectors need to be reformed." Boel warned that the subsidies are stumbling blocks to the successful conclusion of the Doha round — meaning negotiations to hammer out a multilateral free-trade agreement among World Trade Organization member countries. Boel, who is on an official visit to India, said, "The current draft of the new U.S. farm bill pushes in the right direction, but not far enough." She added that the European Union is committed to the multilateral trade talks, but cuts in trade-distorting subsidies have to be reciprocal, indicating the European Union has proposed a cut of 70 percent in its ceiling on trade-distorting subsidies. She said it also has offered to phase out export refunds by 2013 and roughly halve the agricultural import tariff to 12 percent from 23 percent. "The next 60 days are extremely critical for WTO negotiations," said G.K. Pillai, India's commerce secretary. "The situation requires extremely delicate handling."

Talk about cutting subsidies continues, but I'm being cynical today: I don't think it's going to happen anytime soon. Doha has collapsed. (We're not the only ones to blame, but we should . . . consider our role.)

Hunger: FAO

My favorite UN agency has to be the FAO. For a livestock veterinarian, it doesn't get any better than the Food and Agriculture Organization. And they do crops, too!

The FAO has as it's mandate

to raise levels of nutrition, improve agricultural productivity, better the lives of rural populations and contribute to the growth of the world economy.

They aim to help people help themselves (sensing a theme in the organizations I like yet?), by providing technical advice in any area of agriculture. That means teaching new farming techniques, yes, but it also means teaching policy techniques to governments, setting up disease surveillance systems, and alerting the rest of the world to situations that need relief.

The FAO is not a funding agency, but a technical agency. It has limited funds to supply, but large amounts of expertise. That expertise is available to all, in every form from rural extension seminars to Internet databases. People working for the FAO may be in an office in Rome, doing basic research, or out in the bush, putting the research into practice.

Yes, I sound like a cheesy public service announcement. What can I say, I want to work for them!

There is even peacemaking potential at the FAO, as it provides neutral ground for dispute resolution. The directors aim to decentralize, bringing the resources closer to the people who need it, but the central office is still a meeting place for all agriculturalists who need to interact on a global scale.

The FAO is commited to the Millenium Development Goal of cutting hunger in half by 2015. At this point, frankly, it would take a miracle. Still, trying for a major miracle can cause minor miracles to happen.

Book Review: Contagion

Contagion by Robin Cook (this review was written for my class on zoonoses)

Robin Cook’s novel, Contagion, is supposed to be a plausible example of domestic bioterrorism. Published in 1995, before the current fears and instability had a chance to take hold, many of the suggested possibilities may be a bit unrealistic for the modern health industry. Otherwise, the situation described is a fairly accurate portrait of the risks posed by modern health care.

Cook opens the novel with a quote about the dangers of market-driven health care, and that appears to be his agenda for the plot. The protagonist, Jack Stapleton, was driven out of private ophthalmology practice and into a pathology residency by a large hospital administration company, Americare; because of the relocation, his wife and children are forced to take a commuter flight to visit him and are killed when it crashes. He develops an antipathy for all managed care, especially Americare. Taking a job as a medical examiner, he flirts with danger and avoids personal connections until forced into a relationship with an advertising executive, Terese, who is in charge of another managed care company’s advertising account. At the same time, he is investigating several succeeding cases of plague, tularemia, meningitis, and finally influenza at an Americare-run hospital, which is not happy to have him ‘poking his nose in’. Despite his bosses’ resistance, he persists in sneaking around to probe the outbreaks, convinced that no one else is taking it seriously. Over time, he is threatened by a gang, which eventually attempts to kill him and does kill a girl who helped him. He is saved by another gang from his neighborhood, only to be captured by the bioterrorists and transported into the Catskills for disposal. On the way, the influenza virus with which he had been infected in the course of his investigations infects the terrorists, who die without killing him. He escapes with the help of the friendly gang and lives through an effective quarantine that ends the influenza outbreak.

While the novel points out quite rightly that zoonotics can be extremely dangerous in hospital outbreaks, the route of infection portrayed (purposefully contaminated humidifiers) may make it seem as if they are not likely to happen to healthy people. In an obviously pre-9/11 book, the cause of bioterrorism is simply greed on behalf of an advertising executive and morbid curiosity by her brother, a lab tech. The samples were produced in a private lab simply for collecting purposes, so they were not weaponized in any way. History of contact with animals was only seen as a distraction in the search for the cause. In all, I find the premise quite unlikely in today’s society; hospital outbreaks of zoonotic disease, I believe, are more likely to be either purposeful to cause harm to people and society or completely accidental and due to ignorance on behalf of the medical community.

My biggest complaint about this book is the way certain classes of medical fields were associated with moral judgements. Of course, with the protagonist being a pathologist, pathology was seen to be generally good, medical examiners were simply hard-working public citizens doing their best to save the city from itself. In contrast, the city epidemiologist was portrayed as somewhat lazy, self-centered, ignorant, and obstructive to a proper investigation. Being an epidemiologist myself, I resent that portrayal. In my experience, the pathologists are less likely to be interested in outbreaks unless they provide good samples, while it is left to the epidemiologist to draw the necessary links and find the cause. Also, the CDC was mentioned briefly, but only in its role as a diagnostic lab and quarantining authority; in actuality, a medical situation like the one in this book would be controlled completely by the CDC as soon as they knew about it. Also of importance, in the case of zoonotic pathogens, veterinarians were only mentioned in passing, as a source of diagnostics for the pets of the infected; veterinarians were never consulted, the pets were never sampled, and the possibility of a zoonotic source was practically ignored.

Finally, while they make for good fiction, the actions of the various medical authorities in this book are utterly unrealistic. I cannot imagine an American hospital forcibly removing a medical examiner from their grounds during the course of an investigation into dangerous outbreaks on their property. I cannot imagine a medical examiner breaking and entering to find the source of these outbreaks. The role of law enforcement was relegated to deus ex machina, rather than a vital resource in an outbreak investigation.

In conclusion, this book may present a good thriller for those who enjoy the genre, but it is almost dangerously inaccurate as far as zoonotic risks and the proper way to investigate a nosocomial outbreak.

Buying gas by the cob

Speaking of Heifer, I've been predicting this ever since they mentioned the possibility in their magazine:

USDA: ethanol could increase food prices

By Tom Johnston on 3/5/2007 for Meatingplace.com

USDA projects that ethanol production will consume 50 percent more corn this year, taking a big bite out of the food industry's share of the crop and possibly forcing food prices to rise. Keith Collins, the department's chief economist, said farmers are expected to grow a record 12.2 billion bushels of corn in 2007, with 3.2 billion bushels going into ethanol production. In 2006, 2.15 billion bushels of corn were used to make the biofuel. "Even with that increase, we think production will fall short of demand," Collins said during USDA's annual Agriculture Outlook Forum.

Cellular medicine?

This is a great idea: using cell phones to report disease in Africa. Everyone (practically) has a cell phone, and text messages are free. Way to come up with a workaround!

Hunger: Heifer Project

Of all the NGO's dealing with hunger issues, Heifer International is my favorite. The premise is helping people to help each other, which, to paraphrase Terry Pratchett, few of us are talented enough to do.

Heifer works primarily by taking donations from rich people (us) and using them to buy animals for poor people. The animals are not simply given away; the receiving families must train to care for them, prepare a place and food for them, and promise to give the first offspring to another poor family in the program. Thus, we help them help them help them . . .

Some might class Heifer as a faith-based organization, and, indeed, it was begun as one. Now, however, it has moved away from its Christian roots. It is still a great organization doing powerful development work. In the field, however, its focus is becoming more and more development for the sake of warm fuzzies for liberals. Still, it has my firm endorsement for major NGO's ending hunger.

If you're looking for a gift for someone who has everything, buy them a llama. Or some bees. If nothing else, it's a conversation starter. You could tell somebody else about hunger issues! There are domestic as well as international programs, including a Katrina recovery program. There are programs to promote women, education, sustainable agriculture, even urban renewal. If you have time to explore issues in depth, there are camps in the US and international trips that look at what hunger is doing in the world and how Heifer (and you) can help.

In conclusion, Heifer is an example of an NGO that really works well to combat hunger. I advise checking out the website, requesting their magazine, and/or donating.

Hunger: organizing

In the next week, I think I'll discuss some of the organizations that work on hunger issues. There are many, so I'll just mention the ones that I know and care about. Today, then, I'll give a little background on the types of organizations:

• NGO -- non-governmental organization, existing in a wide variety of forms and purposes
• UN agency -- a branch of the United Nations, funded by governmental members of the UN
• Governmental aid programs -- run and funded by the individual governments
• Faith-based organizations -- usually NGO's, not always associated with a particular church or denomination, but usually involved with a particular religion

This is a quick and dirty explanation, but I'm a little tired today. Tomorrow I'll get into specifics.

Hunger: Bill Clinton's Landon Lecture

I was lucky enough to listen to (though not attend) Bill Clinton's Landon Lecture this afternoon, and he discussed the issues of hunger, so I'd like to share his main points with you.

The main questions he thinks everyone should have answers to (with a summary of his answers in parentheses):

1. What one word sums up the world today? (interconnectedness)
2. If the world is interconnected, is that a good thing or a bad thing? (both)
3. What needs to be done? (end inequality)
4. How would you do it? (focus on diplomatic, non-military solutions)
   
5. Who is responsible to do these things? (everyone)

Well, that pretty much sums it up, doesn't it? We are all responsible for ending inequality, primarily through development programs and public advocacy. We are all responsible because we are all interconnected, and the interconnectedness has benefitted many of us in the West while harming most of the rest of the world. Therefore, we can use our benefits to benefit those who need it most. Or, in the words of Christian Vet Missions, we are blessed to be a blessing.

Hunger: the politics of food supply

Why do we subsidize farmers?

Before any farmers find this and throw a fit, I'd like to say that I'm not really sure and I would like an answer. Is it because we want to hang on to our history by keeping people on the farm? Or is it because, in our history, we've 'always' done it. Or is it not historical at all?

The reason I ask is that our subsidies are a major driving force in world hunger. Not just our subsidies, but all subsidies. Remember how the best way to prevent or end hunger is to increase incomes? Well, it's kind of hard to do when our government keeps farm incomes above what the market will sustain. Yes, I know that US farmers are struggling to make ends meet, but even that income level is higher than can really be supported by global trade. We're pricing the low-income countries out of business.

Some might say, hey, our surplus grain is donated to those hungry people! Why should they complain if they're still getting fed? Yes, we send surplus grain grown by US farmers as part of our official hunger relief packages. We send it in ships owned by US companies. We distribute it from warehouses owned and operated by US citizens. We are very generous. Meanwhile, that free grain drives down the price of local grain even more, putting more farmers out of business, increasing poverty and hunger, and kickstarting another vicious cycle.

I'm not saying that all food aid is bad, but it's not quite as altruistic as one might think. When you hear that we're helping the hungry by sending them our surplus, ask why we have a surplus. It could be that we helped create the hunger situation we're now helping to solve.

Hunger: the sociology of food supply

He had become convinced of the duty of sympathizing with the lower orders ever since he made a serious study of the Epistle of St James; but he perceived clearly that the lower orders fell into two classes, that it was necessary to distinguish between them. There were the 'good poor' -- and there were the others. 'I am glad that you have mad acquaintance with some of the good poor . . . I quite agree with you that it is most instructive to visit them.' -- Lytton Strachey, of Dr. Arnold

Who are the 'good poor'? Do they exist? Is it, in fact, necessary to distinguish between two classes of lower orders?

This is a common fallacy, but it is less often openly admitted these days. People will say that it is wrong to blame the poor for their situation, then proceed to blame "the others" for theirs: 'oh, but some people don't want to be helped' or 'well, I'm not saying they're beyond redemption, but I don't know what more I can do.' This bothers me; not that we are responsible for helping every hungry person we ever meet, but we can't start by assuming that some of them don't deserve our help.

The sociology of hunger leads to people looking the other way, actively ignoring, the problem unless they hear a heart-tugging story. Face it: not every hungry person is entirely innocent of any wrongdoing, not every starving mother is a saint in persecution. If we deny aid (not actively, of course not, but maybe that proposal doesn't get funded or that organization doesn't get donations) because of the past of the people who need it, we are playing God with our finances and resources. Maybe the first lesson of working in hunger is the humility to say, honestly, that it could be you.

This isn't actually what I was planning on writing for this issue, but I guess I have 34 more posts to remember my original point.

Hunger: the economics of food supply

This is far too big a topic for me to cover completely here, especially after a long day like today. I'll just touch on the highlights, the take-home points. Wait a sec, I'm starting to sound like a professor . . .

The biggest reason that people go hungry is that they can't pay for food. That sounds like an obvious statement, but it goes deeper than most people think. Yes, on the surface, it means that people simply can't afford food on an individual basis. If I have no money, I can't go to the grocery store and buy a loaf of bread and a gallon of milk. This is the individual hunger of poverty.

Being an epidemiologist, though, I prefer to look at the population level. Why, if there's more than enough food for everyone to eat, are some people not eating? It's because we who are eating too much and wasting are quite literally buying it out from under their noses. This is not saying you need to go on a hunger strike so a kid in the slums of Mumbai can eat. It doesn't work that way; that's the economic fallacy at work. Instead, look at a societal level.

When people have food to sell, they do not sell to the lowest bidder (another duh statement, but bear with me). People sell their commodities to the entities that will pay the most for them. In the case of food, that would be the high-income countries. Thus, food distribution follows the money: more food goes to places with more money. Seeing as there is a serious inequity in money distribution in the world, the distribution of food becomes unequal. Hence, we have obesity while other countries have starvation.

On a side note, this is my biggest worry about the corn ethanol fuel craze; our cars have more money invested in the fuel industry than most people in the world can spend on food, so our fuel industry is going to start outbidding the poor for corn products, leading to higher food prices and more hunger.

What's the solution? Economists would say that if someone can't meet the cost of a required input, they need to increase the capital available for that investment. Translation: they need more money. Jobs, development, any and all methods of raising the income of the poor -- these are the best ways to combat the economics of hunger. Some of them may even have an impact on the social aspects, as well. More on that tomorrow.

Hunger: the food supply

Hunger means there's not enough food for everyone to eat, right?

Every day, 4.3 pounds of food is produced per person on Earth. There is enough food produced in the world to provide 2,807 calories per person per day. There's enough food for most people to get fat (obesity epidemic, anyone?).

Livestock take precious food resources away from the hungry, right?

Livestock are included in the figures above. In addition, there are places in this world that are not viable for cropping, but that can 'grow' meat. Take a look at the pictures of Karamoja and tell me the world has a black and white choice between crops and livestock.

So, if we're producing enough food, and it's not the wrong kind of food to produce, why are people hungry?

This week, I'll be focusing on the reasons for a lack of food where it's needed, economic, political, social, and practical (in that order, I think). Just remember: there's no lack of food supplied to feed the world. Hunger is not physically neccessary.

Some sense? returns to surveillance

From today's news:

USDA to close BSE lab

By Tom Johnston on 2/26/2007 for Meatingplace.com

Saying the prevalence of bovine spongiform encephalopathy in the U.S. cattle herd is "extraordinarily low," and doesn't warrant ongoing costly testing and tracking programs, USDA will shutter the Pacific Northwest's only BSE testing laboratory on March 1.

The Washington State University lab opened after the nation's first BSE case was discovered in nearby Yakima Valley in December 2003, but only two other infected cows have been found, even after the testing of 759,000 animals, including 45,000 in the Northwest.

USDA Spokewoman Andrea McNally told the Associated Press the lack of additional cases spurred the agency's decision to downsize the program and target only 40,000 animals per year. The government plans to close the WSU facility and several others as part of a plan to cut testing by more than 90 percent.

This sounds like sense, right? We're not finding them, and the one's we've found were probably sporadic cases, so our BSE scare died with only a questionable epidemic (by definition, we had an epidemic, but practically, we didn't). So we cut down testing from (on average) over 200,000 animals a year to testing 40,000. We shut down extraneous testing facilities. We save the taxpayer's dollar.

Well, maybe. According to NASS, 4,775 cattle were slaughtered in 1995 (the last year with available data). If we wanted to find a single positive animal in that group, with a perfect test, we would need to test 3,707 animals every year at slaughter. We don't have a perfect test, but we don't know its sensitivity; with the less-than-perfect specificity of our screening test, we'd get a lot of false positives and waste a lot of money. Still, 3,707 is a lot fewer than 40,000.

So what if we're trying to detect BSE in the entire country. According to NASS (again), there were 106,112,000 cattle in the US on January 1, 2006. To detect a single positive animal in that group, with a perfect test, we would need to test just over 1,000,000 animals. That's a lot more than 40,000, and it would just go up with imperfect sensitivity.

So what is the best option? Are we just going midway between 4,000 and 1,000,000 by choosing 40,000? Are we basing that estimate on a different number (maybe the number of downer cows per year)? Or are we playing politics with diagnostics . . . again?

Hunger: accountability

One of the big issues these days in development is accountability. Do you manage to do anything, or do you just shuffle paperwork? The problem is, how do you measure real progress?

The famine relief people have it easy. They can say they fed so many thousand starving people for so long. But relief isn't development.

Within my own sphere, livestock development, things tend to move slowly. One of the reasons Heifer International is so popular is that it moves at a noticible pace: people receive their animal, their lives improve. What about cross-breeding to improve genetics? It takes several generations of animals to see an improvement. Cut and carry to improve nutrition? Slow, gradual improvement. Nothing dramatic like building a dam.

And what metric do you use to measure improvement? If you allow development projects to measure their own success, you may get a more meaningful answer. You may get manipulation of data to ensure funding continues. Metrics are specific to the project, but they can be too specific.

And is it appropriate to punish failure? We like to say that a negative answer is still an answer, but try getting it published. The same goes with programs that have gone nowhere -- we learn something from them, but try getting funded again. If a funding agency cares about accountability, they won't go back to a project that has failed. If it doesn't, its funds will be taken up by projects that look good on paper, but don't necessarily even get out the management door.

In other words, accountability is still an issue. My request for you is that you ask about accountability before donating to a group that funds hunger development. If you don't, your money may not be going where it's needed.

Hunger: How many NGOs does it take to feed the world?

A wonderful resource for more information on world hunger is available here.

There really are a lot of NGOs (non-governmental organizations) working on the hunger issue. They work on nutrition, food aid, food security, agricultural research. They provide hand-outs, hand-ups, participatory research, moral support. They do good work.

Why so many? Well, there are a lot of things to focus on, so it's a good idea to have multiple NGOs working on different issues, right? I don't think so. The various issues are all linked. For example, food prices in Uganda are going up and that's pushing some Ugandans into food insecurity. Why? Because money is pouring into Darfur to feed the hungry, and Sudan isn't producing enough food. The money some NGOs are sending to Darfur is making things harder for other NGOs in Uganda. Wouldn't cooperation be a good idea?

But is the UN (the ultimate in multiple-group cooperation, although not technically an NGO) the answer? Well, that would require the departments within the UN to talk 1) to each other and 2) to other groups. From what I've seen (and I'm young and naive, so I may not have seen this right), the UN departments don't like to communicate outside their own world.

So what is the answer? Well, the HungerWeb is a good start. Start an NGO just to run communications with other NGOs. Get people talking to each other. Know what people are doing where, how it's working (a topic for later), and how it impacts your project.

Until then, have fun searching the double-digit number of free job boards for a specific position. Enjoy observing that the number of people needed in offices is greater than the number of people needed in the field. Streamlining . . .

Beware the methane

Well, the FAO isn't necessarily biased towards animal agriculture, is it? I wonder which is the bigger worry: the places where people keep livestock on pasture from cultural traditions, or the places where people keep livestock on corn in order to save people money? And is eating meat worse than driving in an SUV with no passengers?

Hunger: overexposure

Appropriately enough, today, when I planned to start blogging seriously about the problem of hunger in the world, NPR's Morning Edition did a story on the retiring head of the UN's World Food Program (WFP).

The theme of the interview, it seems to me, is overexposure. Not of the American people; most really don't know all that much about world hunger. No, it's the people working on hunger who become overexposed. They lose one of two things: 1) their ability to be rational about the situation or 2) their ability to feel for the people they're trying to help. James Morris seems to have been fighting the second, but lost out to the lure of statistics. If I just throw enough statistics at it, people will come to grips with the fact that we have a problem, right?

The statistics are overwhelming. Except that the idea of 18,000 children dying is a little abstract for most Americans. We can understand the child next door dying of cancer, 3 children in a fire, the 13 people killed at Columbine. We can't really conceive of 18,000 children dying
every day. Most Americans, too, have never seen someone die of hunger, so they don't know what it entails. (Side note: the angriest I've ever been with an author was when I read that abortion was a more pressing legislative issue because all the children dying of hunger could hang on one day; after all, abortion is immediate and hunger is slow. This from a doctor.)

So, statistics don't really work because we don't understand them. What would? Americans are underexposed as far as world hunger. The people who know about it are overexposed. Suggestions?

The Lenten Theme: Hunger

I wanted to keep up the daily posts, as much as possible. I know it's good for me to come here and write something every day. So, for Lent, I'm committing to write something every day (except Sundays).

As the rest of my Lenten discipline is related to world hunger, I'll be writing on the theme of hunger, organizations involved in it, misconceptions about it, and anything that comes up. I'll probably stick to a theme for each week, to be decided as they come.

Today's comment: fasting makes concentration difficult. I know I've seen the stories about children having trouble focusing in school because of hunger, but I had never really experienced it while fasting before. Today, without changing my routine, I decided to fast. At 2:30, I gave in and ate some bread to avoid becoming sick (which may have something to do with the anti-malarial I took at 1). I was unable to concentrate on anything from 10 on. I couldn't work. Even after the bread, I spent 20-30 minutes sitting on my couch, staring blankly. I know, too, that my fast, only meant to be 24 hours or less, is nothing compared to the constant hunger felt by many. I think the hunger itself may be preventing improvement in their situation.

Today's photo theme: sunrise, sunset

Well, appropriately enough for my last daily posting of Uganda photos, the dramatic skies of Karamoja. People in Kansas talk about claustrophobia in NY because they can't see the sky, whereas I feel more agoraphobia here. In Karamoja, though, the mixture of clouds and sun make the sky an interesting study for anyone.

Here, Venus makes an appearance (the slightly blurred light to the left of the tree) as we prepared to leave for the day. Earlier, we could see the Milky Way, the Southern Cross, and many other constellations. Hooray for a night sky hundreds of miles from streetlights!

And, in case you were curious, here's what I look like with a monkey on my back.

And, as I mentioned to Dad, the (artificially) zebra-striped bulls. These animals are silver-gray; traditionally, the last animal in a bride-price will be this color and will be given zebra stripes with a branding iron (as seen here).

Today's photo theme: plant life

I'm going to stop these daily posts tomorrow. First, I'm running out of good pictures to post. Second, I'm going to do something else for Lent. I'm not sure what yet, but something . . .

Anyways, here's an acacia tree beauty shot, sitting next to a washed out ravine (washed out by the daily rains we had our second week). As usual, more on flickr.

Playing hunches? Or playing innumerate?

In case you don't know, I'm a grad student in epidemiology. My current class in my major area, Design and Analysis of Studies in Epidemiology, started off with discussions and readings on causation, bias, and confounding. And then I read this.

From the title and introduction, I was quite positive; it seemed the author was going to extol the virtues of evidence-based medicine, which (in my opinion) is irretrievably linked to epidemiology. It is the reason we want to apply statistics to health data. It is the best way (again, in my opinion) to choose public health plans that maximize the return on our dollar.

But people not drinking the evidence-based Kool-Aid seem to worry a lot about the ecological fallacy. That's what happens when group data is inappropriately applied to individuals. That's why people thought that it was wrong for a doctor not to order what he thought was an inappropriate test, although the person in question later developed the disease in question.

Too often, however, these people fall prey to the atomistic fallacy. That's what happens when individual data is inappropriately applied to groups. That's why the jury awarding a settlement in the above case was acting more with indignation than sense in second-guessing the doctor and his education.

What's my problem here? Well, I never heard of the atomistic fallacy, in exact or inexact terms, until I did the reading for my class last week. You may have noticed that I do quite a bit of reading on my field. Does that seem odd? I've heard lots about the ecologic fallacy, although never with that term attached, but never anything about an atomistic fallacy. I think that is because of a general atomistic leaning in science and medicine. I've been hearing about (and experiencing) the bias towards bench science since I became interested in epidemiology. What we do, playing with numbers, is not real science in the eyes of many of our colleagues. Of course they would caution against our findings, if they don't trust our methods. But why would they talk about the atomistic fallacy? Their source of funding is reliant on individual, atomistic findings having an effect on a grand level.

That's what most of this comes down to: funding. Researchers competing for funding need to make their research sound applicable. The dominant paradigm is atomistic, so ecological issues are held up for extra scrutiny. And evidence-based medicine, as opposed to "the art of medicine", is considered just as suspect.

Truth is, evidence-based medicine is as much of an art as the old-school anecdotal medicine. The problem is that the art is now based in math and statistics, not hunches. And people going to med (and vet) school don't generally like math and statistics. People in the general public don't generally like math and statistics. Nobody likes art in a medium they don't like.

Today's photo theme: pathologies!

Ok, today is not for the faint of heart. Here's nothing exotic, really, just a big abscess. Many good abbatoir etc. photos will be going up on flickr soon.

What is food?

Well, Josh was right -- this guy sounds like me!

Eat food. Not too much. Mostly plants.

That, right there, will answer any nutrition questions we seem to come across these days. Problem is, nobody knows how to cook that food anymore.

Here's my plea: teach your children how to cook from scratch. If you don't know yourself, get them classes with someone who does. Ask grandparents. But raise them cooking, please!

Who's in charge here?

Senators pitch Safe Food Act again

By Tom Johnston on 2/16/2007 for Meatingplace.com

U.S. Sen. Dick Durbin (D-Ill.) and Rep. Rosa DeLauro (D-Conn.) have re-introduced in Congress a bill that would consolidate into a single food-safety agency the 15 separate federal branches currently charged with protecting the country's food supply.

The two Congress members are pushing for new hearings on the Safe Food Act, a bill they have tried to enact for more than 10 years. They re-introduced it simultaneously in both chambers of Congress.

"From the E. coli outbreak that pulled spinach off store shelves to the Taco Bell outbreak that sickened individuals, it is clear that our food safety structure is collapsing and endangering public health," DeLauro said.

The law would hatch a new agency, named the Food Safety Administration, which would carry out the regular, random inspection of all food processing plants, the increased oversight of imported foods, and the adoption of more stringent standards for tracing foods to their point of origin.

Lawmakers are hoping such a consolidation would eliminate the bureaucratic confusion caused by the existing setup, a network in which, for example, the Food and Drug Administration oversees frozen cheese pizza, while USDA presides over frozen pepperoni pizza. The 15 distinct agencies collectively administer at least 30 laws.

"Our current food safety system has turned into a food fight among dozens of federal agencies," Durbin said. He and DeLauro note that their position is supported by the Government Accountability Office's recent placement of food safety on its list of critically flawed federal programs.

One of the perceived hurdles to creating a mega food-safety agency is the cost. And Kate Cyrul, spokeswoman for DeLauro, told Meatingplace.com, "I don't know if [cost] has been scored."

Yes, we really do have a screwed-up food safety program. One of the other things we need to start thinking about: the lack of food animal vets. These include the vets who are doing food inspection, who are working between the food safety program and the producers to improve food safety 'farm to fork'. Would consolidation help? I don't know, but it would make it a little bit easier to understand who's in charge.

Today's photo theme: the markets

The clothing salesmen who sold us some blankets in Kangole on market day. The boys to the left are selling brooms -- no stick, just the bristles.

Today's photo theme: the men

I said I wouldn't change a post, but I have: the essay regarding our work in Uganda has been updated and improved by suggestions, some from comments (thank you, I appreciate the correction).

And today's photos: the men of Karamoja. Here, one is butchering a goat for our welcome party.

Today's photo theme: cows (of course!)

Calves running joyfully towards the cows, who were returning for our testing procedures, while one of the herd boys tries to keep them back.

Today's photo theme: Mother and child

Okay, the photos on flickr are of human mothers with their children, but I liked this one, too!

What I did in Uganda

Zoonotic Disease Survey in Karamoja, Uganda

Background

In January-February 2007, a team of volunteers from the Kansas State University (KSU) branch of Christian Veterinary Missions (CVM) traveled to Karamoja, Uganda at the invitation of Dr. Val Shean of CVM. The trip was funded by private donations and the members.

The purpose of this project was to initiate a zoonotic disease survey. Zoonotic diseases, while important in high income countries (HIC), become critical in low income countries (LIC). In LIC’s, direct contact with livestock is more common and basic hygiene is less common (and less possible) than in HIC’s. In HIC’s, zoonotic disease surveys and control are often in the hands of the government, as, for example, in the USDA’s brucellosis control programs. In LIC’s, however, the government is unable or unwilling to pay for such expensive programs; the livestock production systems are also too decentralized for such a top-down approach. This leaves the livestock keepers of these countries to rely on private laboratories (which are too costly for subsistence farmers) or development programs for identification of zoonotic diseases in their animals. It is such a development program, Cooperative Livestock Integration and Development Enterprise (CLIDE), with which this survey is being performed, in collaboration with the Italian Cooperation and Development program (CD).

Karamoja is a semi-arid region in the northeast area of Uganda, in East Africa. It is primarily inhabited by the Karimojong tribe, semi-nomadic livestock herders. This survey is currently focused on the Moroto district, which is a central area of about 7000 square kilometers, only 48% of which is arable. 90% of the population relies on agriculture for a livelihood. According to a 1995 estimate, there are over 400,000 head of cattle and over 600,000 goats in Moroto district.

The zoonotic risk factors of the region fall into management and cultural categories. Management issues are generally related to livestock mixing and resource availability. Due to the limited water supply in the region, these livestock congregate regularly at the few water pumps or reservoirs, facilitating the spread of infectious diseases. In addition, due to inter-tribal raiding, cattle are collected into corrals within the compounds (manyattas) overnight to protect them. As the people live in huts surrounding these corrals, aerosolized disease can spread easily from cattle to people. In the dry season, the manure pack of the corrals is also aerosolized and carried in the strong winds, spreading throughout the manyatta. The lack of readily-accessible water also makes hygeine difficult; washing of hands after handling animals or before cooking meals is rare. Disease spread between cattle and people is then potentiated, as is disease spread between people. Dogs are also managed in such a way as to increase risk of some zoonotic diseases; due to a fear of rabies, dogs are rarely handled and thus almost never vaccinated or treated for disease.

Cultural risk factors for zoonotic disease are related to food safety concerns. The Karimojong rely on livestock for their main protein sources: blood and milk. Blood is collected from live animals and at slaughter to be drunk raw or cooked, primarily the former. Milk is most often drunk raw or made into sour butter, or ghee. Cow’s milk is used by adults, while goat’s milk is only drunk by the children. The boys responsible for following the herds to pasture will milk the goats into their hands and drink the milk immediately. This means they are exposed to pathogens in these food products.

Health care is in short supply; in the Moroto district, only 24% of the population has access to health care. When official diagnoses can be made, treatment is often too expensive unless highly subsidized.

Diseases Surveyed

The Matany Hospital, one of the privately-run, donor-funded health facilities in the Moroto district, provides subsidized treatments, treating over 100 cases of tuberculosis (TB) and a fair number of cases of brucellosis each month. Due to the apparent prevalence of these zoonotic diseases in the human population of the region, brucellosis and TB in cattle were chosen as the primary focus of the first survey. In addition, Echinococcus granulosus is a common finding in the small ruminants of the region at slaughter; as this is a zoonotic disease with a life cycle passing through the dog, a canine element was added to the survey.

Brucellosis is a bacterial disease transmitted to humans primarily through unpasteurized dairy products, although manure and saliva are also possible sources of disease. It produces recurrent fevers, mimicking malaria, swollen joints, and nervousness or irritability. The primary symptom in cattle is abortion. The disease is most often spread between cattle by contact with the aborted fetus and the placenta from those abortions. It may also be spread sexually; infected cows will infect a bull during coitus, which can then infect other cows in a similar manner.

TB is a mycobacterial disease also transmitted to humans through unpasteurized dairy products, although human to human transmission of the human-specific Mycobacterium tuberculosis is more common in most of the world than the zoonotic Mycobacterium bovis. Feces, saliva, and aerosolized sputum (from coughing) are all sources of disease, for people and for animals. In people and animals, the symptoms of TB are fever and inappetence, leading to a thin appearance.

Hydatid disease, caused by the tapeworm Echinococcus granulosus, generally exists in a lifecycle between dogs and small ruminants. The adult lives in the intestine of the dog, passing eggs through the feces. The small ruminant then ingests those eggs, which hatch into larvae. The larvae encyst themselves in the viscera; when those cysts are ingested by the dog, the life cycle begins anew. Humans ingesting the eggs may become infected and develop cysts in the liver, lungs, and brain, requiring surgical removal.

Procedures

The team from KSU travelled to Karamoja in order to bring testing supplies and train a local team of animal health workers and veterinarians in the skills necessary to survey the cattle of the Moroto district for brucellosis and TB. Testing supplies sufficient for 1000 head of cattle were supplied to the Karamoja Diagnostic Laboratory, a part of CD. This sample size will allow determination of the true prevalence of disease with 95% confidence intervals of +/- 2%.

Testing procedure within a manyatta was based on clinical signs and relative risk; owners were requested to identify breeding bulls, older cows, and any animals that have aborted or experienced prolonged coughing recently. For each animal, the following information was collected: name, age, sex, color, clinical history, current temperature, and treatment history. Blood was drawn from a tail vein into a red-top tube and tuberculin was injected intradermally into the caudal tail fold. The animal was then given an ear tag and a subcutaneous injection of Ivermectin, as a thanks to the owner for allowing testing. After 72 hours, the caudal tail fold was examined to determine TB reactivity. The blood was taken on ice to the Karamoja Diagnostic Laboratory, where it was centrifuged to produce serum. The serum was then used in the standard Rose Bengal card test, as provided by the USDA-NVLS Brucellosis laboratory.

Results

By the end of the week available for testing, 56 animals had been tested for brucellosis and 26 had been tested for TB. Due to the time constraints of reading TB tests within 72 hours, 30 cattle were tested for brucellosis but not TB; those animals will be TB-tested at a later date.

The Rose Bengal test showed 9 positive reactors in the 56 tested, including both bulls and cows. The director of the laboratory and the laboratory technician were trained in the performance and reading of the test.

The TB test produced one reactor, which will later be confirmed via culture of the sputum and comparative cervical test. Two field veterinarians were trained in the performance and reading of the test.

In the 9 canine fecals performed, only Ancylostomma eggs were observed. One unidentified adult tapeworm was seen; however, follow-up was not possible.

Conclusion

The zoonotic disease survey as carried out so far has established the presence of both brucellosis and TB in the cattle of the Karimojong. It is important to continue this study and establish both prevalence data and risk factor analysis; with that data, a control plan can be established to improve public health in the region. A recent meeting with the district veterinary officers of the four districts in Karamoja and the regional medical centers established the interest and support of the local veterinary and human medical community. It is to be hoped that the survey may be expanded to include other zoonotic diseases and other districts.

Other posts on this topic:I'm back!, More teasers, Today's photo theme: Mother and child, Today's photo theme: cows (of course!), Today's photo theme: the men, Today's photo theme: the markets, Today's photo theme: pathologies!, Today's photo theme: plant life, Today's photo theme: sunrise, sunset

And, of course, my flickr site.

More teasers

New plan for sharing my Uganda photos: I'll post one here and 6 on flickr on a theme each day until I get tired of doing that or run out of room on flickr. Here's today's theme: children in Karamoja.

Finally, having caught up a bit, I can get on to today's news:

South Dakota cow tests positive for bovine TB

By Tom Johnston on 2/12/2007 for Meatingplace.com

Animal health officials are investigating the circumstances surrounding a South Dakota cow infected with bovine tuberculosis. Originating in a cull cow feedlot in the state's southeastern region, the cow that tested positive was sold to a slaughterhouse in Wisconsin. South Dakota veterinarian Sam Holland told reporters that initial tests were negative, but a third test confirmed the infection and the herd was quarantined. Testing will determine whether the disease has spread, he said. The state could lose its tuberculosis-free status if more than two herds are found to be infected.

Having just been testing cattle for TB (albeit in a slightly different setting; see the photo below), I found this very interesting. Feedlot cows would be very susceptible to spreading TB: close quarters, large mixing, stress, respiratory disease. But where did the cow come from? We don't have bovine TB in S Dakota . . . but we do have it in Minnesota. This is where we need the NAID system for quick and easy trace-back.

Fun with data

Interesting post (a little old now):

OIE launches global animal health database

By Tom Johnston on 1/16/2007 for Meatingplace.com

The World Animal Health Organization has announced that the World Animal Health Information Database, a global animal diseases tracking system, is now available. To access the system, click here. A complement to OIE's World Animal Health Information System launched in April 2006, the new database, commonly referred to as WAHID, provides all available data on animal diseases per country, region, month and year. The compilation also includes, among other things, animal population by country, epidemiological events maps, global animal diseases distribution maps and comparative disease status between countries. "WAHID is designed to provide high quality animal diseases information to all stakeholders including veterinary services, international organizations, trading partners, academics, the media and the larger public," said Dr. Karim Ben Jebara, head of the OIE Animal Health Information Department. "All can access and monitor with us the evolution of animal diseases in one or several countries or regions of the world." The new online interface will permanently replace Handistatus II, which compiles data from 1996 to 2004.

This sounds like a fun toy; I can't wait to play with it. Oh, wait, it's supposed to be used for good!

Catching up, slowly

Just a few fun things I've meant to post, but didn't get to before I left:
Statistics fun!
Milk as it is (not) meant to be enjoyed -- sad to say, though, I have used such a product in the construction of custards. I can't stand waste.

I'm back!

Just a teaser here, more on flickr, more to come.

What makes a vaccine?

Well, the definitions say circumcision doesn't count. A vaccine is something that stimulates the immune system against the disease in question. Unless circumcision exposes the man to HIV antigens? I'm thinking not.

But what is the point of a vaccine? In epidemiologic terms, it is to a) prevent infection, b) prevent or decrease transmission, or c) prevent or decrease symptoms of the disease. So does circumcision count? I'm not sure.

Yes, we have good evidence that circumcised men are less likely to become infected. The bias involved, however, is overwhelming -- the differences in most of these studies that led to one man being circumcised rather than another stem from culture and religion. Could either of those factors affect, say, sexual behavior? Probably. Do we have a plausible biological reason for HIV preferring uncircumcised men? Not really, in my opinion, although there's a lot of hot air on the subject. We have a link. That's all we can really say.

So what do we do with a link, with a cultural action that may be protective? In my opinion, ignore it and push cultural acceptance of condoms and abstinence. We know they work and we know why. Until a real vaccine comes along.

Book Review: The American Plague

Fantastic first part, describing how the Memphis yellow fever epidemic of 1878 could have happened. Background, flashbacks, gripping heat-of-the-moment storytelling: it really makes you feel what it must have been like to be there. Strangely enough, all the reviews on the back refer to that section . . .

The rest of the book, outlining the contribution of many, including Walter Reed, to understanding the way yellow fever worked and how to stop it, was good. Not spectacular, but good. Some of the human drama, the stories behind the human subjects in the Havana trials, are really quite stirring. For the most part, though, it's just solid storytelling. It's almost, at times, as if the author got a little bored, herself, and couldn't really be bothered to keep the energy up. With the lessons that could be taught about the spread of yellow fever in modern Texas, I don't know why the end wasn't a bit more . . harrowing? . . frightening? . . interesting?

You should read this book for the story of what happened to Memphis. The rest is good background in the subsequent history of yellow fever, but the book is worth it mostly for the first section.

Just to brag

I want to brag: I have the cutest nephew/godson in the world.

Yes, isn't he adorable? And he likes to pose:
Which, given that I have a new camera and had it with me on my last visit, is very convenient.
Would you believe I took that picture in a completely unlit room? I'll have lots of fun pictures to post when I get back from Uganda.

Oh, and since I did take other pictures, here's a glimpse of WNY in December:














Isn't that depressingly non-white? Oh well, it's snowing here today!

Cruelty?

I don't debate the premise of this article, that vegan clothing is animal cruelty-free. I would wonder if it is human cruelty-free (are all the links on the chain paid living wages?).

No, my problem is more with the idea that non-vegan clothing/food is cruel. It can be, of course. But it doesn't have to be -- and I don't like the implication that it does.

Bias?!?! No!

Yes, that's right: nutrition studies funded by animal food companies are biased.

I'll wait for the shock to die down.

We all know (or we should) that companies funding research into their product will sit on any negative results. Thus, there's a simple publication bias towards positive results (which is there for any study, really, but more so when the funding is private and financially interested). Be aware. Any article will (or, again, should) mention the source of funding. Look at it and understand what it might mean to the results.

So far, so good

Yes, we have a new director at the WHO. A woman, a Chinese woman! And, of course, one of her first priorities is women.

Why? Because women do the best, in most situations, at getting health care to children who need it. Because educating a woman on nutrition affects her entire family. Because women are teachers and nurses and farmers. Good for Dr. Chan!

Second priority is Africa: it's hip, it's got lots of important diseases, and it has the biggest opportunity to show improvement. Of course, it also has the biggest opportunity to fail completely. Good luck, God speed.

At the end of her priorities is bird flu. Why? Because it's not as important as a lot of other things that are going on. But it's the controversy over Dr. Chan; she's Chinese, from the government that hid its bird flu problem (badly). Is she going to favor her non-transparent home government? We'll have to wait and see.

Now, though, she just needs to start the job. Alright, time to show your stuff. Get to work.

Turns out they're not actually a good idea!

Story posted today:

Study: Antibiotic use in poultry hurts bottom line
By Alicia Karapetian on 1/4/2007 for Meatingplace.com
A new study conducted by researchers at Johns Hopkins University contends that using antibiotics in poultry for growth-promoting purposes actually reduces the net value of each broiler carcass.

According to the study's results, growth-promoting antibiotics decrease the value of each carcass by almost one cent.

The research, which appears in this month's issue of the journal Public Health Reports, claims to be the first economic analysis of the practice in poultry production. The Johns Hopkins researchers used data previously published by Perdue Farms, which looked at 7 million broilers produced by the No. 4 processor.

However, a National Chicken Council spokesman told Meatingplace that the study's results lacked significance because industry use of growth-promoting antibiotics has declined in recent years, and the primary use of antibiotics is for animal health.

Jay Graham, one of the authors of the study, told Meatingplace that his research showed that the companies that do not use growth-promoting antibiotics only represent 38 percent of American poultry production. Graham also highlighted international implications of the study. "This [study] is important because poultry production is growing rapidly [overseas], mostly in developing countries," he said. "There is a belief that using [growth-promoting antibiotics] in feed is necessary from an economic perspective."

Organizations such as Keeping Antibiotics Working oppose the use of antibiotics in animal feed due to fears of potential human resistance to drugs deriving from the same substances. NCC maintains there are no proven cases of human health problems resulting from antibiotic use in the U.S. poultry industry.

Graham, however, contends that antibiotic use in animal feed does affect drug resistance levels in humans. "There are studies that indicate some human drug resistant infections most likely originate from agricultural use of antibiotics," he said.

Yes, one of the best uses of epidemiology -- figuring out that something we don't want to happen isn't a good idea economically. Listen, people: use economics to back up your moral views. Otherwise, people just won't listen.

Sad, but true.