Kampuchea Crossings

Bump to baby on the beaten expat track

Work

Dysfunctional Programme Management

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Calling in overwhelmed today … these are generally about the software industry, but applies to any field where you have to work in a team!

Asshole Driven development (ADD) – Any team where the biggest jerk makes all the big decisions is asshole driven development. All wisdom, logic or process goes out the window when Mr. Asshole is in the room, doing whatever idiotic, selfish thing he thinks is best. There may rules and processes, but Mr. A breaks them and people follow anyway.

Cognitive Dissonance development (CDD) – In any organization where there are two or more divergent beliefs on how software should be made. The tension between those beliefs, as it’s fought out in various meetings and individual decisions by players on both sides, defines the project more than any individual belief itself.

Cover Your Ass Engineering (CYAE) – The driving force behind most individual efforts is to make sure than when the shit hits the fan, they are not to blame.

Development By Denial (DBD) – Everybody pretends there is a method for what’s being done, and that things are going ok, when in reality, things are a mess and the process is on the floor. The worse things get, the more people depend on their denial of what’s really happening, or their isolation in their own small part of the project, to survive.

Get Me Promoted Methodology (GMPM) – People write code and design things to increase their visibility, satisfy their boss’s whims, and accelerate their path to a raise or the corner office no matter how far outside of stated goals their efforts go. This includes allowing disasters to happen so people can be heroes, writing hacks that look great in the short term but crumble after the individual has moved on, and focusing more on the surface of work than its value.

Source: Asshole-driven development

The concept of Peace post-conflict

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Mental health trauma after years of war is naturally extensively studied in public health. But even living in Cambodia for many months now hasn’t dawned understanding on me of the ravages of the Khmer Rouge period until I took meditation courses with some Khmers.

The most popular meditation techniques, usually associated with spiritual activity, are of Eastern origin ie. martial arts and yoga. The premise of meditation is to gain insight or focus, by relaxing the body and calming and focusing the mind. It’s a skill that allows positive energy to be summoned at will.

And one of the methods used for clearing the mind is to recall a feeling of peace. I can easily recall such moments: standing on top of a mountain and looking out over the hills… standing on a beach with the waves crashing on the sand… blue skies… I take this for granted. But to the others in the class, this “peace” was not a familiar emotion. They couldn’t grasp the concept. How can you explain peace to someone who’s only known fear…?

Past Plagues Are Prologue

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Disease is a fascinating study, a microbiological commentary and defensive mechanism to the stresses placed on our socio-economic environment.

Given the Avian Flu situation here in SE Asia, I thought I’d dig up an article by Andrew Nikiforuk. It’s a well-written piece geared at the Toronto policymakers in response to the SARS scare several years ago. But in light of recent announcements by WHO on the possible pandemic Avian Flu presents, the editorial still bears relevance.

Past Plagues are Prologue by Andrew Nikiforuk

edited 10 Feb 2010: since the above link no longer works, here it is re-posted:

Epidemics always teach us something, says author ANDREW NIKIFORUK. One SARS lesson is that we’re too dependent on hospitals – which can be scary places
By ANDREW NIKIFORUK

Toronto Globe and Mail Saturday, Apr. 26, 2003

When you learn that epidemic disease exists in a country, do not go there; but if it breaks out in the country where you are, do not leave. –Mohammed

Epidemics, one of the real constants of human history, are pretty rude teachers. SARS, a small virus with a big stick, is a task master complete with quarantines, travel advisories and foreign devils. But it also comes with some surprising messages — and they are not the ones you are hearing from the itinerant professional vandals at the World Health Organization or the TV news.

The first lesson might bruise Ontario egos. Plague historians generally agree that spectacular die-offs are rare events. The biggest global killer this century was the influenza epidemic of 1918. It probably buried anywhere between 40 million and 100 million people. It flooded their lungs with water and poured on pneumonia. It quieted entire aboriginal villages and terrified prairie folk into bundling the sick onto trains, a kind of moving quarantine.

The ill generally got off dead. In the end more than 50,000 Canadians died of influenza in a single year. Now, that was an epidemic.

In contrast, SARS is a modest grave-digger, in the last two months burying 18 Canadians and more than 200 Asians. Hundreds more have been sick and thousands have been quarantined. Now, having a new cold virus running amuck that can superinfect people with an untreatable pneumonia is definitely bad news. So this virus is definitely worth containing.

But SARS is not the plague of Athens (“No one expected to live to be brought to trial for his offenses,” wrote Thucydides). It is not the Black Death (which dispatched nearly a quarter of Europe and Arabia). Nor does it behave anything like smallpox. That mass murderer burnt away the faces, eyes and internal organs of nearly 100-million aboriginals in one century.

But as epidemics have repeatedly illustrated, a microbe doesn’t have to be big to be bad. Polio never killed a lot of children but its paralyzing abilities made it legendary. It also targeted the squeaky-clean classes. So we all remember polio.

But Ontario needs to take its pulse again. SARS is a nasty molecule, not an insurmountable mountain. Thanks to global trade, global health organizations and the global media, the death of 16 people in one month can take on the weight of one thousand in one week. (If a virus with 10 genes can unsettle Canada’s industrial heartland, just imagine what a bioterror attack might do!)

Epidemics are always about trade, politics and fear. In 1881, Egypt clamped a tight quarantine on British ships coming from cholera-infected Bombay, and for good reason. But the move infuriated free-traders in England. So the Empire shelled Alexandria and occupied Egypt. In our own century, China didn’t want to say
much about SARS because it feared an imperial-like cannonade on its trade and tourism. But it got one anyway — and so did Toronto by the virtue of international travel. Globalization works that way:
indiscriminately.

Whether ugly or just plain inconvenient, epidemics always tell us something about the way we live. The Black Death, for example, was an unabashed commentary on overpopulation, undernutrition and peasant architecture (rat-friendly thatched roofs). Tuberculosis is always a signal of much homelessness. Cholera wags a finger at water quality. AIDS reminded us that sex is never safe and that promiscuity has biological consequences. (Syphilis gave us the same message, but as we developed treatments, we forgot it.)

The 19th-century bacteria watcher Rudolf Virchow correctly called disease “life under altered conditions.” He noted that epidemics acted like grand warnings that told statesmen that a “disturbance has taken place in the development of his people.”

So what social disturbance is SARS illuminating? I’m no expert, but I’d wager something is seriously out of sync in Guangdong province, a place trying to move from the 18th century to the 21st in a hurry. Its waters are putrid and its air is as smokey as 19th-century London. The capital, Guangzhou, is home to millions of migrant workers who sleep on the streets like homeless Cree in Winnipeg. Tellingly, the 1968 Hong Kong flu pandemic started in Guangdong. Microbes recognize an opportunity when they see one.

But SARS is also highlighting another disturbance: the shoddy state of infection control in our hospitals. For starters, the virus has been a lazy opportunist that has largely dined on sick hospital patients. As a
result, about 30 per cent of the infected are hospital workers. In fact most of Ontario’s cases can all be traced back to one hospital. Here in Canada, SARS is a hospital-acquired infection.

This is not an accident. Many ancient and recent epidemics, including Ebola, have marked hospitals as formidable disease spreaders.

Why? Hospitals, like nursing homes, are microbial feedlots.

Thanks to medical cost-cutters and promiscuous antibiotic use, hospital infection control isn’t what it used to be. As such, Canadians generally now have a one-in-10 chance (according to Health Canada) of acquiring an unwanted infection whenever they visit an acute-care hospital. The rate at which patients pick up woeful infections has increased by 36 per cent in the last two decades.

Hospital-acquired infections now kill hundreds of Canadians and more than 100,000 Americans every year — and with barely a headline. With the exception of animal feedlots and daycare centres, no institution has done a better job of spreading antibiotic-resistant bacteria to the greater community than hospitals.

Unsanitary facilities, unwashed hands and unsanitary instruments account for most of these preventable deaths. SARS is a another reminder that if you are not deathly sick, a hospital visit just might change your prognosis.

Epidemics always do a good job of exposing these and other vulnerabilities. SARS, for example, has underscored the sorry state of Toronto’s political leadership as well as the short-sightedness of emergency response plans that assume health-care systems won’t get overloaded during an epidemic. It also illuminates the hopelessly complicated nature of a just-in-time-economy that makes no allowance for hazard. Nature doesn’t make that kind of mistake.

SARS does not spell the end of Toronto or world trade. But it is an economic upside-down mess for the golden horseshoe. China has a true epidemic to worry about. A blazing economy there has altered the conditions of life so rapidly that SARS won’t be China’s only biological export.

But, like all epidemics, SARS will soon pass on. It could get uglier, but I suspect it will just take up residence as a another chronic nuisance.

In a strange way, the message of every epidemic is proverbial: Wash your hands and love your children. Life is a gift and a gamble.

Andrew Nikiforuk is the Calgary-based author of The Fourth Horseman: A Short History of Plagues, Scourges and Emerging Viruses.

Fish tales and banana jams– Koh Kong or BUST!!!

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The blistery summer sun finally yawned and shifted attention elsewhere, allowing a lively tropical storm to play in the Cardamom Mountains. Screeching winds and driving torrents of rain obliged the topographical audience of trees and flora to bend and sway in spirited waves. Onstage in the heavens thunder raged while spectacular light shows illuminated our path. Range Rover engineers were done proud on those unpaved jungle passes. Such backdrop commands resonance with the soul, a harmony of earth and spirit, a communion of–

–what the–?

As we awaited transport to cross the river, a curious contraption, defying the tedium of logic, bobbed into view. It asked to be stared at rudely. The apparatus comprised planks of wood wrongly secured atop three rowboats tied together, and was propelled by a small outboard motor looking for all the world embarrassed at such indignity. Fierce currents crashed around rocky protrusions in the water as our vehicle boarded the raft. Sigh. This is for the brave of heart, and I can only doggie paddle. My useless colleagues are unperturbed.

I used to wonder at some of the stories from the field. But they were written in the stars and I am now convinced. At the next channel crossing, at a restaurant stop, my autopilot checklist overlooked a key variable. [Minimal animals, check. Refuse control, sigh, check. No (uh, cross out)– Minimal (mmh, not quite)– PASSABLE! odor, check. Staff lacking symptomatic lesions, scratches, welts, redness in the eyes, swellings, festering wounds, other evidence of disagreeable heaven-forbid-transmissible condition, welllllllllll–squirm–sigh–oh alright, check. All systems go.] Nature called– texted, actually (calls are expensive in these parts). This way, pointed the cook cheerily, and the corners of my relaxed disposition soon dropped. A stilted outhouse stood over the water three meters into the river, the toilet a hole cut out of the wooden floor. Like Koi in a pond trained by daily feedings that an approaching human meant chow, finned creatures and what appeared to be a pig (who knew pigs swim) gathered enthusiastically beneath the outhouse at my approach. As I prematurely thanked lucky stars that I did not have fish or pork, the iced coffee I’d just consumed snickered at departing wits: the icehouse was next door downriver. [Sigh Of Relief exit stage right. Gag Reflex enter stage left.]

Nestled with its back to the jungle, embracing the Gulf of Thailand, lacking paved roads and bridges, far, far from Apple Pie and Elvis Impersonators and the newly snuck-in UN Ambassador and Gray Bureaucrats sealing the fate of the virgin oil field just discovered off its coasts, the poor island city of Koh Kong bears all the charm of an isolated seaside town, where the pace sips a coconut-papaya shake beneath a swaying waterside palm. Its proximity to Thailand allows it to siphon electricity and cable channels from its neighbor. But the conduits are shut down during heavy rains, pitching Magnavoxes and Pioneers and the karaoke on all three city streets into silence. Despite the severe poverty, its people are a positive lot with a ready smile, and they know that better days are coming.

Besides the offshore drilling that will replace the venturesome capitalist’s ten-cent-coconut-papaya shake (or was it a mango-coconut-papaya shake?) with a martini-shaken-not-stirred-charge-it, there is the planned highway linking Koh Kong with Phnom Penh. The ink had not dried on the approved construction project when land prices soared to US levels and hands shook on business deals. The initial phase bulldozed the road in front of our survey site, and access to the health center was via large mounds of dirt and a displaced canal, so off went the shoes and hitch went the britches. But it is rainy season and, really, water buffalo dung is just mashed vegetation.

How can you build Character when it keeps trying to escape?

That’s when the banana dropped. A little Khmer girl was scampering about in the dilapidated clinic, daughter of one of our interviewers. In her small hand was a small banana, peeled, the sweet kind, the kind you can pop whole into your mouth it is that small. Banana scrawled itself onto my mental shopping list while the banana in the little girl’s grip fell to the ground in a careless instant. Unfazed, she picked it up, took a bite, and looked about. I sought cover. But little girls with dirty little bananas in their dirty little fists are quick and the banana was soon being offered to me with the sweetest smile. Kick her, dirty banana will go away, Evil Nat rasped. Angel Nat on the other shoulder —it’s got wings— said kindly, Take the banana.

All eyes turned towards this unfolding drama. Kick her— The little girl looked at me. Take the banana— My team looked at me. Kick her— I looked at the banana. Take the banana— The banana looked at me. [Overhead two pressure systems collided. Tears from timid clouds rained down.] Everyone on my teams are Khmer, hired and paid by NCHADS, —It’s dirty!!— the STI surveillance unit of the Cambodian Ministry of Health, —That isn’t the point!— in turn receiving funds from the US-based ngo FHI, —Kick her!— which in turn works with monies disbursed by the big kahuna in the alphabet soup of development, USAID. [The cauldron of the heavens bubbled and boiled over as oxygen molecules fleed the scene.] As the only foreigner I’m the manifestation of privilege, –Take the banana!– dollar behind the paycheck, a face to link to the billions in foreign aid each year. Each move however insignificant, —Kick her!— in judging eyes directly victimized by our policies, is America incarnate. [Electrons hissed and prepared for landing. The very air cackled and spit!!] Take the banana!! What are you gonna do, the silent universe vortexed ominously. Kick her!! What are you gonna do, the wealth of nations sneered. Take it already!! Kick her!! Take thE BANANA!! KICK H– WHAT ARE YOU GONNA DO, you arrogant, bomb-happy, neo-colonialist hypocrite preaching at masses too starved to care– KICK HER!!! TAKE THE BANANA!!! –trawling the world looking for more–more!!–like you don’t have enough and wheRE ARE YOU GONNA GET IT YOU’RE AT THE ENDS OF THE EARTH HERE!!! [Roar of thunder!!!] WHATAREYOUGONNADO?!?!?!

[Tha-dump-tha-dump-tha-dump. . . ]

I took the banana. And crossed bananas off the shopping list.

Free Trade and Pharmaceuticals

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The average NGO or civic group does not have adequate capacity to actively participate in the increasingly complex policy and legal environment of global trade. This puts decisions and actions taking place in corporate headquarters and multilateral assemblies out of reach of the ordinary citizen. Here is the short-version international legal framework for essential medicines, proprietary drugs, and CAFTA.

From GATT to the WTO
The end of WWII saw the creation of the World Bank (WB) and the International Monetary Fund (IMF) to regulate international economic cooperation. These are known as the “Bretton Woods” institutions, named for the town in Vermont, USA, where negotiations took place. The package of trade rules which came out of this gathering was the General Agreement on Tariffs and Trade (GATT 1947). It began with 23 countries, dealing only with trade in goods, and affecting just 10% of global trade. Thus began international trade liberalizations through progressive reductions of protectionist measures (ie tariffs), ensuring a tremendous momentum of trade growth.

GATT was legally only a provisional agreement and not a governing body. It did such a good job of reducing tariffs and promoting trade that governments had to develop other forms of protections for sectors threatened by overseas competition. Bilateral market-sharing agreements and subsidy structures were then created and implemented in effort to protect domestic products. Unable to respond to the vast overhaul of the global trade environment, the recessions of the 1970s and 80s, and increasing globalization, the Charter’s relevance soon diminished.

Multi- and plurilateral accords between contractual member countries were added to GATT during negotiations called “trade rounds”. At the Uruguay Round of 1986-1994, the World Trade Organization (WTO) was created to replace GATT. This Geneva-based intergovernmental body binds all members to global commercial agreements which are multilateral, mandatory, and permanent. It contains a dispute-resolution mechanism to enforce their mandates. In addition to trade in goods, this new organization added trade in services and intellectual property (IP) to its mandate. Trade in services is covered under GATS (General Agreement on Trade of Services) and trade in IP is covered under TRIPS (Trade Related Aspects of Intellectual Property).

WTO has 148 member countries as of February 2005. It accounts for over 90% of global trade.

WTO/TRIPS
TRIPS covers literary works, phonograms, computer programs. It also covers industrial designs such as copyrights, trademarks, trade secrets, geographical indications, patents, undisclosed information, and is an increasingly important component of trade. Minimum standards of protections against counterfeiting and piracy were laid out at WIPO (Paris Convention for the Protection of Industrial Property and the Bern Convention for the Protection of Literary and Artistic Works). Member states are given a transition period (periodically revised to accomodate country-by-country capacities) to adapt enforcement laws for TRIPS-compliance: 1 January, 1995 for developed countries; 1 January 2005 for transition economies; 1 January 2016 for least developed countries.

A 3rd WTO Ministerial Conference was summoned in Seattle, US, on December 1999 to plan the next round of negotiations, the Millennium Round. But irreconcilable disagreements among the members, aggravated by a massive global movement in protest of the status quo, led to the meeting’s collapse.

WTO/TRIPS/DOHA/Compulsory Licensing and Parallel Importing
The effect of international trade laws on the procurement of essential medicines is a topic of much concern. Patent protections are essential to promote investment and innovation by an industry. But effective legislation must balance all interests and prevent abuse by the patent holder. Pharmaceutical companies, governments, and advocacy groups have been embroiled in legal clashes over this issue, particularly with medicines for the treatment of HIV/AIDS, or combination anti-retroviral therapies (ARVs) for reducing viral load. Almost 90% of HIV/AIDS is in the lowest 10% geographically in terms of GDP.

TRIPS treats pharmaceuticals like any other article of trade, even though these are not just another commodity. These are life-saving consumerables. Pharmaceuticals are covered by patents which grant a monopoly period to the innovator company for 20 years from the date of filing. Without the safety mechanisms in TRIPS, given the existing market structure, drug therapies are not affordable to people of the developing world. The two provisions in TRIPS for health emergencies are compulsory licensing and parallel importation.

Compulsory licensing is a legal intervention for removing the monopoly rights given by a patent, in order to obtain cheaper generic versions of medicines. Parallel importation is the purchase of proprietary drugs from the cheapest source, from someone besides the authorized distributor, because drug prices fluctuate from market to market.

Both of these are powerful tools in creating the competitive environment which forces prices down. These mechanisms must be included in the language of national laws for a country to employ it in leverage against corporate interests in periods of crisis.

In November 2001 at the 4th Ministerial Conference convened in Doha, Egypt, Bush signed the DOHA Declarations under tremendous pressure from developing countries and civil society. DOHA essentially reiterates the right of member countries to break patent monopolies in TRIPS for the purpose of protecting public health, particularly in promoting “access to medicines for all”.

CAFTA/FTAA a.k.a. Monroe Doctrine II…
The Central American Free Trade Agreement (CAFTA) is an expansion of the 1993 North American Free Trade Agreement (NAFTA) further into the hemisphere, and is key to advancing the Free Trade Area of the Americas Accords (FTAA). FTAA talks were shut down by fierce opposition at the 5th Ministerial Meeting in Cancun, Mexico, 2003. Ongoing disputes between the US and Brazil further raises doubts about this pact. Elimination of tariffs as CAFTA-DR is designed to do comes with a theoretical economic boon but have far-reaching ramifications on basic rights, environment, and sustainable development.

Elsewhere, bilateral FTAs are aggressively pursued by the US government. Patent protections for proprietary drugs will be extended beyond the 20 years required under TRIPS. The new language weakens or eliminates a government’s ability to launch generic competition to lower the cost of medicines. It blocks test data from release within the patent period, denying generic manufacturers access to critical safety and efficacy information. It blocks the temporary override of a patent that compulsory licensing allows. CAFTA countries will be required to divert scarce resources to implement more stringent protection infrastructures, in compliance with rules counter to the broader interests of public health. Sanctions by WTO keep signatories from violating these charters.

These priority agendas from the Bush administration are drawing intense opposition from the global South. Even the World Bank has acknowledged the challenges these pacts will have on the participating members. A small number of transition countries who have won landmark legal battles of their own now lead this growing resistance– Brazil, South Africa, India, Thailand.

Fierce lobbying now surrounds this pivotal trade pact. CAFTA is aiming for a floor vote before the July 4 recess of the US Congress.

Free Trade: Patents versus Patients

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It’s been several years since US-backed Big Pharma sued South Africa for obstruction of profit when it bypassed patent laws to provide cheaper generic medicines for its burgeoning AIDS epidemic. The suit was retracted under furious backlash from advocacy groups worldwide. That battle has since stepped up with the ascendancy of IP (intellectual property) and trade imperatives. At issue are patent regimes affecting life-saving pharmaceuticals. It is critical to have flexibilities in global IP rules that accommodate situations whereby a country simply cannot afford brand name originator drugs to respond to a crisis. In protection of public health, and “to promote access to medicines for all”, the WTO TRIPS (Trade Related Aspects of Intellectual Property Rights) contains such provisions, called the DOHA Declarations, which specifically allow countries to break patents without challenge in face of extreme urgency. 2005 marks the year that developing countries are to come to full compliance with TRIPS. LDCs (least developed countries) have until 2016 to establish IP enforcement infrastructures. South Africa was only the beginning.

In the US, lawmakers are now duking out the fate of Bush’s free-trade pact with Central America, CAFTA, an expansion of NAFTA further into the western hemisphere. Fierce lobbying on both sides have intensified for a bill that was signed in the White House last May and stalled in the House and Senate over the past year amid rising opposition. The Congressional Hispanic Caucus has already rejected it. Health advocates cite that the IP protections will confer monopoly-like status to high-priced brand-name drugs in already resource-poor markets, rendering them unaffordable and inaccessible. It extends data exclusivity provisions in TRIPS and creates a more restrictive atmosphere against DOHA.

Outside Brazil’s UN Missions and Embassies this past weekend, AIDS demonstrators called on Brazil to summon the maximum flexibilities accorded by TRIPS for its public health emergency. Efforts to continue discounts for AIDS drugs have been met with enormous opposition from mega-pharmaceuticals (Pharma), despite the legal and voluntary sphere in which Brazil has sought to engage dialogue. This counterweight to the US in the western hemisphere is a model for the Southern Cone countries with its decisive response to its AIDS epidemic in the late 1990s, effectively using DOHA as a bargaining tool to lower procurement costs of ARVs (antiretrovirals) and in creation of a generics industry that is lauded worldwide. In exercising its right to prioritize public health by legally issuing a compulsory license against AIDS medicines patented by American companies, Brazil sits on the IP Priority Watch List for US sanctions. Its status in the Generalized System of Preferences, which bestows favorable trade access to the US market to select countries, is under threat and used as a carrot-stick.

Elsewhere, bilateral FTAs (free-trade agreements) are being pursued by the US that slip just under the radar of watchdog organizations, containing IP clauses which threaten the affordability of life-saving drugs. There is no transparency: the content of agreements are not publicly available before they are concluded. Many lives ride on the outcome of these free-trade pacts, negotiated by legions of American attorneys in language that allows for tightening of IP laws. Developing countries hardly have recourse against the gravitational pull of the Pharma-friendly US government. Thailand is on the near horizon to be sucked into these negotiations, with landmark judgments rolling out of its courts heralding a rough road ahead. Cambodia, the first LDC admitted to the WTO, is excluded from pharma-patenting until 2016.

Pharma influence is pervasive from the international negotiating tables to the consumer spheres. Pharma commands the highest profit margin of any US industry. It has more than one lobbyist for each member of the US Congress. Budgets for promotion to healthcare professionals, direct-to-consumer advertising, and sales forces exceed the GDP of Subsaharan Africa. It pays for over half of American Continuing Medical Education costs. Lucrative rewards are pushed at academics for promising research, with contracts including gag clauses to prevent the researcher from publishing unfavorable results. Leading companies spend two and a half times more on marketing and advertising than on R&D. Even medical journals have become an unwitting extension of Pharma’s marketing efforts. Regulatory agencies– the one consumer recourse– are understaffed, underpaid, untrained in multi-sector evaluations, unknowledgeable in public health concerns, and increasingly under the influence of the big wallets of Big Pharma.

The commerce of medicine and public health is a paradox. It is a complex mishmash of basic human rights, global trade regimes, economies of scale, financing superstructures, back-door legalese– all with ethical and moral underpinnings. It spawns a poverty industry that the development sector falls victim to– or is created for. . . ? Profits are not being demonized here: FTAs are established to safeguard the prosperity of the parties involved. But what good are the safety mechanisms in these negotiations if applying them will incur the wrath of an unstoppable US government?