Wednesday, March 31, 2010

Governments and Health in the Third World

“Curmudge, do you recall our imaginary visit a few weeks ago to that Third World village where the people had such poor health and sanitation? I suspect that those people’s sorry situation is duplicated in many locations throughout the Third World. What’s the root cause of their plight?”

“In my opinion, Jaded Julie, the root cause is poor government. I’ve heard it said that in the U.S. one gets rich and then goes into politics; in the Third World one goes into politics and then gets rich. In these countries, graft is rampant. When the developed world sends (lends?) money to Third World countries, it often ends up in the pockets of the leaders and their cronies. These folks don’t seem to believe that a government should exist for the benefit of its people.”

“Citizens of Third World countries often do quite well if they are able to emigrate to a developed country. What is their country of origin lacking that prevents their ‘pulling themselves up by their bootstraps’ back home?”

“For the most part, the countries of the world that are the most poverty ridden are those without democratic governments that foster free markets. This is documented by
studies published by the World Bank. At the bottom of the ease-of-business scale are those little countries of Africa that would be difficult to find even on an up-to-date map. The vast majority of the populations of these same countries live in poverty.”

“That must mean, Curmudge, that the countries in which the citizens prosper are those in which it is easy to do business.”

“Exactly. At the top of the ease-of-doing-business scale are Singapore, New Zealand, Hong Kong, and the U.S. in that order. The World Bank’s criteria include: starting a business, dealing with licenses, hiring and firing workers, registering property, getting credit, protecting investors, paying taxes, trading across borders, enforcing contracts, and closing a business. We know intuitively that most of these conditions are favorable in the countries of the developed world.”

“I saw you reading an
article by Steve Forbes in which he elaborated on some of these criteria.”

“According to Forbes, the rule of law that we enjoy in the U.S. is essential. Commercial contracts must be respected by everyone, including government bureaucrats, and government cannot seize your property or nationalize your business. ‘Low tax rates on income, profits and capital gains foster more risk-taking and higher growth, bringing about a richer economy with a higher standard of living—along with higher government revenues.’”

“Curmudge, some people don’t believe what Forbes said about lower tax rates bringing a higher standard of living and, at the same time, higher government revenues.”

“Forbes’ statement is undoubtedly based on the
Laffer curve. Although it is somewhat controversial, the political philosophy of those who totally reject it appears to have blinded them to the realities of history. Speaking of history, the concept of the Laffer curve has been around since the 14th century.”

“So back to those impoverished folks in the Third World village we visited a few weeks ago. We could help that single village by sending our own resources, but what can be done to assist the whole poverty-ridden nation?”

“If the source of poverty is despotic leadership, Julie, one solution might be regime change. The feasibility of that depends on the relative strength and determination of the regime and of the people. Peaceful change came to the former Soviet–bloc countries in 1989-90 because virtually all of the citizens participated in peaceful demonstrations that the communist leaders were unwilling to suppress violently. Elsewhere, regime change has not occurred because despotic leaders were willing to put down unrest irrespective of the cost.”

“I have the feeling that today’s discussion might end on a discouraging word, Curmudge. If they don’t get a democratic, somewhat benevolent government, the folks we visited may have to put up with their polluted water and hanging toilet for a long time.”

“They are not the only people with concerns, Julie. Even people in developed countries have to work hard to keep their standard of living from being eroded by their government. To quote
Thomas Paine, ‘The greatest tyrannies are always perpetrated in the name of the noblest causes.’"

Thursday, March 25, 2010

Cultures--Bad and Good

“Curmudge, I believe that you’ve felt that one of the best aspects of the Lean culture was its respect for people.”

“Right, Jaded Julie. Although I always enjoyed my work, I now realize that I often worked in a poor cultural environment. I guess I was just stoic and didn’t know any better. Fortunately, there were other places where the culture was extraordinary.”

“We can learn from experiences that were bad as well as from those that were good. Let’s start with the bad ones. Can you give some examples?”

“The company’s culture was great until the founders retired. The new CEO was from Chicago, so he moved corporate headquarters there (at great expense). As I recall, the building had five stories; the top floor was for the exclusive use of the top executives and their administrative assistants. Whenever I met with my boss, her assistant would escort me from the third floor; the elevator door wouldn’t open at the fifth floor for mere peasants. When one stepped out of the elevator, you faced a life-size stylized horse which likely cost much more than a real one. If the horse could have talked, it would have announced, ‘You are now in executive country.’ The art work on my boss’s office walls was exquisite. It had to be because it was inspected periodically by the ‘picture police.’”

“To say the least, the corporate culture doesn’t sound very egalitarian. You once told me that it wasn’t so much the executive floor that bothered you; it was the political stratification that seemed to be palpable throughout the whole building.”

“That’s for sure, Julie. Corporate royalty had an executive dining room on the top floor and a garage beneath the building for their company-owned cars. Fortunately, some of the perquisites trickled down to the lower floors. Managers had offices with a window, and directors had corner offices. Others, like me, had cubicles in the middle of a big room. I was grateful that because my regular location was here in the Fox Valley, I only visited corporate headquarters occasionally for meetings.”

“Although the whole situation sounds pretty dismal, were there other aspects of the culture that really got your goat?”

“There sure were. Another location of the company had layoffs that occurred in waves. During one of these periods, when the P.A. system summoned a person to report to Human Resources, it usually meant that his job had been eliminated. In addition, when I read the company’s annual report, I learned that they paid more for the executives’ golf club memberships than they paid me in salary. I remain perplexed at the top-level executives’ apparent disinterest in how the company’s venomous culture impacted the rest of their employees.”

“Wow, Curmudge! Your experience with medieval management must have been a real downer.”

“There are more examples, but perhaps not quite as egregious. Many years ago in a different organization, a new president was hired from a university in the South. Despite the organization’s extraordinary culture, he made no attempt to understand it or to build upon it. It was his way or the highway, and most staff members—including me—chose the highway.”

“I hope, Curmudge, that these truly bad experiences were matched by some that were truly good.”

“We’ll talk about those soon in
Kaizen Curmudgeon, Julie.”

Thursday, March 11, 2010

Return to the Third World

“Jaded Julie, I’m certain that you recall the unpleasant details of our imaginary trip to the third world last week. Remember those local people who were staring at us as we were inspecting their hanging latrine? They sure didn’t look very happy.”

All of the details were unpleasant, Curmudge. Maybe those folks thought that we were going to add to the overcrowding in their primitive toilet. No need to worry. I’d suffer extreme constipation before I’d use that grubby thing.”

“That assumes, of course, that you didn’t have diarrhea, which you would have gotten within a few hours after drinking the local water. But what I also noticed was that many of the locals appeared to be in poor health.”

“You’re right, Curmudge. Some of the children had distended bellies, and I saw a woman with a grotesquely enlarged leg. She looked as if she were part elephant.”

“That’s why they call her disease elephantiasis, Julie. You must have cut class the day they covered tropical diseases in nursing school. Actually, there may have been several of the locals who weren’t able to come down to peer at the visitors from far away. They were bed-ridden because they were too ill with malaria or AIDS.”

“I’m becoming convinced that life is extremely fragile in undeveloped countries.”

“Here are some data on the top five diseases that show just how fragile it is (1):
Lower respiratory infections (pneumonia, etc.): Over 4 million deaths per year.
HIV/AIDS: Over 3 million deaths from AIDS in 2004. 39.4 million infected with HIV.
Malaria: Between 1 and 5 million deaths per year. 300-500 million cases per year.
Diarrhea: 2.2 million deaths per year. 4 billion people infected per year.
Tuberculosis: 2 million deaths per year. 2 billion people are infected.”

“I’ve read the list. The next five are measles, whooping cough, tetanus, meningitis, and syphilis. Then there are the so-called 13 neglected tropical diseases (NTDs) that infect 1.4 billion people worldwide (2). The most common of these is roundworm; that’s what gave distended bellies to the kids we saw. Elephantiasis (I just looked it up), snail fever, and river blindness are on this list. So Curmudge, why aren’t people in the industrialized world more concerned about these people and their diseases?”

“My speculation, Julie, is that people are very insular by nature. We read about the problems of our own world every day, and those are the ones we are concerned about. If we perceive a personal threat from our immediate surroundings, we’ll cling to that belief as strongly as if it were a religion. Dogma usually trumps objective science.”

“If that’s the case, we’re apt to become preoccupied with the first threat that someone puts into our head.”

“That seems likely, Julie. Skeptics probably sleep better at night, and realists do everything in their power to solve real problems like those we’ve seen in the Third World.”

“Specifically Curmudge, what can we do?”

“As you said last week, everybody should revisit their priorities. Senior citizens can open their checkbooks, and as a nurse, Jaded Julie, you would be a great asset on the mission trip from Affinity to Peru next fall.”

(1) Top killer diseases in the developing world. http://www.alertnet.org/topkillerdiseases.htm
(2) Global Network for Neglected Tropical Diseases. http://globalnetwork.org/

Wednesday, March 3, 2010

A Trip to the Third World

“Jaded Julie, please name the most serious environmental problem you can think of.”

“That’s easy, Curmudge. Global warming. At least that’s what everybody says.”

“Who is ‘everybody’?”

“The newspapers. The politicians. Well…everybody.”

“I’d like you to take an imaginary trip with me to a rural area of a third world country. Will you go?”

“As old as you are, I knew it was going to be imaginary. Okay, let’s go.”

“We’re here. That shack over there is where you’ll be staying.”

“Wow, it’s hot! What’s that horrible odor? It smells like a sewage treatment plant with a power failure. I hope those mosquitoes buzzing around my head aren’t carrying malaria. And if my ‘luxury villa’ (shack) has only one room, where’s the bathroom?”

“The ‘hanging latrine’ is right over there (1). It’s an outhouse with a rag door on 4-foot high stilts. There’s no seat, but there is a ditch underneath. It doesn’t flush, but in the monsoon season the rain carries everything farther down the ditch. One walks up a rickety sloping ladder to get to it; if you lose your balance on the way up, the result will be—to say the least—memorable. Oh, and by the way, you’ll be sharing this ‘facility’ with those 500 people who are staring at us, and you’ll share your one-room ‘villa’ with seven of them.”

“Where’s the toilet paper?”

“Don’t ask.”

“And where do I wash my hands?”

“In that stream over there; see where the ditch runs into it. It’s the same place you’ll get water for cooking and drinking. I hope you brought your own soap. Or if you want somewhat cleaner water, there’s a well five miles down the road.”

“Please, Curmudge, get me out of here! I’ve seen (and smelled) enough.”

“We’re back home, Julie. Appleton never looked or smelled better. After experiencing our imaginary trip, you may be interested in these statistics (2):
· 40 per cent of the world’s population do not have access to a basic latrine. That’s 2.6 billion people who don’t even have a bucket or box (3).
· Up to 80 per cent of illnesses and five million deaths per year in the developing world are related to sanitation and water.
· 4,500 children die every day from diarrheal illnesses.
· Every year more than 3.5 million children do not live to celebrate their fifth birthday because of diarrhea and pneumonia.”

“Curmudge, I couldn’t stand spending a day in the place we just visited, yet those people must spend their whole lifetime there. I’d better revisit my earlier thought about global warming. Let’s see…the world’s leaders—even those from developing nations—are talking about spending billions of dollars per year on an uncertain solution to an uncertain problem that might occur at an uncertain time in the future. Contrast that with spending orders of magnitude less money on known solutions to the known problems of dirty water and inadequate sanitation that will kill 4,500 children today. The everybodies that I mentioned earlier need to re-think their priorities. I have certainly changed mine.”

“Jaded Julie, you are indeed a gem.”

(1) WaterAid The State of the Worlds Toilets 2007.
http://www.wateraid.org/documents/the_state_of_the_worlds_toilets_2007_1.pdf

(2) Dickson, B. and Salmon, B. Looking Back at International Year of Sanitation.
http://www.theepochtimes.com/n2/index2.php?option=com_content&task=view&id=9791&pop=1&page=0&Itemid=1

(3) George, R. Nowhere to Go. The Rotarian—January 2010.
http://www.rotary.org/en/MediaAndNews/TheRotarian/Pages/toilets1001.aspx