In the portacabin

Sorry for my delay in posting; I’ll probably backdate some stuff I wrote previously just to spread out the postings. I switched “offices” and moved out to a portacabin, which is what they call trailers here. (I have a running joke with one of my friends that I should really write my med school thesis on the role of the portacabin in Botswana health care: most of the NGO/university-type research units are full of portacabins, and you could draw all sorts of interesting conclusions about permanence and procedures and permits…anyway…) The point is, all the cool people are in the portacabin (not really) but it took more than two weeks to get someone to come upgrade my internet explorer to a version that lets me access crucial sites like NYT and gmail and this one. So I'm only now posting stuff I've written over the last couple of weeks.

By the way, speaking of NYT access, GO DEMS!!! I’d like to commend the Kalamazoo election officials for sending my absentee ballot all the way to Gaborone with good haste! (Whether it got back in time is another question, but I don’t have much control over that.) My office-mate was quite intrigued by the U.S. ballot, especially since I also got to vote on things like affirmative action (interesting discussion trying to explain the history of that one), limiting eminent domain (likewise), and mourning dove hunting licenses (yeah, didn’t even try)!

Ke ithuta setswana

I am learning Setswana! I finally started an official class this week at the university. I’m so pleased to finally be learning more than the bare minimum. This is a crazy-fun language. There are around 15 people in my class, and we’ve all lived and worked in Botswana for at least a few months (two have lived here more than 25 years) so we all know random words and phrases but have never studied it systematically. We’ve mostly been working on grammar basics and building vocab.

Grammar pluses: you never have to conjugate verbs in the present tense, except in an easy way to make them plural. Yay! Also, you can leave out lots of the little linking words necessary in English and don’t have to do crazy Germanic word order involutions. Grammar minuses: you do have to sort of “conjugate” nouns. It turns out there are 18 classes of nouns and between the noun and verb you have to insert a “subject marker,” which is a one-syllable but essential word (e.g. “e” “di”). Sometimes you can tell the subject marker from the noun’s spelling or meaning--like all singular persons get “o,” all singular animals get “e”--but often you can’t. I’m hoping I can just mumble my way through that little syllable without people noticing too much.

Pronunciation is challenging too in many ways. Setswana is a tonal language, and I’ve never tried to learn a tonal language before. Whether you say vowels pitched a bit higher, lower, or at the same level as the rest of the word actually matters. And unfortunately this applies to many rather important words. For example, “o” means either “you” (pitched low) or “he/she” (pitched high). The verb “bua” means either “speak” or “skin a goat” depending on the tone (context should prove helpful here, one would think!). “Bring the ladder and the walking stick” can apparently be said “Lere lere lere” with three different tonal combinations. Plus there are lots of rolled “r”s and I have never successfully rolled an r in my life.

However, the best news is that in practice, English works for nearly everything in my day-to-day life (with the exception of talking to most patients--and there are always nurses to translate if I am at clinic). People are almost invariably pleased (and amused) by any efforts to go beyond the most basic greetings. One of my American friends here who knows quite a bit of Setswana says that when she uses it, 80% of the time people laugh and repeat back verbatim what she just said! They keep doing this throughout the conversation, as though they’re amazed she’s speaking Setswana at all. Even our teacher, who is great, laughs throughout most of the lesson as we attempt to make sentences or repeat her pronunciation. It is therefore difficult for me to imagine speaking Setswana about serious subjects.

By the way, we had to choose Setswana “names,” which were mostly nouns chosen out of the book (virtually every name here has a meaning: light, star, gift, friend, lion, humble, happiness, etc., which helps a lot with learning some of these basic words). I chose Molemo. Yup, you can call me “good medicine.” Good for the body, good for the soul...

Lesotho

I spent last weekend in Lesotho (one of those tiny countries tucked into South Africa)--a new country for me! I rode down with some friends and after crashing at one of their boyfriend’s houses in Maseru three of us took a combi up into the mountains and went on a two-day pony trek. Yes, I said pony trek. After seven hours on a horse two days in a row, breaking only for lunch and a two-hour steep climb to a waterfall, I could barely walk. But the mountains were amazing and Setswana is close enough to SeSotho that my basic greetings worked fine. It was so lovely to see green again, and crops being planted, and rivers that actually had water in them. We stayed overnight in a rural village—no amenities, sheep out the hut door, bring your own food and sleeping bag, drink from the nearby spring, etc. Highlights included my friend’s cantankerous horse calmly kneeling down, “elbows” first in the middle of the trail and rolling her off! Twice. I’ll write more and try to post some pictures if I manage to get my computer online this weekend.

Lack of TB funding article

Warning: soapbox approaching.
Reminder of context: TB is the major co-infection that people with HIV actually die from in this part of the world.
From WHO website:
Someone in the world is newly infected with TB bacilli every second.
Overall, one-third of the world's population is currently infected with the TB bacillus.
5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.
Nearly 5000 people die of TB every day worldwide. This is only getting worse with rising HIV infection rates, increasing drug resistance, and outdated diagnosis and treatment options.

OK, so here's a quick overview of TB research funding status:
(BTW: I'm thinking my thesis is going to have something to do with this!)

TAG Demonstrates Shocking Underfunding of TB Research
3 November 2006
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Top 40 Funders Spent Just $400 million on TB R&D in 2005

Less than 5% of HIV/AIDS R&D Investments

Activists call for $2.0 billion per year in TB R&D, a five-fold increase

New Report Documents Dramatic Shortage in R&D Funding for New and Improved tools and Calls for an Increase Totaling $2 billion Annually to Curtail Tuberculosis

PARIS — A fivefold increase annually from less than $400 million spent in 2005 on TB R&D is needed to achieve the WHO's global targets of slashing TB incidence and death rates over the coming decade. Treatment Action Group's unprecedented report, Tuberculosis Research & Development: A Critical Analysis, tracks the major funders of basic, targeted and operational TB research, revealing a lower than expected baseline of investment in new and improved tools to control TB at a time of escalating threat from drug-susceptible, multi-drug resistant (MDR) and extensively drug resistant (XDR)-TB.

"The necessary money will only come with a worldwide TB advocacy movement that raises the political profile of tuberculosis," said Javid Syed, Treatment Action Group's TB/HIV Project Director.

TAG interviewed 100 institutions and documented the top 40 investors in TB R&D in 2005. Results highlighted in the report showed that new tools including diagnostics, drugs and vaccines received combined funding of $206 million in 2005—diagnostics, $16 million; drugs, $120 million; and vaccines, $70 million. At this rate, only $2 billion will be available over the next decade, whereas the Global Plan to Stop TB 2006-2015 estimates that $9 billion will be needed, revealing a new TB tools funding gap of $7 billion. Basic science and operational research received $94 million and $50 million, respectively, but there are no global targets from which to compare the investments in basic and operational research.

"Clearly the current tools are failing us as evidenced by the annual TB death toll of 2 million and the continuing spread of extensively drug resistant (XDR)-TB," said Mark Harrington, Executive Director of Treatment Action Group. "Without a major scale-up of investment in TB R&D we will be unable to prevent 20 million deaths over the next decade. TB needs to learn the lessons from AIDS, where activists and scientists joined forces to demand more resources for better research leading to improved diagnosis and treatment, saving millions of lives since 1986."

Among national governments, the report shows the leading funders were the US, the UK, France, and India. The top institutional donors were the US National Institutes of Health ($158 million), The Bill & Melinda Gates Foundation ($57 million), the UK Medical Research Council ($31 million) and US Centers for Disease Control ($20 million). The private sector accounted for 11% of the total investments in 2005.

To improve upon decades old technology and match urgency with need, Treatment Action Group demands donors of TB R&D worldwide—including G8 and developing countries—to increase their investment fivefold, from less than $400 million per year to $2 billion per year, with $1.05 billion directed towards new tools research and $950 million directed towards basic science, infrastructure development, and operational research each year, for a total of $20 billion in TB R&D over the coming decade.

Additionally, TAG calls for the development of a comprehensive, global TB research agenda to incorporate the entire spectrum of research that is needed to achieve the goals set forth in The Global Plan to Stop TB. This plan should address the need for major expansion of the basic and operational research foundation that supports new tool development.

TAG also urges the standardization of donors' internal tracking systems according to disease, research category, and research phase to enable more comprehensive annual tracking of R&D investments in all diseases of global health importance. Pharmaceutical and biotechnology companies are urged to provide transparency around their investments in TB R&D. This will help inform efforts by policymakers, research funders, and TB control programmers worldwide to coordinate their investments in TB research.

TB R&D: A Critical Analysis is on-line at http://www.treatmentactiongroup.org. The author was Cindra Feuer, with Javid Syed and Mark Harrington editing. TAG's report will be presented as a late-breaker session at the 37th Union World Conference on Lung Health in Paris, France, on Saturday 4 November 2006.

About Treatment Action Group: The Treatment Action Group (TAG) is dedicated solely to advocating for larger and more efficient research efforts, both public and private, towards finding better treatments, a cure, and a vaccine for AIDS. TAG’s TB/HIV Project works to combat TB/HIV co-infection through a combination of community-based advocacy, education and mobilization efforts involving AIDS advocates in developed and developing countries.