Got Bim

I harbour no illusions about elections. I do not expect that Greece, or the world will auto-magically be transformed into a better place the day after. Such transformations take ingenuity, meticulous planning, hard work, sacrifices and a fair amount of luck. I was not holding my breath for any miracles before the count started and I’m definitely not going to start now that the count is almost over. What I was hoping for was a sign that some perceptions may have shifted to a slightly more productive direction. Boy, was I wrong.

I’ve mentioned before that I put weight on ideas and I consider ideologies a deadweight and an admission of failure in terms of an individual’s own capacity for independent thought. That being said, I cannot consider a bigger blunder coming out of these elections than the fact that a neonazi party has found its way into the Greek parliament. For my readers who are not familiar with greek politics I would like to point that I do not use the term NAZI liberally here, I use it quite LITERALLY. I am talking about people who have written eulogies for Hitler, being elected in what I was told was a western country in the year 2012. The same people think that at the very least we should have a minefield across the entirety of our borders and would not say no to going to war with most of our neighbouring countries. It’s also these people who would have a trouble accepting a thing such as my extended family, because we tend to be quite a bit more colourful than most.

Some friends who have seen a previous blog post have pointed out that in a lot of ways my thought process seems to be closely reflecting that, of a recently formed libertarian party named Drasi. I strongly believe that more libertarian policies will have a positive impact in Greece and I followed a few articles covering the course to the voting booths mostly on lolgreece. A funny tidbit is that for a small country like Greece, there currently exist 3 libertarian parties, that at the moment of this writing approach a total of 6% of the popular vote.

What’s not so funny is that because of the intricacies of greek electoral law, none of these parties will make it into parliament. There have been a few voices in the libertarian world calling for a fusion of these parties for the sake of having some sort of strong libertarian presence in parliament. Although I avoid labelling myself as a libertarian, I think that the first major precipice of libertarianism is deciding what you want to do for yourself. Obviously these three parties could not reach a consensus, and now they have to live with the consequences of that fact. If I’m being honest here, maybe it’s better to be able to reach a consensus than having to include descendants of some of those political dynasties I have found troubling for a democracy. Than again I might be wrong, but this choice is irrelevant now.

The other interesting story today is the rise of the radical left coalition as well as a party called independent Greeks have surged substantially. Before going any further I must point out that Independent Greeks include a large number of politicians formerly associated with other parties in greece, and currently unified under a common ideological platform. For a nation that claims to have invented irony, we certainly have a very poor taste of the stuff. But I digress…

What this shift from the previous, essentially two-party systems indicates is not on me to interpret. I didn’t vote in this one. I will repeat myself by saying that bypartizanship is a definite desideratum for a healthy democratic society. The context in which I’ve previously written that statement was a reference to the re-inforced proportionality rule of entering greek parliament. If you want to see how plainly silly that rule is I will give you another example. “New Democracy”, the first party in these current elections managed to gather approximately 19% of the vote. Meanwhile smaller parties got about 18% of the vote. Since none of those afore-mentioned smaller parties managed to break the 3% threshold none of them made it into parliament. At the same time, the “New Democracy” party has about a third of the seats in the house from less than 20% of the popular vote. What’s funny is that the people managed to break re-inforced proportionality and arrive to a situation that calls for bypartizanship and coalition government, or repeating elections. Congratulations on that front, what took you so long?

Sometimes, I call myself an adherent of kaizen. Kaizen is rougly translated as incremental improvement, or change for the better. These elections have definitely achieved the change part. With things like neonazis in parliament I just don’t think it’s in any way for the better. The kinds of people I dare say hoped to see in parliament were far off from making the cut. I’m not going to spend more time on this. Whatever’s supposed to happen will happen. I have work to do tomorrow morning, and I have a mission. My only hope is that the greek ruling class understand what their job is and get out there and do it as soon as possible.

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For a country that is 3 days away from a general election, AIDS dominating the news headlines is a very unexpected turn of events. However, on wednesday, Greek authorities announced the arrest of 17 HIV-positive women who allegedly worked illegally as prostitutes, accusing them of intentionally causing serious bodily harm. To add insult to injury, with what can only be called an impressive skill at elucidating evil intentions, the authorities also released names and pictures of 12 of the women on the Greek police website.

This comes hot on the heels of a crackdown on hundreds of unlicensed brothels around Greece, brought forth from the enactment of tougher AIDS testing laws for prostitution. While prostitution is legal in Greece, apparently only a fraction of brothels are operating with a license. Which brings me to something I would really like to ask; Where do the authorities get off in this case? It is true that the mixture of illegal prostitution and serious sexually transmitted diseases is undeniably creating a public health risk, creating a spectacle out of this, in clear violation of medical confidentiality and human dignity by publishing photos and details on the police website is simply appalling. But this is also barely the start of the absurdity.

The primo surrealism starts with statements the greek Health Minister, Andreas Loverdos issued, stating that he would like to criminalise the act of having unprotected sex at brothels. Ever heard of unenforceable legislation minister? Greece is a country which has trouble enforcing a ban on smoking in public places. In theory, smoking should have been banned over two years ago, but in practice I think that anybody who’s been to Greece recently can attest to the fact that it isn’t enforced and what’s funnier is that it’s something you can plainly observe. What do you propose exactly minister? That Greece issues condom officers, going around from brothel to brothel knocking on doors and making sure that everybody has their condoms on?

Which brings me to another point I would like to make. There has been a surge to the greek centre for disease control by people who had unprotected sex with these prostitutes. Let’s recap for a second in case you’re feeling like you’re losing the plot. People who have unprotected sex with prostitutes sit around, waiting for the greek police in a blatant violation of privacy post pictures of said prostitutes on their website to get tested? Are you effing kidding me? I don’t count myself among those who have paid for sex, but I do get my blood panels regularly. Primarily because I want to track my health throughout my life, and most importantly because even if I’m not that much sexually active and not sleeping around with particularly high risk groups, I would still like to know if anything’s wrong with me and the people I’ve been intimate with, as soon as possible. I believe this is called being responsible, but with the way things are going in Greece, I may be wrong.

The other thing which is particularly eerie about this is the timing. As I said in the very beginning, the general elections are just three days off, and these general elections are shaping up to be one hell of a catastrophrack. The reason for this is that the majority of the Greek population is reaching a new level of disillusionment with the current political establishment and thusly voting for what would previously be called fringe elements in the far right, most unsettling among which, the Golden Dawn party.

The Golden Dawn party espouses a far right, neonazi philosophy. In the previous general elections in 2009, they walked of with 0.29% of the vote. But given the current turbulent political climate they were polling at as high as 5.2% a week ago. And blaming the events described above on illegal immigrants, who prostitute themselves in the busiest illegal immigration transit point in the european union can only further enflame such far right positions.

I’ve said it before, and I’ll say it again. My biggest beef with the majority of my compatriots is the fact that they are almost clinically unable to assign and take responsibility. As far as responsibility is concerned you start small, with things like taking care of yourself, waking up early enough to go to work. Small, everyday simple stuff. Like not spending more than you make on things you don’t really need in the first place, or going to the doctor to make sure about your cholesterol levels and the fact that you don’t have AIDS! I’m afraid that this kind of blatant sensationalising is not doing much to help with that.

 

 

 

PS. In case the greek health minister’s statements sound completely stupid and nutts, here’s a post at huffpo. Yes, sometimes truth is stranger than fiction.

A lot of things are going on back home right now. Greece appears to be struggling with a boat load of issues, answering almost universally to anything, with what a lot of people characterize as brutal austerity measures. Here’s the thing; I don’t really like talking seriously about greek politics. Occasionally I do like to talk about politics when I find things have entertainment value, but I think the situation in Greece has stopped being funny a while ago. This is the first and hopefully last time I will ever write up anything about the political situation in Greece, so here goes.

Before I move further let me clarify one thing. I am ideologically non-euclidean. That means I don’t belong to any particularly identifiable ideological space, whether that be left, right, centre, up, down east, west etc. I strongly believe in IDEAS and I think that developing entire tomes in support of a handful of few ideas, also known as IDEOLOGIES is believing that people are incapable of reaching their own logical conclussions, so other people will have to force feed them/spoon feed them(depends on your regime) whatever it is they’re supposed to be thinking.

I’ve had far more than a few pet peeves with Greece, long before moving to the UK almost a decade ago. It is unfortunate but Greece really has issues when it comes to corruption, nepotism, self serving political hacks and tax evasion and that’s merely the tip of the iceberg.

Unfortunately for as long as I care to examine modern greek democracy, the country appears to be run by a handful of political families. While the phenomenon of a political family having a prominent position for generations is not isolated in Greece, if you mix with it the apparent incompetence of the Greek ruling class over the last few decades it becomes obscene. Obviously at this point you may be asking , “if the ruling class is so corrupt, why don’t you just vote them out?”- good question. BUT, at least the way things are right now the system is rigged in a self perpetuating manner. That’s thanks to an electoral law that does not put any trust in a politician’s ability to communicate in a by-partisan manner (also called, re-inforced proportionality), as well as what may be the biggest case of state sponsored voter pandering known to man.

What do I mean by the above? First of all re-inforced proportionality as the name may imply is a way of reinforcing the first party elected to parliament so as to make it easier to obtain the majority of seats in the house. That means for example that if a party got elected first with something like 40% of the popular vote, it takes over 50% of the house seats. What does that mean in practical terms? Independents and smaller parties are screwed. Basically if you’re just a guy that could get elected on your prefecture you cannot do it on your own. Because the reinforcing part of the house-seats flows out of your votes and into whoever is first party. So much for representation and a chance to get elected for what you really believe in. Say hello to adopting the party line and kissing the ring of the political clan patriarchs.

As for pandering think of the following. The public sector in Greece accounts for 40% of economic activity. It is the major employer and the major partner for a significant amount of private industry. What does this mean? It means that a lot of jobs are practically handed out to people. Created out of thin air, we money that we couldn’t really afford. What’s even worse? It creates huge beaurocracies because all these new civil servants need to somehow justify the fact that they’re on the greek public’s payroll. Can I blame them? Well not exactly. While this is definitely painting with a broad brush here, a lot of Greece’s civil servants have pretty cushy and relaxed jobs. Or at least they used to have until very recently.

So, who pays for them? Normally we would say the greek tax payer, but recent financial developments have cast a lot of doubt on that. Yes, tax evasion is rampant in greece. One of the things that really got on my nerves during the last year was the following. A lot of people from the justice ministry were making a lot of noise for a list of aproximately 30,000 , yes thirty thousand people who supposedly owed more than 1 million euros to the greek public sector in revenue. If you want a really quick multiplication, that equals to at least 30 billion euros in lost revenues for the greek state. How can this be? Well true to our origins the greek tax code is byzantine (or labyrinthine if you will). Funnily enough this is literally the case, at least for some parts of ecclesiastic property laws, but that’s a story for another day. The current tax-code is full of loops that make it possible to only pay forward a small amount of your tax while avoiding a court-date.

Is that all? No, not really. Greece is not a stranger to market manipulation either. Especially one with involvement by political parties. Thank god for our representatives that they have immunity and they can get away with murder. Actually scratch that thought, some have gotten away with murder. I remember a case in the 90s when a member of parliament drunkenly run over a young lady, accidentally killing her. Of course parliament retains the right to revoke an individual’s immunity. Did it get revoked in this case? Actually, no. So much for the third branch of government.

In case you’re wondering how the hell politicians in Greece got to have immunity it comes from this; During the junta years of 67-74 free speech and free exchange of ideas, as is usually the case with most dictatorships was under attack by the regime. This led to a lot of political exiles and the blood shed of many innocent students in the National Technical University of Athens. With the restoration of democracy immunity was provided to elected members of parliament as a recognition that the same phenomena could happen again in the future. Also, universities were recognized as asylum against common law. In other words, that meant that police could enter a campus only under the express invitation of the provost. Due to the episodes happening throughout the last 5 years, the last part is now repealed. College campuses and schools are not as important to protect as our 300 (not entirely elected) members of parliament.

So the public sector is nepotic, twisted and jumbo-sized. What about the private sector? Also a good question. Let’s see what my beloved country does to encourage private sector growth. First of all, remember the broad brush painting a large group of civil servants as underemployed and over-rated? Reverse that for most private sector companies in Greece. Greek private sector workers are the most overworked among the entirety of europe. Funnily enough, with the introduction of the cap, according to the new memorandum, they will also become the most underpaid.

What has led to this situation? Actually something very simple. Starting your own gig in Greece actually costs money. Enough money to make it hard to grow upwards on a shoe-string budget. And it involves a lot of paperwork. Co-ordinating with the IRS and your trade union and its respective pension and insurance fund to make sure you don’t owe money to anyone, so you can than start paying your dues from day 0. Now that, is something to behold. You may have no income, no clients, no product, but you will still have to pay your dues to your trade union if you want to start your company. And also run around chasing your tail between that, and the IRS. That’s until you can grow big enough to go back a few categories and screw both IRS and unions, for a fraction of the cost. But that’s way in the future. However, with conditions like that it’s no wonder people in Greece opt for a public sector job when they can. It’s a permanent position, with limited responsibility and no possibility of overtime. I saw some of the best minds of my generation turn into overqualified, underemployed public sector workers…

So, any ideas on what to do?

 

• Streamline the fuck out of everything
• Rethink the election law. If the law considers bipartizanship an impossibility, the political parties will act like-wise.
• Break any kind of oligopoly. Which there are more than a few in greece. Including but not limited to taxis and ground transport services etc
• While we’re at it, break ALL monopolies such as the energy sector
• Stream line the tax code and make it simple and easy to execute
• Prioritize tax cases somehow. Trust me, a lot of people wouldn’t mind having their trial dates pushed back a bit if it means fewer taxes for them
• Repeal immunity for members of parliament. I’m sorry but this is not an Orwellian book. This is the real world and saying that “all animals are equal, but some are more equal than others” does not work. Besides you would be giving pigs a bad name, dude.
• Streamline the process to start a small business. While you’re at it find a way to lower the cost. I remember a story by a Singaporean friend of mine about how easy it is to start your own business over there (and with a 5% tax rate for god’s sake).
• CLEAN YOU FUCKING ACT UP. Petty partizanship has no place, especially in a time like this. It never should, but let’s face it we’ve elected hacks for generations. Might as well try making a good impression on your way out.
• Finally, and most importantly, I remember the following: CREATE EQUITY. Yes, create equity, or at least support the people that want to do that. I’m sick of seeing friends of mine give up on their dreams because frankly the way current conditions are in greece their only hope is the public sector or nothing. So make it easy for people to do that. At the very least don’t enable those asking for a hand and a foot up front before people have even had the chance to dip their toes in the market.
• And while I’m at it; Legalize weed. It is better for everyone that way. More, legal income for both state and growers. Safer and better drugs. And that feeling of recognition for every kid that flies to amsterdam and sees that the house special is made in Rethymno or Made in Kalamata. Smugglers will always find a way to grow it, why not make it better for all of us and get a piece of that action. Plus it stops taxing our already overtaxed police officers. And last, but not least, when an entire country is feeling boned, I feel everybody could use a joint.

Anywho, that’s it. No ideology. Just observations and ideas. Next move? Up to the people of Greece.

Introduction

This is an essay I wrote back in 2010 for a policy course I was taking at UCL. The purpose of the essay is to provide a look at the interplay between various stakeholders in the formulation of global malaria policy.

The subject of worldwide malaria policy has garnered increasing attention over the last couple of decades. The target is to find a combination of methods for effective malaria control and hopefully eventual eradication of the disease. This is a complex target that needs to take into account the health effects and transmission dynamics of large human populations with diverse socioeconomical backgrounds dispersed over broad geographical regions.

There are many stakeholders included in the formulation of malaria policy. Organizations such as the Gates foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria have provided funding for malaria treatment and prevention. As Jackson et al write, the role of dialogue in science is not just providing a communication platform for scientists but putting science in the broader social context and including more expertise with regard to its implications. In light of the possibility of a funding shortfall it is important to understand what the current dialogue about the programs and policies set in motion is, and consider the social, scientific and economic requirements for their successful implementation.

In their attempt to illustrate the strengths of dialogue in science related issues, Jackson et al presented an idealized model for the incorporation of public engagement from setting the research agenda to evaluating its consequences. My intent is to show how the goal of formulating an effective policy for combating malaria fits into their model, with particular focus on what the role of research should be. To that effect, I have interviewed Dr Tony Holder and Professor Olugbemiro Sodeinde who have a long lasting collaborative study on the subject. It is my hope that their insights can shed some light on the different problems that need to be addressed and the importance of basic scientific research in the global treatment agenda.

It is indisputable that a number of different cases have illustrated in recent years that carefully designed and methodically implemented policies can substantially alleviate the burden of the disease. My belief is that while further research is paramount in ensuring our capacity to replicate these results and offer viable long term solutions, this research would not amount to much if we fail to improve communication and encourage dialogue among the stakeholders.

Background

 

In 2009 malaria was considered responsible for  873 thousand deaths and 243 million cases of fever according to the World Health Organization(WHO). Malaria is an infectious disease,  transmitted by the anopheles mosquito. It is important to understand that malaria refers to a group of parasites, the plasmodium genus. The most commonly encountered and life threatening member is plasmodium falciparum which accounts for over 93% of malaria episodes and deaths. Some background.

While the 2009 WHO World Malaria Report illustrates cases such as Eritrea, where a focused and pragmatic approach with active involvement and efficient collaboration from stakeholders at all levels successfully reduces the burden of malaria, more attention is needed in order to achieve similar results in larger countries, which account for the majority of malaria cases and deaths. To date there is an apparent disconnect between policy suggestions and realistic capacity to move to implementation in these larger and more heavily burdened regions. Simple approaches costing no more than a few dollars per person each year can still be out of reach for inhabitants of sub-Saharan Africa and even if there was a solution to the financial and logistic aspects of these policies there are even more pitfalls plaguing the long-term sustainability of such plans.

 

Current policy : Prevention & Treatment Strategies

 

Given that the vector for the transmission of malaria is the Anopheles mosquito, it is only logical that reducing the contact between humans and the mosquito vectors has been the focal point of preventive malaria control activities. The most commonly deployed method is Insecticide Treated Mosquito Nets (ITNs), which are typically treated with a pyrethroid insecticide. They are estimated to offer a 70% protection against malaria and also offer protection from other insect-borne diseases such as Yellow fever.

However there are problems with the deployment of ITNs. According to the latest estimates only 35% of the needed distribution of nets has been achieved. The low coverage has much to do with financial capacity when it comes to procurement as well as the low production volume of ITN manufacture. 141 million nets where produced in 2007 and 2008 whereas the number of people at risk in 2009 was 336 million.  A further problem is the fact that conventional nets have to be reimpregnated with insecticide at regular intervals. Long Lasting Insecticide-Treated nets have recently been developed and the estimated retreatment interval for them is aproximately 5 years, which is a substantial improvement on the 6-12 month estimate for most conventional nets. More interesting is the fact that owning an ITN does not necesarrily mean using one. Establishing better downstream communications is necessary in developing ways to raise awareness in the local population. The 2009 report from the Red Cross and Red Crescent societies indicates that a simple visit by a volunteer can be enough to achieve this.

Other preventive strategies are indoor residual spraying where insecticides are sprayed onto the interior walls as well as general insecticide spraying. It is important to note that the preventive methods mentioned so far, rely on insecticide. Historically the case of DDT use during the Anti-Malaria campaign in the 50s and 60s illustrates that these results may prove unsustainable. There is no mass produced affordable alternative to Pyrethroids, the current choice of insecticide, since their development in the 70s. The big question is, when there is a requirement for insecticide based malaria control policies to scale up, how fast would the resistance situation deteriorate especially when there are already reports of insecticide resistance and a plethora of evidence supporting its negative impact.

The Abuja declaration states that regardless of way of life every child should have access to early diagnosis and prompt treatment.  In the beginning of the last decade the WHO drug recommendation changed from Cloroquine to Artemisinin-based combination therapy (ACT). Currently there are four WHO recommended ACTs that combine artemisinin with other compounds in order to reduce the risk of encountering resistance. Although the principle of an ACT combination treatment is good, there are many complications arising from substandard and counterfeit drugs. Reports from southeast Asia have shown that a degree of resistance has already surfaced. The problem is further complicated by the fact that there have been no significant developments in malaria-specific drugs for a long time. Chloroquine was discovered in 1934 and Artemisinin in 1972. Other compounds of therapeutic value are available but their efficacy is not as high and the cost may be prohibitive even by western standards. This can only be taken as evidence that we still have a long way to go in providing treatment.

Taking a look at Nigeria

 

There are a number of problems with the content of the policies, but most importantly with the actual stage of implementation. The following are findings of a 2005 survey from the handbook for National Antimalarial Treatment Policy, by the National Malaria and Vector Control Division of the Federal Ministry of Health of Nigeria.

The public at large in Nigeria has a poor understanding of the cause of malaria, sometimes even being unaware of the link between mosquitoes and the spreading of the disease. Furthermore a large number of cases (reported to be 80%) are inadequately handled at the local community level by home based care givers who often fail to adjust appropriately the treatment dosage, while only 5% of convulsive patients where actually referred to hospital. What is more, poor laboratory support is reported in numerous incidents and 85% of local facilities where not stocking the necessary drugs while 89% of the drugs tested where substandard. Because of these conditions 40% of severe malaria cases resulted in death.

According to Professor Sodeinde, the focus of the Nigerian federal policy is on prompt diagnosis and treatment rather than prevention of malaria, the rationale for that being that the growing child would eventually develop a level of immunity. During his work at the University College Hospital of Ibadan, his main concern as a physician has been cerebral malaria and severe malarial anaemia. During his 30 year tenure in the hospital the clinical outcomes of the severe cases he encountered have improved significantly reaching a 90% survival rate for cerebral malaria and virtually no severe malarial anaemia fatalities. In his view this is a result of the streamlined integration between hospital staff at all levels, which allows the initiation of treatment within 30 minutes of patient admittance. While this is a far cry from the picture in other regions of the country it is encouraging to note that thanks to a successful training program these positive results seem to be spreading in the area around Ibadan.

In order to achieve wider progress it is necessary to improve coordination between different institutional stakeholders. An example of this is the Nigerian President’s 2005 promise that every vulnerable member of the population would sleep under a bed net. While providing the incentive to remove taxation for bednets, Nigerian customs would tax them as textiles. Even more important is dealing with counterfeit and substandard drugs. Counterfeit drugs not only adversely effect individual treatment outcomes but can also accelerate resistance on a systemic level, when for example an artemisinin monotherapy is unknowingly used instead of a combination treatment.

Current &  Future Research

According to Dr Holder, the primary target of research should be the discovery of novel antimalarials to effectively address resistance. Although he is optimistic that one day there will be a safe, effective and cost efficient malaria vaccine, our near term capacity to treat depends on new drugs and improving diagnostics. Currently diagnosis is usually performed by microscopy and treatment of suspected cases can be preemptive, with anecdotal estimates of up to a 10:1 ratio of patients who have wrongly received treatment for one that has been correctly diagnosed. A fast and reliable diagnostic test would substantially alleviate drug misuse.

In Dr Holder’s view knowledge of the malaria genome has not been exploited properly. A systematic approach in its examination is bound to yield new drug targets and diagnostic methodologies. However this approach is in many ways terra incognita, and with the vast majority of malaria researchers finding themselves in a position where they must publish or perish, this kind of work is considered extremely high risk in the research world. While there is definitely an appetite in fundamental research labs to do broader research, there simply are not enough resources to make this possible beyond just a small number of what Dr Holder characteristically called pet candidates.

In November 2009 GlaxoSmithKline initiated phase 3 trials of its RTS,S vaccine in seven African countries. While the results so far indicate an estimated 40% reduction of chances of infection for 2 years, we are just beginning to evaluate its efficacy in the field. Assuming the trials are successful, the cost of mass production for this vaccine is unknown and it is not clear whether governments in endemic areas can afford it. It’s important to note that the first clinical trial for the vaccine was in 1987 and by the time it reached phase 3 trials in 2009 dozens of different trials had to be performed and the exact cost is several million dollars. Incidents like this discourage pharmaceutical companies from undertaking research in malaria. The few companies that actually have interest in malaria usually do so by participating in public-private partnerships, often outsourcing the fundamental research phase to publicly funded research labs and in essence only participating in the development once proof of concept for the research has been established.

Some very promising results from public-private partnerships have recently emerged. The Innovative Vector Control Consortium, an initiative funded by the Gates foundation, in partnership with BASF, is working to produce new insecticides in an attempt to address the resistance problem.  The partnership has already demonstrated positive results in problematic areas of Gambia. Work between the Swiss Tropical Institute and the university of Nebraska Medical Centre, have produced OZ 439, a novel drug candidate which was slated to enter human studies in 2009.

The interaction with policy 

A number of different entities partake in policy formulation at different levels. These can range from international coordinating authorities such as the WHO, to simple regional professional organizations and grass roots community action programs. While there has been considerable progress in recent years, current policy fails to take into account a number of contingencies arising both in the current plan as well as the practical aspects of its implementation.

Both Dr Holder and Professor Sodeinde stressed their belief in the importance of promoting the deeper involvement of people in malaria endemic areas. They shouldn’t be imposed on from the outside, but should be encouraged to make their own contribution, which can be truly invaluable as they are the ones primarily being called to deal with the problem in their everyday life. A lot of the current research fails to take into account the idiosyncrasies of the living conditions in endemic areas and do not in any way incorporate local knowledge. To misquote Brian Wynne, the significance of ‘lay knowledges’ should not be misunderstood when dealing with this subject. However, as the fact that 80% of people in Nigeria did not associate mosquitoes with malaria illustrates, it is even more important to ensure policy makers have the capacity to communicate downstream, in simple and understandable terms.  Doctor Sodeinde mentioned that there have been successful government efforts to help public understanding of health matters in the past. Closer examination of such past successes can greatly benefit policy makers and provide an important reference point for future programs.

Countries like Nigeria have the means and could provide the rest of the world with significant breakthroughs in controlling and even eradicating the problem. They have able medics and scientists, with a deep understanding of the disease and the problems it causes there. Some of them are already running studies on natural products that could identify future anti-malarial drug candidates and while at the moment they do not possess the manufacturing capacity to move to mass production, countries like India are a strong example of how coordinated mobilization can solve such problems. In addition, local involvement such as community action programs can help resolve the issues with local community awareness, education, and training with regards to the problem and help with improving the socio-economic factors that make elimination unrealizable at this stage.

In some of the success cases in the 2009 WHO report, malaria was peripheral to start with. Undoubtedly every little step is positive, but the current policies and resources could never be applied in politically unstable regions with heavier disease burden. The numerous international aid initiatives have provided tremendous help and had a profound effect on this problem by increasing both mobilization in affected areas and have also provided motivation to act from the research community. Professor Sodeinde also further argues that national organizations such as the pediatric association of Nigeria can become a platform for spreading good practice at least in larger area hospitals. Current clinical and bench research takes a long adoption process. While they can be rapidly absorbed in institutional policies, the road to new research becoming accepted practice on national and international levels is long.

As Dr Holder has stated, fundamental research by enriching our knowledge and understanding of the disease process can provide a greater set of tools for the future and that should be the target contribution for the research community. The 2009 report indicates that so far the recommended policies are working. The aim of research should be to make these recent trends equate to long-term benefits and ensure their sustainability. It is also very important to understand what we don’t know about the problem. The few small successes so far are no excuse for complacency. By changing the dynamics of the disease we create epidemiological shifts that have never been studied before, and these can potentially lead to an unexpected new spectrum of symptoms. While we still cannot ascertain how much of the observed changes so far are the result of observer’s paradox, where the mere act of intervention for study purposes changes the actual outcomes for healthcare provided.

Conclusions

The purpose of public dialogue in the case of a global malaria policy should be to identify the true stakeholders and enable communication between them in a way that is the most effective with regards to the end purpose of alleviating the situation. Increased public engagement has revitalized the attention of many institutional stakeholders and in extension provided the pressure necessary to ensure that the scientific community has been engaged in meaningful research with a number of potential applications over the last decade.

Public dialogue continues to play a crucial role. Policy makers face many challenges, such as having to deal with counterfeit drugs, funding research into new drugs and providing incentives for the pharmaceutical industry to take a more active role in this line of research. Raised awareness helps to make sure that pledges by institutional stakeholders are kept and on the international level puts pressure on regional authorities to act more effectively and responsibly. However the dialogue should expand in a way that includes more people from endemic areas and accommodates their participation. While there are further problems that need to be addressed, increased social engagement in endemic areas can provide a catalyst in making all the stakeholders come together, acknowledge the targets and move forward toward successfully formulating and implementing a comprehensive and effective policy.

Bill Gates at the 2008 World Economic Forum in Davos, Switzerland, called for creative capitalism. In his view creative capitalism is a platform for people and corporate entities to address social inequities and solve the many problems the world’s poorest people have to live with on a daily basis.  I wish to believe that finding ways to raise living standards with minimal outside help is an investment that will pay off many times over the initial capital. Malaria is a major contributing factor in stalling the economic development of many regions in Africa. Its treatment and eradication will give many people a fighting chance for a better future and hopefully many people from these regions can make meaningful contributions to our understanding of the situation and help in finding better ways to continue the fight.

Peope I am grateful to for their help with this essay: 

• Professor Olugbemiro Sodeinde is the former head of the department of pediatrics at University College Hospital of Ibadan, where he has worked for over 30 years. He is currently a visiting professor at the National Institute for Medical Research
• Dr Tony Holder is the head of the division of parasitology in the National Institute for Medical Research. He is credited with the discovery of the prime vaccine candidate for Malaria.
• Dr Matthew Child and Dr Barry Ely have provided a lot of conversation on the topic along with valuable feedback on this essay.

 

 

 

 

References

[1] NATIONAL ANTIMALARIAL TREATMENT POLICY, FEDERAL MINISTRY OF HEALTH, NATIONAL MALARIA AND VECTOR CONTROL DIVISION, ABUJA-NIGERIA, MAY 2005

[2] The Control of Malaria 2005-15: progress and priorities towards Eradication, sixth report of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases

[3] W.H.O. World Malaria Report 2009

What follows is a quick and dirty setup of an openvpn server. Openvpn can address a lot of needs such as privately routing your data from wherever you may be in the world, keeping you connected with your machines that may be behind a firewall etc. The use case for this setup is actually quite simple. A group of friends and me would like to be able to play multiplayer games and share files, documents and a wiki privately and securely over the internet. Additionally having access to our machines from wherever we may be in the world is an added bonus. If all we wanted to do was to play games over the internet we could have opted for something like gameranger. To achieve some of the other targets however, the need for a vpn becomes pretty obvious.

Before we get started here’s what you need:

• An ubuntu machine with an internet connection and an open port for the openvpn server to listen
• The ability to create a tun/tap device on set machine (this can be tricky if it’s a virtual machine. I had one of these on openvz and it took me a while to figure out why the vpn was constantly failing to start up)
• A few minutes to spare.

So, let’s get started. First things first, install openvpn on the server:

sudo apt-get install openvpn

Next, we need to generate the public key infrastructure. That means generating the server and client certificates, as well as the configuration files.  OpenVPN comes with some template configuration files stored in /usr/share. So copy those over and let’s get started (i’m doing these as root so I omit all the sudo’s in the front):

mkdir /etc/openvpn/easy-rsa/
cp -r /usr/share/doc/openvpn/examples/easy-rsa/2.0/* /etc/openvpn/easy-rsa/

The next thing to do is to edit the vars file, so on your favorite editor open /etc/openvpn/easy-rsa/vars

export KEY_COUNTRY=”UK”
export KEY_PROVINCE=”LONDON”
export KEY_CITY=”LONDON”
export KEY_ORG=”gotbim.com”
export KEY_EMAIL=”myemail@gotbim.com”

(the last line was changed for those damn spambots)

Now source those variables and start creating those certificates:

cd /etc/openvpn/easy-rsa/
source vars
./clean-all
./build-dh
./pkitool –initca
./pkitool –server server
cd keys
openvpn –genkey –secret ta.key

Now going back to  /etc/openvpn/easy-rsa generate keys for the other hosts that will be part of the vpn

./pkitool hostname

If you have the need to add further hosts in the future just do the following

cd /etc/openvpn/easy-rsa/
source vars
./pkitool hostname

Now that you have the server and client key pairs you can proceed to generate the server configuration. In my case I wanted a tcp-based server listening on port 1194 and the ip range for the vpn to be 192.168.4.[1-254] . Arguably a udp based server would achieve the same with less network overhead and you can have more complex configurations, but for just gaming this will work just fine.

 

daemon
port 1194
proto tcp-server
dev tap0

ca /etc/openvpn/easy-rsa/2.0/keys/ca.crt
cert /etc/openvpn/easy-rsa/2.0/keys/server.crt
key /etc/openvpn/easy-rsa/2.0/keys/server.key
dh /etc/openvpn/easy-rsa/2.0/keys/dh1024.pem

server 192.168.4.0 255.255.255.0
ifconfig-pool-persist openvpn.dhcp

keepalive 10 120
comp-lzo

user nobody
group nogroup

persist-key
persist-tun
status /var/log/openvpn/openvpn-status.log
log-append /var/log/openvpn/openvpn.log
verb 4
mute 20

;push “route 192.168.4.0 255.255.255.0″
;push “route 192.168.173.0 255.255.255.0″
;push “redirect-gateway def1″

;client-config-dir ccd
;route 192.168.40.128 255.255.255.248
client-to-client
; max-clients 10

Save that configuration as /etc/openvpn/vpn1.conf

You should be ready to start the service by

openvpn vpn1

The next thing is to distribute the clients and configurations to your friends/clients. To do that you need to package the server certificate, along with a client key and certificate pair and a configuration file telling them where and how to connect. So for example if I wanted to connect my laptop, I would need to package together

ca.crt

dmuLaptop.crt

dmuLaptop.key

 

Then, if the ip address for the server is 123.123.123.123, the client configuration file would look like the following:

float
client
dev tap
proto tcp

remote 123.123.123.123
port 1194

;redirect-gateway

resolv-retry infinite
nobind
persist-key
persist-tun
ca /Users/dimitriosath/Library/openvpn/ca.crt
cert /Users/dimitriosath/Library/openvpn/dmuLaptop.crt
key /Users/dimitriosath/Library/openvpn/dmuLaptop.key
ns-cert-type server
comp-lzo
verb 3
;mute 20

For other linux clients all they have to do is have the configuration file and keys in the appropriate directories. The same can work with other, windows based clients using the openvpn gui . Finally, for mac os x clients you can use the excellent tunnelblick front-end. You can package all the afore-mentioned files in a directory. Than rename the directory to <direcrtory>.tblk and all you need to do is double click it and tunnelblick will install the configuration (makes it really easy to distribute things with people who don’t want to mess around with too many files). Enjoy your vpn.

This is a quick and dirty hack based on the official ubuntu and openvpn documentation. If you would like to extend the functionality of your vpn and do more interesting things perhaps you should take a look there?

• ubuntu documentation for openvpn
• openvpn page

Inspired by a recent post by Kostas, as well as my general adoration of coffee, I decided to write how to make greek-style frappe coffee. For this howto you will need:

• 1 Battery powered frother
• A coffee that is amenable to being frappe’d
• 1 Relatively large glass and a straw
• Depending on your tastes, sugar/sweetener.
•  Water, ice, and a couple of minutes.

First, assemble your materials. Finding coffee that’s ammenable to becoming a decent frappe is hard outside of greece. Ironically the coffee used in Greece to produce frappe is pretty crappy otherwise, but damn can it make frappe. One brand that I have found works pretty well outside of Greece is Douwe Egberts.

Now add coffee and sugar/sweetener to your liking. I tend to go with two spoons of coffee and two spoons of sugar. Getting to find exactly how you like your coffee takes a bit of experimentation, but it is agreed among frappe connoisseurs that it’s worth the trouble. Once you’ve put a couple of spoons of coffee and as much sugar as you think you’ll need, fill the glass to about a sixth of it with water. It should look like this:

Now take the frother and put it to work on the mixture.

 

 

Once it has become a froth of consistent texture put the straw and some ice. It should look like the following:

Now, just add water until it fills up the glass while using the straw to stir the mixture.

Wait for a minute and your end result should look like the following:

So this is an extremely short introduction.

This page will get populated very soon with content.

If you want more info about me check the about page.

The rest will follow soon.

Peace,

Dimitrios