Sirens and Lights

...5 year anniversary thoughts from a Watson fellow from my class (’03-’04). He recently made a move back to Latin America, though his is much more indefinite in duration than my own. (Buck, hope you don’t mind the link!)

A column in The Economist on learning languages that I’ve been enjoying this week…maybe not in his exact experience and words, but in the joy and inevitable amusement, the intense thrills and frustrations of trying to conquer a love, navigating the twists of subtle desires….

I’ll be home in 2 months. ACK.

More later….

http://www.technologyreview.com/blog/editors/22041/

Micro-lending is gaining in popularity for good reason. This article acknowledges that truth, yet presents the oversights of the micro-lending system, mainly that of the lack of job production. As Surowiecki writes, “Just fourteen per cent of Americans, for instance, are running (or trying to run) their own business. That percentage is much higher in developing countries—in Peru, it’s almost forty per cent. That’s not because Peruvians are more entrepreneurial. It’s because they don’t have other options. What poor countries need most, then, is….more small-to-medium-sized enterprises, the kind that are bigger than a fruit stand but smaller than a Fortune 1000 corporation. In high-income countries, these companies create more than sixty per cent of all jobs, but in the developing world they’re relatively rare, thanks to a lack of institutions able to provide them with the capital they need….Supplying the missing middle will require backers who want to invest in companies rather than just lend to them. There’s been some progress on this front of late; three weeks ago, Google.org, the Soros Economic Development Fund, and the Omidyar Network announced that they are setting up a firm in India that will invest only in small-to-medium businesses.”

As a recent new “lender” who is pretty inspired by the process of micro-lending, I agree with the author that there are real benefits to this process, not to mention the satisfaction of seeing a “donation” be paid back (a fairly strong sign of efficacy, as measures of aid go). Applying this model to appropriately lend to larger small businesses could lead to increased employment and might provide another avenue for economic growth… I wonder if it might not be worth it to explore how those small-to-medium businesses got to where they are, be it from a small individual-owned business that attracted enough support to grow or not, and to focus on that bridge a bit more.

http://www.newyorker.com/talk/financial/2008/03/17/080317ta_talk_surowiecki/?yrail

(1) I’m still sorting out the semantics of my reaction to the Samantha Power’s resignation from the Obama campaign, and more to my general weariness/wariness towards the way this race seems to be going these days. My siblings and I had a fairly intense discussion yesterday morning regarding the Democratic primaries and the danger of so much passion with its resultant polarization. This is, of course, not a new topic, but one that took on a little more reality to me when I saw a link to a Times blog discussing Power’s slip and the consequences (You can read the article for the full story.) . She, for those of you who haven’t heard of her, is someone who is actually really inspirational on her own, with her intelligence, boldness, principles and hard-work….not to mention incredible writing skill (please please go read A Problem from Hell: America and the Age of Genocide, if you haven’t) and passion. My reaction, quite honestly, was a mixture of sadness/foreboding combined with a somewhat paradoxical sense of relief. For as much as it concerns me that these kinds of comments appear to be spreading and kind of think Power is a good enough influence that she maybe shouldn’t have resigned, I really respect Obama for wanting to keep this a clean fight, and respect that he has supporters who believe in and abide by those principles. Everyone makes mistakes, especially passionate individuals, but that there are consequences (and discouragement of others following down the path) represents more to me that most of the increasingly suspect rhetoric that makes up the campaign season these days….

(2) I wrote a post a few years ago talking about a program in Brazil intended to incentivize keeping children in school and out of the labor force. A fellow Fogarty scholar emailed out a comment from The Lancet (a medical journal) discussing this type of program, Conditional Cash Transfers (CCT), which is described as:

During the past decade, countries with transitional and middle-income economies have introduced programmes that transfer money to poor households on the condition that they comply with a set of requirements, including attendance for health care, food and nutritional supplementation, and enrolment of children in school. Conditional cash transfer (CCT), a type of social contract, is both an alternative to more traditional social assistance with handouts and a complementary strategy to the provision of health and education services.1 Because poor families usually face the greatest barriers to health interventions, CCT helps to redistribute resources and thus reduces health inequities.2 For very poor families, cash provides emergency assistance, while the conditions promote longer-term investments in human capital.

The author goes on to discuss the numerous known benefits of programs such as this one, including evidence from a “systematic review of six CCT programmes in Latin America and Africa showed a fairly consistent picture of the effects of such programmes on the use of health-care and education programmes and, to some extent, growth and health outcomes for children early in life, despite some methodological concerns.”

The accompanying concerns are not too surprising, dealing with a need for a better understanding of which aspects of programs such as these (eg, health interventions, food supplements, and cash transfer) truly affect health-outcomes and the expense of programs such as these– particularly with regards to low-income countries for whom the program may not be cost-effective, let alone feasible without appropriate health and education services.

Conditional cash transfer: a magic bullet for health?
The Lancet 2008; 371:789-791
Kenji Shibuya

Maturity, Grace and a little bit of Discourse

…and, um, how exciting that my (Pennsylvania-based) vote matters?!

The report notes that multidrug-resistant TB is on the rise in many countries, including in Peru. http://www.who.int/mediacentre/news/releases/2008/pr05/en/index.html

From the WHO News Release:

Multidrug-resistant tuberculosis (MDR-TB) has been recorded at the highest rates ever, according to a new report published today. The report presents findings from the largest survey to date on the scale of drug resistance in tuberculosis.

The report also points to some successes. Thirteen years ago, Estonia and Latvia were singled out by WHO as drug-resistant TB “hotspots”. Following a substantial investment and a sustained assault on MDR-TB, rates in these two Baltic countries are today stabilizing and TB case notification rates are falling.

The true scale of the problem also remains unknown in some pockets of the world. Only six countries in Africa - the region with the highest incidence of TB in the world - were able to provide drug resistance data. Other countries in the region could not conduct surveys because they lack the equipment and trained personnel needed to identify drug-resistant TB. “Without these data, it is difficult to estimate the true burden and trends of MDR-TB and XDR-TB in the region. It is likely there are outbreaks of drug resistance going unnoticed and undetected,” said WHO TB expert Abigail Wright, the principal author of the report.

WHO estimates that US$ 4.8 billion is needed for overall TB control in low- and middle-income countries in 2008, with US$ 1 billion for MDR-TB and XDR-TB. But there is a total finance gap of US$ 2.5 billion, including a US$ 500 million gap for MDR-TB and XDR-TB.

From the report:

Data from nine sites in India show that drug resistance among new cases is relatively low;
however, new data from Gujarat indicate that 17.2% MDR among retreatment cases is higher
than previously anticipated and it is estimated that 110,132 (79,975-142,386) MDR-TB cases
emerged in India in 2006, representing over 20% of the global burden. Although plans have been
developed for management of 5000 MDR-TB cases annually by 2010, insufficient laboratory
capacity is seen as the primary limitation in implementation of these plans.

A story about Trader Joe’s, stolen from Sujal’s blog, which he stole from another friend’s blog. As Sujal pointed out, the most interesting quote is the following:

Coulombe also wanted to make sure his employees were paid fairly, instituting a policy in the 1960s that full-time employees had to make at least the median household income for their communities—an average of $7,000 a year at the time, $48,000 today. Store captains, almost all of whom are promoted from within, can make six figures annually. Trader Joe’s also allows part-timers to earn health-care benefits, a feature that makes the store a haven for artists, musicians, and other creative types who wouldn’t normally seek supermarket jobs.

In line with my perpetual [informed, I'd like to think] idealism, I thought it worthwhile to point out this policy. As much as I believe in universal healthcare and consider it the main solution to the country’s current horrendous state for all of the economic reasons, there is always a place for straight-up social responsibility, unmandated and out of the simple sense of doing the right thing.

So, our former neighbors were arrested yesterday in a scheme to clone credit cards! Crazy… We did always think they were a bit sketchy and were quite relieved when they moved out a week or so ago.

scary.

Tonight, the members of my research group presented the findings from two studies looking at STI/VIH prevalences and related behaviors in urban areas and in indigenous communities along the Amazon. If you’re interested in the studies, I’d be happy to discuss some of the findings, but otherwise enjoy the photos!

‘night!

and on the note of small victories: the roommate and i made palak paneer from scratch (well, the palak part)! yum! note: queso fresco is a decent substitute for paneer. I assisted with the aloo gobi making yesterday. yum yum comfort food!

Photos, at long last! This is one of the places where I work, the public health school at a university here. This fellowship pairs each American fellow with a local fellow from the country where we’re working. Isaac and Magaly were the Peruvian fellows in the first two years of the program. The (newlywed!) couple in the bottom picture are in the office where I usually work. I’m really lucky to be working with a supportive and fun group of young researchers.

Very honestly, I probably am spending way too much time these days sitting in front of a computer, working furiously when not staring in complete confusion at some statistics program or another. The year’s wrapping up all too quickly, and it’s a mad dash at this point to sort out the remaining tasks– which, happily if stressfully, are pretty numerous these days! Two or three days a week, I can be found at the public health school or at the Instituto Nacional de Salud, but usually the work also means long hours at home, which is where I usually wile away the days (perhaps not the best choice of words…working from home: luxurious, but also surprisingly challenging!).

This all, of course, makes my escapes from the house that much more necessary! So, I was really excited last weekend to be able to attend a great play produced by and starring one of my friends here, Mijail. There’s something really amazing about seeing a friend take his first big step (though really the compilation of countless little steps) into bringing his aspirations to fruition, especially when you’ve been there not only for all of those moments when it seems that all of the work might have been for nothing, but also for those in which the universe suddenly aligns to guide a dream to reality. Congratulations, Mijail!

What else have I been up to? Well… dance classes, running along the cliffs overlooking the Pacific, dinners with friends, helping with interview and dissertation defense preparations, and reading of course. Tonight, I visited a beautiful crafts market near the Instituto Nacional de Salud and then headed to a film by Doctors Without Borders (MSF) with a few friends. The film is called Invisible and is supposed to tell the stories of the victims of five separate struggles (defined as broadly as neglected diseases to civil war) who are treated as though they are invisible by the world. Interestingly, two of the stories take place in the Andean region of Latin America, one relating to Chagas in Bolivia (not a big problem in most of Peru, except for Arequipa) and the other to guerrillas in Colombia. While I knew about the former, I was surprised to realize how narrow my knowledge is about a few of the other conflicts mentioned in the movie, both in Latin America and in Africa. Suggestions welcome (websites, books or movies, but only if they’re fairly thorough). Anyway, the documentary is decent, but not earth-shattering….there’s an odd scene where the usually solid MSF push for access to essential meds appears rather awkwardly, but otherwise the stories are might make you think, especially (as usual) if you’re not someone who already knows much about these topics.

Ok, enough staring at computer screen for one night… sweet dreams! I’ll figure out how to post photos soon!

So…. did you vote (if you had the opportunity)?!? Pennsylvania’s primary isn’t until April, so I haven’t had the opportunity yet….but it doesn’t mean that I’m not following the proceedings closely from my little house in Peru. It seems like many of the undecided votes are going to Obama, and judging by Georgia, we might be in for a more decisive election than I had thought possible…

In any case, this might be a bit premature, but I keep flashing back to the last election (not primary, actual election), when I had just returned from a year in many countries listening to such a diverse and yet harmonious collection of voices. As I will be this next election, I was in Hershey, feeling overwhelmed by the beliefs of those around me, and yet still rebelliously and naively, it turns out, hopeful.

We are lucky to be where we are. Go out and vote to make the change you believe in.

Flashback Post…

What it feels like to be so wrong
Posted by: sural in Back in the U.S.A 2005

*note: not everyone i met expressed the opinions below; there was certainly quite a range, and almost always appreciation of some facet(s) of our country…and almost never were these opinions given in a hostile or threatening way, just critically. The vast majority of these opinions came from friends.

In today’s NYTimes, there’s an op-ed on President Bush’s inauguration, and more significantly on the world view on our country’s re-election of this man. Reading the opinions written by the author, I found myself nodding in agreement and even murmuring “yeah” and “exactly” to myself (it’s 2:30 am and I’m the only person in the library’s entire computer lab right now…so, i suppose the behavior is a little excusable!). Long ago (or so it seems…really about 18 months ago), I found myself in Switzerland working at the World Health Organization. As one might imagine, my co-workers in many cases were either (a) European (and thus particularly likely to be more left than the average American); (b) not American (and thus likely to be more left than the average American); (c) interested in health and human rights (and thus likely to be more left than the average American); or (d) some combination of the above. Suffice it to say that they were generally strong opposers of Bush and, in many cases, of Americans as a whole….variations on the theme of “I dislike America” included:

“I dislike America.”
“I dislike Americans.”
“America(ns) is/are selfish, materialistic and/or arrogant .”
“I dislike your country, but not the individual people–I love you!”
“I dislike your government.”
“I dislike Americans because they do not think about others. The whole world should get to vote in your elections.”
“I dislike your government, but I realize that people only have so much control over their governments and so I do not dislike you.”

Observation: The comments often strongly reflected the individual’s own background. For example, those in countries where people have a stronger influence on their government were much likelier to avoid the last phrasing and to select “I dislike Americans” as their argument of choice, often directly associating Americans with the then current American administration. However, people in countries such as India and Brazil, which are both embracing capitalism and addressing corruption in their own countries, almost always expressed themselves with the last phrase.

I’ve never been one to wave the flag of patriotism with much vigor, but after a number of rather sharp attacks on my American background and the country’s politics despite my openness about my own criticisms, defensiveness began to creep in… Rather than blindly defend our actions, however, I began to consider the actual matter at hand.

So…how to defend/explain away America/the American people’s selection of Bush and condoning of his behavior? Well, I tried several of the usual methods: the fear factor, the ignorance card (most Americans don’t pay attention beyond their own lives, let alone the lives of people by whom they may even feel threatened 1000’s of miles away–this encompasses lack of awareness, lack of depth of understanding and even lack of concern–depending on the day), the “big country/government with small individual [perception of] influence” theory…. in the end, I think I opted for a combination of the final explanation and the idea that we, the Americans, didn’t know what Bush would do. We hadn’t anticipated 9/11 upon electing him, and certainly not his response to the attack. I settled on this explanation, delivered in soothing, empathetic tones designed to both calm the inquirer and head off further discussion as well as to express my own sympathy to their frustration with my government’s actions. Perhaps surprisingly, it generally worked…particularly in countries like Brazil where the distinction between the government and its people is well understood.

Even more surprising, maybe, is that the explanation began to work on me, as well. The silent message to all of that was as follows: “just wait, we’ll redeem ourselves when we get a choice to express how we feel about the last four years–we’re good people and we agree!” In November, I had been home for approximately 3.5 months and for all of my efforts to support Kerry, I don’t think I ever changed my belief that we would right our wrong and elect Kerry. I believed that America would redeem itself. A few friends from abroad sent me emails half-jokingly commenting on how the Americans had better come through for the world, and that I’d better have done my part to ensure a Kerry victory, especially in my own home swing state of PA (yes, people abroad are aware of the intricacies of our election process), and I laughed, certain we would. When PA went blue, I nodded silently, “of course PA went blue,” despite the fact that where I attend medical school was very red…perhaps that should have been my first sign. When it all came down, I was stunned, much more so than those European/non-American/justice-seeking friends who had been suspicious of Americans all along. And instead of me being the one nodding knowingly, it was them, not just silently, but also vocally confirming their opinions of not only our country’s government, but of its people.

Perhaps a bit ineffectively, I sent apologies for the significance of the election (because, as the article’s writer says, it affects them as much as us–only they don’t get a say), but this time I didn’t offer explanation. I know I’m not anti-American…I know many of these people who turned the Hershey area red; they are friends, mentors, colleagues. They are not ignorant or materialistic or arrogant people. And perhaps for this reason, in my letters, I didn’t broach the topic which was so bothersome to me… less of how had I been so wrong about my fellow Americans– countless people have discussed this idea since well before the election even occurred– than of what being wrong means…

….thoughts for the next entry (for now, there’s an exam in 27 hours and I need to study… :-P)…

Lawrence Clark Powell - “Write to be understood, speak to be heard, read to grow.” (thanks, gmail quote of the day)

Currently Reading:

I suppose my love of books was more or less inevitable. My mother became a librarian when I was 6, bringing home stacks of colorful stories to be trapped in tug of wars (as far as was allowed) between my twin and me. We fought and bonded over the Baby-Sitters Club, Nancy Drew and Encyclopedia Brown, books by Lois Lowry, Ann Rinaldi, Louisa May Alcott and the Brontes. We, maybe slightly embarrassingly, even were student counselors at reading camp, encouraging reading and playing games about books with dozens of little kids (it was fun!)

Emerging into the real world of book-acquisitions unaided by a librarian, however, it’s hard not to be shocked by the price of books and the nagging sense of being wasteful when amassing large personal collections of books (tricky question of whether or not non-textbook books are, for practical and relative purposes, a luxury). Finding myself frequently in other countries without the benefits of amazon.com, it’s even more challenging to find books I would both like to read and can reasonably afford. So…. you can imagine my excitement at finding an organization that addresses just about all of these concerns: www.betterworld.com. I first heard about this organization at AMSA convention when students were collecting medical texts to be sent to sites in Africa, and recently again from an expat friend who received books this way. Their website does a far better job of explaining their mission and successes, but I’ll sum it up here:

(1) The Practical Stuff: They sell used (mostly) and new books at reasonable prices. Shipping is free in the U.S. and $2.97 to the rest of the world. To buy books, click here. To find more information on their work and to donate, click here.

(2) From the Times:

However, Better World Books (www.betterworld.com) offers a different option. Started by some freshly minted Notre Dame graduates in 2002, it collects used books and textbooks from about 1,000 campuses and 700 libraries nationwide.

As an individual, you can donate if you pay for shipping yourself; but you can buy anything off its Web site and shipping is free anywhere in the country.

“It’s like 1,000 sidewalk sales rolled into one,” said a co-founder, Xavier Helgesen. He estimates that his organization receives about 15,000 used books a day and sells about 5,000 daily.

Some of the unusable books are recycled, many of the textbooks are sent to universities in Africa and of all the books that are sold, a certain percentage of each sale — it varies but ranges around 15 percent — goes to nonprofit partners promoting global literacy.

(3) From the website (and thus unmeasured and unconfirmed by me):

Social Impact

* Collected over 10 million books through active book drives at over 1200 colleges and universities and collections from over 750 libraries
* Raised over $2.3 million for over 80 literacy and education non-profit organizations (check website for list of orgs)
* Raised over $75,000 for the New Orleans Public Library Foundation
* Raised more than $1.2 million for libraries and thrift stores nationwide
* Contributed more than $850,000 to college service clubs who have run book drives
* Directly sent more than 570,500 books to Books for Africa, the National Center for Family Literacy, and Feed the Children
* Established Better World Books Fund to finance specific shipments through Books for Africa – more information coming soon!

Environmental Impact

* Saved over 5,250 tons of books from landfills
* Reclaimed more than 680,000 pounds of metal shelving from libraries across the United States
* 775 tons of carbon offset on Betterworld.com sales

Based on the new results, Dr Kochi reckons that a five-year campaign costing about $10 billion would be enough to bring malaria under control in most of Africa, reducing the death rate to a matter of thousands a year.

This graph was featured in the Economist this week, along with an article discussing the successes (drops in cases and death rate) of a fairly straightforward insecticide-impregnated net distribution program through the World Health Organization and funded by the Global Fund on AIDS, Tuberculosis and Malaria. Combined with the introduction of a new medication derived from wormwood, the drops in deaths have been drastic in the four countries studied (Rwanda, Ethiopia, Zambia and Ghana*). The Economist article was interesting in that it focused on the approach of providing free nets through mass distribution programs. The writers alluded to a common belief that free services are less effective than ones in which people are charged a small fee because free items are disregarded more easily (this is true when we discuss the provision of health care in the U.S. as well). This program contradicts that theory, and is particularly relevant in this situation as the insecticide in these nets are only effective for about 3-5 years and will need to regularly be replaced as long as the disease still exists in a community. It’s an investment which will need to be maintained, and it’s reassuring to see that as far as low-cost to funders, free to communities, one-off mass interventions go, this seems to be an effective one.

*Drops in deaths in Ghana were lower, as you’ll read in the article, but this was matched with a corresponding overall drop in deaths in children from other causes.

Well, if you’re watching the debate this evening, you’re seeing the discussions on healthcare that are dominating the early part of the night. These debates emphasize the plans themselves, the morality of universal healthcare, and furthermore the overarching changes in financial policies that will be necessary to fund the plans.

If you’re looking for clearer delineations on the plans proposed by Clinton and Obama, the following website offers some helpful guidelines on the information provided by their respective campaigns. It’s also possible to look at the Republicans’ plans from the main page.

Clinton v Obama

Global Challenges | Writers Participate in Gates Foundation Initiative Aimed at Promoting Dialogue About HIV/AIDS in India

A group of Indian writers is participating in an initiative funded by the Bill & Melinda Gates Foundation that aims to promote public dialogue about HIV/AIDS in the country and abroad, the Hindustan Times reports. According to the Times, 15 writers will visit communities and families affected by the disease to explore different aspects of India’s epidemic.

Parmeshwar Godrej, who is closely involved with the project, said the authors’ works will be similar to news magazine articles and compiled together. The anthology will be published in August with a foreword by Indian writer Amartya Sen. Authors participating in the project are Salman Rushdie, William Dalrymple, Nalini Jones, Vikram Seth, Kiran Desai, Amit Chaudhuri, Siddhartha Deb, Nikita Lalwani, Sonia Faleiro, Shobhaa De, Jaspreet Singh, Siddharth Dhanvant Shangvi, C.S. Lakshmi, Sunil Ganguly and Mukul Kesavan, the Times reports. The Gates Foundation said it hopes the initiative will humanize the epidemic, according to the Times (Bhayana, Hindustan Times, 1/19). According to estimates released earlier this year, about 2.5 million people in India were living with HIV/AIDS in 2006 (Kaiser Daily HIV/AIDS Report, 12/21/07).

Now that I have a few minutes, I should also add that some of these authors are really, incredibly talented authors, personal favorites even. I just finished Rushdie’s Shalimar the Clown, and have to say it’s an incredible experience to read for the variety of stories beautifully blended into this one. It is definitely a new resident of the favorite books list. Kiran Desai wroteThe Inheritance of Loss, which I loved for the beautiful imagery. It will be exciting to see these two, among some of the others (Vikram Seth, as well, holds his own, as does Amit Chaudri), dedicate their talents to promoting dialogue on a (sadly) rather taboo issue. Since the list seems to include members of the Indian diaspora, I wish -surprise surprise- Jhumpa Lahiri could get involved…and on the Indian side, Arundathi Roy, I’m sure, could do an incredible job with her writing talent.

On a somewhat related note, I recently read Danticat’s Brother, I’m Dying, and really appreciated her reflections on her family’s experiences in Haiti and in the U.S. Despite all of the Paul Farmer-esque books on the subject, I was surprised by how many of this woman’s stories related to health (perhaps the title should have given me a clue…), the knotted intertwining of physical and political struggles that facilitated so many jails, the contrast of her own life story maturing into adulthood, family and career as an immigrant to the U.S. A slightly different perspective to those of a physician or academic of the social sciences sort, but powerful in that. Simplicity, but effective simplicity.

I’m looking forward to seeing the styles the above writers choose, and hope they do effectively create dialogue beyond the intellectual set that will read the stories themselves.

(thanks, James)

Somehow that doesn’t sound as good as “winter of my discontent.” At least it’s a happier thing! It’s summer here in Lima, a new season in which to be living and working. One of the heads of the program I’m on this year will be in Lima next week, and we’ve all been asked to give a presentation on our experiences and work in our time on this grant. My projects have all exploded as of late, bursting in new directions, setting course for some increasingly visible destination. It’s a wonderful thing, to have convinced the powers-to-be of the value of your research to the point of not only ethics approval, but cooperation in the form of time and resources. I have projects in various stages of development at this point, from waiting for ethics approval to a just about ready for submission paper, and am happy to improving my education in study design, data analysis and writing skills through these projects. From an academic standpoint, those were really my goals for this year, in addition to developing local research connections and getting a better sense of research areas that might be worth dedicating some time to over the next few years (at the very least). Obviously, there’s a lot more to learn, consider and do over the next few months, but this is a decent trajectory. Clinically, as well, things look as if they will be improving. I’m starting at a new hospital next week. The hospital houses one of the largest pediatric wards and has a specific ward for pediatric TB. I think my improved Spanish will allow me to help out clinically rather than just observing, though I’ll be grateful to be able to interact with people regardless, to hear their stories and concerns. Also, I’ll be heading to Iquitos (in the Amazon) for a little bit at the end of February. I’ve been working a bit on a study on sexually transmitted infections in communities along the Amazon, and will be going as part of the research team to deliver the test and study results to the communities. After my team leaves, I’ll spend some time in one of the hospitals in Iquitos and possibly with an NGO involved in some of the bigger HIV clinical trials. It won’t be much in terms of exposure to the unique needs of a much more underserved/affected by infectious diseases community, but I’m hoping my experiences will contribute to improving my clinical ability to help patients in the future, in addition to possibly guiding research directions.

Not the most organized post, but a general idea of why I haven’t been posting? Hope you’re all doing well…

This isn’t going to be profound. I’m just a little annoyed. As someone who gets most of her news via on-line newspapers rather than TV, I think it’s easy to select the reports to which I’m paying attention (i.e. reports on world leaders getting assassinated-worth reading, story about a presidential candidate female or otherwise showing emotion- not so interesting). Yesterday, though, I took a break and was watching CNN en espanol’s coverage of the primary in NH. I’m sure this is surprising to those of you who are subjected to the inane prioritization of news as offered by most television channels, but it was the first time that I came across the clip of Hillary Clinton tearing up (not even crying), as well as all of the to-do about how this must be the reason she won the primary in NH despite her loss in Iowa (something like 47% of female votes went to her). Last night, I clicked on a few more of the links on nytimes.com and cnn.com following the “story.” All I can really say is that I almost feel bad adding more writing on a subject that is complete speculation (for really obnoxious writing, no matter your candidate preference, try reading Dowd’s editorial in the times….not that I should be encouraging its popularity).

We’re finally at a point where we have at least 2 very viable Democratic candidates that would probably do a good job as President. For all of the personality traits that one has versus the other, the differences are quite often relative instead of absolute. As voters in the primaries seemed to have been prioritizing, they’re both “electable.” What that means is that we are left free to focus on their policies, which do differ a bit, including on health (will have another post later on that).

Regardless of whom we ultimately choose, I wish we didn’t have to cheapen Clinton’s candidacy by harping on this factor as more important than her politics, especially in a woman who has done little to “exploit” this characteristic herself.

A good op-ed by Gloria Steinem was sent to me by Payal, linked here. The interesting quote, in my mind, though, was the following: “What worries me is that male Iowa voters were seen as gender-free when supporting their own, while female voters were seen as biased if they did and disloyal if they didn’t.”

The article brings up a few ideas I didn’t bring up here. Steinem says, “What worries me is that some women, perhaps especially younger ones, hope to deny or escape the sexual caste system; thus Iowa women over 50 and 60, who disproportionately supported Senator Clinton, proved once again that women are the one group that grows more radical with age.”

Despite graduating from an all women’s college (as Hillary Clinton did), I think it would personally be hard for me to vote along those lines alone, as much as I want to honor the path. As Steinem acknowledges, “This country can no longer afford to choose our leaders from a talent pool limited by sex, race, money, powerful fathers and paper degrees. It’s time to take equal pride in breaking all the barriers. We have to be able to say: “I’m supporting her because she’ll be a great president and because she’s a woman.”

Overheard giggles. I’m sitting in this cozy twin bed in my family’s house, having just finished a lazy conversation on the usual subjects with a friend of the growing-up-together-variety…an exchange interrupted by my twin asking my friend via IM if she was talking to me, because she could hear me giggling in her room (taken over from my brother in 1992) down the hall. I feel like it could be 1990 or 1999 or 2005 or any year in between, breathless -or snorting, as the case may be- bursts of laughter interspersed with empathy, encouragement and discussions on books/relationships/the next time we’ll get to go dancing together in Philly. twin interruptions required (though at least I can roll my r’s these days!).

Forgive the sappy. Heading to back to Peru entirely too soon…