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Count Dracula and the WHO

It was a bit like appointing Count Dracula as the goodwill ambassador for the blood donor service.

Truth is stranger than fiction, because fiction has to be plausible. Reality is under no such constraint, and regularly produces events that would never be credible in a novel. Like the decision last Thursday to appoint Zimbabwe’s Robert Mugabe as the World Health Organisation’s goodwill ambassador.

The newly elected head of the WHO, Tedros Adhanom Ghebreyesus, said he hoped that the Zimbabwean president would “influence his peers in the region” to devote more effort to health care, but Mugabe doesn’t really have much by way of peers.

Mugabe, in power since 1980, is effectively president-for-life, whereas all the neighbouring countries except Angola are more or less functional democracies. All of them, again except Angola, provide better healthcare to their citizens than Zimbabwe. Not good, but significantly better.

In Zimbabwe, heathcare improved significantly in the first twenty years of Mugabe’s rule, as did the economy in general. He built clinics, hospitals and schools, and Zimbabweans became one of the healthiest, best educated, and most prosperous populations in Africa. But then it all went wrong.

After a referendum in 2000 rejected a new constitution designed to strengthen Mugabe’s grip on power, he became increasingly paranoid and authoritarian. The sole purpose of government became hanging on to power at any cost (to others), so favoured cronies in the ruling party and the military were allowed to loot the economy – which duly collapsed..

By now, in fact, there is hardly any Zimbabwean economy left beyond subsistence agriculture. Unemployment has soared to 75 percent or higher, and the schools and hospitals have fallen apart. Adult life expectancy has plunged from 61 years to 45, and state-run hospitals and clinics frequently run out of even basic medicines like painkillers and antibiotics.

Mugabe has presided over this catastrophe for seventeen years now, insisting all the while that all is well. At the World Economic Forum on Africa in Durban last May, he claimed that “Zimbabwe is one of the most highly developed countries in Africa.” He is planning to run for re-election as president next year at the age of 94, and nobody dares to defy him.

He will win, of course, after the usual number of opposition activists has been beaten up, jailed or murdered – if he lasts that long, but he is beginning to show serious signs of wear. In fact, Mugabe has made three “medical visits” to Singapore for treatment this year.

Why Singapore? The presidential spokesperson, George Charamba, says that it’s a problem with Mugabe’s eyes, which would helpfully explain away the fact that he frequently appears to fall asleep at public meetings. (He’s just resting his eyes, really.) He needs a foreign specialist for that, but for everything else, Charamba claims, Mugabe goes to a Zimbabwean doctor – who is, he assures everybody, a “very, very, very black physician”.

There are very good Zimbabwean doctors, of course, but most of them, frustrated at the lack of medical supplies, have long since left the country for greener pastures. And it does seem unlikely that it’s an eye problem that has caused Mugabe to make three “medical visits” to Singapore this year. It’s probably something more serious, and Mugabe just doesn’t trust his own health service to deal with it.

How did the new head of WHO hit upon the idea of making this man, of all people, the organisation’s “goodwill ambassador” for Africa? He and his advisers must have discussed it in various meetings for weeks before announcing it. Did nobody ever bother to point out that it would be a public relations disaster? “Special ambassadors” don’t have to do very much, but their choice does shine a light on the judgement and integrity of those who choose them.

In the event, the public outcry about the choice of Mugabe was so instant and widespread that within three days his appointment was cancelled. Mugabe had been the head of the African union when the organsation endorsed Tedros as the sole African candidate for the WHO job, and no doubt Tedros felt some obligation to return the favour, but the organisation’s financial support comes from elsewhere.

So it’s just politics as usual. The WHO’s reputation will eventually recover, but healthcare in Zimbabwe won’t as long as Mugabe is alive. And the world will continue to rotate in an easterly direction.
To shorten to 700 words, omit paragraph 5. (“In Zimbabwe…wrong”)

African Elections

There are a number of ways to win an African election. The simplest, obviously, is to win the most votes, but this is sometimes hard to achieve, especially if you have been the president for a long time and people are getting fed up with your rule.

If your country’s constitution only allows two terms as president, then your first task is to change it, as half a dozen African leaders have already done (Namibia, Rwanda, Uganda, etc.). Now you can run again – but you still have to win the election.

You might just stuff the ballot boxes and have the army shoot anybody who objects, but this approach has high potential costs. Killing protesters will damage your international reputation, and may even lead to sanctions and freezes on your secret assets abroad. The African Union or Ecowas (the Economic Community of West African States) may also take you to task, or even send troops if you kill too many people.

It’s better to make it look like you really won the election. Fiddling with voter registration can exclude lots of opposition voters, and turning off the internet on election day makes it hard for the opposition’s election monitors to keep track of the count.

But if the votes are being counted in public and the numbers are going against you, then you have to stop the count until you can fix it. Standard practice in this case is to claim technical difficulties until you have time to massage the vote.

This was President Ali Bongo’s solution in Gabon’s election last August. He was clearly losing the count, but the results from the distant province of Haut-Ogooue (Bongo’s home province) were mysteriously delayed.

The opposition leaders weren’t worried, because to change the outcome almost every living person in Haut-Ogooue (and a few of the recently dead) would have had to vote for Bongo. But then the results arrived: 99.93 percent of the province’s population had allegedly turned out to vote, and 95 percent of them had allegedly voted for Bongo. So he “won” another term as president by 5,594 votes.

People in Haut-Ogooue may be remarkably healthy and civic-minded, but you NEVER get a 99 percent turnout in an election. (The turnout in Gabon’s other provinces was between 45 percent and 71 percent.)

It was a transparent and shameless fraud, but fewer than a dozen people were killed in the subsequent protests, so Ali Bongo is starting another seven-year term as president. Not bad for a kid who started out as the humble son of Omar Bongo, president of Gabon from 1967 until his death in 2009.

President Joseph Kabila of the Democratic Republic of Congo should have used the same tactics to get re-elected. DR Congo’s constitution imposes a two-term limit, and he had already served two seven-year terms since his father, President Laurent Kabila, was assassinated in 2001, but for whatever reason, he didn’t change the constitution in time.

Instead, Kabila ended up facing an election in November 2016 in which he was not legally allowed to run. To win more time, he announced that the election could not be held on time for “logistical and financial reasons,” and that he would therefore stay on as “transitional president” until 2018.

It’s ridiculous. In the seven years since the last election, Kabila couldn’t find the time and money to organise the next one? The only possible conclusion is that he is either completely incompetent or a bare-faced liar. (In fact, he’s both.)

And since DR Congo is big enough (70 million people compared to Gabon’s 1.6 million) to contain lots of tough, clever politicians with their own strong regional bases, Kabila is not getting away with it.

The powerful Catholic church has stepped in to act as mediator, and Archbishop Marcel Utembi has just persuaded government ministers and opposition leaders to sign a document promising to hold the election this year. In the meantime, an opposition politician will serve as Kabila’s prime minister.

Kabila has not yet signed the document himself, but the agreement also says that he must not try to end term limits. It looks like he will have to retire – in which case DR Congo will see its first peaceful transfer of power since independence in 1960.

It’s easy to be cynical about democracy in Africa, but there is as much good news as bad. Last month Ghana’s sitting president lost an election and tamely handed power over to the winner. In 2015 the same thing happened in Nigeria, Africa’s biggest country. The glass is not empty. It is half-full.
To shorten to 725 words, omit paragraphs 2 and 8. (“If…election”; “People…percent”; and

Malaria and Chickens

I had malaria once, and it was extremely unpleasant. I had been working in Yemen, but I actually contracted it when I was flying home on a Dutch airline that must remain nameless. The flight made a stop in Jeddah in Saudi Arabia, and the plane was parked out on the runway while waiting to pick up passengers – right on the edge of a mangrove swamp on the Red Sea coast .

The pilot turned the engines off to save fuel, and then opened the door to give us fresh air. It was night-time, and so a million mosquitoes swarmed into the plane. In five minutes everybody had been bitten multiple times. The passengers then revolted and the pilot shut the door and turned the air con back on, but it was too late.

I fell ill and collapsed a couple of weeks later, when I was at my wife’s family’s house in a small village in southern France, but I was lucky. My wife, who grew up in Africa, thought it was malaria, and the village doctor (who had served with the French army in Africa) confirmed it, so there and then he gave me a massive dose of antimalarial drugs.

By the time they got me to the hospital in Bayonne, they couldn’t even find any of the Plasmodium parasites in my bloodstream. They kept me in hospital for a couple of days anyway, but it wasn’t that bad, because in French hospitals they give you wine with your meals.

Small crisis, not many hurt. But the point of the story is that none of this would have happened to me (and presumably to some of the other passengers too) if only there had been chickens on the plane.

Statistics can sometimes lead to significant medical breakthroughs. In this case a team of Ethopian and Swedish scientists did a statistical study in three villages in western Ethiopia about the feeding habits of nocturnal, malaria-carrying Anopheles arabiensis mosquitoes. The results were instructive.

Outdoors, the mosquitoes preferred to feed on cattle (63 percent of bites), with human beings coming next (20 percent), and goats and sheep bringing up the rear (5 percent and 2.6 percent). Indoors, people provided 69 percent of the mosquitoes’ meals, compared to cattle at 18 percent and sheep and goats coming last again. (In this part of Ethiopia, people sometimes bring their animals indoors at night.)

There were also plenty of chickens around, both indoors and out. But in one outdoor sample, only one female mosquito out of 1,200 had chicken blood in her. In the indoor sample, none did. MOSQUITOES DON’T BITE CHICKENS.

Why not? Maybe evolution has taught mosquitoes to avoid chickens because chickens eat mosquitoes. But how do mosquitoes actually spot a chicken? Certainly not by sight: tiny compound eyes are good for spotting movement, but they do not give you much detail or any distance vision at all. So maybe by smell? That would be handy.

We can’t disguise ourselves as chickens, but we could try smelling like them. Or at least have something that smells chickeny nearby. In one experiment, the scientists even hung cages with live chickens in them over people’s beds at night, and lo! They had very few mosquito bites – fewer even than people sleeping under insecticide-treated bed nets.

Admittedly, this approach is a bit impractical for general use. Something more compact and less noisy would be preferable. So the scientists tried putting chicken feathers near people’s beds, and it still worked. Then they tried distilled essence of chicken odour (isobutyl butyrate, naphthalene, hexadecane and trans-limonene, if you must know), and that worked too.

Almost half the world’s population (3.2 billion people) lives in areas where malaria-bearing mosquitoes are present. About one in fifteen of those people actually comes down with malaria each year, and almost half a million of them die of it. Many tens of millions more spend a long, agonising time being very sick indeed.

Anything that cuts into those numbers would be most welcome, and prevention is much better than cure. CHEAP prevention is even better, and compared to insecticide-treated bed nets and various experimental vaccines, just sprinkling some “essence de poulet” (chicken fragrance) around before going to bed has got to be cheaper.

Essence de poulet probably won’t be on the market for a while yet, but hats off to Professor Habte Tekie of the University of Addis Ababa and Professor Rickard Ignell of the Swedish University of Agricultural Sciences, who led the Ethiopian-Swedish team that did the study. (Their full report is available online in the 21 July issue of Malaria Journal)

Meanwhile, if you want to bring a chicken along on our next camping trip, it’s fine with me. But don’t get the supermarket kind. They don’t work as well.
To shorten to 725 words, omit paragraph 9. (“Why…handy”)

Lifespan: Three Months a Year

Everybody knows where the population explosion came from. Two centuries ago birth rates and death rates were high everywhere, and population growth was very slow. Then clean water, good food and antibiotics radically cut the death rate—and the human population of this planet increased 300 percent in the past 90 years.

Eventually, as people moved into the cities and big families were no longer an advantage, the birth rate dropped too. The world’s population is still growing, but it will only increase by 50 percent in the next 90 years. So far, so obvious. But what’s happening to the human lifespan is equally dramatic.

Here’s the key statistic: the average human lifespan in a developed country has been increasing at three months per year ever since the year 1840.

Everybody assumes that lifespan grew much faster in the 19th and early 20th centuries, and is growing much slower now. But no. It has plodded along at the same rate, adding about three months to people’s life spans every year, for the past 175 years. And yes, that does mean that a baby born four years from now can expect to live, on average, a whole year longer than a baby born this year.

There have always been some people who lived to 70 or 80, but the average age at death in 1840 was only 40 years. By the year 2000 it was 80 years. That’s 40 more years of life per person in 160 years.

And lifespan is still increasing at the same rate. In Britain, for example, the average lifespan has increased by 11 more years in the past 44 years. Three months per year, just like in the 19th century.

This is why actuaries predict that babies born in the year 2000 will have an average lifespan of 100 years. Give those babies the 80 years of life that people who died in 2000 enjoyed, then give them an extra three months for every one of those 80 years—and they will have 20 years more years to live. That is, an average of 100 years.

This sounds so outlandish that you instinctively feel there must be something wrong with it, and maybe there is. The fact that it has gone on like this for 175 years doesn’t necessarily mean that it will go on forever. But it’s not stopping or even slowing, so the smart money says that it will continue for quite a while yet

What about the developing world? Most of it has been playing catch-up, and by now the gap isn’t very big any more. In China the average lifespan was only 42 years as recently as 1950—but then it began increasing by six months per year, so that the average Chinese citizen can now expect to live to 75. Once you hit an average lifespan of 75 years, however, the pace slows down to three months per year, the same as in the developed countries.

India is a little behind China: average lifespan was still 42 years in 1960, and is now 68, so it’s still going up at six months per year. But we may expect to see it fall to the normal three months per years in about 2030, after the average Indian lifespan reaches 75.

All the developing countries of Asia, Latin America and the Middle East are in the same zone. The sole exception is Africa: where 35 countries have average life spans of 63 years or lower. But even most African countries are seeing a slow growth in average lifespan.

So do we end up with a huge population of people so old they can barely hold their heads up, let alone eat solid food? Probably not.

Three hundred years ago Jonathan Swift wrote about people like that in his satire Gulliver’s Travels. Struldbrugs, he called them: people who could not die, but went on ageing until they were so decrepit and disabled that death would have been a mercy.

They were declared legally dead when they reached eighty, as otherwise their longevity would mean they ended up owning everything. But they weren’t really dead; now it was the public that had to support them for the rest of their interminable lives.

In real life, crippling diseases and disabilities are still mainly a phenomenon of the last decade of life, and as the lifespan lengthens that final decade also moves.

Demographers now talk about the “young old”, who are in their 70s and 80s and still in reasonably good shape—and the “old old”, in their 90s and 100s, who are mostly frail and in need of care. So the time is probably coming when people must work until into their 80s, because the over-65s will amount to a third of the population. No society can afford to support so many.

But by then people won’t be decrepit in their 80s. And the only alternative is dying younger.