Sunday, July 31, 2011

America's Asthma and Allergy Epidemic

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Back in 2008 I attended a symposium at the NYU School of Medicine where I work. The symposium was about Inflammation and Host Defense. There were many good talks, including one on how the immune sysytem itself can participate in the development of cancer, of how inflammation interacts with metabolism, and how inflammatory bowel disease develops depending on a complex interaction between the immune system and the natural bacteria in our gut.

But one talk in particular caught my attention in the context of the modern epidemic of allergies and asthma. And it came at a particularly important time because certain talk show hosts were spreading misinformation about asthma. Radio talk show host Michael Savage insensitivity attacked children with asthma:

"[W]hy was there an asthma epidemic amongst minority children? Because I'll tell you why: The children got extra welfare if they were disabled, and they got extra help in school. It was a money racket. Everyone went in and was told [fake cough], 'When the nurse looks at you, you go [fake cough], "I don't know, the dust got me." ' See, everyone had asthma from the minority community."

This is just stupid. Really literally stupid, as well as mean-spirited. There is real science out there regarding the asthma epidemic and related allergy epidemic and these ignorant statements by the likes of Michael Savage and I hope he chooses to get better informed. I want to counter the misinformation about asthma that talk shows have been spreading.

First off, allergies and asthma are both, in essence, an over-reaction by the body's immune system to harmless molecules in the environment. The over-reaction is such that it can actually harm a person. A related syndrome is auto-immunity, where the body's immune system, possibly triggered by an actual infection, starts to attack one's own body. The immune system is extremely complicated, with many different types of cells and chemical messages that coordinate the immune response. The exact balance of all these cells and messages are what determine how well your body responds to stresses like infection. For example, two different responses to the HIV virus can determine the difference between rapid onset of AIDS or longer life with the infection. If I am remembering this correctly, if the body produces predominantly one type of cell (Th1 T-cells) in response to the virus, you are more likely to have rapid onset AIDS and a poorer prognosis. If the body produces predominantly adifferent kind of cell (Th2 T-cells) you are better able to control the infection and have a better prognosis. It is unclear why some people's immune system react to HIV with a Th1 response and others with a Th2 response, but genetics probably plays a part.

A similar situation occurs with asthma, allergy and auto-immunity. The precise balance of what chemical messengers and what immune cells that are produced by the body in response to the environment determines if the body doesn't react, reacts appropriately, or damages itself by over-reacting.

At the 10th annual Skirball Symposium at the NYU medical center in 2008, among many interesting talks, was one by Richard Locksley on asthma and allergy which has some very interesting implications. And shows how unhelpful and unscientific Michael Savage's attacks on victims of asthma is.

Let's begin with some numbers from the talk. Between 1980 and 1994, asthma rates went up 75%. I will add (from here) that over the same period the rate for children under the age of five increased more than 160%. This is one of those epidemiological red flags that indicates SOMETHING has changed rapidly that is affecting health. Too often these epidemiological red flags are sadly ignored, yet they can teach us so much. And the cost of this is some $12 billion a year in healthcare costs (other estimates are as high as $18 billion per year in direct and indirect costs). Asthma accounts for one-quarter of all emergency room visits in the United States, which accounts for part of the high cost to society. These are the real numbers behind what Michael Savage thinks is a scam, yet in reality is a real healthcare issue with a very real cost. And the cost is beyond the economic costs. Children 5-17 years of age missed 14.7 million school days due to asthma in 2002. This impacts on a child's education. Asthma accounts for approximately 24.5 million missed work days for adults annually. This impacts on American productivity and thus our economy.

The impact of asthma is greater on poorer Americans (who often are also minorities) than on wealthier Americans. This may be partly due to a better ability of wealthy Americans to treat asthma because they have better access to healthcare, but it goes beyond this. From WNBC back in 2006:

High levels of pollution in the South Bronx may be related to an asthma epidemic experienced by the area's children, according to a new 5-year study released by New York University on Monday.

Researches from NYU's School of Medicine and the Wagner Graduate School analyzed data collected by children wearing special backpacks, which measured the air in their homes, neighborhoods, and their schools...

During the study, the symptoms of asthma doubled among elementary school children on days with a greater-than-average amount of traffic...

George Thurston, from the NYU School of Medicine, said the diesel soot was most associated with the worsening of the children's symptoms.

Twenty percent of children in the Bronx attend school within 500 feet of a major highway, which are typically places where pollution exceeds the acceptable levels, the report said.

Pollution seems to be part of what is causing the current asthma epidemic according to this study. And pollution is generally worse in poorer areas. From an article in The Nation:

Of course, given the deliberate placement of highways, industrial factories, airports, and other emitting infrastructure in American cities, poor youth are bombarded with a disproportionate amount of poisons. Frighteningly enough, as climate change warps the environment, these airborne toxins may strengthen, too. In a 2004 report, the American Public Health Association and researchers from Harvard University concluded that a "powerful one-two punch" of elevated pollen levels and modifications in the types of molds incited by climate change will boost the asthma rates of children in America's cities.

Pollution and mold. At the talk on asthma by Richard Locksley, he described his work identifying the cellular responses of the immune system that cause asthma. Allergies and asthma are actually related to our response to parasites like parasitic nematode worms. These worms are common parasites in the developing world and probably represented our normal state of life through most of our evolution. Our immune system evolved to deal with these parasites. There is considerable evidence that asthma and allergy (and maybe auto-immunity) are this immune response to parasites gone wrong. This can be seen clearly in the fact that the chemical messages and cells involved in responding to nematode parasites are largely the same as those involved in asthma and allergy. Furthermore, treatments that impair the immune response to these worms also inhibit asthma and allergy responses.

Dr. Locksley looked at what genes are turned on in response to the chemical messages that are shared between the immune response to parasitic worms and in asthma. Among the genes he found turned on were ones the protein chitinase. Chitinase is an enzyme that breaks down chitin, which most people know as the substance that makes up the shells of insects, crabs and lobsters. In fact, there is a syndrome among people hired in industrial crab processing plants of sudden asthma attacks on the job. Some 25% of newly hired people have this response, possibly due to the chitin they are handling. This implies that a good part of our immune response to parasites, and hence of allergy and asthma, is a reaction to chitin. Why chitin?

When I thought about it, this makes perfect sense. All around us are things encased in chitin. Parasitic worms lay eggs coated in chitin. Dust mite droppings include chitin. I suspect cockroach droppings do too (certainly cockroaches themselves are nasty little chitin critters). And fungi, including molds, contain chitin. All of these are well known to produce immune or allergic responses.

In my research (not professionl!) on black mold, which has been an ongoing problem in many buildings including the one I live in, I discovered that according to a 1999 Mayo Clinic study, nearly all chronic sinus infections (afflicting about 37 million Americans) are a result of mold. When I first saw this, my wife and I both wondered how much of those chronic sinus infections were really allergic reactions rather than actual infection. I know personally when my apartment was suffering from various leaks and had recurring mold outbreaks, I myself had recurrent chest infections. When we finally got rid of the mold, those infections disappeared. In retrospect I suspect I was reacting to the mold.

Well, mold contains chitin. Chitin is one of the main molecules that produce a strong immune response. Since nematode worm infections are not common in America, and since dust mites are ubiquitous anyway, I suspect another factor that influences the rise in asthma and allergy rates is an increase in mold in our environment. I know of no figures on whether mold is an increasing problem, but the incidences of black mold infestation, which can actually lead to buildings becoming uninhabitable, have been on the rise. I suspect aging buildings (particularly public housing) and aging pipes (which leak, as I can tell you from my own building!) will create the perfect environment for mold to grow. Global warming also, as long as moisture is present, encourage more mold growth. This sounds to me like an ideal situation for an asthma and allergy epidemic and I think it could well affect poorer neighborhoods more than wealthy neighborhoods, though it is occurring everywhere.

There is another theory that the almost OCD style cleanliness fixation America currently has (with advertisements scaring us about all that bacteria around us) is why asthma rates are increasing. This theory goes that there is a balance between bacteria and fungi in the environment. Kill off one and the other has a better chance of growing. Bacteria also break down chitin, so in another form this could be seen as a balance between bacteria and chitin. If we are so obsessed with killing of bacteria in our environment, we may be inadvertently helping the chitin world and thus exposing ourselves to more chitin.

While I DO believe many are too concerned about sterilizing our homes with bleach, I am not convinced by this. Bleach kills fungus as well so it is unclear whether we are altering that balance by bleaching every surface. But another, vaguer version of this theory is merely that by reducing the real things our immune system react to, we are increasing inappropriate responses. This also, I feel, has little factual backing. But both versions are possible. We DID evolve to be adapted to an environment full of parasites, bacteria and such. We did not evolve to be adapted to an environment that is sterile on the surface but mold-filled behind the walls and filled with air pollution.

Pollution and mold. These are likely to be responsible for a great deal of the increase in asthma and allergy rates in the US. It wouldn't explain everything necessarily. For example, how would pollen allergies fit into this? I think that is unclear right now. Pollen does not contain chitin. Possibly irritation of the lungs of any sort, like pollen grains and pollution, creates a low level immune response that generally makes one more sensitive to allergic reactions. Certainly allergies can occur to other things, like the particularly deadly peanut allergy.

It would be interesting to see WHICH KIND of pollutants trigger allergies and asthma. Soot? Nitrous compounds (which in some ways mimic some of the chemical messengers in the body)? Sulfur compounds, which acidify rain and water? It is unclear and I am unaware of any research in this area.

But what is clear is that pollution and chitin are two major factors involved in high asthma rates and possibly are involved in the INCREASING asthma rates. Better appreciation of this and practices that reduce urban pollution and deal with mold problems throughout cities could decrease asthma and allergy rates, thus saving our society money, improving productivity and reducing absence rates among kids in school.


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Saturday, July 30, 2011

Book Review: A Long Way Gone; Memoirs of a Boy Soldier

A Long Way Gone is an autobiographical book written by Ishmael Beah who spent several years caught in the middle of the civil war in Sierra Leone. It spans pretty much exactly the period of his exposure to the war, starting with the day before the fighting first impacted his life in 1993 and ending with his eventual escape from Sierra Leone into neighboring Guinea in 1997. Only glimpses of his life both before and after this appear as flashbacks or flash forwards in the story.

My high school friends have begun to suspect I haven't told them the full story of my life.

"Why did you leave Sierra Leone?"

"Because of the war."

"Did you witness some fighting?"

Everyone in the country did.

"You mean you saw people running around with guns and shooting each other?"

"Yes, all the time."


I smile a little.

"You should tell us about it sometime."

"Yes, sometime."

Sierra Leone was one of the main sources of slaves feeding America's Southern states and its history, in many ways, is inseparable from this. Native cultures in Africa were devastated by the slave trade, with entire tribal groups either enslaved or turned into slavers to feed American greed. In 1787, British abolitionists, perhaps also inspired by the recently ended little war between Britain and the American insurgents, helped 400 freed slaves from America return to Africa to settle what became Freetown, the capital of Sierra Leone. In many ways these freed slaves formed a new ethnic group within Sierra Leone that did not integrate well with the native cultures. A similar history is evident for neighboring Liberia, which was founded as a nation by resettled American slaves by the American Colonization Society starting in 1821. The histories of Liberia and Sierra Leone were very much intertwined. And it is this background that sets the stage for Ishmael Beah's life. Liberia gained independence in 1847, and held onto its independence since then while the rest of Africa was carved up by European powers.

Sierra Leone gained independence from Britain in 1961. By 1967 instability was already setting in with power conflicts among two main political parties and various military factions, leading to many coups, attempted coups and counter-coups. This led in 1978 to the establishment of a corrupt, one-party state. In 1991, a small revolutionary group began to oppose the corrupt, single-party government. That small revolutionary group, the RUF, became, under the influence of Liberian strongman Charles Taylor, one of the most brutal, disgustingly blood-thirsty band of thugs in history. Ishmael remembers his father's explanation in one flashback in the book right after seeing a woman carrying her dead little girl after a rebel attack:

Siaka Stevens returned to power in 1968, and several years later declared a one-party state, the APC being the sole legal party. It was the beginning of "rotten politics," as my father would put it. I wondered what he would say about the war that I was now running from. I had heard from adults that this was a revolutionary war, a liberation of the people from corrupt government. But what kind of liberation movement shoots innocent civilians, children, that little girl?

That was the Sierra Leone background to the conflict: "rotten politics" opposed by the RUF. The RUF was founded by Foday Sankoh. From Wikipedia:

A former corporal in the Sierra Leonean army, wedding photographer, and television cameraman, Sankoh became a student activist in the 1970s. After his activism earned him a short prison term, Sankoh joined a Cold War guerilla camp in Libya sponsored by Muammar al-Gaddafi, where Muammar al-Qaddafi was preaching revolutionary ideas to West African dissidents. It is here that he met Charles Taylor, future president of Liberia and Sankoh's financial benefactor and ally throughout the civil war. With his encouragement, Sankoh and two allies, Abu Kanu and Rashid Mansaray, returned from Libya to form the Revolutionary United Front (RUF).

From wedding photographer to brutal rebel leader. Think about that next time you're at a wedding and that photographer is in your face.

In some ways Sankoh starts as a sympathetic figure, an idealistic opponent to a corrupt regime. Similarly, Charles Taylor of Liberia also starts as a sympathetic figure. From the Liberia Wiki entry:

In late 1989, a civil war began. The harsh dictatorial atmosphere that gripped the country was due in large part to Sergeant Samuel Doe's rule. An Americo-Liberian named Charles Taylor with the backing of neighbouring countries such as Burkina Faso and Cote d'Ivoire entered Nimba County with around 100 men. These fighters gained high levels of support with the local population who were disillusioned with their present government. A large section of the country came under the invaders' control as a result.

Again, a seemingly idealistic rebel against a harsh dictator. By 1997, Taylor had won the civil war and become the elected president of Liberia. Taylor's regime rapidly became even more brutally dictatorial than Doe's had been. Foday Sankoh led a parallel, allied, and equally brutal rebellion in Sierra Leone. It wasn't until 2002 for Sierra Leone and 2003 for Liberia that these civil wars finally ended and stability restored to this region. Interestingly, around the time I first read this book, Virginia had just elected Tom Perriello to Congress. Congressman Perriello has worked with child soldiers and local pro-democracy groups, and played a significant role in the peace and reconciliation process that ended the Sierra Leone civil war. He also became Special Advisor and spokesperson for the International Prosecutor that forced Liberian dictator Charles Taylor to surrender power without firing a shot.

A Long Way Gone begins with Ishmael and some of his friends starting off from their home village, Mogbwemo, for a neighboring village for a talent show. Ishmael was 12 years old. While in that neighboring village, some other friends came home early from school because their school was closed down because of a nearby rebel attack. The rebel attack had occurred in Mogbwemo where Ishmael's family were. This was the first moment where Ishmael realized that the civil war within his nation could impact his life. He never saw his parents again.

Immediately Ishmael and his friends from Mogbwemo head back home to find their family. This already is a horrible choice to have to make: flee to safety and abandon your family, or head right into a war zone to try and find your family. Ishmael, a child of only 12, chose to head into the war zone to find his family. Very soon they saw what they were getting themselves into.

"Do you guys think it is a good idea to go back to Mogbwemo?" Junior asked. But before either of us had a chance to answer, a Volkswagen roared in the distance and all the people walking on the road ran into the nearby bushes...The vehicle stopped in front of my grandmother's house...we saw a man run from the driver's seat to the sidewalk, where he vomited blood. His arm was bleeding. When he stopped vomiting, he began to cry. It was the first time I had seen a grown man cry like a child, and I felt a sting in my heart. A woman put her arms around the man and begged him to stand up. He got to his feet and walked toward the van. When he opened the door opposite the driver's, a woman who was leaning against it fell to the ground. Blood was coming out of her ears.

They turned back, never making it back to Mogbwemo. What does a 12 year old do when his home and family are suddenly taken from him? Ishmael stayed where he was hoping everything would be okay. It was weeks later that Ishmael got his first glimpse of the rebels themselves. Unexpectedly, gunshots erupted around them in the village they had taken refuge. The Sierra Leone soldiers who had been stationed in the village had run away once they realized they were outnumbered. The civilians were left to themselves. Many simply ran. Some drowned in the river as they fled. Others were shot in the back. Ishmael and his friends escaped, beginning a period of aimless wandering, hunger and fear. Their world became one where they could trust no one and no one trusted them. Both sides, particularly the rebels, used child soldiers, so a band of 6 children wandering the countryside terrified civilians.

Being a group of six boys was not to our advantage. But we needed to stay together because we had a better chance of escaping the day-to-day troubles we faced. People were terrified of boys our age. Some had heard rumors about young boys being forced by the rebels to kill their families and burn their villages. These children now patrolled in special units, killing and maiming civilians...So whenever people saw us, we reminded them of the massacres...some people tried to hurt us to protect themselves, their families and communities.

Ishmael and his friends were even captured by the rebels and saw first hand their senseless brutality, even being lined up for execution. A sudden nearby gunfight, presumably soldiers attacking the rebels, gave him and his friends a chance to escape. Finally they settle in a village where, in exchange for doing guard duty (yes, even civilians used children as soldiers) and helping farm, they were given food and shelter. After several months, this village was also attacked by the rebels. In fleeing from this attack, Ishmael became separated from everyone and spent a strange month in the jungle alone before he finally met up with another group of boys, some of whom he had known at school.

Once again I was with a group of boys. This time there were seven of us. I knew this was going to be a problem, but I didn't want to be by myself anymore. Our innocence had been replaced by fear and we had become monsters. There was nothing we could do about it.

Lord of the Flies for real.

At one point they received word that their families might have taken refuge in a nearby village. By the time they reach that village the rebels had just attacked, killing everyone.

More than twenty people lay facedown in the earth. They were all lined up, and blood still poured out of their wounds. A stream of it had begun running along the ground, making its way under each body, as if joining them together.

Ishmael is left only with the rumor that his family had been staying in a hut that had been burned to the ground with everyone in it. Never any confirmation of his family's fate.

My entire body went into shock. Only my eyes moved, slowly opening and closing. I tried to shake my legs to get my blood flowing, but I fell to the ground, holding my face. On the ground I felt as if my eyes were growing too big for their sockets. I could feel them exploding, and the pain released my body from the shock. I ran toward the house. Without any fear I went inside and looked around the smoke-filled rooms. The floors were filled with heaps of ashes; no solid form of a body was inside. I screamed at the top of my lungs and began to cry as loudly as I could, punching and kicking with all my might into the weak walls that continued to burn.

The rebels chased the boys and the one surviving adult from the village, shooting at them as they ran. Once they reached safety, they realized the adult had been shot while they fled and he died in their arms.

This was life in Sierra Leone if you were on your own. Running, starving, finding refuge until the rebels hit again, then running again. Seeing everyone die, often brutally and senselessly.

Finally they were captured by soldiers of the Sierra Leone army and taken to a village they had made their base. At this point the army seems to behave differently than the rebels, because they didn't threaten, kill or torture unless they captured an actual armed rebel. And no one was forced, initially, to fight for the army. What is not clear is whether this changed, or if the army always was sometimes as bad as the rebels, sometimes better. But later Ishmael himself participated in actions that, to my mind, were scarcely different from what he had seen the rebels do. Both sides justified it in the name of revenge.

Think of the Israel/Palestine conflict. Think of America's involvement in Afghanistan and Iraq. Think of the Balkan wars, Rwanda, Burundi...As killing continues, and the more techniques like terror, torture and killing of civilians are used in a war, the more vendettas pile up and the harder it is to find resolution. To me one of the worst decisions Bush ever made (among many) was to employ torture. By doing so all he did was give the people of Afghanistan and Iraq fiercer and fiercer vendettas. Brutality begets brutality in a cycle that is hard to break. In some cases it lasts for centuries. Bush fell into the trap of returning brutality with brutality, justifying it in the name of "national security," and all it has done is make our situation worse. Reading about Ishmael's life shows how a group of children first witnessed brutality then sank into that same brutality themselves.

At first the army protected the village, but as the children go about an almost normal life, they see the army slowly losing the fight and the rebels closing in. Finally, the rebels are right outside the village and the soldiers on the verge of defeat. So the army commander gives everyone in the village a choice: become part of the army or leave the village. The first two to try and leave are shot by the rebels. There is no choice. Everyone joins the army, memories of their brutally killed families inspiring them to WANT to join the army.

Training is brief and designed to inspire brutality. Imagine any rebel is the one that killed your family, then drive in the bayonet. Feel that each time you shoot a rebel, you are killing the very ones who killed your family. Take revenge. Very shortly the children, some as young as 9, are sent into battle along with the remnants of the soldiers. Before they go they are given drugs (initially they sound like simply amphetamines). They win, driving off the rebels.

The next years are a blur of drugs (including pot, amphetamines and "brown brown," a mixture of gunpowder and cocaine), fighting, slaughter and brutality. Children become officers leading their own squads into villages that they destroy completely, leaving no survivors. At some point it is clear that the army and rebels are scarcely different:

But what kind of liberation movement shoots innocent civilians, children, that little girl?

Lord of the Flies for real. But Lord of the Flies with heavy weapons and drugs.

Before we got to a rebel camp, we would deviate from the path and walk inside the forest. Once the camp was in sight, we would surround it and wait for the lieutenant's command...Whenever I looked at rebels during raids, I got angrier, because they looked like the rebels who played cards in the ruins of the village where I had lost my family. So when the lieutenant gave the orders, I shot as many as I could, but I didn't feel better. After every gunfight we would enter the rebel camp, killing those we had wounded.

The army generally pressed the civilians into helping them, rather than rape and kill them like the rebels. But it is clear that despite this, often the army would shoot at anything that moved, to the point where there would be no one left to carry any supplies they captured.

What struck me the most about the descriptions of the war is that although both sides at times showed a good grasp of tactics, there was no sense of strategy at all. It was all about killing, capturing weapons, fuel, food and drugs, and keeping others away from weapons, fuel, food and drugs. In some cases it seemed as if Ishmael's unit didn't even look carefully enough to see if a camp was rebel or army before going in to capture what they could. It was barely controlled looting and revenge killings with little sense of strategy. I think this is why civil wars of this nature never progress to any completion until a foreign force (sometimes UN, sometimes mercenaries, sometimes regional nations like Nigeria) intervenes. Such intervention imposes a strategy above and beyond simple vendetta and short-term need for supplies.

One day in 1996 Ishmael is in a camp when UNICEF representatives come through. He and a group of other child soldiers are told to put down their arms and go with the UNICEF reps. These children, now disarmed and soon to enter massive drug withdrawals, are driven to Freetown, the capital that saw the first return of freed slaves from America to Africa some 200 years before.

What followed was almost a farce, but in the end it worked. The rehabilitation of the child soldiers was clearly handled with more idealism that thought at first, but those who were doing it learned from their mistakes and succeeded in rehabilitating these children back into society. Among the initial mistakes were seemingly not realizing how severe the drug withdrawal symptoms would be after years of nearly constant drug use. They also put rebel and army kids together, leading to a brawl where the children grabbed guns from the guards and opened fire on each other. After that rebel and army kids were kept separate through rehab. I wonder why have armed guards at all! It is clear the guards had no intention of using their guns on the children, so all it was was a source of weapons for children who still considered themselves soldiers. Most of the children were plagued by nightmares and delusions, suffering full blown post-traumatic stress syndrome that kicked in as drug withdrawal faded. The children often beat up the rehab staff and each other, only slowly losing their brutality. But patience and routine slowly won out and the children began to become children again.

The rehab workers were amazing, even in the face of violence and sullen teen angst beyond anything you see in an American middle school. It was here I was thinking of Tom Perriello, now Congressman from Virginia's 5th district. He was one of these wonderful people in some capacity and his work along these lines was one of the reasons I saw him as someone whose views and expertise could be of considerable use among the sea of wealthy lawyers in Congress.

Ishmael initially was typical of the violent, sullen, nightmare-plagued lost children of the war, but as he recovered, he became one of the best spokesmen for the child soldiers, speaking to representatives from all over the world about his experiences and the importance of rehabilitation. Finally he was released from rehabilitation into the care of an uncle he had never previously met until most of the way through rehab. His life with his uncle was the first moment of normality since he said goodbye to his family and left Mogbwemo in 1993.

Ishmael gets selected to go to a conference in NYC on child soldiers. He leaves Sierra Leone wearing his summer clothes, to arrive in NYC during a snowy winter.

I knew the word "winter" from Shakespeare's texts and I thought I should look it up its meaning again.

It isn't until later in his stay in NYC that he is given a winter coat by a woman who later became his sponsor and adoptive mother. His initial impression of NYC in some ways matched my own:

There were so many cars on the street, and they impatiently honked, even when the light was red.

Reminding me of when a friend of mine first visited me in NYC and his first comment to me (even before "hello") was "What's with people here. Are their hands permanently fused to their horn?"

At the conference Ishmael gives a speech that beautifully sums up his experiences and the problems around the world, and shows a greater understanding of the dynamics of civil war than many Republicans have:

I am from Sierra Leone, and the problem that is affecting us children is the war that forces us to run away from our homes, lose our families, and aimlessly roam the forests. As a result, we get involved in the conflict as soldiers, carriers of loads, and in many other difficult tasks. All this is because of starvation, the loss of our families, and the need to feel safe and be part of something when all else has been broken down. I joined the army really because of the loss of my family and starvation. I wanted to avenge the deaths of my family. I also had to get some food to survive, and the only way to do that was to be part of the army. It was not easy being a soldier, but we just had to do it. I have been rehabilitated now, so don't be afraid of me. I am not a soldier anymore; I am a child. We are all brothers and sisters. What I have learned from my experiences is that revenge is not good. I joined the army to avenge the deaths of my family and to survive, but I've come to learn that if I am going to take revenge, in that process I will kill another person whose family will want revenge: then revenge and revenge and revenge will never come to an end...

This would have been a wonderful end to the book. But sadly life does not make for wonderful endings. When Ishmael returned to Sierra Leone, the civil war soon came to Freetown. On May 25, 1997, Ishmael woke to gunshots. By then one of his friends who had also been a child soldier had joined him in living with his uncle. When they heard the gunshots, they looked at each other: "Not again."

What had happened was a military coup. The coup leaders joined with the RUF and the same lawlessness that had haunted the countryside came to Freetown. It is almost heartbreaking to read how a child who had escaped the life of a child soldier found this kind of madness following him into his new life. At first violence controlled the streets, and most civilians stayed home hoping to be left alone. Food was hard to come by and soldiers shot at any protesters against the coup. Slowly, chaos became normality, and people began to find a new, surreal routine.

People began going about their daily business of searching for food, even though the stray bullets were likely to kill them. Children played guessing games, telling each other whether the gun fired was an AK-47, a G3, an RPG, or a machine gun. I mostly sat outside on the flat rock with Mohamed and we were both quiet. I was thinking about the fact that we had run so far away from the war, only to be caught back in it. There was nowhere to go from here.

This reminds me of a scene from Grief of My Heart, the memoirs of a Chechen doctor who survived both Chechen wars. There the author witnessed a similar surreal childhood game in the midst of an urban battlefield:

"You're dead!" shouted a small boy to his friend who crouched behind a burned-out car on the street.

"No! I killed you first. Fall down!"

I stopped in my tracks. I counted fifteen kids of all ages, including girls, playing "war," oblivious to the danger all around them...

In the background you could hear the firing of real guns. I couldn't believe what I was seeing. They had lived with war so long, that was all they knew...

I couldn't get those kids out of my mind. If someone didn't get them off the streets, they could grow into little animals with no knowledge of right or wrong; no traditions to guide them. Bang! Bang! You're dead! That is all they would know.

This is another reason why these kinds of conflicts can simmer so long. The next generation doesn't learn anything but war. Violence and war become normality, making peace that much harder for the next generation to achieve.

The new chaos in Sierra Leone was ended only by Nigerian intervention in 1998, restoring civilian government. Even then, the RUF kept fighting and it wasn't until 2002, with Nigerian and UN help, that the civil war officially ended in Sierra Leone. But Ishmael could not wait that long. He was faced with almost certain death or rejoining the army. Mere days after the death of his uncle, he chose to escape through Guinea and back, eventually, to NYC where he was adopted by a woman he had met on his first trip to NYC. The book ends with him entering Guinea, with the fate of Sierra Leone left unresolved.

Ishmael now rides the same subways I do in NYC and has finished his education, graduating from Oberlin and working for the rights of children worldwide. Like Sierra Leone, Ishmael seems to have achieved stability. His book has been accused by an Australian newspaper of inacuracies, though to me, given the drug use described by Ishmael, perfect acuracy would seem impossible. The writing style is up front and uncontrived. I found the gist of the book very convincing. I did feel there were certain descriptions that struck me as odd, but as the memories of a child under the influence of drugs in a war zone, what would you expect? The book is compelling, rings true and without a doubt captures the genuine truth about what civil wars around the world boil down to.

Meanwhile Charles Taylor is in custody and on trial on 11 counts of war crimes and crimes against humanity. Among Taylor's American supporters is Pat Robertson. From Wikipedia:

According to a 2 June 1999, article in The Virginian-Pilot,[31] Taylor had extensive business dealings with televangelist Pat Robertson. According to the article, Taylor gave Robertson (who also had business dealings with dictator Mobutu Sese Seko of Zaire) the rights to mine for diamonds in Liberia's mineral-rich countryside. According to two Operation Blessing pilots who reported this incident to the state of Virginia for investigation in 1994, Robertson used his Operation Blessing planes to haul diamond-mining equipment to Robertson's mines in Liberia, despite the fact that Robertson was telling his 700 Club viewers that the planes were sending relief supplies to the victims of the genocide in Rwanda. The subsequent investigation by the state of Virginia concluded that Robertson diverted his ministry's donations to the Liberian diamond-mining operation, but Attorney General of Virginia Mark Earley blocked any potential prosecution against Robertson.

I should note, Mark Earley is a Republican. Yet another example of corrupt Republican greed and disrespect for the law. Earley ran for Governor of Virginia, but thankfully this man who was willing to shelter possible war crimes, lost to Democrat Mark Warner.

Liberia went on, in 2005, to become the first African nation to elect a woman president, the amazing Ellen Johnson-Sirleaf.

Meanwhile, Charles Taylor's son, "Chuckie Taylor," a US citizen, has been convicted of participating in torture in Liberia. Legally, U.S. citizens can be tried for committing torture in other countries, perhaps something many Blackwater mercenaries should take note of.

Foday Sankoh died of a stroke while awaiting trial in 2003. The current president of Sierra Leone is Ernest Bai Koroma, a member of the APC, the political party of the "rotten politics" days, now supposedly reformed. From what little I can gather, Koroma spent all the years of civil war working for insurance companies.

For my part, Sierra Leone is one nation in which I have been making loans to small businesses through I hope my small efforts through Kiva will help stabilize this long-suffering nation.

Buy A Long Way Gone and learn about what civil war really means.

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Musical Discovery: Remembering Israel Kamakawiwo'ole

I recently discovered Israel Kamakawiwo'ole, whose musical style is NOT my typical Tom Waits or punk rocker or blues preference.

But I find I like the dude. Seems he was a kick ass Hawaiian singer from the 1970's until his death at age 38 from complications of obesity in 1997.

Here's the big man singing (in an amazingly eerie yet beautiful style) "Somewhere Over the Rainbow," one of his top songs:

And here is a song I hated until the movie Whispers of the Heart made me fall in love with I was primed to love Israel Kamakawiwo'ole's version:

As someone who was raised by a mother who listened to Don Ho, THIS guy strikes me as a really genuine performer and just a nice guy.

If I may add the Whisper of the Heart Version (in English but with new lyrics...sadly I can't find the Japanese version anymore):

I love the depiction of a shy teenager learning her confidence in this scene.

But even more than his cover of a Judy Garland song, I like his real Hawaiian songs

The sound flows so smoothly...and I don't normally go for that, preferring Tom Waits' gravelly sound or a hard punk sound. But Israel Kamakawiwo'ole catches me in a way that most smooth singers can't. Again, I think it is the genuine nature of his sound. It doesn't sound contrived or popularized, and it touches on the roots of a Native culture that Don Ho kind of trivialized, in my view.

And almost his last concert, he speaks directly to the Hawaiian culture in their language...telling them to Wake Up...and it is clear from his appearance that he was not long for the world, and yet his dedication to his fans and his culture are clear:

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What about those Bed Bugs!

Best bed bug mattress cover for bedbug infestation

About 5 years ago I wrote an article about a relatively new but spreading problem: bed bugs. Since I wrote that the problem has gotten bad enough that it has sparked a whole industry of detection and extermination of bed bugs and has led to hundreds of articles all over the mainstream media reporting on this growing problem. But this has led to misunderstandings and some shady businesses as well. This article is designed to help you avoid bedbugs if possible and get rid of them if you do get them.

Last summer the building I live in had a bed bug scare. Turns out only one apartment ever had them, but had the building's managing board not acted rapidly it would have spread. As it was the managing board spent tens of thousands of dollars to pinpoint possibly affected apartments and proactively treat them. During that time we became quite informed about the pests. The bad news is the problem continues to spread and a lot of what is being done about it is the wrong approach. The good news is there are some very simple things you can do that will prevent them from coming into your living space.

From the NYC Department of Health and Mental Hygiene website:

Bed bugs are small insects that feed on the blood of mammals and birds. Adult bed bugs are oval, wingless and rusty red colored, and have flat bodies, antennae and small eyes. They are visible to the naked eye, but often hide in cracks and crevices. When bed bugs feed, their bodies swell and become a brighter red. In homes, bed bugs feed primarily on the blood of humans, usually at night when people are sleeping...

Typically, the bite is painless and rarely awakens a sleeping person. However, it can produce large, itchy welts on the skin. Welts from bed bug bites do not have a red spot in the center--those welts are more characteristic of flea bites...

Although bed bugs may be a nuisance to people, they are not known to spread disease.

That is also good news. Bed bugs are not disease vectors like mosquitoes. They are just irritating in the extreme...and they can really infest an apartment if not properly addressed.

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The problem first became wide spread in NYC in 2005...after a lull of about 60 years where there were few or no reportings of bed bugs in NYC, one of the current epicenters. Since then the epidemic has taken off. Now I have heard from one professional that one out of every eleven buildings in NYC has bed bugs. Let me emphasize that I was sounding the alarm early on this one!

Why the sudden epidemic? There are several possible reasons. Some have tried to blame it on immigrants. That is almost certainly not true since here in NYC we have a pretty constant influx of immigrants and the influx of bed bugs has never correlated with influx of immigrants. If this was going to be a major source of spread, there would not have been a 60 year lull. NYC has always been a major immigrant hub (I know my ancestors came through here) but the upswing in bed bugs seems to have only started around 2005 for NYC. But elsewhere in the country the upswing started more like 2000, according to a an article from Time Magazine back when I first looked into this.

One aspect of the sudden rise of the bed bugs is simple evolution. I have often reported on how the misuse and overuse of antibiotics, particularly in animal feed, has led to a huge emergence of antibiotic resistant bacteria. This has been a huge problem and is one reason why I now only buy meat and chicken raised without antibiotics. Well the same thing happens with insects. Overuse and misuse of pesticides in America has led to bed bugs that are resistant to most pesticides. For the record, same goes with lice. Those horribly toxic shampoos are mostly useless by now because the lice have evolved resistance against them. And many treatments for bed bugs are ineffective for the same reason.

Another aspect that I suspect is going on is global warming. Simple fact is that most insects prefer warmer temperatures. I want to emphasize that this is speculation. The evolution of pesticide resistance is not speculative. But global warming HAS been shown to be the cause for the spread of many pests, and it almost certainly will eventually be shown to play a role for many more. So I am betting that rising temperatures have helped the bed bug infestation spread.

So what can you do? I'm going to work backwards, from treatment to detection to prevention. Why? Because if I give you an idea about how awful the treatment and expensive and potentially inaccurate the detection, prevention will sound much better to you. And honestly the more we all work to keep these things under control the more likely it will be we can limit them. Remember that if your neighbors get them, you will probably get them too if you aren't actively trying to prevent them.

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There seem to be three main treatments. All three are horrible to go through and hugely expensive. They are basically heating, freezing, and poisoning. I guess there is a fourth which you can use for any items that can't stand up to the other treatments: bag everything for 2 years. That is about how long it takes to kill bed bugs by starvation. I did notice that the more convinced exterminators were that we didn't actually have them, the more they backed off that number. Eventually they seemed to settle on 6 months. But there has been research that showed even after a year sealed in a bag with no food or water, they could still find bed bugs not just living, but actually reproducing! They are tough SOBs.

Treatment usually involves bagging almost everything you own for months to years, punching about 1 inch diameter holes in many of your walls, then either getting poison all over everything including inside your walls (and it takes MONTHS to fully clean up) or raising the temperature in the whole apartment above what they can tolerate or lowering the temperature to below what they can tolerate. All of these horribly inconvenient, expensive and disruptive. Best to avoid them!


Detection has issues as well. Usually what is first obvious is the itching. Then people will notice the bugs' very dark droppings (basically like dried up flakes of blood...yeah...your blood if you've got itching bites). By the time you are noticing them, it is likely that you have a pretty bad infestation. People won't always see them because they mostly come out at night, but a really bad infestation they will be everywhere, day and night.

There are two expert methods of identifying them: trained people and trained dogs. The dogs have been getting a lot of press these days, and they CAN be very effective. The dog's nose is an amazing thing, and they really can be trained to sniff out anything and tell you about it. There are bomb sniffing dogs, drug sniffing dogs, and now bed bug sniffing dogs. The flaws are that they are extremely expensive and, though potentially extremely accurate, are in practice sometimes very inaccurate. Dogs basically want food and attention. They don't care about accuracy...they just want to be rewarded, so they are easily distracted. We are pretty sure that our building had many false alarms because of a dog. I am not saying it is a scam or the dog was poorly trained. It just has a built in inaccuracy which has to be kept in mind.

But so does the human detection system. People will miss the very beginning of an infestation that a dog could catch, but they do the inspection in a smarter manner and so can be more accurate overall once an infestation has gotten going beyond the first stages. Dogs are potentially more accurate but sometimes people do the inspection in a smarter way. So it's a toss up which to hire.

But the bottom line is if either a dog or a person with training in detection tells you you have them, it is really hard not to say yes to the treatment because far, far better safe than sorry. The earlier you catch it the easier it is to stop, so if you want to wait and see if the dog or person is right, you may find yourself with an out of control infestation which will be even harder and more expensive to deal with.


Oh, and is now a good time to mention bed bugs are ALL OVER THE CITY? Hotels. In the UN building. In places of work. In movie theaters. The good news is that they don't really move around so much except at night, so they aren't jumping from person to person much. The main vector is bringing into your apartment items that have already got them living inside, books, etc. But one exterminator I talked to believed people's shoes are a major vector. So they aren't spread so much directly from one person to another but by bringing infested things into your building.

So what can you do to prevent them from coming into your living space?

First be really, really careful scrounging anything, particularly furniture. Now I have scrounged a lot of stuff in my time...still do from time to time, but now I am highly careful. If a book has bed bugs, it is pretty easy to detect...if you look. You will see the black specs that are their droppings. Furniture can be harder, but there are treatments if you really want to bring a scrounged piece of furniture into your apartment. Heating (if you can) or diatomaceaous earth (see below). But my wife figures the safest is to not scrounge at all.

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Mattresses and pillows can be sealed up. This costs some money, but if you get good mattress and pillow covers, even if you have an infested mattress or bed you can just leave it in the cover and they will eventually die and you keep the bed from being their favorite habitat. These covers are the most recommended action you can take. When exterminators heard we already had them, they were 90% sure we couldn't have a problem. So covering your mattresses and pillows with high end versions of these covers will really protect you. This is a cost you probably don't want to skimp on.

But shoes are an issue as well. One exterminator said you should always take your shoes off when you come in and if possible place them in a container with diatomaceous earth (again...see below). He believes that (scrounging an infested bed aside) this would prevent almost all spread of bed bugs. Not sure if that is true, but it certainly would help.

Now we come to some amazing stuff that I was dubious about but have seen in action. Diatoms are tiny animals that live in the ocean and create a silica shell. These shells are beautiful (if you have a microscope to look at them with), elaborate, and very sharp. These animals die, fall to the bottom of the sea, and form thick beds of diatom skeletons. When plate tectonics (earthquakes and continental drift) brings these deposits up above sea level, they can be mined. These deposits of tiny silica skeletons of long dead diatoms is called diatomaceous earth. It is a white powder of very tiny sharp skeletons. To us the sharpness, at worst, will irritate our skin a bit. Can't really harm us. But to something small like an insect, it is like the death of a thousand cuts. The coating around an insect that helps keep in moisture gets pierced and they dry out and die.

You can get diatomaceous earth online or in a hardware store. It isn't that expensive. If you even get so-called "food grade" it is considered so completely harmless that you can eat it if you want...though there is no reason you would and I suspect it would kind of irritate your digestive system. But it can be used in a kitchen.

We got diatomaceous earth and I basically spread it around the entire perimeter of every room in our apartment, making sure to get it into every crevice. The problem is this stuff gets everywhere. I found it irritating to my lungs at first, but once most of it settled and we vacuumed up anything not around the edges of a room (this is also good for making sure your vacuum isn't infested!) that went away. For months afterwards the diatomaceous earth was still visible in the crevices and corners around many of the rooms but isn't a problem.

And the effectiveness? Within one day of spreading it around every single crawling insect, including ants, confused flour beetles, and cockroaches, just disappeared. And they didn't come back for about a year.

This year we started seeing some ants again and I spread diatomaceous earth next to the sliding glass door and our basement windows. And again all crawling insects just disappeared. I still see plenty of ants outside, but none have come inside. And no cockroaches for a year now! In NYC...almost unheard of.

So if most of NYC put their mattresses and pillows into bed bug covers, took off their shoes and put them in containers of diatomaceous earth when they got home, and spread diatomaceous earth around the edges of their apartment, I am betting they would find many pests would be greatly reduced from their apartments. Bed bugs, ants and flour beetles are hard to get rid of. Diatomaceous earth does it. And it isn't the kind of thing that is easy to evolve a resistance to so it won't lose its effectiveness over the years.

So there you go. Together we can all fight bed bugs. Hope this helps!

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