Last week the Washington D.C. Department of Health and the CDC reported that over HALF of AIDS-related deaths in DC from 2000-2005 were NOT reported.
Half! After a thesis-full of lamenting the lack of AIDS data collection in aid-receiving nations, I see the same problem in my own backyard. I would have assumed DC’s notoriously high prevalence rates - estimated between 3% - 5% -- are cause for above-average vigilance. If AIDS' impact is so tragic, how was DC not ready and able to receive the AIDS deaths information?
According to Shannon Hader, senior deputy of the health departments HIV/AIDS Administration, the information was missed partly because they discovered boxes of unexamined paper records signifying that “our surveillance system wasn't complete enough."
‘Routine’ can breed discipline and enforce preparedness, but as Hader demonstrates, it can breed complacency and trick us into not paying attention, not being fully awake. My fellow Truman, Christine, and I have developed our own morning routine, strolling onto the street at 8:30, stopping for Starbucks, changing her flip-flops to heels at the sidewalk corner before the World Bank, and walking through the sun lit lobby to the NE elevator up to our office. The initially breathtaking photography and local artistry from communities in which the Bank works has become part of the anticipated scenery, as has the enormous World map in the hall just outside our quarters (which still says Zaire, but that’s the least of our concerns). Last Tuesday, turning the corner, we were unexpectedly intercepted by our co-worker next door.
"I need ONE vole-une-teer," announced our beloved Chilean ex-Panelist and now Consultant to the Panel. "There is a Congressional Hearing today and I need someone to come with me."
I quickly held back an instinctual jaw drop, being a complete rookie to the Hill scene and dying to see Congress in some type of action. But before we could fight for the chance, as loyal friends we politely replied that he would have to make the choice, as we both were equally eager to take the opportunity. Thankfully our boss approved a double team, and together as three we headed right back downstairs and caught a cab up to First St.
The aggregate knowledge I've gathered between C-SPAN, politics textbooks, policy professors and DC tours could never have prepared me for the Hearing ahead. Sitting wide-eyed and open-eared, I sat fully awake as the session started in the House Committee on Financial Services, expecting a discussion on replenishment of International Development Association (IDA) and World Bank loan conditionality...
***
In a slight digression I want to revisit a key conclusion of my senior thesis on AIDS-aid efficacy. More key than realizing the inefficacy of top-down aid, and more key than than realizing the US uses AIDS dollars to fight terror, I observed an enormous data deficit. My most valuable observation was the most simple, involving no logit regressions, no Heckmann selection model, no marginal effects. Simply, there is an abhorrent lack of data available around HIV/AIDS, and the deficit runs across aid sectors (recently argued by Bill Easterly "Where Does the Money Go?")
Just like DC carried on healthcare with such a knowledge deficit, I wonder how are we approving, disbursing and investing billions of dollars every year for AIDS when the descriptive statistics available are merely prevalence rates, and underestimated at that? At least the prevalence data is skeptical; incidence and AIDS-related mortality are oftentimes unreported and unavailable. Further exacerbating the missing data are we the donors, who do not send a clear message that we expect them. Over $100 million to Afghanistan for AIDS programs when it stands as one of the only countries who does not submit annual progress reports to UNAIDS? There certainly is an AIDS problem and I am not suggesting cutting funding because of the government's poor monitoring behavior. But when do donors start setting standards, expectations, conditions? Or should we not? Or should we, but tied together with a promise to help conduct monitoring and evaluation? How do we promote and enforce a culture of constant knowledge cultivation? How do we create an environment in which people must be fully awake and aware?
****
...Back on the Hill I sit wide-awake at the hearing, and quickly realize there are some pieces missing. 3 Representatives are present. 4 more eventually trickle in, and all leave and return at some point of the 2-hour hearing. Briefed extensively by staffers in the sidelines, everyone is scripted. Despite the topic of conversation, Representatives blatantly if not disrespectfully veer off course to make a specific statement, presumably of importance to them or their constituency. One Rep's cell phone even kept ringing and she made no effort to turn it off.
The Assistant Secretary of the Treasury testified with a thorough, fact-filled introduction covering all facets of IDA and why it must be replenished to $3.705 billion over three years. But the raised voices seemed to not have been listening to a word. Instead they were screaming the scripts:
"I was just in Haiti and there are food riots. People have no water in Africa. What are you doing about those things?"
"Tell me what you’ve done to stop aid disbursement to Iran!”
" There are people just off the shore of our own country literally starving to death. I just found out about this today.”
These are unbelievably important and courageous questions that I commend these Congress-people for bringing up. But these questions are only truly courageous and important when they are asked in the correct context to the appropriate people. Otherwise they are a waste of precious time, a distraction from the task at hand. In this hearing they were tangential and sensational, not focused and logical, causing any agenda that may have existed to crumble statement by statement.
If these smart people had been listening and awake they might have asked a few clarifying questions in place of their soapbox statements, and may have found each other sharing a vision instead of interrupting each other’s to promote their own. Food riots are, sadly, nothing new to Haiti. Instead of feigning furor for 5 minutes straight the Rep could have asked for details on how IDA accounts for different scales of aid-worthy situations and how the aid increase to IDA would have outcomes in Haiti. And even if they wanted to, IDA does not have the authority to stop aid disbursements already decided on. Instead of raging on about how aiding Iran fuels terror, perhaps the Rep could have listened to the Secretary’s explanation that, “We have a problem with the Iranian government not the Iranian people." Starvation is also nothing new. Sensationalizing poverty will not fix poverty. Attempting to care more about poor people living meters away from Florida than poor people in the Himalayas is pretty insulting to the poor and revealing of your character, or lack thereof.
I walked out a bit deflated, feeling like I did when I realized Santa was no longer real. There was no "hearing" in the Hearing. Perhaps my judgments are harsh but I do expect immense intelligence, character, and vigilance from my Members of Congress. I was surprised not just at the amount of information they did not come to the hearing with, but also at their inability to extract useful, meaningful data from the opportunity before them to ask.
Reflecting throughout the day with concern, I conjured up the always-comforting voice of my beloved boss, the warrior woman Leigh Blake. Speaking in her trademark mature urgency and deep focus, Leigh shared this story with me over the phone last week when I ducked out of the Bank for a breather:
"Shiva and Shakti, the divine couple in Hinduism, are in their heavenly abode watching over the earth. They are touched by the challenges of human life, the complexity of human reactions, and the ever-present place of suffering in the human experience. As they watch, Shakti spies a miserably poor man walking down the road. His clothes are shabby and his sandals are tied together with rope. Her heart is wrung with compassion. Touched by his goodness and his struggle, Shakti turns to her divine husband and begs him to give the man some gold. Shiva looks at the man for a long moment. "My dearest wife," he says, "I cannot do that." Shakti is astounded: "Why, what do you mean, husband? You are Lord of the Universe. Why can't you do this simple thing?" "I cannot give this to him because he is not yet ready to receive it," Shiva replies. Shakti becomes angry. "Do you mean to say that you cannot drop a bag of gold in his path?" "Surely I can," Shiva replies, "but that is quite another thing." "Please, husband," says Shakti. And so Shiva drops a bag of gold in the man's path.
The man meanwhile walks along thinking to himself, "I wonder if I will find dinner tonight-- or shall I go hungry again." Turning a bend in the road, he sees something on the path in his way. "Aha," he says, "Look there, a large rock. How fortunate that I have seen it. I might have torn these poor sandals of mine even further." And carefully stepping over the bag of gold, he goes on his way."
Leigh finished speaking and we connected in silence over the cell phone, meditating on the message. "You have to be AWAKE, Katie, you MUST be AWAKE for what is going on around you. We all have to be."
In Shiva and Shakti's case, the man perpetuates his own suffering by not being awake to the world around him. If he had just examined that ‘rock’ for a second longer he may have realized in it lay his salvation! When failing to look closely, to notice, to pay attention to detail what I find most dangerous is that anyone in power necessarily has the ability to perpetuate not only her/his own suffering, but also the suffering of those under their jurisdiction.
What distracts us from being present in the moment and awake to what the true opportunities are around us? Why are we losing our senses instead of using our senses?
I think of Congress as that poor man, except I have to imagine that that poor man also has an enormous community to support as well. As my time in DC passes, I understand mores specifically how many pressures and challenges and distractions our Congresswomen and men face every day. Zipping between hearings, connecting with their constituency, handling the Press. The mission of public service is daunting, and the expectations are many. However I think a necessary ability of any leader must be an ability to keep an active mental inventory. To be able to see all that is in one's mind, and utilize that knowledge to overcome obstacles.
(And I see now why Staffers are so important! Some people even forget the basics sometimes, like being unsure that condoms prevent HIV)
Such an open mind requires the ability to find peace and clarity amidst the chaos going on outside. The ability to organize and map out all the knowledge to see how it works together. Internal surveillance systems.
‘Receiving’ as a verb implies something is handed to us, unmistakably given to us. And indeed this is the case, but sometimes the gift comes in disguise, requires questions to be asked or conversations to be had or a closer look to be taken. A rock for a bag of gold? I can only cringe to imagine the immense wealth our public leaders may be walking over by failing to seek out full data and information when they have the opportunity to do so.
Let's not fool ourselves. We all have the agency to be ready to receive, to be awake to our surroundings. The immense amount of information that must be gathered, read, understood -- yes perhaps this is daunting. But we need to do it if we want to make any progress in our intended areas of change.
Half! After a thesis-full of lamenting the lack of AIDS data collection in aid-receiving nations, I see the same problem in my own backyard. I would have assumed DC’s notoriously high prevalence rates - estimated between 3% - 5% -- are cause for above-average vigilance. If AIDS' impact is so tragic, how was DC not ready and able to receive the AIDS deaths information?
According to Shannon Hader, senior deputy of the health departments HIV/AIDS Administration, the information was missed partly because they discovered boxes of unexamined paper records signifying that “our surveillance system wasn't complete enough."
‘Routine’ can breed discipline and enforce preparedness, but as Hader demonstrates, it can breed complacency and trick us into not paying attention, not being fully awake. My fellow Truman, Christine, and I have developed our own morning routine, strolling onto the street at 8:30, stopping for Starbucks, changing her flip-flops to heels at the sidewalk corner before the World Bank, and walking through the sun lit lobby to the NE elevator up to our office. The initially breathtaking photography and local artistry from communities in which the Bank works has become part of the anticipated scenery, as has the enormous World map in the hall just outside our quarters (which still says Zaire, but that’s the least of our concerns). Last Tuesday, turning the corner, we were unexpectedly intercepted by our co-worker next door.
"I need ONE vole-une-teer," announced our beloved Chilean ex-Panelist and now Consultant to the Panel. "There is a Congressional Hearing today and I need someone to come with me."
I quickly held back an instinctual jaw drop, being a complete rookie to the Hill scene and dying to see Congress in some type of action. But before we could fight for the chance, as loyal friends we politely replied that he would have to make the choice, as we both were equally eager to take the opportunity. Thankfully our boss approved a double team, and together as three we headed right back downstairs and caught a cab up to First St.
The aggregate knowledge I've gathered between C-SPAN, politics textbooks, policy professors and DC tours could never have prepared me for the Hearing ahead. Sitting wide-eyed and open-eared, I sat fully awake as the session started in the House Committee on Financial Services, expecting a discussion on replenishment of International Development Association (IDA) and World Bank loan conditionality...
***
In a slight digression I want to revisit a key conclusion of my senior thesis on AIDS-aid efficacy. More key than realizing the inefficacy of top-down aid, and more key than than realizing the US uses AIDS dollars to fight terror, I observed an enormous data deficit. My most valuable observation was the most simple, involving no logit regressions, no Heckmann selection model, no marginal effects. Simply, there is an abhorrent lack of data available around HIV/AIDS, and the deficit runs across aid sectors (recently argued by Bill Easterly "Where Does the Money Go?")
Just like DC carried on healthcare with such a knowledge deficit, I wonder how are we approving, disbursing and investing billions of dollars every year for AIDS when the descriptive statistics available are merely prevalence rates, and underestimated at that? At least the prevalence data is skeptical; incidence and AIDS-related mortality are oftentimes unreported and unavailable. Further exacerbating the missing data are we the donors, who do not send a clear message that we expect them. Over $100 million to Afghanistan for AIDS programs when it stands as one of the only countries who does not submit annual progress reports to UNAIDS? There certainly is an AIDS problem and I am not suggesting cutting funding because of the government's poor monitoring behavior. But when do donors start setting standards, expectations, conditions? Or should we not? Or should we, but tied together with a promise to help conduct monitoring and evaluation? How do we promote and enforce a culture of constant knowledge cultivation? How do we create an environment in which people must be fully awake and aware?
****
...Back on the Hill I sit wide-awake at the hearing, and quickly realize there are some pieces missing. 3 Representatives are present. 4 more eventually trickle in, and all leave and return at some point of the 2-hour hearing. Briefed extensively by staffers in the sidelines, everyone is scripted. Despite the topic of conversation, Representatives blatantly if not disrespectfully veer off course to make a specific statement, presumably of importance to them or their constituency. One Rep's cell phone even kept ringing and she made no effort to turn it off.
The Assistant Secretary of the Treasury testified with a thorough, fact-filled introduction covering all facets of IDA and why it must be replenished to $3.705 billion over three years. But the raised voices seemed to not have been listening to a word. Instead they were screaming the scripts:
"I was just in Haiti and there are food riots. People have no water in Africa. What are you doing about those things?"
"Tell me what you’ve done to stop aid disbursement to Iran!”
" There are people just off the shore of our own country literally starving to death. I just found out about this today.”
These are unbelievably important and courageous questions that I commend these Congress-people for bringing up. But these questions are only truly courageous and important when they are asked in the correct context to the appropriate people. Otherwise they are a waste of precious time, a distraction from the task at hand. In this hearing they were tangential and sensational, not focused and logical, causing any agenda that may have existed to crumble statement by statement.
If these smart people had been listening and awake they might have asked a few clarifying questions in place of their soapbox statements, and may have found each other sharing a vision instead of interrupting each other’s to promote their own. Food riots are, sadly, nothing new to Haiti. Instead of feigning furor for 5 minutes straight the Rep could have asked for details on how IDA accounts for different scales of aid-worthy situations and how the aid increase to IDA would have outcomes in Haiti. And even if they wanted to, IDA does not have the authority to stop aid disbursements already decided on. Instead of raging on about how aiding Iran fuels terror, perhaps the Rep could have listened to the Secretary’s explanation that, “We have a problem with the Iranian government not the Iranian people." Starvation is also nothing new. Sensationalizing poverty will not fix poverty. Attempting to care more about poor people living meters away from Florida than poor people in the Himalayas is pretty insulting to the poor and revealing of your character, or lack thereof.
I walked out a bit deflated, feeling like I did when I realized Santa was no longer real. There was no "hearing" in the Hearing. Perhaps my judgments are harsh but I do expect immense intelligence, character, and vigilance from my Members of Congress. I was surprised not just at the amount of information they did not come to the hearing with, but also at their inability to extract useful, meaningful data from the opportunity before them to ask.
Reflecting throughout the day with concern, I conjured up the always-comforting voice of my beloved boss, the warrior woman Leigh Blake. Speaking in her trademark mature urgency and deep focus, Leigh shared this story with me over the phone last week when I ducked out of the Bank for a breather:
"Shiva and Shakti, the divine couple in Hinduism, are in their heavenly abode watching over the earth. They are touched by the challenges of human life, the complexity of human reactions, and the ever-present place of suffering in the human experience. As they watch, Shakti spies a miserably poor man walking down the road. His clothes are shabby and his sandals are tied together with rope. Her heart is wrung with compassion. Touched by his goodness and his struggle, Shakti turns to her divine husband and begs him to give the man some gold. Shiva looks at the man for a long moment. "My dearest wife," he says, "I cannot do that." Shakti is astounded: "Why, what do you mean, husband? You are Lord of the Universe. Why can't you do this simple thing?" "I cannot give this to him because he is not yet ready to receive it," Shiva replies. Shakti becomes angry. "Do you mean to say that you cannot drop a bag of gold in his path?" "Surely I can," Shiva replies, "but that is quite another thing." "Please, husband," says Shakti. And so Shiva drops a bag of gold in the man's path.
The man meanwhile walks along thinking to himself, "I wonder if I will find dinner tonight-- or shall I go hungry again." Turning a bend in the road, he sees something on the path in his way. "Aha," he says, "Look there, a large rock. How fortunate that I have seen it. I might have torn these poor sandals of mine even further." And carefully stepping over the bag of gold, he goes on his way."
Leigh finished speaking and we connected in silence over the cell phone, meditating on the message. "You have to be AWAKE, Katie, you MUST be AWAKE for what is going on around you. We all have to be."
In Shiva and Shakti's case, the man perpetuates his own suffering by not being awake to the world around him. If he had just examined that ‘rock’ for a second longer he may have realized in it lay his salvation! When failing to look closely, to notice, to pay attention to detail what I find most dangerous is that anyone in power necessarily has the ability to perpetuate not only her/his own suffering, but also the suffering of those under their jurisdiction.
What distracts us from being present in the moment and awake to what the true opportunities are around us? Why are we losing our senses instead of using our senses?
I think of Congress as that poor man, except I have to imagine that that poor man also has an enormous community to support as well. As my time in DC passes, I understand mores specifically how many pressures and challenges and distractions our Congresswomen and men face every day. Zipping between hearings, connecting with their constituency, handling the Press. The mission of public service is daunting, and the expectations are many. However I think a necessary ability of any leader must be an ability to keep an active mental inventory. To be able to see all that is in one's mind, and utilize that knowledge to overcome obstacles.
(And I see now why Staffers are so important! Some people even forget the basics sometimes, like being unsure that condoms prevent HIV)
Such an open mind requires the ability to find peace and clarity amidst the chaos going on outside. The ability to organize and map out all the knowledge to see how it works together. Internal surveillance systems.
‘Receiving’ as a verb implies something is handed to us, unmistakably given to us. And indeed this is the case, but sometimes the gift comes in disguise, requires questions to be asked or conversations to be had or a closer look to be taken. A rock for a bag of gold? I can only cringe to imagine the immense wealth our public leaders may be walking over by failing to seek out full data and information when they have the opportunity to do so.
Let's not fool ourselves. We all have the agency to be ready to receive, to be awake to our surroundings. The immense amount of information that must be gathered, read, understood -- yes perhaps this is daunting. But we need to do it if we want to make any progress in our intended areas of change.
1 comment:
Maybe the hearing would have been more productive with a testimony from elmo. One problem you've touched on is a general lack of intellectual curiosity among some members of congress - something to consider the next time you're in the voting booth. Also, the three or four day work week for congress hurts real intellectual discourse. Too often a member of congress spends most of their time in transit between dc and home and not enough time in study. At one time in the past, the five day congressional work week allowed members more time for reflection, though less time for correspondence with constituents. Changing the work schedule might help foster the increased introspection we should expect as voters.
Post a Comment