The Canuck Goes Amuck in the Globe and Mail!

My first (and likely last) appearance in the Globe and Mail. Enjoy my twisted tale of a Lao massage gone horribly wrong!

http://www.theglobeandmail.com/life/travel/activities-and-interests/my-laotian-massage-turned-into-a-three-stooges-gong-show/article15118099/

Dengue

The past month has not been an easy one for Laos. One of its provinces, Luang Prabang, has been suffering through a chronic food shortage that began months ago and has resulted in over 15,000 people dealing with moderate to severe food insecurity. A recent flash flood in Borikhamxay caused the Nam Xan river to overflow, sweeping away livestock and destroying rice stores for the families there.  As the well-worn joke goes, it’s a bit like living in the Old Testament here. If the sky opened up today and rained frogs, I’m pretty sure my neighbours would just shrug and buy bigger umbrellas.

But we now have a budding epidemic to deal with that has dwarfed the natural disasters in terms of loss of life this year. Dengue is a vector-borne illness transmitted by mosquitoes, just as malaria is. Unlike malaria, there are no prophylactics to prevent or lessen the impact of the disease and no antivirals or other medicines to specifically treat dengue once a person gets the disease. Symptoms of the disease include a mild to high fever, muscle and joint pain and rash. Though no treatment will cure the disease, allowing the disease to continue without any form of medical response could cause it to worsen and lead to death in some cases.

Dengue is endemic to Laos and the country deals with the disease every year. But the numbers this year are off the charts for some unknown reason. The season for Dengue generally runs from April to November, with the number of cases to this point of the year usually around 1,500 people. Three years ago was seen as an abnormally high year with 3,500 people affected. By comparison, there have now been 15,000 people infected with Dengue so far this year. Fifty-four people have died so far from the disease, compared to 22 for the entire year in 2010. And things may only get worse from here.  Dengue traditionally tends to reach its peak only toward the end of the rainy season, in August and September, so the numbers seem destined to rise.

As there is no vaccine to prevent the disease, the only way to protect yourself is to keep from being bitten at dusk and dawn, the times when the Aedes mosquito is most active. Long-sleeved shirts and mosquito repellent are the order of the day. Even I’m becoming cautious in this respect. I lived in Cameroon for 18 months on a half-bottle of Muskol, but I’m spraying myself every day now if I expect to be out early or late.

As the numbers have risen, the Lao Government has been working in conjunction with the World Health Organization (WHO) to find a way to contain the problem and reverse the trends. Beyond raising awareness of the problem, they are also attempting to address its cause by staging community clean ups of the areas where the mosquitoes tend to breed. This means removing the pools of water that collect as the rains come and cleaning areas that tend to attract mosquitoes. Particularly vulnerable in this respect are the villages around the country, so the focus has been placed on the eleven provinces showing the highest rates of infection, with the hope that up to 6,000 volunteers can be mobilized to assist with the response there this month. As the numbers rise, it is anticipated that medical students will be added to hospital rosters to assist with case management. As might be expected, the costs associated with making these responses are soaring to match the rising rates of infection, with estimates now reaching into the millions of dollars.

To this point, I haven’t personally been affected by Dengue. Vientiane Province has been impacted by the disease, with over 1200 cases and one death reported, but to the best of my knowledge, none of my UN colleagues have been infected. One friend outside of the UN did contract the disease earlier in the year as did his neighbours, but all of them were able to recover without incident. He informed me of this as we sat around his patio table that was decorated with enough cans of Off mosquito repellent that each of the party goers could have taken one home as a souvenir. “Dengue seems to be really bad in this neighbourhood,” he said, as I checked the sun that was sinking below the horizon and reached for my own spray bottle.

As the central hub for UN operations in the country, the Resident Coordinator office that I head has been receiving regular updates from WHO, as this is one of the main UN agencies in the country. A recent appeal from them to assist with funding the response has left me at a loss, as the budget for the RC Office is not broad enough to pitch in for such extraordinary efforts, but we continue to explore the options for finding funding sources within and outside of the UN. In a country that is prone to large-scale natural disasters such as flooding and typhoons, the tiny mosquito may prove to have the most devastating impact on Laos in 2013.

Radar on Steroids

When I tell people that I’m the Head of the Resident Coordinator Office in Lao PDR, they tend to either think I’m in charge of a dormitory set up for UN staff or they wish me well and slowly back away to avoid the deadly dull explanation that’s bound to follow. As many of you may be about to do with this blog. But stop! I promise a summary that’s both educational and fun. But then, I tend to promise many things.

Frank Sinatra once sang that love and marriage go together like a horse and carriage – you can’t have one without the other. The same is true for the UN Resident Coordinator and the Resident Coordinator Office that supports her or him. In most countries, the RC has two roles, as representative of the entire UN on behalf of the UN Secretary General and as the lead person for one of its larger agencies, the UN Development Programme. With over a dozen other UN agencies in the country and more outside, the RC is in a position of having to represent the UNDP while also providing governance to the others. A tricky role to hold, as the potential for conflicts of interest is great. To deal with this, the UN has developed the following system:

 

 

One thing you learn early on here – the UN loves its acronyms, so if you don’t, you’re SOL . As can be seen from the above diagram, a division between the two roles for the RC has been developed to maintain the distinction in the governance of the work to be done. To support the RC on the UNDP side, this means two deputies being assigned to the sheriff, er, I mean, RC, one for Programmes and one for Operations, to ensure the RC manages the work of the UNDP just the same as the other Heads of Agencies. On the other side of the firewall, there’s me and my staff, the Resident Coordinator Office. As firewalls go, it’s a friendly one, with regular interaction and only occasional confusion about where a particular issue needs to go.

So, that’s the division. But practically speaking, what is the role of the RC (and the RCO) in the work to be done? Here’s an overview:

So, there are primarily three areas of concentration. The Development side focuses on initiatives to support the country, generally on a longer-term basis, for anything from health to crime prevention to education. The Humanitarian response is dedicated to dealing with emergency preparation and response for crises such as flooding, typhoons and disease outbreak. And the security wing monitors and responds to dangers, whether man-made or otherwise. Seems fairly straight-forward, right? Next slide, please:

 

 

Boom goes the acronym dynamite! I won’t attempt to summarize the groups that are set out above, as I think it might cause the blog to melt down. Suffice to say that each of the groups listed under the headings above have their own mandates, and especially on the development side, this means they have their own ongoing workloads managed by their particular leads who in turn report up to the Resident Coordinator.  But to give a greater sense of the complexity of the system, if we take one of the groups shown above, the UN Country Team, and break it down further to show the agencies involved, we get the following:

Some of the agencies are instantly recognizable, such as UNICEF and WHO, as they tend to have a high profile in the public eye. Others, like UNAIDS, UN-Habitat and UNWomen, are less well known, but hints to their mandates can be found in their names. And finally, there are the agencies such as UNODC (drugs and crime), FAO (Agriculture) and IOM (Migration), which require a bit more investigation. The most important thing from a coordinator’s point of view is that each of these agencies run independently and have their own set of goals to achieve while still needing to work together on common objectives for the UN as a whole.

You may note from some of the diagrams above that the RCO is shown as a branch to the RC, and this is an accurate portrayal of the office. To use a reference point from the TV series M*A*S*H that some of you will recall, the RCO is the Radar O’Reilly to the RC’s Colonel Potter, an assistant who goes beyond being an assistant, anticipating and dealing with things before they require the attention of the commander-in-chief as well as responding to those things that do make it to his desk. I haven’t reached the point of hearing the helicopters before anyone else, but I’m getting there. The Radar analogy doesn’t quite capture the breadth of responsibilities for the office, as some of the RC’s duties are often delegated to the RCO, including chairing the committees responding to emergencies, so there is a level of independence granted to the office in achieving the objectives. So, the RCO is like Radar on steroids.

Any questions? I know I still have many, as I work my way through the responsibilities of this position. I hope to be able to share more in the future regarding the work I’ll be doing. I can see already that it will be a job that will likely fascinate and frustrate in equal measure, depending on the day (or sometimes, the hour of the day).

 

 


 

Buy A Leg

Sculpture outside of the COPE Centre, composed of UXO remnants

The COPE Centre in Vientiane is a museum unlike any you’ve likely seen before. COPE stands for Cooperative  Orthotic and Prosthetic Enterprise and is dedicated to the production and provision of artificial limbs and supportive devices for those who have lost limbs or have mobility restrictions. The loss of limbs in Laos has particular prominence in the country, primarily because of the continued presence of UXOs (or unexploded ordnances) in the country.

Some background on this. During the Vietnam War, Lao suffered greatly as a neighbour to the conflict. Bombing runs over the region were indiscriminate in their targeting, resulting in Laos being more heavily bombed than even Vietnam, on a per capita basis. The estimates quoted reveal some astonishing statistics: approximately two million tons of bombs were dropped over the country in the period from 1964 to 1973, enough to average a planeload of bombs every eight minutes for the nine years. The chart below shows the individual target points for each of these bombing runs, with parts of the country turned red by the sheer number of these missions:

 

Of the bombs dropped, the majority consisted of cluster casings that would open and spread smaller bombs (known colloquially as “bombies”), as pictured below:

The estimated number of these submunitions still existing in the country today, forty years after being dropped, is approximately 78 million, and they continue to pose a danger to both life and limb. The number of people killed each year through encounters with these bombs still averages three hundred or more and stories fill the news on a regular basis of the latest deaths. The COPE Centre goes to great lengths to tell these individual stories to avoid having the details swept away by the numbers. Tragically, many of the deaths are of children who discover the bombs and do not know to keep away from them. Those that do survive often suffer horrendous injuries – nearly forty percent of the patients at the COPE Centre who receive prostheses have been injured as a result of contact with an UXO. The issue of UXO contamination extends beyond those directly affected, to the point that Laos has added the containment of UXOs to its list of Millennium Development Goals to be achieved by 2015. The United Nations is working alongside the Government in an effort to help it achieve this goal. But a discussion of the MDGs merits a separate examination and another blog post.

Picture of Survivor of UXO Contact

 

Display of prosthetic legs

 

The patients suffering losses due to UXOs may be the highest profile, due to the sensitivity of the issue, but the COPE Centre also works with those who need assistance due to losses suffered as a result of traffic accidents, diseases such as leprosy and birth defects such as club feet. While the events bringing patients to the COPE Centre are undeniably grim, the Centre exists as a place of hope for those who have benefitted from their services. Such is the case with Santar (with the following story taken directly from COPE’s website – www.copelaos.org):

Since a traffic accident two years ago, 13-year-old  Santar was confined to the house.  Santar had been injured when crossing a road.  His deaf father had called him to cross but hadn’t heard that a truck was coming.  Following the accident Santar lost one leg and the other was severly damaged. His left foot was fixed with his toes pointing downwards so that he was not able to stand or walk. Before the accident Santar was like any normal 8 year old boy who had been attending school and was a very active child.

In Vientiane, local surgeons corrected his left foot.  Then the local clinical staff fitted a prosthesis for his right leg and an orthosis to his left. Over a period of four months Santar received regular physiotherapy at the centre.  As a result of his treatment Santar began to realize that returning to school was achievable and this helped to sustained Santar through the four months of treatment. Now living in Vientiane, Santar is at school studying English, enjoys cooking, swimming, computing and is currently top of his class! No longer the depressed boy we first met, he is now optimistic about his future.

Stories like this abound at the COPE Centre, making a visit here far from depressing. Rather, inspiration can be drawn from both the patients and those seeking to help them.

As with many small organizations, COPE struggles for funding to support its services. In an effort to raise awareness, it has undertaken many different initiatives, including the “Buy a Leg” campaign and developing a line of products, such as those pictured below, designed to raise awareness through their cheeky approach to the issue. I decided against the “Hello Kitty” shirt, but couldn’t pass up on the key chain.

 

 

The COPE Centre proved to be that rare combination of education and poignancy – stories to reach both the head and heart. As a museum experience, I expect it will remain unique for me. For more on the issue of UXOs and their impact, have a look at the following video, produced by UNDP: http://www.youtube.com/watch?v=RZ9_g0t57e0&lr=1

Hammer and Tickle

“Give me your wallet!”, the cabbie demanded, impatiently waggling his fingers at me. Sitting alone in the back seat of his taxi, I meekly did as I was told. So much for riding solo at night, I thought. As I mentally kissed my credit cards and cash goodbye, the driver rifled through the money jammed haphazardly in the crease of the billfold. Pulling out a 20,000 kip note, he said, “This is what you should be paying me” and handed the wallet back to me. Looking at the meter, the red light beamed “20”, and I realized I was actually receiving a taxi tutorial on Lao currency. “Kup jai”, I mumbled as I fumbled my way out of the back seat on to the street, still shining blackly after the early evening shower.

And so it goes in Vientiane, the capital of Laos, and my new hometown. Arriving with a foreigner’s baggage of suspicion and anxiety, one soon learns to relax, just a little. Though the guidebook descriptions of Vientiane as an undiscovered gem and a bucolic capital are outdated by a few years, judging by the streets swollen with traffic and tourists, the city does deserve its reputation as the most laid-back of all the major cities in Southeast Asia. Walk down any of the tree-lined streets and one is greeted with ancient temples sharing space with pizza parlours and cafes promoting themselves with wi-fi internet and frappucinno knockoffs.

Being surrounded by these Western (as in North American, not Git-along-little-doggies) hallmarks does pose a particular problem for this writer. Inspiration for me came from the unfamiliar, the new experiences that amused me as much as they made me miserable. Living without electricity, finding a scorpion nestled between my feet in the shower, careening on top of a Bangladeshi bus in the pouring rain, being attacked by chimpanzees. Now, those were easy to write about. I moved in to my new apartment in Vientiane this week. Included in the rent are air conditioning, microwave, housekeeping, internet, laundry service and cable TV (with HBO, no less). That isn’t funny at all. I walked into the Home Ideal megastore the other day and was greeted by a display promoting five different kinds of Spam. This place is going to be a challenge.

I had high hopes when I arrived in town. Eighteen hours of flying and crossing the date line had left me hopelessly bedraggled and ripe for being swindled. Getting off my last plane as the clock struck midnight, I expected my visa application to be rejected after an interrogation that would be both lengthy and delightfully embarrassing. Imagine my disappointment when I had my visa and customs clearances in ten minutes. Arriving in the baggage claim area, my two suitcases stood waiting for me, almost mocking me in their banal readiness. At least the taxi ride was bound to be interesting – strange city, a foreign language, the Witching Hour. I ended up sharing the cab with a nice couple who had just opened their own restaurant in the city. Ten minutes later, I arrived at my Guesthouse, with my room reservation still cheerfully honoured. Any hope that I would be able to start my stay in Laos with a Martin-Sheen-Apocalypse-Now-hotel-room-freakout was forever shattered.

Sigh. That’s not to say that inspiration can’t be found. Hammer and Sickle flags fly everywhere, a constant reminder that I’m in one of the last Communist states in the world. And there is an endearing quirkiness to things here to offer a counterbalance to the seriousness of the ruling party. Whether it’s the seafood restaurant proudly advertising its “crap sticks”, the ice cream shoppe topping its “golden sundaes” with kernels of corn or the Swedish Pizza and Bakery down the street, there are plenty of sights to tickle the funnybone. But there’s a significant risk that I could end up, gulp, contented and happy here. I’ll just have to hope that I can find more cab drivers willing to take my wallet.