The James Carville School

Whatever political consultants Fujimori has on his staff must`ve studied at the James Carville School of Campaigning. The top lesson at that school? "Keep it simple stupid!"

Fujimori is detained in Chile, so Martha Chavez is his appointed candidate. But all the commercials on the radio just say "CHINO CHINO CHINO!" It´s damn catchy and might be the only campaign commercial I retain after April 9 ("...Fujimori presenta!"). Please, please no segunda vuelta!

A candidate I could stand behind...

With the elections fast approaching here in Peru, it looks more and more like the country will continue what the Economist would call a "trend" towards the left in Latin America (my call is that Ollanta wins going away).

I personally would prefer Lourdes, but my ideal candidate would be someone (anyone!) that could reduce the constant barage of noise pollution. The worst offender in my neighborhood is the taxi that delivers supplies to Nuveos Helados. He has one of those truck-backup sounds, but at a ridiculous high-pitched tone and set at about 115 decibels. Of course, the political candidates are some of the worst offenders with their bullhorns and annoying jingles so I guess that leaves me as a man without a country...

Lucent is finally being sold Apparently
for $12.6 billion dollars.

The NYTimes article mentions that when AT&T spun off Lucent in 1996 it was a $3 billion IPO. Were there a series of subsequent offerings* in the last 10 years or do people only talk about the “collapse” of Lucent because it was once valued higher than AT&T?

10 years: $3 billion to $12.6 billion. That`s a 15.5% average annual return (not accounting for any splits). Doesn`t sound like a collapse to me. Sounds like a publicly traded company that was overvalued in 2000, but performed solidly for 10 years. Maybe some of you Lucent shareholders or market afficianados can fill me in on where I went wrong with this line of thinking?

*Even accounting for a second hypothetical $3 billion offering in 1997, we still see annual returns on market cap of more than 8 percent!

This story on Botswana`s AIDS testing program caught my eye:

http://www.mercatus.org/enterpriseafrica/subcategory.php/338.html

Botswana Addressing HIV/AIDS

Jasson Urbach - The current precautionary policies to fight the onslaught of the HIV/AIDS disease are outdated. Indeed, voluntary counselling and testing (VCT) as it is currently conducted was developed over 15 years ago and has lost a great deal of applicability in today’s day and age when we are able to substantially prolong the lives of infected individuals through a strict regimen of antiretrovirals. Furthermore, voluntary counselling and testing centres are almost always geographically isolated and this serves to perpetuate the stigma involved with testing. HIV/AIDS tests should be treated just like any other test for life threatening diseases.


Botswana is among the countries most severely affected by HIV/AIDS. In 2003 there were an estimated 350,000 people living with HIV. This, in a country with a total population of approximately two million, gives Botswana an adult HIV prevalence rate of 37.3 per cent. As a result of the disease, life expectancy at birth has plummeted from 65 years in 1990-1995 to 39.7 years in 2000-2005. However, the country is slowly beginning to see some success thanks in large part to a breakthrough in the way individuals are being tested.

At the beginning of 2004, Botswana began routine testing as part of checkups in public and private clinics. The test is part of the standard routine, but people who do not want to be tested can opt out. As a result of the policies, it is estimated that 35 per cent of the 1.7 million people that live in Botswana know their status. Sub-Saharan African countries grappling to win the war against the disease have a great deal to learn from the policies that Botswana has recently adopted.

A study of antenatal clinics in Francistown, (Botswana’s second city) found that approximately 90 per cent of women tested for HIV in the first three months of the introduction of routine testing compared to just over 75 per cent in the last four months of the voluntary counselling and testing approach. However, it was noted that many individuals failed to return for their results.

Apart from routine testing, another attractive alternative to the current method of voluntary counselling and testing (VCT) is home self-testing (HST). The possibility of HST is particularly relevant in those countries that lack adequate infrastructure or where individuals have to travel vast distances to the nearest clinic where HIV testing services are conducted. Self-testing can be done without fear of stigma and/or discrimination. The rapid tests that are currently available are highly effective with a 99.6 per cent accuracy rate and typically take 20 minutes to return the result.

Individuals should be given the option to test themselves in the privacy of their own homes and the tests should be widely available in pharmacies, clinics and hospitals. Being overly cautious with regards to VCT is not going to significantly increase the number of individuals who know their status. The World Health Organization (WHO) estimates that less than 10 per cent of HIV-infected people in sub-Saharan Africa realise that they are infected with the virus. The more people that are tested the more people will know their status and steps should be taken to increase the numbers.

No single preventative measure should necessarily preclude any other. Individuals should be allowed to choose the method they prefer. However, testing in the home allows for more confidential results, more privacy, and ultimately the chance for a greater number of individuals to learn their HIV status. Individuals will then be better equipped with the knowledge to seek treatment, practice safe sex, and plan for the future care of their dependants.

What really interested me is the difference in efficacy of the home AIDS test for Botswana vs. a market like the United States or Peru.

To wit, let`s say that there are 1 million people in the USA w/AIDS and 100 million in the "at risk" population.

A random sample of 10 million take the test.

9,960,000 receive accurate results meaning that 99,600 receive confirmed positives and 9,860,400 receive confirmed negatives.

HOWEVER -->> 40,000 receive inaccurate results. Of these, 400 receive false negatives and 39,600 receive false positives!

That means that nearly 1 out of every 3 people that thinks they are HIV-positive will in fact be a healthy individual! Obviously this is an ineffective test, right?

WRONG.

In a small country of 2 million people where 1 million (50%) are infected this test would work surprisingly well.

Assuming half the population takes the test, then there would be 996,000 accurate results (498,000 positives; 498,000 negatives) and 4,000 inaccurate results (2,000 false positives; 2,000 false negatives).

In this case false positives make up <.5% as opposed to roughly 30% in the American case above. Just one more way that dealing with health issues is completely different in the developing world...

Dispatch numero uno

(Originally sent 5 Marzo, 2006)

Hi all,

First off, yes I am still alive. No, I didn´t die in some horrible third world car crash (although I have been involved in a side-on bus collision and mototaxi vs. real taxi crash). I didn´t get sucked out to sea in a riptide surfing and I wasn´t bitten by tropical snakes in the rainforest. To tell you the truth, I´ve just been too damn busy working to get our project up and running to check in with an update.

"Wait, you left the country?"

Yes. For those that I haven´t kept in great touch with, I am now working on a randomized trial of savings incentives and marketing treatments for microfinance customers in Ica, Peru.

"That sounds awfully shady, is this just cover for some South American CIA front?"

Actually no. It is kind of difficult to explain what we´re doing and what my role is, but so far it has involved a lot of shopping; hiring and training a survey team; writing, testing and implementing IS and survey systems that will hold up for the next year; building relationships with relevant partners and people at the bank who can make things run smoothly; and trying to gently push people forward in the context of Peruvian time...

"I heard you don´t have any hot water?"

Yup. The first month I was here, I managed to make due without the creature comfort of a hot shower. Considering that it´s sunny and 90 degrees almost every day, it wasn´t that bad. Since then I have rented a very nice new appartment. It includes hot showers, but wierdly doesn´t have a towel rack or toilet paper dispenser.

"Pisco es Peru, no?"

Sí! Even with the brutal work schedule, I have managed to get myself out a few nights to cause trouble. I attended the National Pisco Sour Day festival (why can´t we have holidays like that?) and (grudgingly) helped some coworkers from the bank finish off a couple bottles of pisco puro. After a month, I can confidently say that pisco from Ica is much better than the stuff you get in Chile, but that the same grapes make for a pretty shitty wine. Peru also loses bigtime on the quality of beer scale -- luckily it´s cheap!

"And the food?"

Pretty good so far. Nothing super-fancy, but ceviche for lunch with a view of the Pacific is an experience that´s hard to top. In the desert I haven´t been as eager to eat the fish, but there are great locally grown asparagus, juicy mangos, tasty pecan candies from Ica, and the ubiquitous potato dishes and roasted chicken restaurants.

"And the Santa mug?"

Apologies to all MSH people who weren´t really interested in the rest of this email. Unfortunately, the santa mug was left behind in the United States due to space constraints. Hopefully, Santa will get his chance to see Machu Picchu and the other sites after my next round-trip in June!

"Are you going to have time to actually do stuff when I come visit or will you be too busy working?"

Thank god, yes. The first 6 weeks have definitely been a grind to get things in place, but starting soon I´ll be able to set more of my own schedule. So I definitely look forward to seeing a few of you here in Peru!

"Is that it?"

Yeah, that´s my update. Y´all have my email address, but I´ve also been using Skype a lot if you want to to check in over the phone. Apologies for the length and I hope that everything is going great in your life wherever you might be!

Saludos,
Ish