THE WAIT – Healthcare in Vanuatu

A young woman shows off her chest X ray after a visit to the Peace Ark, a Chinese PLA Navy hospital ship. photo: Graham Crumb - imagicity.com

A young woman shows off her chest X ray after a visit to the Peace Ark, a Chinese PLA Navy hospital ship. photo: Graham Crumb – imagicity.com

The failures of Vanuatu’s health services are felt by everyone. But these shortcomings are particularly vivid to me today. As I was working on PiPP’s latest multimedia story on the state of health care in Vanuatu, I buried two friends on consecutive days. I have not the slightest doubt that they would both be alive today if they lived in Auckland or Sydney.

Danny Tetiano and Dr John Otto Ondawame were both influential, important people. One was a gifted musician, mentor to a generation of aspiring artists in Vanuatu. The other, of course, was one of the leaders of the West Papuan independence movement. In addition to the loss to society and to the world, both left grieving widows and young children behind.

To put it plainly, Danny and John died of poverty, not disease.

The cost to society is immense. One of the very reasons West Papuans have struggled to organise themselves and become a well-defined locus of international attention is the lack of well-educated, dynamic people, skilled in persuasion and diplomacy. They lack entrepreneurs to improve prosperity, education to create the entrepreneurs, and health services to preserve and protect them.

The lack of basic services is characterised as systemic abuse when Indonesian government policy is concerned. But how should we characterise such neglect in Vanuatu?

Health services in Vanuatu – there is no health system, per se – are rudimentary at best. Post-operative infection rates make even the most run-of-the-mill surgery a cause for concern. One long-time acquaintance died following the amputation of his big toe. A well-intentioned (but unforgivably vague) blog post by the UNDP raises the point that life expectancy in Vanuatu and other Pacific island countries is ten years less than in Australia and New Zealand.

Ten years, and three hours flight away.

The difference is quantum. It’s at once tantalisingly close and achingly distant. But the bitter lesson that I’ve learned this week, and repeatedly in the past, is that the cost of inactivity is not an abstract one. Death impacts directly on a nation’s ability to grow, to gain experience, and ultimately to survive.

Honour is respectable

Vanuatu’s first prime minister Walter Lini famously said, ‘respect is honourable.’ The phrase is often quoted today by people from all walks of life as a means of recalling the best aspects of Vanuatu society: its use of deference and respect as an integral part of community peace-making. Modern influences have transformed kastom in many ways, but respect is still held tightly to the national breast.

We might do well, though, to turn the phrase around.

It must be said that traditional life in Vanuatu is indeed happy… for those men who survive their first five years in comparatively good health. And some women may be content living within the confines of their village roles. But like it or not, that life is no longer available to a growing number of people.

If we include people living in peri-urban areas around Port Vila and Santo, census figures show nearly a 10% change in the urban/rural population ratio between 1999 and the last complete census in 2009. Much of this change is composed of the so-called youth bulge – a growing number of young adults with limited opportunities both in the modern economy and in traditional life.

These are not the only source of discontent. Household dynamics are increasingly complex. Domestic relationships, both formal and informal, are more fluid –and generally more violent– than they were. This is largely a result of the clash between the de facto status of women as chattels, and women’s increased economic independence, and thence mobility, in the modern economy.

Men and women both are no longer subject to the social and geographical confines of village life. Mobility and distance undermine traditions that have sustained Melanesian societies since time immemorial. The coercive or corrective power of community scrutiny recedes once it becomes possible to evade the villagers’ gaze. The village’s role as collective conscience has been eroded and, to date, nothing has arisen to take its place.

At all levels of society, the dwindling power of social pressure leads to behaviour that once might have been unconscionable. Legal and regulatory checks go unheeded and national institutions teeter on the edge of dissolution.

But kastom is a resilient term. It has survived thousands of years of challenge and changing circumstance; it has managed to remain a viable idea throughout even the last two centuries of transformation. There is no reason to believe it won’t survive the changing economic and social conditions of the present day. Continue reading

The potholed road to prosperity

Originally published on Pacific Politics

Vanuatu’s budget books, released earlier this month, reveal a fairly healthy economy. When you look at the broad strokes, that is. But they are far less revealing than they should be about the road ahead for the tiny island nation.

Overall, the economic news is okay. Revenues have improved significantly, largely because customs and inland revenue has tightened up its processes. Businesses are now closer to paying what they actually owe. The world economy is improving, and so is Vanuatu’s. Growth is expected to increase, from 3.3% in 2013 to 5.1% in 2014, and even higher in 2015. Inflation will remain low, likely less than 3% in the coming year. The government is taking on USD 5 million in new debt in order to contribute to a number of largely donor-funded infrastructure projects.

But dig a little deeper, and things appear less rosy. The budget does little to reflect the government’s goal of ‘a Just, an Educated, Healthy and Wealthy Vanuatu’. Overspending on scholarships in 2013 has not only left the department of education constrained at the very moment when it should be investing heavily in teachers, schools and educational resources, it’s diverted money from other areas as well.

In health, things don’t look so good either. Whatever we may think about the department’s recent decision to focus on medicine to the exclusion of other activities, it’s clear that much could be done to improve the ministry’s policy-making and implementation processes. A recent outbreak of dengue in Port Vila has caught it flat-footed. The cost in terms of medical care and, potentially, in lives, will only add to the nation’s burden.

Vanuatu managed to get through the recent global economic downturn with less damage than some of its neighbours. Some part of this is due to the government’s efforts in recent years to liberalise certain sectors, to improve conditions for businesses large and small, and to improve its own administrative processes as well. The result is that the country is a better place to do business than it was.

But we’re facing a welter of challenges still. The 2010 census contains stark evidence that the country is becoming increasingly urbanised. When peri-urban neighbourhoods like those surrounding the Port Vila and Luganville municipalities are factored in, we see that the old 80/20% rural/urban split no longer holds. Over the last few years, falling commodity prices and lack of opportunity have drawn more and more young adults into our towns. Back in 2010, the division was closer to 70/30, and based on observation alone, it’s clear that this trend is continuing at a rapid pace. Continue reading

Talking Shop

The Internet Governance Forum is sprawling, unfocused and formally useless. You should go.

I hate talking shops. Most sensible people do. If you are involved in any way in policy making, advocacy –or heck, if you just have to work for a living– the last thing you want to do is waste time talking. The Internet Governance Forum is a global conference that draws together governments, telecommunications interests, standards & technical management bodies, NGOs & social development groups… well, pretty much everyone who gives a fig about the internet. It was one of very few tangible results to emerge from the 2003 World Summit on the Internet Society, a UN-sponsored get-together that attempted (and ultimately failed) to address a widely-held perception of US dominance of the internet’s governance structures.

The IGF, quite deliberately, was designed to have no regulatory authority, no policy levers and indeed, no formal mandate to advocate even for issues about which the entire world is in screaming agreement. It can’t even publish findings. And that is its genius.

It’s a sprawling, unfocused event with disparate interests. Discussions cover everything and anything even remotely related to internet governance, from human rights and freedom of speech to child protection to spam and cyber security to standards development and law. It draws thousands of attendees from all walks of life. It’s uneven in quality and sessions range from the enlightened meeting of minds to fractious verbal brawls. As Winston Churchill might have said, it’s the worst possible forum we could possibly have, except for all the others. Continue reading

Buddies in bad times

Pacific island countries could –and should– do more to help one another

[Originally published on Pacific Politics.]

The recent breakdown of Vodaphone Fiji’s investment in Papua New Guinea’s BeMobile is just the most recent in a series of missed opportunities in cross-investment that could not only improve small island economies, but mitigate against some of the worst aspects of large-scale development projects in the Pacific.

Pacific island nations possess a chronic, unfixable weakness: With few exceptions, their economies are so small and fragile that a failure which might cause only ripples in a larger economy can hamstring theirs for years. Furthermore, their diminutive markets make them unappealing to most investors. Although they’re often put in the same basket as Caribbean states, their distance from other markets renders them unique – and in the eyes of many, uniquely unsuited for investment.

It serves no one’s interests to imagine that the development and financial approaches that work well in other developing states can simply be cut-and-pasted into the Pacific. And yet, far too often, this is the hole into which our development pegs are hammered. Although development banks and donor nations offer loans at extremely low interest rates, the assumptions under which funding is offered are sometimes unrealistic. And because return on investment is generally smaller than just about anywhere else on the planet, governments are expected to offer either guarantees or exclusive concession rights to investors, or to become shareholders themselves, and sometimes both.

Continue reading

Surveillance, censorship & secrecy – island style

Global villagers could learn a thing or two about information security from Pacific island societies

[Originally published on Pacific Politics.]

It’s telling, and rather tragic, that even after the lessons of Wikileaks, democratic governments have still not learned how to deal with secrets. Ask a Pacific islander, and he’ll tell you how. If he trusts you. It’s high time for global villagers to take a seat by the fire and take a lesson on surveillance, censorship and secrecy from societies that have been using them as their stock in trade for nearly 3000 years.

Viewed from this side of the lagoon, one of the most startling aspects of the Manning and Snowden scandals is that people, organisations and entire governments were taken utterly by surprise by the breakdown of secrecy. If it weren’t so damaging, the US’s flailing reaction would be comical. The Obama administration’s actions resemble nothing so much as a grasping debutante whose connivances have been exposed mid-cotillion. Swearing vengeance, warning others off from even talking to the tale-teller, harping shrilly about the damage, the harm, the lost integrity – it’s all a bit much, really. Unfortunately, this particular prom queen has nukes.

Continue reading

THIS is how you do posterity

I just posted this to Facebook, but they deliberately design their service as a memory hole, so….

Facebook is designed as a memory hole. Its search tools are crippled and external search engines are not allowed a look in. The manner in which posts and comments are displayed is predicated on their ephemerality. We -they- are deliberately repudiating posterity.

It galls me to no end that I have to bitch about this on Facebook in order for it to be seen. Nobody will even remember I said it….

End of an age….

In an online discussion concerning an ‘old-school’ geek’s fear of change, there was a lot of back and forth concerning luddism on the one hand and change for change’s sake on the other. At one point, someone chastised the poster for his trepidation.

“I’m going to guess he’s going to look back on his life and realize that he was dumb to think he’d seen it all at age 24. He talks as though the Third Age of Middle Earth is ending…”

In some important ways, it is. The process isn’t complete, but there is a fundamental change happening, and it will discomfit some of us.

The days of ‘Homesteading the Noosphere‘ (as ESR put it), are coming to a close. Scale, network topologies, business models and legal encroachment on the principles of individual online freedom are all conspiring to make the technological world we live in substantially more constrained than it’s been since the internet became part of our lives.

The land rush is over, the cowboys are gone (either buried or rich) and the homesteaders are being bought out by the speculators and tycoons. Community-based governance is under siege by national and international interests.

And this is being reflected in the tech world. The craftsman’s approach to software (always greater in repute than in reality) is decidedly more difficult to practice as a trade than it was. Toolkits are giving way to frameworks and apps replace applications. Backyard-mechanic roadsters and dirt-track races are swallowed up by Nascar – VCs get us excited by the prospect of building only big enough to sell out to someone bigger.

The physical networks themselves are being taken back by the telcos and proffered to governments for surveillance in exchange for ever more egregious rent-seeking behaviour. What we used to call sharing is now piracy. The word ‘copyright’ now means ‘don’t copy at all, ever.’

And in the midst of it all, we’re grateful to lockin-vendors who make Free software difficult, if not impossible, to use. We rent what we used to own. Even our identities are no longer our own.

I grieve to say it, but unless there’s a sudden and immense resurgence of the DIY spirit, especially in peer networking and distributed data, we’re going to fall back into the bad old days of the dumb terminal and the smart network. And that network’s smarts will not exist for our benefit.

I’m pushing 50 now, and do I fear change? Not really. I just regret the lost freedom, the creative anarchy of the ’90s, the ability to hack something cool and new, the chance to achieve things never before possible. It’s not gone yet. We could still turn things around. But every day we don’t brings us a day closer to the day when we can’t any longer.

 

On God and Science

Science doesn’t require a God of any kind to be complete.

Some people construe this to mean that they can keep God in one pocket and science in the other. But science is much more dangerous than that. In rationalising a space between the two, people implicitly accept Aristotle’s theory of the primum movens (or, unmoved mover). In other words, we can regress evolution, or cosmology or what have you back beyond the point of measurement, and beyond that resides the godhead. So Big Bang is okay, because God lit the fuse, as it were.

But the fly in the ointment is that you can actually push science past Big Bang and it still remains coherent (it’s not easily testable, but it’s theoretically coherent). Likewise, you can reverse engineer forces and causes of the evolutionary process past the origin of life. In other words, science doesn’t just end where God begins, and vice versa. No, science is complete – that is, it can conceive of the universe in its totality independently of any conception whatsoever of a Creator.

… Which doesn’t leave a lot of space for God, if you’re honest about it.

(And God, for his part, says, ‘I am that I am‘ and plagues me with boils. So, swings and roundabouts, I guess.)

The Revolution May Not Be Digitised

The internet is putting down tenuous roots in the Pacific – but do we really understand how to foster its growth?

Over the last year or so, we’ve seen a string of articles and papers about the small but sudden growth of the internet throughout the Pacific region. Ranging in tone between cautious optimism and untempered –and often uncritical– enthusiasm, few capture the essence of the struggle that Pacific island states face even keeping pace with the rate of change in the world of telecommunications and the internet.

When I first arrived in Vanuatu the better part of a decade ago, the entire country was sharing only slightly more bandwidth than I’d had at my personal disposal back in Canada. To add insult to injury, the cost was roughly ten times greater even for the paltry amounts on sale. Getting access to what would be considered even a nominal connection in the developed world involved expenditures equivalent to thousands of dollars a month.

Now, following years of consistent and determined effort, Vanuatu has widely available commercial internet in its urban areas. But prices remain high. As this piece is being written, the cost of a 2 megabit connection (the lowest tier of what is considered broadband in many developed nations) starts at about AUD800 per month, and rises quickly once usage fees are factored in.

In spite of this, internet service providers have found inventive ways to get people started, offering small (cynics might say paltry) connection speeds and bandwidth limits. Comparisons aside, such packages are at least sufficient to move the uptake indicator from effectively zero to… something slightly more than zero.

Make no mistake; that first step is a doozy. It’s allowed tens of thousands of people who never had any access at all to begin using the internet on a regular basis. As many a breathless commentator (including myself, on occasion) has noted, this has led to a vast increase in public dialogue online. This has led in turn to equally breathless speculation about the likelihood of a coming revolution in political awareness and activism, social justice, education and countless other shibboleths of progressive idealism.

With a few notable exceptions, commentators ignore key details about this incipient social revolution:

First, this ‘revolution’ resembles Iran’s Green movement more than Egypt’s uprising. In the vast majority of Pacific countries, price and availability limit access to all but a tiny proportion of the population. And these people are almost exclusively urban, affluent and educated. In short, they are already the best informed and most engaged. Simple arithmetic leads to the conclusion that limited access to internet limits the scope of its impact as well.

The internet is a ‘force multiplier’, in the sense that it renders many kinds of labour-intensive tasks vastly more efficient. While the impact on the minority who have recently begun to access it daily is immense, how much greater it could be if the other number in the equation (the sum of the population using it) were to rise even higher.

Second, the results of public dialogue, awareness and coordination on politics are measurable, but decidedly mixed. In Papua New Guinea, we saw a number of new faces in Parliament whose election can at least in part be attributed to the profile they garnered by participating in online fora such as Facebook’s Sharp Talk group. But we also saw many familiar faces returned, some of whom were widely reviled online. The same can be said of Vanuatu, where populist MP Ralph Regenvanu repeated his record-setting electoral performance, successfully expanded his base and managed to elect three other MPs under his Graon Mo Jastis (Land and Justice) banner. Regenvanu is the first politician since Independence to run an entirely issues-oriented campaign, and his appeal has only been amplified by his consistent presence online.

But popularity didn’t help Regenvanu on the tactical level. He won enough votes individually that, due to the vagaries of Vanuatu’s Single Non-Transferable Vote system (which elects multiple MPs in each constituency), he could have got three MPs past the post. Failures in messaging and on-the-ground organising, however, meant that his party’s second candidate in the capital constituency missed capturing the necessary votes to number him among the winners.

More to the point, Vanuatu too saw many familiar faces returned to Parliament. While its future seems uncertain, the current cabinet is nearly identical to the one that led the country to the polls only weeks ago. Even if it is ousted in the coming days, the champions and heroes of the small but growing online community can hope for a minority voice at best in any new government.

Third, and perhaps most importantly, commentators and researchers often underestimate the fragility of this flowering in the digital sphere and overstate its importance relative to other uses of digital communications. Despite the occasional public bun fight over self-censorship and media standards, it’s becoming increasingly clear that the Fiji government has been quite successful in its efforts to, in its words, ‘raise standards’ across the spectrum of media, both online and off, and to introduce ‘balance’. The stifling effects of official disapproval on certain kinds of commentary and content in Fiji are making themselves felt throughout the online community. They reach so far that it’s becoming harder to engage writers to perform any kind of independent analysis of government policy, ironically, even to praise it.

But to express unmitigated dismay at this outcome would be naïve, to say the least. Given that Fiji has the most highly developed telecommunications infrastructure in the region, and that the current regime has presided over its significant growth and improvement, why should we be surprised if they prove adept at making sure it serves their purposes? There is a very real chilling effect generated by the imposition of state views on the public dialogue, that’s true. But simply to write off the region-leading gains that have been made in telecommunications pricing and availability –as a recent Lowy paper did– is a textbook case of throwing the baby out with the bathwater.

In last week’s budget speech, Voreqe Bainimarama committed his government to building ten new telecentres in the coming year, and to removing duties entirely from smart phones in order to encourage uptake across the board. Informal reports indicate as well that there are plans afoot to provide broadband access to ‘almost 100%’ of the nation’s schools within the next four years.

The plain fact is that Fiji is a regional leader in understanding and embracing the importance of broad and deep investment in telecommunications capacity. They see their role in the coming years as that of a ‘knowledge hub’ for the Pacific.

Improved communications capacity, therefore, does not necessarily equate to increased freedom of speech, nor indeed the flowering of a diverse and broad-based social dialogue. This should not be news to us.

Melanesian and Polynesian societies all feature tight familial bonds and a preference for dialogue over confrontation. It’s not at all surprising, then, to see online groups arise whose membership comprises the majority of the online community. Hunger for change is generally evident, but it’s not overwhelming. There are in fact deeply conservative aspects to Pacific societies that can counterbalance and often quash an individual’s ability to enact change. Wantok-ism and a long tradition of respect for the so-called Big Man can overwhelm the desire to challenge the status quo.

If only to view the development of internet in the Pacific more clearly, it’s useful to look at online discourse and the networks that make it possible as separate, but linked endeavours. Building out infrastructure widely and deeply are necessary preconditions to achieving the progressive ends we most commonly associate with social media. But in and of themselves, they are not sufficient.

When we look at the landscape through this split prism, we can learn important lessons about how to achieve the former. The same paper that was so quick to toss aside Fiji’s recent gains ascribed the massive expansion of mobile services in the region to ‘deregulation’. Actually, the opposite is true. Virtually every successful step taken in this sector has been the result of increased government engagement in telecommunications: by negotiating (sometimes foisting) competition on incumbent monopolies, intervening when players tried to ignore or alter the rules, by closing the door to the back room and by giving their regulatory authorities the ability to bite back.

This may discomfit some, but in the Pacific it seems that more government, not less, is the recipe for success in terms of making the internet a part of their peoples’ lives. While Digicel’s example may have shown that even small markets can be profitable, the relatively large investments required to build out international fibre-optic links and robust nationwide networks carrying more than token bandwidth to the entire country are enough to make even the most risk-loving enterprise blanch. Simply put, no matter how much demand ensues, the capital investment costs per customer are astronomical.

It’s been argued that the only way a commercial entity can countenance such an investment is through a monopoly arrangement –the very thing that Pacific countries have spent the better part of a decade getting out from under. But even when other approaches are tried, the numbers are daunting. Tonga’s undersea cable connection to Fiji is heavily subsidised by the World Bank, and it’s being developed on a consortium basis, but the government the largest shareholder by a wide margin. Even with all of these interventions, prices promise to remain extremely high.

Simply put, it’s nearly impossible to make a profit-based business case for the kind of connectivity that will be required to provide affordable, widely accessible internet services in the Pacific. And those voice and data companies who do invest in the region will go to great lengths to protect their investment, up to and including interfering in the political process. The Pacific’s success (or failure) in embracing information technologies, therefore, will be determined by the level of commitment and firmness of will shown by government.

Even under the best possible circumstances, any gains will likely be tenuous. Renesys, the internet consulting group that broke the news of national internet blackouts in Iran, Egypt and more recently in Syria, recently used their international traffic monitoring tools to find out which countries were most vulnerable to disruptions in internet service. Needless to say, Pacific island countries were over-represented among those faced with ‘Severe’ or ‘Significant’ risk. Not even Fiji managed to find its way into the ‘Low’ risk category.

Renesys was worried mostly about the ease with which a government could turn off the internet tap on its own people. That may be a worry for some in the region, too, but those very same attributes that make national networks vulnerable to political interference also make them vulnerable to systemic threats. In 2004, the failure of a single satellite resulted in numerous nations going entirely dark, some for days. As the Renesys survey shows, little has changed in the interim.

If –and as we’ve seen, it’s a big if– Pacific nations do somehow succeed in integrating the internet into people’s daily lives, we still have no guarantee a flowering of awareness and online dialogue will necessarily follow. Once again, those in power will play an over-large role. No matter what decisions they make, there will be winners and losers at the top. Canny politicians and parties will follow the example set both by the insurgents in Vanuatu and PNG and by the incumbents in Fiji. Those who are adept at messaging and dialogue will likely flourish. Those who remain aloof, who ignore or refuse to take up these new social tools, will slowly (too slowly for some) but inevitably find themselves pushed to the sidelines. But they may succeed in slowing development for years before that happens.

The revolution, in other words, may not be digitised; there may not be any revolution at all. Every outcome, for better or for worse, will be determined by the will of governments to act.