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BODHI Times No 16, 1999

Message from His Holiness XIV Dalai Lama

BODHI’s Founding Patron

For the last ten years, BODHI has been doing very good work. It is not enough merely to wish for the world’s problems to be solved; practical work (and money) are required. BODHI has made a start, even though eradication of all our problems is a long way off. If one person were to try to address these problems alone he or she would likely despair. BODHI allows for the benefits of a group effort and all the support that entails.

It has also made admirable efforts to work with people of many faiths and races. It has supported Tibetans in India and Tibet, people in Thailand and Hindu untouchables in India’s poorest state, Bihar. BODHI’s advisory board includes Christians as well as Buddhists from several lineages.

It is only one small organisation when we think of the extent of the world’s problems, but I sincerely hope that with the support and efforts of like-minded people, BODHI’s activities willcontinue to increase.

For the last ten years, BODHI has been doing very good work. It is not enough merely to wish for the world’s problems to be solved; practical work (and money) are required. BODHI has made a start, even though eradication of all our problems is a long way off. If one person were to try to address these problems alone he or she would likely despair. BODHI allows for the benefits of a group effort and all the support that entails.

It has also made admirable efforts to work with people of many faiths and races. It has supported Tibetans in India and Tibet, people in Thailand and Hindu untouchables in India’s poorest state, Bihar. BODHI’s advisory board includes Christians as well as Buddhists from several lineages.

It is only one small organisation when we think of the extent of the world’s problems, but I sincerely hope that with the support and efforts of like-minded people, BODHI’s activities will continue to increase.

==========================

From the Medical Director’s Desk

WAS GANDHI RIGHT OR WRONG?

Words ought to be a little wild, for they are the assault of thoughts upon the unthinking. J.M. Keynes

The great fighter for Indian independence against the British occupiers, Mahatma Gandhi, is famous for saying that there is "enough for everyone's need but not for everyone's greed." Is this true?

I argue that the history of humanity suggests otherwise. A major drive of human exploration and settlement has been not just curiosity, but the struggle to find new resources to satisfy essential human needs. How can greed alone have driven our ancestors to take the enormous risks that led to human diffusion across the globe? At least 40,000 years ago, humans had not only walked out of Africa but also crossed the Wallace line. This line follows the sea channel that separated the Australia-New Guinea land mass from that of Southeast Asia during the Ice Age, when the sea level was far lower than it is today. Crossing it involved a substantial sea voyage.

Perhaps 12-15,000 years ago, the ancestors of the indigenous population of North, Central and South America braved the land bridge between Siberia and Alaska, and then spread through the whole of the American continents. Hunger and competition for resources forced our ancestors to take risks.

This is not to deny the role of curiosity. Curiosity may have led to danger, but was rewarded sufficiently frequently to repay the risk. I argue that scarcity and competition contributed to this curiosity. Later, I propose, these same forces led to the development of farming.

BLOWIN’ IN THE WIND

Agriculture appears to have developed independently in at least five areas, all of which had suitable, naturally occurring wild plants: the Middle East (wheat), South and North East Asia (rice and millet), New Guinea (sweet potato) and Mesoamerica (corn). Significantly, agriculture did not develop in these areas until human beings had been present for a considerable time. It is plausible that agriculture only developed at a time when human population and hunting technology had increased to the point where hunting was beginning to have a significantly reduced marginal return.

In other words, human success at hunting began to deplete animal stocks. Hunting became more difficult. This may explain the relatively late development of agriculture in America, which was settled much later than the rest of the world.

Where suitable native plants existed, agriculture could supplement hunting and gathering. If no native plants existed, other strategies had to be found. The key was to maintain a low population density when expansion to uninhabited territory was impossible. How can we say that greed led humans to develop agriculture? Was it not need?

Humans have always had to maximise their sustainable carrying capacity, wherever they went. Need has led to risks and rewards as new technology developed. The remarkable progress since the Industrial Revolution has seen global carrying capacity and human population increase enormously, the latter nearly quadrupling this century, from 1.6 to just over 6 billion.

SCARCITY GENE

Today, even though distribution of our relative abundance is grossly inequitable, most people have more resources at their disposal than were available to the average person only a few hundred years ago. But the phenomenon of abundance is recent. The structure of human societies, and their genes, has been shaped by hundreds of millennia of scarcity. I think that understanding this helps to explain both the extent of the existing global resource maldistribution and the reason for such savage ethnic wars recently seen, for example, in the Balkans and Indonesia, and against the Kurds in Turkey.

These wars are in no small part fuelled by resource maldistribution. Economic hardship contributed to the breakdown in Rwanda, partly by a fall in the price of coffee, Rwanda's main export. Indonesian chaos has undoubtedly been exacerbated by the withdrawal of billions of dollars of capital which led to and followed the downfall of President Suharto. Economic hardships also contributed to recurrent wars in the Balkans, which were partly caused by international financial pressure (Michel Chossoduvsky: The globalisation of poverty).

The adverse effect of modern, "wild" capitalism on Indonesia and Africa is undeniable. Here greed does enter the picture. The behaviour of wealthy investors and corrupt elites in developing nations was greedy. Perhaps Gandhi meant that, for the first time in human history after the Industrial Revolution, technology has the potential to produce enough goods and services to satisfy physical needs of food, shelter and clothing.

Human needs are greater than this, I think. I propose that, unique among species, humans need a kind of buffer capacity, a stock of "reserve carrying capacity", an insurance policy for the hard times which we subconsciously fear will return. As a species, we have experienced recurrent hard times since we evolved; the species from which we evolved no doubt had similar experiences of insecurity and scarcity. Consequently, it is hardly surprising that humans are driven to maximise their own personal wealth and security; something that very easily can be seen as "greed".

The ability of humans to recognise scarcity and to appropriate "reserve carrying capacity" have been effective means of guaranteeing human survival for thousands, if not millions of years. Simply having enough food, clothing and shelter for the day has never, I argue, been enough to satisfy real human needs, and most humans alive today continue to experience

profound insecurity, albeit subconsciously.

THE OTHER

The gradual spread of humans through the world led to diversity and homogeneity--the bonding necessary for a group to survive. Human survival in a hostile environment--due to wild animals, drought or territorial boundaries--must have always depended on identification with one's group, family, kin, tribe, culture and language. By definition, identification with one group necessitated identification of the other, the group that does not help and may in fact hinder. Conflict, refugees and war are likely to continue, as long as humans perceive the other as distinct from my side.

Thanks to technology, global carrying capacity continues to increase. We don’t know if this increase will continue at the rate of population growth. Conflicts are likely to recur frequently in the coming decades. As weapons of mass destruction, nuclear but also biological and chemical, continue to spread, such conflict could yet have devastating worldwide consequences.

If humans are to continue to evolve, then the next big risk may be not be a physical journey such as a sea voyage, but a psychological and spiritual venture. This would involve increasing the identification of my side to encompass all of humankind.

This does not mean that we abandon laws and institutions, any more than recognition of the rights of other species means we should live only off the air. A sustainable future is not necessarily incompatible with a humane future. It may be the only safe route left.

=========================================

Our advisers series continues with Shelley Anderson

ANOTHER WOMAN FOR PEACE

I’ve worked in the peace movement, specifically with the International Fellowship of Reconciliation (IFOR) for over fifteen years, first as a local organizer, then as editor of Reconciliation International, IFOR’s bimonthly magazine, and more recently as co-ordinator of IFOR’s Women Peacemakers Program. IFOR, founded in 1919, defines itself as a spiritually based movement for active nonviolence.

A spiritual turning point in my life, brought on by a stint in the US military, convinced me that I wanted to dedicate my life to peace. Seeing the suffering created by war and preparations for war, especially in US inner-city communities, where precious resources are directed away from health care, education and community development towards the military, convinced me of the need to work for peace in the world. Discovering the teachings of the Buddha convinced me of the necessity to cultivate inner peace, and gave me an inkling of the false dichotomy between the inner and outer worlds.

WOMEN LEAD WAY TO PEACE

I work with IFOR because I feel that if we do not delegitimise war and find better alternatives to armed conflict, human life will end. Since the beginning of this century alone, in some 250 armed conflicts, over 110 million people have been killed, and millions more wounded or displaced. At this very moment, one-sixth of humanity is directly affected by armed conflict. I work with women because, quite simply, it is women who are leading the way to peace. In Liberia, Bougainville, Sudan, Northern Ireland--everywhere that communities are struggling to rebuild themselves from the trauma and devastation of war, it is women who come up with the most innovative, far reaching strategies for ending violence and pursuing reconstruction and reconciliation. Perhaps, as a Northern Irish community worker said, it is because women have struggled so much against violence against women and have learned much from this struggle that can be used to confront other forms of violence. Certainly the most common type of daily violence is violence against women and girls.

One study commissioned for the World Health Organization talks of the pandemic of violence against women, and states that in any given culture between forty and sixty percent of women and girls will experience rape, wife battering or incest at least once in their lives. The links between this "private", individualized violence and the more "public", organized violence of armed conflict are many and inseparable.

In my work I organize regional consultations that bring together women from different sides of armed conflicts, to dialogue with each other and strategise about ways to end the conflict. I help organize trainings in active nonviolence for women’s groups. We also produce documentation, including videos and an annual action pack for May 24, International Women’s Day for Peace and Disarmament, on women’s peacemaking initiatives, as women’s work for peace is often unrecognized–and always underfunded.

Recognising that development is impossible without peace, and that without women, neither peace nor development will happen, we also support the development of independent women’s organizations. I see such hope today in the work of women in Bosnia and Rwanda to rebuild multicultural societies in the declaration of the United Nations that the years 2001 to 2010 will be a Decade for a Culture of Peace and Nonviolence; and in the dedication of Burmese and Tibetan women. This is the essence of engaged Buddhism, of bringing the hard practice of peace out of the temple and into the streets.

I am grateful to be a small part of BODHI, which is also part of this worldwide move towards more humane, more just, life for all.

Shelley Anderson, Program Officer, IFOR Women Peacemakers Program, International Fellowship of Reconciliation, Spoorstraat 38,NL-1815 BK Alkmaar, The Netherlands, Tel. +31 72 5123 014, Fax +31 72 5151 102, Email: s.anderson@ifor.org.

==============================

 

TWO VOICES

Mr Arun Kumar Chaudhary, retired Director General of Police, Bihar, India, longtime BODHI donor, talks about meeting the Dalai Lama.

 

In one’s life, strange perceptions of reality occasionally surround us. One such moment occurred when my five-year-old granddaughter made an extraordinary comment. It was raining hard. We were sheltering in our room, idling the hours away in small talk, when she suddenly asked me, "Dada, why does it rain"? I was completely stymied.

 

FAIRY WATER

 

Should I give a scientific, erudite explanation or tell her a fairy tale in which fairies make it rain by waving their magic wands? I took the middle path and said, "When it is too hot around us and we’ll feel very uncomfortable, God orders his angels to pour down some water from Heaven to make the air cool and make us happy. This is what comes down to us as rain". She gave me a sneer and gravely commented, "No no no. You don’t know anything about it. It rains when God cries. All this water is His tears. This metaphysical explanation astounded me. I wisely nodded and said, "Yes, that too happens".

ETERNAL ENCOUNTER

The picture which immediately came to my mind was one of His Holiness the Dalai Lama's visit to Bodh Gaya some years back when Tibetans from far and wide had gathered and lined up to pay homage. Many were obviously living in penury, with soiled and torn clothes. The agony of a pitiful existence was writ large over their faces. I looked at His Holiness and saw compassion dripping from His eyes, even while His usual charming smile lit His face. This encounter will always remain imprinted on my mind. The child's comment made me immediately conscious of the feelings I had carried since those moments, of seeing God feel compassion for His suffering children. I wondered why it did not rain at that moment.

The same experience flooded my being some years back when His Holiness received me at His cottage at Dharamsala. I had suffered a serious heart attack and sought His blessings for whatever recovery I could make. His Holiness did not just give me some herbs with His own hands, but asked His personal physician to visit me and take my pulse so he could prescribe the appropriate medicines. I was so overwhelmed that my voice came out in a choked whisper.

In a recent telecast of His Holiness, a most extraordinary event took place. Along the pathway there were security people scattered for protection. As He passed a sentry who had his rifle up in what is technically known as the "Present Arms" position, as a mark of respect, His Holiness placed His palm over the barrel of the rifle, with a childlike, benevolent, yet mischievous expression. I shall always treasure in my heart that very moving scene.

At the moment of my conversation with my granddaughter, all these scenes floated across my mind and I said to myself, "Yes, God does shed tears for His suffering people--tears which come down to earth as drops of rain". Who knows?

 

 

TENPA TK WRITES FROM MUNDGOD

I am extremely happy and proud that BODHI has completed its tenth successful year of health and education promotion and social upliftment of the most deprived, neglected and poorest of the poor in India, Tibet and other Asian countries.

FIRST MEETING

I first met Dr Colin and Mrs Susan at Phende Hospital, Hunsur, South India, in 1990. We realised that lack of education is a main cause of common health problems. Frequent health education is necessary for improvement. How could we begin? I started health education at Hunsur in the conventional way, and soon found that many changes were needed. When I was transferred to D.T.R. Hospital at Mundgod, I realised that the local people knew very little about health. Until people are made aware of the importance of health and healthy habits, the community will continue to suffer. I approached various people and departments for help. Response was poor or negative.

APPLICATION ACCEPTED

At that time, BODHI’s newsletter announced a vacancy for Field Representative. I applied, feeling that by associating myself with BODHI I could develop my knowledge and better carry out my work. Luckily, my application was accepted. BODHI has given me real moral support and inspired me to be at my best.

The Tibetan community has benefited a lot from BODHI’s generous financial help, in the field of providing life-saving requirements like water bore, medicines, evaluation of newly arrived refugees and many health-related problems. The Tibetan Colony at Mundgod has been especially lucky to receive continued help year after year. BODHI’s help in getting the community health workers (CHWs) trained has made a lot of difference in monastic health and the general health and sanitation of the monasteries.

Regular contributions towards the Village Sanitation Competition have made much difference in people’s attitudes and habits. Initially, people used to curse us for giving extra work and conducting the inter-village cleanliness competition once a year in the first and twice in subsequent years. These days, people request through the local assembly that we conduct competitions as frequently as possible. This invitation is indeed a great pointer to changed attitudes and realisation of the importance of personal hygiene and community sanitation.

TB WATER PUMP

BODHI’s contribution of a wind-water pump to D.T.R. Hospital has given us much-needed relief by solving a long-standing water problem. The Tuberculosis Isolation Ward’s inmates have benefited most.

I would like to congratulate everyone at BODHI for devoting their lives, energy and precious time and money for the benefit of the deprived, ignorant and needy poor and sick for ten long years. I pray that the coming decade will be even better for BODHI, and am proud to be associated with BODHI for so many years.

 

===================================

Along the way . . .

Here are some of the projects in Thailand, India and Tibet made possible by your help.

Most of our work among Tibetan refugees in India has been in the south, where most Tibetan refugees live and need is greatest. Visits to eleven Tibetan communities in North, Central and South India in 1990 identified many competing needs. Some of our initiatives have been:

HEALTH

General drugs to the Department of Health (DoH), Tibetan Government in Exile, Dharamsala, N. India

Tuberculosis medication to DoH

Research of TB trial using an innovative immunotherapy technique in conjunc-tion with traditional medications, India

Support ophthalmological training, Tibet

HEALTH EDUCATION

Community health worker (CHW) training and refresher courses for monks in Tibetan monasteries, Mundgod, S. India

Health education talks culminating in poster competition for schoolchildren, Kollegal, S. India

Village Sanitation Competitions, Mundgod

ENVIRONMENTAL

Concrete pathways for a Tibetan nunnery, so that the nuns do not get muddy in the monsoon season, Mundgod

Solar cooker to save wood to Ganden Shartse Tibetan monastery, Mundgod

Trash collection system and maintenance to Ganden Shartse

2 well covers to a village in Tibet

Water pump to Tibetan Medical and Astro Institute (TMAI) medical clinic in Bandhara, Central India

Windmill to D.T.R. Hospital, Mundgod.

Water purification system, SOGA School

for New Arrivals, Dharamsala, N. India

Environnmental education and trees for planting by schoolchildren to Massihi Gyanodhay Abiyan (MGA, Campaign for a Literate Bodh Gaya), Bihar, India

EDUCATION

Bicycles for rural schoolchildren in Thailand

Education for Burmese refugee girls in northern Thailand about to be sold into prostitution

Supported Satellife satellite link between the University of Tasmania and the medical library in Dhaka, Bangladesh

Computer, printer, science laboratory, dental kits and educational materials to Tibetan Educational and Children’s Home (TEACH), Kollegal

Educational materials to schoolchildren in two villages, Tibet

Teachers’ training courses, teachers’ salaries and vitamins to Campaign for a literate Bodh Gaya

Informal education of 500 child labourers aged 8-14, in UP, India. The children also received environmental instruction from community elders.

VOLUNTEERS

Australian nurse to hospital in Kollegal.

Australian English teacher/construction worker to Kollegal

Australian English teacher to school for new arrivals from Tibet, Dharamsala

3 U.S. students from Lake Erie College, Ohio to teach English at Tibetan Medical & Astro Institute (TMAI), Dharamsala.

2 U.S. doctors planning to spend 6 months at D.T.R. Hospital, Mundgod as this goes to press.

ANIMAL

BOWSER (BODHI’s Wild Dog Sterilisation and Eradication of Rabies Programme), N. India

Help purchase and equip ambulance-mobile clinic, People for Animals, New Delhi, India

Funds to vaccinate wild dogs against rabies, Help in Suffering, Jaipur and Darjeeling, India

The rest of the journey

Educational and environmental projects in Tibet. This is working very well, due to the experience of the people involved. We would like to expand our work in Tibet. We’d like to at least double the US$2,000 we’ve sent in the last year. Most donors send $20 annually; some send $100 and even $500 regularly.

Can you consider raising your donation to enable BODHI to expand its work? Won’t you consider making BODHI a beneficiary in your will?

Over the years, we have tackled unglamorous, sometimes controversial problems. These remain unconquered, for example tuberculosis among Tibetan refugees and the threat of rabies from wild dogs in towns and Tibetan settlements in India. TB continues to be a major health problem for Tibetans as new refugees continue to arrive in India, fleeing the repression and discrimination experienced in Chinese-occupied Tibet.

Two ways in which we are tackling the TB problem are health education and the training of monastic community health workers (CHWs). Monks are considered to be leaders in the Tibetan community. We hope to try again to include nuns in this training.

===========================

EAT FOR BODHI

Wherever you live, whatever your circumstances, one thing is definite: we all eat. One painless way you can help is to eat for BODHI: host a dinner, morning or afternoon tea, luncheon: anything at which food and liquids are consumed. Contact us for suggestions.

Do you have something valuable you can donate for an auction, raffle or door prize? A vintage bottle of wine, an antique carpet, an old book or a work of visual or literary art perhaps? Please keep BODHI in mind.

 

What is BODHI?

Benevolent Organisation for Development, Health & Insight (BODHI) focuses on sustainable ways to improve health, education, the environment and human rights, particularly in developing countries. BODHI was founded in 1989 on the principle of skilful, compassionate action.

BODHI is neither religious nor political. We have supporters and advisers from many faiths. We ask only for a kind heart and practical assistance.

Realising the interdependence of all beings is in our enlightened self-interest. If we don’t work together to reduce the world’s much discussed problems, then who will?

============================

AUSTRALIAN TAX-DEDUCTIBILITY

As this goes to press, we are in the midst of preparing our records to make another submission to AusAid for tax-deductibility. We have met their reasons for rejecting our application last time, and are hoping for success.

This preparation is a tedious process which includes compiling and pruning many pages of old minutes from committee meetings and correspon-dence over our entire existence. We are also lobbying in Canberra.

WE STILL NEED YOUR HELP

Thanks to your generosity, BODHI has been begun exciting and innovative projects. We need your donations to continue.

Please send your donation, payable in US or Australian dollars, to an address below.

U.S. donations tax-deductible

============

BODHI AROUND THE WORLD

From its inception a decade ago, Colin and Susan thought that BODHI had the potential to become a worldwide organisation, with support from all inhabited continents, active on all continents. BODHI was first registered in the U.S., where tax-deductible status was granted in 1991. Our first work was with Tibetans; we have always wished to work in Africa as well--indeed, wherever there is need.

We recognised that this was a very ambitious dream. We had to start with something manageable; we have done so. Ten years later, we still believe BODHI has both a unique niche and the potential to grow much stronger.

This will not happen without your support. If you would like to help, we'd really like to hear from you, especially if you live outside of Australia. Of course we need money, but time is just as important. Perhaps you can think of a dozen people in your country to whom you could give our newsletter. Perhaps you can tell people who like to see co-operation among different religious faiths about our work.

From the Director of Electronic Communications

BODHI has a new home page. It is located at

https://www.angelfire.com/on/bodhi/

We hope you find what’s there useful. For example, minutes for the last AGM are to be found on

https://www.angelfire.com/on/bodhi/agm1998.html

This issue of BODHI Times will appear online at the site above shortly. The last issue is also online.

Those of you on email may wish to add the address of BODHI's web page to your signature.

We welcome contact with you on any matters to do with BODHI and its activities, so please don’t hesitate to email. If you have any suggestions that will help us, we would love to hear from you.

Thanks to the speed and simplicity of electronic communications, it should be possible to establish lots of fruitful links among people located anywhere in the world who support our ideals. As a truly international organisation, we are well placed to tackle global issues!

 

==================

BODHI TIMES sets available

Support our work: give a set to your friends. An almost complete set of newsletters (Numbers 2-15) is available at a rockbottom price. Please send $20 to either BODHI U.S. or BODHI.

=======================

BODHI Times is the biennial newsletter of Benevolent Organisation for Development, Health & Insight (BODHI).

Founding Patron

His Holiness XIV Dalai Lama, 1989 Nobel Peace Laureate

Medical Director

Colin Butler, M.Sc., F.A.C.T.M.

Editor

Susan Woldenberg Butler

India Representative

Tenpa TK

Dir. Electronic Communications

Denis Wright, Ph.D.

Advisory Board

Roshi Robert Aitken Hawaii, US

Shelley Anderson The Netherlands

Sen. Bob Brown Tasmania, Australia

Sr. Mila de Gimeno The Philippines

Prof. John Guillebaud London, UK

Dr Maurice King Leeds, UK

Dr Christopher Queen Boston, US

Sulak Sivaraksa Thailand

email: bodhi@iname.com

https://www.angelfire.com/on/bodhi/

BODHI U.S.

PO Box 7000 GRD, Redondo Beach, CA 90277 USA

Tel: 1-310-378-0260

Directors: Colin Butler, Martin Rubin, M.D., Scott Trimingham, Susan Woldenberg Butler

BODHI

4 Queen St., Campbell Town, Tasmania, Australia 7210

Tel: 1-61-3- 63- 811675

Directors: Colin Butler, Susan Woldenberg Butler, Denis Wright

BODHI EUROPE

Dr. Michiel Marlet, c\- Etnalaan 27, 5801 Venray,

The Netherlands

Printed on recycled paper

We greatly value your support and keep our mailing list confidential

=============

TIBET:Where we’ve been

Your donation of US$1,000 provided badly needed reference material in Tibetan to seventy-four students in one village and 206 in another. Each student also received about twenty notebooks. Materials were purchased wholesale and taken to the villages, rather than simply giving money. "A few notebooks were kept to later give to particularly poor students", we are told.

Your donation also provided two villages with new water well covers.

Where we’re going

These children need school supplies, among other things. We have just sent another US$1,000 to Tibet for these and other children, bringing BODHI’s donation to US$2,000 in the last year. We would like to expand our work in Tibet and at least double our annual donation. Can you help?

 

 

 

TB WATCH

Dr Colin Butler writes about TB and Nigeria.

The World Health Organization (WHO) estimates that tuberculosis (TB) is killing more than 3 million people worldwide each year--about 8000 people a day--more adults than any other infectious disease, including malaria and HIV/AIDS. Unless this can be controlled, close to 1 billion people will be newly infected, 200 million people will get sick, and 70 million will die of the disease between now and 2020.

 

TB: DISEASE OF POVERTY

Generally, TB is curable, except very rarely when patients are infected with strains resistant to all normally effective antibiotics. In the West, better living conditions and improved hygiene, for example less public spitting, led to rapid decline in the rate of TB, even prior to the discovery of the first effective antibiotics in the 1940s. TB is a disease of poverty, like other big killers of children and adults such as chest infections, diarrhoeal disease, malaria and, increasingly, HIV/AIDS.

In 1993, WHO described TB as a global emergency. Yet there is no evidence to suggest that TB had become more common or lethal. Drug resistance did not start in 1993. However, for the first time in decades, TB threatened to emerge in wealthy countries. Wealthy countries, especially the U.S., saw a resurgence of TB affect the most deprived of their populations, for example in prisons and among the homeless. At about that time, four health care workers in New York died of a resistant of TB, despite receiving the best medical care.

Furthermore, TB, which can lie dormant for many years if suppressed by a healthy immune system, can be re-awakened by the immunosuppression that follows HIV infection. For this reason there are still fears that the spread of HIV will lead to an increase in active TB cases in Africa and Asia, not only to those dying of AIDS, but to others who come into contact with them. At about the time of the so called global emergency HIV was still a major problem in many western countries; so the combination of multiply drug resistant TB infecting AIDS patients in the west was a real worry.

WHO couldn't call TB a "rich country emergency" so they called it a global emergency. While the rich countries took the problem seriously in their own countries--the US alone spending more than US $1 billion trying to eradicate the disease in New York City--there is no evidence that they took the word "global" seriously. If they had, the statistics quoted above might not be as dreadful.

DOTS

Something had to be done! WHO acted, expanding a policy which had first been mooted nearly a decade earlier. This is now called DOTS, or "Directly Observed Treatment, Short-course." As discussed in BODHI Times No. 2, July, 1992, lack of "compliance" is the biggest problem in thetreatment of TB. Treatment is ineffective because the patient does not complete his or her course of medication. DOTS overcomes this by requiring the patient to swallow his or her pills in the presence of a health worker. DOTS also means that resistant-strains are far less likely to develop. In wealthy countries with plenty of health workers, DOTS is cost-effective.

CHINA, NEPAL

Can DOTS--a strategy that, I argue, was introduced to protect populations who are better-off--also be applied to reduce TB in the poorest communities? In theory, of course, it can, but DOTS is relatively expensive. According to WHO, China is using a loan from the World Bank to expand its coverage of DOTS from its current level of 50%. Such an investment may well pay off; the traditional authoritinarianism of Chinese culture may increase the acceptance of a strategy which, for me, raises ethical concerns concerning patient autonomy and paternalism.

In countries like Nepal, where a patient may have to walk six hours to the nearest health worker, how can DOTS be implemented? A farmer with TB cannot afford to spend six months away from his or her field. Also, it is difficult to envisage how the extra funds required for DOTs will be found in sub-Saharan Africa, where life expectancy has already fallen dramatically because of HIV/AIDS.

Nonetheless, despite my concerns, I agree that DOTS should be the mainstay of TB treatment, in poor countries as well as rich. DOTS may be the cheapest and most realistic method to reduce the terrible burden of suffering that TB currently causes, at least in the next decade.

References available from the author, or on the web.

 

 

NIGERIAN KINDNESSES

In 1985, when I was a medical student, I travelled in one of those semi-lethal Nigerian taxis from the northern city of Maiduguri to the plateau town, Jos. The bus and train system was rudimentary. The way to get between towns was to go the taxi stand at city’s edge, find a yellow-and-green Peugeot and wait for it to fill with passengers with the same destination. The journeys were a great stimulus to prayer. Although the unwritten road rules gave precedence to taxis over everything that moved--except trucks and tanks--there was always the chance of hitting a herd of unlicensed goats, or, at night, one of the unmarked barrels of concrete that sometimes were found on the roads.

But I made it back to Jos, with my backpack, on a very hot day. I then had to walk about a mile from the taxistand to the Christian mission hospital where I was had been staying, before my time in the Lake Chad region. I had been very impressed with the sincerity and love of the missionaries, almost enough to feel guilty about being Buddhist. Walking on the road, I toyed with the idea of converting. I prayed for a sign. Within a minute a car stopped, to offer me a lift, even though I was not hitchiking. Inside was a courteous and helpful Moslem who insisted on taking me to my door. God is great, read the sign on his dashboard.

This story reminds me that all the religions are valid. Kindness is found everywhere.

END

   




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