Saturday, February 26, 2011

Two more articles on the Middle East to add to yesterday's selections

Articles on the Middle East

An excellent analysis by Olivier Roy in the New Statesman

An excellent speech. by Australia's Foreign Minister. One of the clearest enunciations of Australian Foreign Policy I have read in some time.
Comments from friends
One Friend on Facebook did not agree this was a good speech:  "MPC not an attack on you or your views, but I am going to disagree about the 'excellence' of this speech. It does depend on your yardstick. As a clear enunciation of current policy, perhaps. As a vision of where our policies need more subs...tance and content, not. First, I can imagine myself sitting in the audience, lashes fluttering as Rudd drones on and on in that robotic voice he has...and perhaps startling myself awake as a little snore erupts from my lips. Second, I might have found the cliched phrases at the start rather tiresome. Third, but probably more concerning, the entire thrust of it is all about his egocentric pusch to have 'middle powers' like Australia play a larger role in bodies like the UNSC. Fourth, and the reasons why we would want to play this role is because 'we have global interests' beyond the region. Yes, true, but he's completely neglected to mention the challenges of climate change, which is probably the only truly global problem we face today. Fifth, he's played the 'fear' card about radicalisation of the middle east in a reference to fundamentalist Islamic movements. Now, I don't know what the current read out on these forces is in govt. but no one seems really concerned - so why mention it at all? I think it's boring and too long!"
My response:   "yes, I must say I am not somebody who personally subsribes to the points made about the radicalisation of Egypt and what it means for western interests as my blog argues. However, I do believe that it is the clearest articulation from a foreign Minister in a long time. It is very clear on what developments in the ME mean for Australia, why we should play a role and how we can play a role. It pulls the various tenets of our FP framework into this vision for the ME. About time we explained our FP in such clear terms to the public"
Friend's comments:  "As to Greg Sheridan's response in the Australian to the speech itself, it doesn't seem like the sharpest critique of areas where a response could be made more effective? He chucks bricks at the growth of the aid program, without linking that idea to pointing... to the gross inequalities that exist in the region & which may be a proximate cause of people's unhappiness & militancy for democracy. As far as I can tell from my miniscule knowledge of the ME & N. Africa (I am willing to stand corrected) overall GDP is not an issue. Some of these countries are oil producers which make absurd amounts of cash. The maldistribution, the high levels of people in poverty, are largely due to filthy rich Arabs including not a few dictators, demagogues & members of their remnant aristocracies I suppose living like leeches off the great mass of their own people. The corruption & disregard for their own people is sickening. South East Asian & South Asian migrant workers flock to this area of the world to do work that Arabs won't do. Rich Arab countries do nothing at all to remedy the sources of unrest in neighbouring countries - look at Yemen at the arse end there with some of the worst poverty indicators, internal unrest & right next to one of the richest countries in the world! Foreign donors are expected to make up the difference. Foreign aid is not going to fix the problems. Fundamental domestic reforms, driven by demand for more democratic governance in those countries, will be a move in the right direction. If moderate Islamic influences helps inform a move in the right direction, we should let them at it & stop trying to impose a 'western' ideology which essentially always ends up being rejected anyway. As to Sheridan's next criticism about Australia not having enough diplomatic representation, well that might be the case, but then we'd have to think about whether those people would be allowed to move from the safety of their embassies anyway during periods of strife...what literally would they be able to do? The problems of N Africa & ME are ones that are not of Australian making - the Europeans & the US have been benefiting for some time, presumably, through trade & defence relations that seem fundamentally directed at maintaining access to oil. Let's get off fossil fuel dependence. And let the US & Europe fix problems of their making in that region...the chickens have come home to roost. I wouldn't criticise Gillard for focusing on more pressing, domestic issues right now - that's what I voted her in to do."
My response:    "I liked Daniel Korski and Ben Judah's take on it: that the West's three pillars of FP in the Middle East - military presence, commercial ties and client states - are crumbling in the sand.

As for points about the risk of Iranian influence,... while many on the "Arab street" have long admired Tehran's defiance, it is unlikely that centuries of mutual antagonism and three decades of outright hostility will be undone by current events.

It seems that many in these countries are not interested in the West's advice about democracy and how they should be governed. But it seems inevitable that whoever emerges victorious in future elections in Tunisia, Egypt or elsewhere, whether of nationalist or Islamist stripe, they will be reluctant to give up the many perks of engagement with the West."

Thursday, February 24, 2011

Maria’s Top Picks from the International Media Today

Now that we are all obsessively following Libya, four very different articles on Libya that I think are worth reading.

(1)Vijay Prashad, "The Libyan Labryinth, The Bang that Ends Qaddafi's Revolution", in CounterPunch.
(2) For a good history of Qaddafi's regime and the dynamics of the uprising.  "Gaddafi Defiant as the State Teeters" on Al Jazeera.  A good blow-by-blow account of the revolution and Gaddafi's loss of control of the country.

(3) Robert Fisk, "Q
addafi raved and cursed, but he faces forces he cannot control"

I always find a good rant from Fisk entertaining. And this is Fisk at his best. He explains why regimes that block media access have rocks in their head if they think this is going to stop the outward flow of information. 
(4) Scott Stewart, Jihadi Opportunities in Libya, Stratfor website. 
He talks about the risks of a power vacuum and the potential of islamists filling the void. He analyses the history of islamic militancy in Libya and how radicals could exploit current circumstances.
Finally,  the International Crisis Group has called on the international community to respond immediately. In a very direct communique, they bemoan the slow response of the international community to the democratic uprisings in the Middle East, going so far as to say that many States only fully backed the Tunisian and Egyptian uprisings once the outcome hadbecome clear.  The press release states: "Libya presents a critical test. So far, the Libyan regime has offered its people no prospect beyond submission, civil war or a blood bath; its actions have condemned it in the eyes of its own people and of the world". 

I have copied the ICG media release recommendations below.

Immediate International Steps Needed to Stop Atrocities in Libya

Brussels  |   22 Feb 2011

The Crisis Group recommends the following urgent steps:
  • Imposing targeted sanctions against Muammar Qaddafi and family members as well as others involved in the repression, including an immediate assets freeze;
  • Offering safe haven to Libyan aircraft pilots and other security personnel who refuse to carry out illegal regime orders to attack civilians;
  •  Cancelling all ongoing contracts and cooperation for the supply of military equipment and training to Libyan security forces;
  •  Imposing an international embargo to prevent the sale and delivery of any military equipment or support to Libyan security forces while refraining from any commercial sanctions that could harm civilians;
  •  In light of the intensity of the violence and its likely regional effects, the United Nations Security Council should:
  • strongly condemn Libya's resort to state violence against civilians and call on the Libyan government and security forces to immediately halt all such attacks and restore access for humanitarian flights to Libyan air space;
  • call on member states to take the above-mentioned actions;
  •  establish an international commission of inquiry into alleged crimes against humanity in Libya since 1 February 2011, tasking it to investigate the conduct of the Libyan government and all its varied security forces, as well as allegations concerning the involvement of foreign mercenaries. The body should provide recommendations on steps to be taken by national and international authorities to ensure accountability for any crime;
  • plan the establishment of a no-fly zone under Chapter VII if aircraft attacks against civilians continue.
Individual nations, particularly those with close ties to Libya, and international actors -- such as the African Union, the Arab League, and the Organisation of the Islamic Conference -- should support these and other similar measures.

Monday, February 21, 2011

Democracy in the Middle East: Only If It Doesn’t Cost Us

East Jerusalem- the Separation Wall (2008)
I encourage friends to read Richard Falk's thoughtful piece, Post-Mubarak Revolutionary Chances.  He argues that Egypts democracy campaigners need to guard against outside influences and work to add a veneer of democracy to a military regime. He is UN Special Rapporteur for Palestinian RIghts and Professor Emeritus of International  law Princeton

A young student recently asked me in an English class in Vietnam recently– if you had to choose between wealth and freedom, what would you choose? I thought it odd at the time. But this question came to mind today as I listened to CNN and read the editorials of major dailies from New York to Sydney.
Nothing frustrates me more than hearing liberals and Western media say that they support legitimate demands for change, but then in the same breath say it is equally imperative to ensure Western strategic interests are maintained. Unfortunately for those wanting democracy, those same western strategic interests have preserved the status quo for many years. 

Today’s editorial in The Australian states:
Much harder is trying to promote the clamour for a new order in the likes of Bahrain and Yemen while at the same time protecting Western interests.”
What are these western interests exactly? Middle Eastern dictators have been supported by Western governments for years because they are vital energy suppliers and, to a lesser extent, because they are supposedly the enemy of our current bogymen, Islamist militants. What is at stake, as many commentators have argued, is Western access to Gulf oil reserves at prices and amounts that will not roil global markets - as well as the loss of lucrative markets for arms sales. Also at risk is the security of Israel, so long as its government refuses to allow the Palestinians to have an independent and viable state within 1967 borders that accords with the two state solution long favoured by the international community - and long opposed by Israel. And why is support for the demonstrators so qualified and qualitatively different depending on where it fits in the geopolitical scale of strategic significance to the US and Israel? Why is democracy in the Middle East considered so antithetical to Israeli interests? These are important questions that need considerable discussion, not the sort of dumbed-down diplomatic double-speak we have been hearing from Foreign Ministries around the world.
 The editor of The Australian didn’t mince his words:
“Bahrain's strategic importance cannot be overstated. The Fifth Fleet is crucial in confronting Iran's brutal dictatorship. As well, it is critical to the battle against extremism in Afghanistan and Pakistan, and maintaining oil supply routes through the Persian Gulf, the Red Sea and the Arabian Sea, and controlling East African piracy….Unrest in Bahrain could spill into Saudi Arabia, the spear carrier of US interests in the Arab world”.

Strategic interests tip the scales again.  Of course, Saudi Arabia has also been the spear carrier of international terrorism but then that is not something we are meant to discuss in polite company. In the US, a comprehensive investigation drawing on government sources, including the CIA’s Illicit Transactions Group, estimated that two-thirds of the $70 billion spent by the Saudis between 1979 and 2003 on “international aid” was used to infiltrate institutions and promote Wahhabism and anti-Western and anti-Israeli propaganda (David E. Kaplan, “The Saudi Connection: How billions in oil money spawned a global terror network”, US News & World Report, 12 July 2003).
While Bahrain has long been depicted as relatively moderate compared with its Salafi neighbor, the reality is that the country is repressive and far from free, as citizens have almost no ability to transform their government, which according to the State Department "restricts civil liberties, freedoms of press, speech, assembly, association, and some religious practices."
Democracy is fine (as long as you clear your candidates with us first)
This mealy-mouthed lip service to democracy by Western governments and the media is not just about protecting Western strategic interests.  There is also a certain patronising orientalist perspective that has surfaced with every official statement from the EU, US, Israel and other governments.  The fear of political Islam and the Brotherhood has dominated editorials. This, the Western media argues, is antithetical to democracy.  What do these young Facebook and Twitter heroes understand about the Brotherhood and extremist threats to democracy? Greg Sheridan, on ABC television (Q&A) argued that the Muslim Brotherhood’s moderation was “tactical, temporary and fraudulent.”  He asserted that “the media and the middle class in Egypt were talking about them like they’re a Boy Scout movement with a country’s women league branch.”

We know enough about President Obama’s and Secretary of State Hilary Clinton’s qualified support for democracy. We have watched them weigh and determine their response to each crisis according to their assessment of which group would emerge victorious. It has little to do with backing the people.  Indeed, if it is about supporting democracy, they would have put their weight behind the people many years before the current crisis.  Alain Juppe, the then French Defence Minister, now Foreign Minister, said: "We have to trust the democratic movements and accompany them, while remaining vigilant towards the way they evolve." Another well-known commentator declared that if Islamic groups take part in government then “elections are the end of the [democratic] process, not its beginning.”  The arrogant assumption here is that all Egyptians, analysts of Egypt and their supporters are na├»ve for believing in a democratic future.  Commentators point to the Iranian example and argue that the fate of Egyptian democracy may very well be identical to that of Iran in 1979 in the second phase of the revolution.
However, as many have argued, this fear is unfounded. The uprising comprised a mass movement of Egyptians.  And even if the Muslim Brotherhood did win a significant share of a parliamentary vote in the future, democracy dictates that this is a choice for Egyptians to make.  The people protesting across the Middle East are asking for elected government, economic opportunity, an end to corruption and a respect for their human rights. Each uprising has its own dynamics, but all protesters seem united by frustration over economic hardship and a lack of political freedom under entrenched elites that have been propped up by Western powers eager to secure energy supplies or to protect Israel. From Jordan to Bahrain, Morocco, Djibouti, Libya, the current crisis reflects not only a popular demand for the expansion of political freedoms but, more broadly a loss of confidence in the state.  Neo-liberal economic policies that have resulted in inflation and widening economic gaps and endemic corruption have angered people across all sectors and from all walks of life. This is a crisis which has been brewing for many years.
Here come the horsemen....
After years of lamenting the absence of democracy while doing nothing, the US and other Western nations are now clamouring to show they care about democracy in these countries.  A summit in Brussels this week, called by Baroness Ashton, the EU foreign policy chief, is ostensibly aimed at nurturing democratic structures and supporting economic opportunities.  But there is something unsettling about watching western powers after 30 years of turning a blind eye to repression in these countries now offering advice about democracy and providing economic assistance.  Many on the blogosphere are seeing it differently. They see it as Western powers strategizing to ensure democracy doesn’t clash with “strategic interests.” The important thing as ever is to ensure Western interests are protected.  Neera Tanden, a former senior policy adviser to Mr Obama, has offered the White House an economic plan for Egypt based on ending barriers to imports of cotton, increasing civilian aid, but more revealingly, to expand special industrial zones where Egyptian businesses gain access to world markets in return for cooperation with Israel's private sector. The concern of many is that US efforts to offer emergency economic assistance is more about mollifying protestors and creating the impression that life is returning to normal, thereby creating conditions that would support a restoration of the essence of the old order.
Unqualified Support for Democracy
For years we have valued stability over democracy.  Unfortunately, our understanding of what makes regions stable was seriously flawed.

For years we lamented the absence of democracy, but bank-rolled dictators and their police states which have proven inherently unstable.

It is imperative that Western aid to Middle Eastern countries be directed to addressing economic inequalities, building the institutions of civil societies and building capacity more generally. It is time for a serious recalculation of where our interests lie:  in a meaningful, unqualified support for democracy in the Middle East.

This means unqualified support for a governing process based on human rights, the construction of an equitable economy and the will of the people. External actors do not have a right to dictate how that democratic process will unfold. That is for the citizens of these countries to decide. It should not be a choice between western interests and real democracy.

Friday, February 18, 2011

Essential Reading and Viewing - Maria's Top Picks from World Media this week

Now that I have some time to trawl the international media, I will choose my top picks of essential reading every day or so. 


(a) Country by Country - the BBC has created an interactive map where you can compare corruption levels, literacy rates, unemployment, poverty levels and the average age of protestors across the Middle East.

(b) Bahrain Tense Ahead of Funerals.

(c) Why Egypt's Muslim Brotherhood Isn't The Islamic Bogeyman

Western fears of Islamist takeover in post-Mubarak Egypt are unfounded, according to the authors Faris and Yadav from Roosevelt University.  During recent protests, the Muslim Brotherhood demonstrated a commitment to peaceful political participation.  They argue the US and other nations now have an opportunity to support a truly democratic Egypt, including the Brotherhood.

(d)  ROBERT FISK - Is The Army Tightening Its Grip on Egypt

As Fisk and others have argued this week, it is important not to lose sight of the fact that elements of the old order are still in control. Senior members of the military owe their positions to the former Mubarak regime. Until they set a clear date for free and fair elections and grant other concessions, such as the repeal of emergency laws, release of political prisoners, there is little room for complacency.

(2) The Forgotten Man: Bradley Manning
Reporter: Quentin McDermott, Four Corners

Video - ABC Australia - Broadcast: 14/02/2011

While WikiLeaks boss Julian Assange has been cast as a heroic champion of free speech, his ongoing expose of US foreign policy would not have been possible without the work of Private Bradley Manning, who now languishes in a US military prison.

Quentin McDermott tells the inside story of Bradley Manning and his intelligence heist. David House is one of the few civilians allowed to visit Bradley Manning in jail. He describes the young soldier's mental deterioration and his struggle to deal with long hours of confinement.  This is the only recording of Bradley Manning's voice and we listen to the logs of alleged conversations with the man who ultimately betrayed him.

3) Obama’s Budget: Freezing the Poor

Obama has called for a freeze on annual domestic spending over the next five years. This freeze would cut the deficit by more than $400 billion over the next decade.  Education, health and other essential service are the obvious targets. Amy Goodman examines the current state of defence and intelligence spending in the US. Her figures apparently do not include spending for drone attacks in Pakistan. Neither does it include the increased military aid to Israel which the Congress approved in late 2010. The article is shocking but accurate.

Wednesday, February 16, 2011

Tamil Militancy - Bullets in the Heart

Tamil Militancy – Bullets in the Heart
The ICG's submission to the Sub Commitee  on Human Rights of the European Parliament, Meeting of 6 December 2010 ( is an excellent analysis of the post-conflict environment in Sri Lanka. Certainly worth a read.  It is perhaps the most accurate and balanced account of the current state of play I have seen.

The Sri Lankan military decimated the LTTE in May 2009, killing its top leaders, including its elusive leader Velupillai Prabhakaran, and ending one of the longest and bloodiest insurgencies in the world.

Despite the group’s decisive annihilation, its supporters in the West are keeping the dream of a Tamil homeland - Eelam - alive.

LTTE supporters number thousands in the West. But it has virtually no fighters. Those who survived the military onslaught of 2009 are mostly in Sri Lankan custody or living as displaced persons.  Of the estimated 12,000 people who surrendered or were detained at the end of the war on suspicion of involvement with the LTTE, many, perhaps most, have now been released. The latest numbers according to ICRC – despite the lack of public registers – suggest that some 5,400 remain in detention, with 600-700 of these identified for legal prosecution. Those who have been released to their home areas are subject to frequent and arbitrary questioning by the police and military. However, the absence of independent monitoring of either the detention or “reintegration” of suspected LTTE cadres remains very worrying.

During my recent visit to Sri Lanka, I spoke to many Sri Lankans and foreign aid workers about the future of Tamil militancy in Sri Lanka.  While views differed about its future trajectories, all agreed that the silencing of guns did not mean the end of the conflict in Sri Lanka. The movement now relied on the activism of the international diaspora to raise money and to continue weaving dreams of a Tamil homeland. ( LTTE supporters in the Tamil diaspora are, however, a divided lot.)  Current conditions in Sri Lanka are still fanning the smoldering  flames of discontent. 

The Political Landscape in Sri LankaAssessments about the situation of Tamils are as diverse as the range of actors in the post-war environment.  Government and military officials paint a rosy picture of life in the North and East. The Sri Lankan Commissioner General of Rehabilitation, Brigadier Sudantha Ranasinghe, portrayed the official view most graphically, explaining that “killing and capturing LTTE cadres was a fact of life” when he was in the army.  “It was my duty.”  Now, however, he was putting his “heart and soul” into working with Tamil communities in the post-war phase of rehabilitation and reconciliation.  “We no longer have bullets in the heart,” he said.

For a Senior Analyst at a leading policy think tank, and one of the most respected analysts of Tamil militancy,  the political situation in Sri Lanka remains deeply worrying, despite official proclamations that the Truth and Reconciliation process is on track.

“The unique opportunity the Sri Lankan government has to build a lasting and a just peace after the defeat of the LTTE is rapidly being lost. Democratic governance more generally has deteriorated since the end of the war”.

This analyst was not alone in his view that the Government was feeding Tamil grievances and sowing the seeds of future conflict. Tamil politicians, Heads of International Organizations and journalists I spoke to agreed that prospects for reconciliation between ethnic communities continued to be undermined by the government’s lack of serious interest in constitutional reforms that would address the political marginalisation of Tamil-speaking people.

Occasional meetings between the President and leaders of the Tamil National Alliance and the pro-government alliance of Tamil parties known as the Tamil Political Forum are positive and necessary. To date, however, there is still no sign of any structured and inclusive process of negotiations or constitutional dialogue. Indeed, President Rajapaksa has made clear that he does not support devolution of power to the provincial level as long requested by Tamils and other minorities.  

To be fair, following international pressure the government has worked to resettle the nearly 300,000 people displaced from their homes by the last two years of fighting.  The large majority have left the military-run camps in which they were locked for months. This is good news. Nonetheless, according to the most recent government figures, available from the UN and repeated in a recent ICG report more than 20,000 people remain in the camps and another 70,000 live with host families and are not back on their own land. Those who have returned home face huge problems, including a lack of housing and other infrastructure, few economic opportunities, continued security presence and difficulties farming their land and fishing off the coasts.

According to a high profile Tamil politician who asked to remain anonymous because of his affiliation with the Governing party, there was little evidence that the Sri Lankan government was approaching these issue with the requisite transparency and urgency. This could be seen in the restrictions placed on the activities of local and international humanitarian NGOs.  The International Committee of the Red Cross (ICRC) was ordered last year to close its remaining offices in the Northern Province, after previously being blocked from working in government detention camps for LTTE suspects.

Representatives of an international organisation confirmed that agencies were currently permitted to do little more than deliver tangible material goods.. None of the crucial post-war work of building the capacity of civil society, dealing with the psychosocial damage from the war, tracing missing persons, or attending to the needs of war widows, orphans, the disabled, the elderly– was officially permitted. A senior ICRC representative said he recently saw a government list of 14 international organisations that were likely to be asked to leave the country in coming months.  It may not be a direct request, more a gradual sacking by denying visas over time.

The thousands of troops stationed in the the North and East closely monitor the few development activities permitted by the government. Crucial decisions are made by the military and predominantly Sinhalese officials in Colombo, chiefly by the Presidential Task Force headed by the President’s brother Basil Rajapaksa. In this context, the growing numbers of Sinhalese moving to the north has fed fears by Tamils that the government plans to change the ethnic make-up of the Tamil-majority north. The Government’s repeated promises that all of the 70,000 or more Muslims forcibly evicted from the north by the LTTE in 1990 would be allowed to return home, while promising, has been undermined by the distrust generated by failure to involve Tamil community groups in the decision making processes.  This is sowing the seeds of renewed ethnic conflict.

Since the end of the counter-insurgency campaign, there have been fewer extrajudicial killings and enforced disappearances. Nonetheless, reports of kidnappings, disappearances and politically motivated killings do continue according to the ICG and other organisations, and the apparatus established to destroy the LTTE remains in place. There have still been no proper investigations, much less prosecutions, in any of the thousands of disappearances or more high profile political killings from the war.

The Diaspora and Links to other Terrorist Groups

With the continuing hardships, Tamils have been leaving Sri Lanka in droves, seeking the protection of established communities in Europe, Canada, Australia and India.  Most of these Tamils are tired of war and violence.  Ironically, the Tamils who suffered the least in Sri Lanka’s conflict are now working to build the foundations of a future Tamil uprising.  Attention has inevitably turned to the activities of the politicized Tamil diaspora.  Stories linger of the Diaspora’s attempts to raise funds internationally for humanitarian and long-term military purposes, and efforts to build strategic links with other terrorist outfits, including the Maoists in India.

 Following these rumours, the Tamil movement in India and the UK sought to downplay the links.  In an open letter to an Indian minister, the vanquished Liberation Tigers of Tamil Eelam (LTTE) described as “totally untrue” claims by Indian officials that the Tigers had links with Indian Maoists. The letter, dated 5 November and reproduced by pro-LTTE websites believed to be operated from the West, was copied to External Affairs Minister S.M. Krishna and Tamil Nadu Chief Minister M. Karunanidhi. The letter was signed by “R.M. Supan, Coordinator of LTTE Head Office”. Supan is believed to be the nom de guerre of the person heading the media wing of what remains of the LTTE.

The letter did little to convince Indian authorities whose intelligence authorities observed that remnants of the Tamil terror outfit were trying to regroup in Tamil Nadu in South India. The Indian government extended the ban on Liberation Tigers of Tamil Eelam in late 2010 by another two years following these intelligence reports. 

Policy Responses

Memories of injustice will be difficult to erase, nor should they be. Tamils grievances are well-founded and must be addressed as a matter of justice. Diasporic nationalism is especially dangerous because it is easier to vent frustrations from a distance. The anger is building and as a leading Tamil human rights lawyer explained, “it will reach boiling point as it has in the past.” 

Policy makers in Australia and other asylum seeker-receiving countries will need to take a hard look at the factors which led to the diaspora activism which sustained LTTE terrorism for such a long period of time in the past.  Apart from the triumphalism of the Sri Lankan government and the hardships that Tamils continue to endure , there is also what can be called ‘long distance nationalism.’  Furthermore, it is clear that certain dislocations related to their reception in host countries were also responsible for diaspora activism in the past. The difficulties in accessing desirable employment, feelings of alienation in a different cultural setting and perhaps discrimination and scape-goating by the media are some of the reasons for continued activism. While most of these reasons appear to be disappearing, there is still a cohort in the diaspora that supports LTTE politics perhaps in a different form. One form is the Transnational Government for Tamil Eelam (TGTE).  Prescribing the LTTE and affiliated groups as Terrorist Organisations would send a clear message that support for Tamil militancy will not be tolerated in Australia, but it will also serve to feed feelings of dislocation and discrimination. It is appropriate for Australian policy makers to make it clear that LTTE sympathisers would have to leave their fantasies of revenge behind.

Australia and other Western countries should encourage their Tamil Diaspora communities to examine the actions of the LTTE throughout the war and to initiate a process of reflection on the destructive effects on all communities from the LTTE’s militarism and elimination of moderate voices.

Australia has an important role to play in encouraging Sri Lanka towards a path of durable peace. It still contributes a significant amount of development assistance to Sri Lanka, both directly and to the World Bank and the Asian Development Bank (ADB). It is incumbent on Australia to ensure that development projects, especially in the north and east, do not help institutionalise an unjust peace or fuel new grievances and violent conflict, particularly with regard to the use and ownership of land. Unfortunately, under current conditions in the north and east, where local communities and their Tamil and Muslim political representatives have little involvement in the physical and economic reconstruction taking place, it is extremely hard for international development assistance to be “conflict sensitive” without much more active monitoring and political engagement.  Australia should join more influential players and institutions to press the World Bank and the ADB to tie the delivery of their aid to more inclusive, participatory and democratic forms of planning and implementation, especially in the north and east, and to develop a more coordinated and principled approach to humanitarian and development assistance.  The aim would be to encourage the Sri Lankan government to adopt more democratic and rights-friendly policies.

Are Australians the Cultural Plebs of the World?

Are Australians the Cultural Plebs of the World?

The Australian newspaper seems to think so.  This week’s cracker of an editorial from the Australian (“It is Enough to Makes Us Cringe, 16 Feb) bears repeating. According to the Editor: “ The cargo-cult mentality... has not been eradicated from ABC, where producers still insist on giving star billing to disgruntled expatriates with little useful contribution to make to the national debate. Watching the ABC fawn over John Pilger and others who admonish us for what they think is wrong with the nation they left half a century ago is amusing on one level but betrays a troubling cultural insecurity at the highest levels of the national broadcaster”.

The editorial was a reaction to Pilger's appearance on the popular ABC show Q and A.

Rather than portraying a cultural insecurity by the ABC, it points to an inexplicable insecurity by The Australian about anybody who dares to present a world-view which differs from its own. John Pilger’s views resonate with millions of people fighting for justice and freedom around the world.  Everywhere he goes he commands considerable respect for his fearless and honest journalism.  He is certainly one of Australia’s leading journalists and documentary filmmakers.

The editorial goes on to say that “Pilger's shallow arguments were easily exposed by Egyptian Middle Eastern politics analyst Lydia Khalil, who countered the anti-American rhetoric with measured, factual debate”.  Khalil is an intelligent analyst, but her arguments were often contradictory and pandered to the accepted official narrative in the United States and Australia. However, that is not a criticism. It is important to be offered a wide-range of views and to encourage this sort of debate in the interests of strengthening public understanding of issues that are already a lively part of discourse in Europe, the Middle East and the United States.  (I hope Khalil, as a credible analyst, is not fooled by this flattery into the trap of feeding the Murdoch machine with one-sided analysis in the future. Many before her have been bewitched and co-opted in this fashion and have become cynical, faithful apologists and sounding boards for the accepted wisdom of the day in the paper's editorial pages).

The Australian editorial reflects a parochialism that continues to plague the media and Australia’s understanding of world events. John Pilger, Germaine Greer and Jeffrey Robertson are intellectual exports of which we should be proud. We should not cringe when confronted with their sophisticated analysis of issues to which they have shown life-long commitment.

Regrettably, the Australian press has become difficult to read.  Analysis that is full of sloganeering and bashing of the left and anyone who demonstrates some passion for a cause merely confirms Pilger's longstanding view that the concentration of media in Australia has been to the detriment of thoughtful, honest, evidence-based reporting. I used to look to these papers for a range of views.  Instead, I find my  views (based on hours of meticulous reading of journals, opinions on blogs, scholarly articles and official comment) are often slammed and ridiculed.  Like many, I have turned to blogs and alternative media for my news.  I don't mind my views being challenged by others. It is the bullying disguised as serious journalism that concerns me the most.
The revolutions in Egypt and Tunisia and protests elsewhere in the Middle East point to an unstoppable trend of people sharing information in spite of the flood of Government and mainstream dribble.

Monday, February 14, 2011

The Profit Motive in Medicine - the Bottomline vs. Patient Welfare

I will always rally against the profit motive in medicine after a recent encounter with private health providers in Hanoi.  Of course, I have always been a firm supporter of public medicine and friends have accused me of being driven by ideology rather than reason.  However, my recent experience has given me a practical example of the perils of neo-liberals' policy of choice  -  privatisation of health care.

‎Six months ago a well-known foreign-owned medical clinic popular with expatriates in West Lake, Hanoi, advised me that it was not possible to get a mammogram in Hanoi and that I would have to visit its sister clinic in Bangkok. I rather stupidly relied on a physical examination and didn't follow up. Six months passed and I discovered a painful lump in my breast. I consulted a rival clinic and was advised that it had been offering mammograms and ultrasounds for some time. It was apparently a policy of the other clinic not to refer clients to rival medical institutions. I have since discovered that this has happened to other peope in Hanoi.

When I posted this story on Facebook, friends were upset that I challenged the profit motive.  One friend promptly responded that it wasn't the profit motive - just plain stupidity no matter which way you look at it.  Others accused me of not being sensitive to different standards of care in the third world, the most surprising accusation of all given my repeat visits to hospitals and clinics in the developing world. 

Another friend argued:

"I've noticed in the developing countries I've lived in, not unlike the developed US in fact, there are tiers of care. For those who can afford it, the private sector will provide largely because the public sector is too under resourced to provide health care beyond a basic level. As you've discovered, buyer beware is the principle to apply with private medicine. As unethical as that behaviour might be, that clinic is still providing some service where none might exist at all if there were no private sector market for medical care. I'm assuming the rich & wealthy of Vietnam now have access to services once reserved for overseas visits as a result of Doi Moi? So long as the State is providing for average Vietnamese, let's hope...."

My argument is this. Whichever way you cut it, my experience points to unethical and dangerous  business practices by this medical provider. It was ultimately driven by the bottom line, eager to avoid losing business to rival medical providers. Stupidity is ingrained in this approach to service delivery - granted.

I do not accept these arguments as you cannot depend on the private sector when there is no profit to be made. In most developing countries, public spending on health care is on average less that 5 percent of that spent in developed countries. Obviously, this is insufficient to meet health needs in most countries. However, a modest redistribution of resources away from military and other unnecessary expenditure in some of these countries would appear to be economically as well as socially justified. I am tired of IMF and World Bank mantras about the virtues of the private financing of health care. Immunisation, control of vector-borne diseases, sanitary waste disposal, cancer screening, maternal care, family planning, health education, HIV/Aids prevention and care-  these should all be public services of the highest priority. There are no profits to be made in most of these things, but I am sure the private sector will find a way to make money out of even these essential services.

A friend in the medical profession had this to say:
"I think perhaps ideology may also be creeping in here Maria. As someone who has worked in several different aspects of healthcare and who has a purely pragmatic approach, the best solution (for everyone) is a mixed system, like most "first world" countries have. Certain things are definitely worth a society banding together and paying collectively - yes, immunisation is an excellent example. However, healthcare is an infinite "want", funded by a finite amount of money, that is valued by different individuals in different ways, so if you go down the UK ideological path, you will always fail to provide good care for everyone/everything. In fact, I would go so far as to say the NHS is sometimes more draconian about what it funds than many private providers (depending on what the service is). In a good system, the doctors/nurses etc are asked to focus on the patient in front of them, certain core services are paid for using the collective wealth of the people via taxation, and there is transparency about what you can pay extra for and get faster/better quality for. Your example above Maria is just plain stupid - bad medicine, bad business and you are demonstrating this by not going back to them".

Bad medicine indeed.  I accept that a mixed system is necessary as  health care is an infinite "want" that is valued by different individuals in different ways. But I stand by my position that cancer screening is an essential public service. As for the clinic - plain stupid is an understatement.  It is one thing to say I am taking my business elsewhere, but they also need to understand that they are playing god with patients' lives.

I wrote to the Clinic and this was the response:

"Thank you for your email to our Clinic Manager  regarding local referral for mammography.

It is (*name deletd*)  policy to only refer for mammography, or any other procedure, when this can be performed to an acceptable standard.

The current "Gold Standard" in Australia and the USA is for the mammographic films to be reviewed by two radiologists (i.e. specialist doctors) who have received further training in interpretation of mammograms. It is our understanding that this is NOT the current practice for mammography performed in Hanoi. Therefore, if we were to refer patients for mammography locally we could not ensure the validity of the results. The consequences of a missed or delayed diagnosis of breast cancer would be devastating. It is our duty of care to our patients to ensure that this does not occur, by referring to a facility which can provide investigations to an acceptable standard.
Should the local situation change we would be happy to review our policy".

If that is the case, I would have appreciated advice to this effect during my consultation. I believe it is best practice to provide patients with all the available information and allow them to decide how they wish to proceed.  It need not be an official referral. It would just be furnishing them with all the relevant information, including that the procedure does not meet international best practice at other clinics.

A medical practioner had this to say:

"As pure scientists, we are not allowed the luxury of never making a decision. We must (all of us, not just health care providers) learn to understand levels of certainty and make as informed decisions as we can. Not all of us will make the right decisions, but if you believe in individual freedom then we must take responsibility for our own choices".

The question is can individual choice and patient safety be guaranteed when profits are at stake?

PS- I have since found out that the "gold standard"of mammography is indeed offered in Hanoi. Aftering hearing about SOS Clinic's policy of non-referral, the clinic where I ended up having a mammogram and ultrasound has decided to hold a Breast Cancer Awareness Week.  I have not yet received a second response from the first Clinic.  However, I will be working to change their policy  of non-referral.