Christopher

Mason

Writer, Editor, Photographer


TMI — Too Much Information

I consume a lot of information. Too much, really. After many failed information diets, I’ve decided to try to curate instead of quit. Inspired by sites like Longreads, I seek the best and the most memorable writing the web has to offer.

Rejecting Canada’s rate condundrum (Business Spectator)

September 10, 2012, Mason0 Comments

By Christopher Mason

Not so fast with the rate cuts, says ex-RBA board member Warwick McKibbin… he’s worried if Glenn Stevens and the board cut rates today, Australia won’t have enough bullets left in the gun if the economy starts to seriously slide.

If McKibbin wanted an example of a country with few bullets left in its gun, and to bolster his case for keeping a loaded weapon, he could have looked to Canada.

Canada entered the 2008 financial crisis in similar interest rate territory to that which Australia finds itself in at the start of an uncertain 2012. Canada’s benchmark interest rate in January 2008 was 4.25 per cent – the same as the RBA’s rate (this morning).

Within 17 months, the Bank of Canada had carved its rate down to 0.5 per cent. Though the deep rate cuts were among several key factors that contributed to Canada’s stability through the worst of the 2008-2009 financial crisis, the country has paid a steep price. Canadians are staring at the possibility of a renewed crisis with little remaining leverage and a fear of what will happen when rates inevitably creep higher for a population struggling to service existing debts even at bargain interest rates.

Household debt levels in Canada have risen to 152.98 per cent of disposable income, up from 146 per cent in 2010 and up 40 per cent in the past decade. Those debt levels are beyond those in American and British households, and slightly higher than those in Australia.

Canada’s central bank chief, Mark Carney, has estimated that roughly one in 10 Canadians are spending more than 40 per cent of income on servicing debt. He has repeatedly warned that Canadians have been over-capitalising on a low-interest rate environment.

The fact that Canadian home buyers are being offered five-year mortgage rates of 2.99 per cent, with only a five per cent down payment, has not exactly discouraged Canadians from taking on debt at unsustainable levels. Yet Canadians have been comfortable taking on extra debt because – amongst other positive factors – average house prices have risen 85 per cent since 1998. Now, with its ratio of house prices to income at 30 per cent above its historical average, the Canadian housing bubble alarms are increasingly being rung.

BoA Merrill Lynch recently warned that rock-bottom interest rates were the only factor propping up Canada’s rising home prices and that under normalised interest rates home prices would by 25 per cent overvalued. In comforting contrast to Canada, Australia has leverage to lower rates to help the country respond to an economic storm or help prop up the housing market.

On the other hand, Canada has a one per cent benchmark rate, and predictions of rates as low as 0.25 per cent by the end of 2012, leaving its central bank with little room to respond to soaring household debt, an increasingly overinflated housing market and questions about the impact of the eurozone debt crisis.

The case for RBA rate cuts has been made. But the conundrum that has handcuffed Canadian policymakers may give pause to any Australian politician or economist lobbying for a lower interest rate environment, and perhaps bolster Professor McKibbin’s calls for caution.

Christopher Mason is a Toronto-based journalist and staff reporter for Business Spectator.

Published February 7, 2012

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Its Wild Heart Broken, a City, Like Its Eagles, Rebuilds (NYT)

September 10, 2012, Mason0 Comments

By CHRISTOPHER MASON, New York Times

VANCOUVER, British Columbia, Jan. 24 — A toppled oak near the entrance to Stanley Park awaits cleanup crews. Some 85 to 90 percent of trees in one park area were knocked down.

Nothing symbolizes this dichotomy more than Stanley Park, a 1,000-acre forested oasis next to downtown Vancouver that juts into the Burrard Inlet. Its trails and pathways are an escape for the growing legions who may live in a high-rise building and conduct an otherwise urban life but who disappear by the thousands into the park’s hiking trails or jog the six-mile path along the water.

That tranquillity was shattered, though, by two recent brutal winter storms that have all but decimated huge swaths of the park, knocking down some 10,000 trees and forcing much of it to be closed as crews struggle to clear the debris.

The park has been a part of Vancouver since the first city council was established in the late 1880s. The council’s first action after taking power was to create the park, preserving the lands that had until then been a marine base for the Royal Navy.

“This park has a very special place in Vancouver’s heart,” said the city’s mayor, Sam Sullivan, who choked up while discussing the damage. “It is part sacred cathedral, part just an icon of the city.”

The park is a hybrid of sorts, mixing urban features — like the paved seawall path, a petting zoo and areas of manicured lawns ripe for picnics — with wild pleasures like the hiking trails that weave through the park’s interior where vestiges of city life seem farther away than just beyond the next grove of trees. Several pairs of bald eagles live in the park, as do coyotes.

Its wilder sections have always been an important outlet for Vancouver’s many nature-loving residents, but they have become even more crucial with the city’s growth.

Downtown Vancouver has seen waves of high-rise development, first 50 years ago, and again in the 1990s, leading to a densely built core. The city is facing further urbanization as Mr. Sullivan, who was elected in 2005, champions a development strategy — called “ecodensity” — that is meant to cap urban sprawl by encouraging sustainable but dense development within the city.

“If we want to convince people to live in higher densities we have to provide them with the amenities that will make that type of living attractive,” Mr. Sullivan said. “And Stanley Park is one of the reasons for that.”

During a recent tour of the damage, the steady rain did not diminish the mist-filled view from the highest point of Stanley Park. Some 200 feet below, birds of dazzling variety swooped out over the inlet; several spectacular peaks loomed in the distance.

But the view, however breathtaking, is in reality some of the most clear evidence of the storms’ destructiveness. Six weeks ago, the view did not exist. It was obscured by hundreds of towering red cedars, Douglas firs and hemlocks, now felled and lying at obtuse angles on the forest floor.

“It looks like a bomb went off,” said Brian Quinn, a foreman at the park.

On one hill overlooking the park’s northwestern flank, the number of trees still standing could be counted on one hand. Park staff members estimate 85 to 90 percent of the trees in this area of the park were knocked down during the storms, though many of those left standing are unstable and will be taken down during the cleanup.

“There will be almost nothing left here by the time the cleanup is done,” said Mr. Quinn, who then pointed at one of the few remaining trees, long dead, where a bald eagle was landing with a fresh branch to add to its nest. “We’re all rebuilding from the storms.”

The worst of the storms came Dec. 15. Nearly 80-mile-an-hour winds blew inland during the middle of the night and struck the park like a stone skipping over water, leaving concentrated pockets of destruction.

About 250,000 people in southwestern British Columbia lost power, and Lions Gate, the main bridge between the Vancouver’s two heavily populated shores, was closed. The access road to the bridge on the southern side runs through the park, and it was blocked by fallen trees.

Park workers could barely comprehend the devastation. The only way to travel was by foot, with a chainsaw to clear a spot for each step. The extent of the damage was not known until someone managed to survey the area by helicopter.

“I felt sick,” said Jim Lowden, director of the park, in describing his reaction to the aerial images.

Another storm, on Jan. 9, felled trees that had been weakened in December.

Even now, nearly a month after the last of the storms, much of the park is still closed off. Barricades block hiking trails, and about half the seawall path, used by an estimated two million people each year, remains closed.

The closed-off section of the seawall is littered with trees that fell about 40 feet from the cliffs above. Ocean swells added to the damage, picking up entire sections of asphalt and depositing them intact farther down the path.

Efforts to put the park back together will focus first on rebuilding the seawall and then on slowly restabilizing the soil and clearing the fallen trees to make way for new saplings.

The federal, provincial and city governments have pledged the equivalent of $5.1 million for the work, and the local community has already raised the equivalent of $2.6 million with a telethon fund-raiser.

Mr. Lowden, the park director, predicted that the restoration would take nearly two years, but it is likely to take 40 more years for the forest to regain its density and many more before the trees reach the height of their predecessors.

“People of my age will never again see the park as it was,” said Mr. Lowden, who is in his early 60s.

But amid thousands of downed trees, Vancouver’s hardiest continue to use the park as though nothing happened. Groups still congregate at the dozens of monuments, statues and lookout points and joggers run through on the few paths left open.

“This park is my saving grace,” said Emily McPherson, 32, who moved to Vancouver six years ago and runs regularly in the park. “The way I look at it, the trees will grow back eventually, and in the meantime we’ll keep on enjoying it.”

Photo credit: Farah Nosh

Published: January 29, 2007, New York Times

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Reducing infant mortality rate a challenge in Liberia (CMAJ)

September 10, 2012, Mason0 Comments

By Christopher Mason

Tubmanburg, Liberia

In the shade of a tree outside a special clinic for malnourished children, 20-year-old Ma-Kulah Turray reflects on how lucky her 6-month-old baby is to be alive.

Fed only dry rice and water for his first few months, the child quickly became malnourished and was nearly dead by the time Turray arrived at the hospital, telling staff she was not equipped to fix whatever was wrong with her baby.

“I need training on how to care for my child,” says Turray, who is in the eighth grade. “I was leaving him alone while I went to school, so he was not getting enough food and no healthy food.”

The education system ground to a halt during the west African country’s 14-year civil war, which ended in 2003. A push to complete the education of young adults has driven many, like Turray, back into the classroom. But in doing so, Turray inadvertently risked her baby’s life.

Malnutrition is among the leading causes of infant death in Liberia. This clinic in Tubmanburg, a county capital, takes in up to 30 malnourished children each month to nurse them back to health while providing their mothers with training on how to feed and care for their children.

“We are not having a crisis like we did during the war, but many people do not know malnutrition is caused by lack of adequate food,” says Yvonne Jackson, program manager for the malnutrition clinic at Liberia Government Hospital in Tubmanburg. “Some of the mothers do not know how to prepare food or which food prevents malnutrition.”

Turray and her boy are among the fortunate. Liberia’s under-five mortality rate remains among the five highest in the world, and more than 15% of children die before reaching their first birthday, according to UNICEF.

But at the G8 meeting in Huntsville, Ontario, in June, Canadian Prime Minister Stephen Harper obtained a five-year, US$5-billion pledge from G8 countries, along with US$2.3 billion from others, to reach several targets by 2015. The agreement calls for under-five mortality rates to be cut to two-thirds of 1990 levels and for maternal mortality rates to be cut to three-quarters of 1990 levels over the next five years. The countries also pledged to reach universal access to reproductive health.

The goals are ambitious, as illustrated by Liberia, a small country with a history of instability and conflict dating back to a 1979 coup and whose health indicators suggest is exactly the type of setting the G8 pledge targets.

On each of the three goals in the pledge — under-five mortality, maternal mortality and universal access to reproductive health — Liberia ranks among the world’s most challenged.

Besides having one of the five highest infant mortality rates, maternal mortality rates nearly doubled to 994 deaths per 100 000 live births between 2000 and 2007, and fewer than half of births in Liberia are attended to by health professionals.

Addressing those challenges in Liberia requires a big picture approach that takes into account systemic under-staffing, underfunding and the effect of a civil war that devastated both infrastructure and the education system.

Liberian President Ellen Johnson Sirleaf — Africa’s first female elected head of state — has made reproductive health among her priorities as part of a strategy called “Reach Every Pregnant Woman.” The plan aims to provide equipment to clinics and hospitals, and training for staff. It also trains traditional midwives in rural areas where the closest clinic or hospital may be days away on foot or communities are inaccessible by road.

What remains unclear, though, is how and where G8 support will be administered. Each country pledged varying amounts to be committed over varying time lengths and in varying regions (Canada has said its $1.1 billion share will be focused on countries it has identified as aid priorities: Haiti, Afghanistan, Mali, Tanzania and Mozambique).

Some maternal and child health advocates, who had hoped G8 leaders would commit to much more than $5 billion (CMAJ 2010;DOI:10.1503/cmaj.109-3303 and CMAJ 2010;DOI: 10.1503/cmaj.109-3300), are lobbying for the money to be channeled through large international bodies such as the World Bank and UNICEF. Others argue the money should go directly to the health care budgets of countries such as Liberia which have high infant and maternal mortality rates.

Among the other significant challenges facing G8 countries will be how to ensure their commitments actually benefit the individuals whose lives illustrate the global statistics.

“I hope to never have to return to this clinic,” says Turray. “I want to help other mothers in my community to care for their children.”

Photo credit: Christopher Mason

Published October 2010 by the Canadian Medical Association Journal

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Gay Marriage Galvanizes Canada’s Right (NYT)

September 10, 2012, Mason0 Comments

By CHRISTOPHER MASON, New York Times

OTTAWA — It was a lonely time here in the capital for the Evangelical Fellowship of Canada in the early days of the gay marriage debate in 2003.

Of the scattered conservative Christian groups opposed to extending marriage rights to same-sex couples, it was the only one with a full-time office in Ottawa to lobby politicians. “We were the only ones here,” said Janet Epp Buckingham, who was the group’s public policy director then.

But that was before the legislation passed in 2005 allowing gay marriage in Canada. And before the election early this year of Prime Minister Stephen Harper, a Conservative and an evangelical Christian who frequently caps his speeches with “God bless Canada.”

Today across the country, the gay marriage issue and Mr. Harper’s election have galvanized conservative Christian groups to enter politics like never before.

Before now, the Christian right was not a political force in this mostly secular, liberal country. But it is coalescing with new clout and credibility, similar to the evangelical Christian movement in the United States in the 1980s, though not nearly on the same scale.

Today, half a dozen organizations like the Evangelical Fellowship of Canada work full time in Ottawa, four of which opened offices in the past year, all seeking to reverse the law allowing gay marriage.

They represent just some of the dozens of well-organized conservative Christian groups around the country and more than a hundred grass-roots campaigns focused on the issue. In recent months, religious groups have held rallies, signed petitions, drafted resolutions and stepped up their efforts to lobby politicians to overturn the law.

These Christian conservatives have been instilled with a sense of urgency in the expectation that Mr. Harper will follow through on a campaign promise, as early as the first week of December, to hold a vote in Parliament on whether to revisit the gay marriage debate.

“With the legalization of gay marriage, faith has been violated and we’ve been forced to respond,” said Charles McVety, a leader of several evangelical Christian organizations that oppose gay marriage and president of the Canada Christian College in Toronto.

“Traditionally people of faith in Canada have not been politically active,” he said. “But now we’re finally seeing organizations that are professionalizing what was a very amateur political movement.”

Mr. McVety, who recites from memory the decision of an Ontario judge in 2003 that paved the way for gay marriages, has organized dozens of rallies attracting altogether some 200,000 supporters.

He asked the Rev. Jerry Falwell and other American evangelical leaders for advice on building a religious movement in Canada and traveled Ontario and Quebec in a red-and-white “Defend Marriage” bus.

Though the expected vote in Parliament will not decide whether to rescind the gay marriage legislation, but instead whether members wish to reopen the issue for debate, it remains significant for the Christian right and the government.

For leaders of the Christian right, the vote is a chance to get the marriage issue back on the government’s agenda and to get a better sense of where individual politicians, especially newly elected ones, stand. They have adopted that strategy in part because they say that the vote in Parliament will be difficult to win.

For Mr. Harper and his Conservative Party, the vote is an attempt to appease the religious social conservatives who form the core of the support for his minority government without losing moderate voters who want to avoid the issue.

If Mr. Harper appears to be too aggressive in pushing to revisit gay marriage he also risks losing votes in Quebec, where his pro-Israel stance and an environmental plan that does not meet Canada’s Kyoto Protocol commitments have already hurt his support in a province that is critical to his chances of securing a majority in the next election.

“Harper needs to show he is not the right-wing evangelical’s rump if he wants to grow into a majority government,” said Jonathan Malloy, a political science professor at Carleton University in Ottawa who studies the politics of evangelical Christians in Canada.

Mr. Harper’s government has not introduced an avalanche of socially conservative measures, but has instead shifted subtly to the right, one policy at a time.

In addition to derailing Liberal measures to loosen marijuana and prostitution laws, Mr. Harper has introduced tougher crime legislation, bolstered the military with new money and equipment, lowered the national sales tax and plans to raise the age of sexual consent to 16 from 14.

But the Christian right wants more and realizes a lot is at stake in the marriage question.

“Let’s say there’s a vote and the issue dissipates from the agenda in the same way abortion has faded away,” Mr. Malloy said. “Then they won’t have a clear-cut issue they can strongly organize on. They’re developing a base here but they need something to organize and keep the funds going.”

The Christian movement’s leaders are discussing how to sustain the momentum and growth spurred in the campaign against gay marriage. They agree that one issue is not enough to fuel a long-term movement. But they disagree on how to carry the momentum of the marriage campaign into other socially conservative issues like euthanasia and polygamy.

Fueling their hopes for sustaining the movement are polling figures from last winter’s election that show an identifiable bloc of religious voters, mainly evangelicals and Catholics, supporting the Conservative Party.

In a country where church attendance has dropped to about 20 percent of the population from about 60 percent since the 1940s, the Christian right hopes the polling numbers convince politicians there are still enough votes to be won by championing socially conservative issues.

But the experience of Canada’s abortion debate in the 1980s and early 90s looms ominously over optimism that the movement can be broadened beyond gay marriage.

At the time, evangelical leaders formed groups, raised money and drew significant support in an effort to establish stiff laws against abortion. In 1989, Prime Minister Brian Mulroney introduced legislation banning abortions in cases where the health of the mother was not at risk but the bill failed in the Senate and never became law.

Soon after, the evangelical political movement disbanded, remaining relatively dormant until the gay marriage issue arose.

“When the abortion legislation died everyone just went home and all the momentum was lost,” said Joseph C. Ben-Ami, executive director of the conservative Institute for Canadian Values, which opened an office in Ottawa last year to team up with Mr. McVety’s organizations in Toronto. “I do worry something like that could happen with what we’re seeing now.”

Photo credit: Jean Levac, Ottawa Citizen

Published: November 19, 2006, New York Times

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Public–Private Health Care in Sweden (CMAJ)

September 10, 2012, Mason0 Comments

By Christopher Mason

At first glance, the Sabbatsbergs Närsjukhus Hospital in central Stockholm is indistinguishable from the medical centres that together form the front line of Sweden’s vaunted health care system.

Its facilities, offering specialized services but no emergency room, are busy with patients who appear to be making use of a public hospital.

But looks can be deceiving. Once a government-managed facility, Sabbatsbergs today is — like nearly one quarter of primary care facilities in Sweden, and like nearly half in Stockholm — privately run, and has been since the mid-1990s.

This hospital, tucked amongst the low-rise heritage buildings of central Stockholm, is part of a growing trend in Sweden, where medical services are increasingly being provided by privately run, but publicly funded clinics in a country famous for its universal health care system.

And compared to the controversy surrounding private health care in other countries, in Sweden, of all places, the private sector has taken on a larger role with relatively little fanfare.

For decades, Sweden has been the global bastion of socialized health care. In many ways, it still is. But as countries the world over struggle with rapidly changing technologies, spiking medical costs, rising demands for service with noncorresponding appetites for increased fees or taxation, Sweden is increasingly turning to the private sector to reduce the burden on a health care system at risk of being crushed under its own weight.

“Many of the developments in the last 15 years have been about going from a government-funded system to a more open system that includes the private sector,” says Dr. Birger Forsberg, a professor of international health at the Karolinksa Institute medical school who also advises Stockholm on health care policies.

The Scandanavian model of a welfare state built on high taxation is known the world over, especially in countries, like Canada, that have adopted various forms of the system.

In fact, Sweden’s success at adopting a public–private hybrid was cited by the Supreme Court of Canada in its 2005 decision to strike down prohibitions against private health care insurance in Quebec, saying that countries such as Sweden and Germany, that allow private insurance, have successfully delivered medical services that are superior to and more affordable than services available in Canada.

About 18% of overall health spending in the country comes from the private sector, according to the World Health Organization. But on top of that, private companies compete alongside public facilities for government funding and the right to provide health care to Swedish citizens.

The winning bid — whether public or private — receives government funding with the goal of leaving the end service (in other words, what the patient sees) unchanged, regardless of the service provider, while rewarding those who can provide the quickest and cheapest treatment.

According to the most recently available survey, 250 such privately run but publicly funded clinics operate in the country, representing 24% of the country’s health centres. That’s up from 146 private clinics representing 14% of overall health centres in 2000, according to Sweden’s Association of Private Care Providers.

In addition, the country has 9 fully private, fee-for-service hospitals that operate parallel to the public system.

Sweden is perhaps an unexpected place to find such a mix of public and private health care. But experts here say the country has been forced well past the point of debating the merits and risks of incorporating private health care because Sweden faces such extreme accessibility problems and a rapidly aging population.

“Today the discussion is not whether private health care should have a role in the system, but rather what role private health care will have,” says Klas Öberg, of Sweden’s National Board of Health and Welfare. The board studies health care services in each of Sweden’s 21 county councils responsible for delivering health care and advises the federal government on policy changes and developing trends.

Accessibility issues have been at the core of many health care policy shifts in Sweden of late. Therefore, recent changes like a policy to allow patients to seek care from physicians anywhere rather than being tied to one doctor are geared more toward reducing wait times than reducing costs.

Earlier this year, the National Board of Health and Welfare found that nearly 45% of patients have longer wait times than are supposedly guaranteed by the health care system. This, despite a recent influx of 250 million Swedish kronor ($42 million) into reducing wait times.

“These figures are not satisfactory,” Swedish Health Minister Göran Hägglund, said in February when the findings were released. “They show that we haven’t approached the problem of availability with the level of force needed. … The wait to receive attention — be it a telephone call to a local clinic or a first visit to a physician — is simply too long.”

The accessibility problem highlighted by the health minister is not going to go away, with a growing demographic challenge similar to that emerging in many Western countries.

Besides a senior citizen population that has grown by more than 10 000 since 2000 (to more than 300 000 total), the Swedish Association of Local Authorities and Regions expects the country’s overall population to grow by 870 000 before 2030, only 75 000 of whom they predict will be active in the workforce.

“We’re facing a situation where fewer are paying for more services, and where expectations for welfare services continue to increase steadily,” says Anette Åkesson, a member of the Association’s welfare financing committee.

Such growth stokes fears of what will happen to a system already overburdened by too many people seeking services from too few medical practitioners. In an attempt to address that influx, the system is turning increasingly to the private sector in the hope that the answer can be found among those with an eye for results, and the bottom line.

Compared to the sensitivity surrounding the public-versus-private health care debate in Canada, Sweden has thus far managed to introduce an increasingly hybrid system with relatively little controversy.

The differing tones of the debate between public and private — hot under the collar in Canada and shrugging shoulders in Sweden — is partly explained by the way in which the Swedish government has approached the issue. It has allowed the 9 private, fee-for-service hospitals to open for business, with little handwringing. But the largest role for private medicine is in the public sector, where the privately run facilities receive public funding to provide citizens much the same services they would at government hospitals.

Within that system, citizens in government-funded clinics are charged user fees that account for about 5% of overall health funding, while the government contributes the rest.

Hospital stays cost about $13 a day. Patients are charged about $20 for each doctor visit, and about twice that to see specialists. But after $150 in 1 year, visits are free, and no citizen pays more than $300 per year including prescription drugs.

The country’s drugstores are government-run, though the first private pharmacies are slated to open by January 2009.

Emergency services remain the domain of public hospitals, but as the tone of debate over public versus private health care in Sweden softens, there are fewer and fewer sectors of the system that are off-limits to private companies.

“What couldn’t be said 20 years ago can be said today,” Forsberg says. “The ideology is not so important any more, it is just a matter of figuring out how to get the system to work.”

Photo credit: Andrej Kropotov/iStockphoto.com

Published July 2008 by the Canadian Medical Association Journal
Stockholm, Sweden

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“Polluted Waterways and Physician Shortages (CMAJ)

September 10, 2012, Mason0 Comments
By Christopher Mason

Monrovia, Liberia

It is difficult to comprehend that some 75 000 people live on the tiny swath of land known as “West Point,” pinned between the Atlantic Ocean and the swampy banks of the Mesurado River in the downtown portion of Monrovia, the capital city of Liberia.

In West Point, there are “too many” people and not enough of many more, namely, doctors.

A single doctor serves West Point’s residents. But that doctor is also responsible for two other clinics elsewhere in the city, so he is available, at best, four hours a day.

“With the lack of safe drinking water, few toilets and not enough food, so many people get sick,” says Donna Dennue, a resident of West Point and a member of a community organization called West Point for Health and Development.

West Point is not alone in facing a shortage of qualified doctors. It is a country-wide problem severely hampering efforts to strengthen the health of a population deeply affected by decades of instability.

At last count, Liberia had 130 doctors, 51 of whom are Liberian, serving the country’s 3.5 million citizens, according to the World Health Organization. Aid groups say Liberia needs at least 1000 more doctors. Likewise, Liberia’s estimated 600 nurses are a fraction of the 4800 the Ministry of Health and Social Welfare says are needed.

Liberia’s 14-year-long civil war came to a head when former President Charles Taylor — now on trial for 11 counts of war crimes and crimes against humanity at The Hague — was sent into exile in 2003. By that time, the ranks of health care providers were decimated, while 95% of the country’s health facilities were destroyed or made nonfunctional, according to the United States Agency for International Development.

The shoreline in West Point, Liberia, where trash and ramshackle latrines pollute the water that residents use for washing. Image courtesy of Emily Brennan

Reconstruction efforts focused on restoring a semblance of normalcy to the health care system and the traumatized population. As recently as 2007, 70% of Liberia’s health facilities were operated by nongovernmental organizations, while the country’s sole medical school, the A.M. Dogliotti College of Medicine, graduates only a handful of students each year, instead of the 40-plus it graduated annually before the civil war.

The government, with help from international donors, is trying to strengthen the medical school through refurbished facilities, new textbooks, higher pay for instructors and programs to bring in international doctors and professors to teach and offer some front-line medical services.

“International doctors come for a short time, often one week or two weeks, then go,” says Dr. Bernice Dahn, Liberia’s deputy health minister and chief medical officer. “We hope to develop programs that would encourage doctors to come for six months to a year and really take part in substantive work.”

The current class is nearly 50 strong and it’s hoped as many as 35 will graduate five years from now.

The government is also seeking ways to strengthen international training opportunities for Liberian doctors and medical students, without increasing the risk that they will not return home after the training. As with many sub-Saharan African countries, Liberia is struggling to convince their health workers to stay rather than seek opportunities elsewhere.

Negotiations are underway to establish relationships with other countries such as Ghana, Nigeria, South Africa and Kenya to allow medical students, including those seeking specialist training, to study at their institutions. The thinking is the training will be cheaper, and it will be easier to ultimately convince them to practice in their home country.

“You send them to America or any other country overseas for medical studies and they will not come back,” says Dr. Tabeh L. Freeman, Dogliotti’s dean of medicine. “With little money we can train a whole lot of them in South Africa or any other African country.”

Liberia’s Ministry of Health and Social Welfare is also pursuing short-term solutions to provide front-line health care while the medical ranks are being regenerated. Those include a training program for midwives and plans to train nurses to perform emergency surgery when doctors are unavailable.

The goal of the midwife program is to expand the current roster of midwives to 1600 from 400, while bolstering their level of training, particularly in rural communities.

But even once the shortage of physicians and other medical workers is resolved, Liberia won’t be out of the woods. Less than 25% of the population has access to toilets, and only 32% can access safe drinking water. The WHO links one in five deaths to lack of proper water and sanitation.

Communities like West Point illustrate the challenge. Its 75 000 residents often have nowhere to turn when they fall ill from using the same water for cleaning and bathing that is polluted by those who use the many ramshackle wooden latrines hanging out over the waterways. After all, there is only one doctor.

Photo credit: Emily Brennan

Published by the Canadian Medical Association Journal (October 2010)

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Camps, cholera and cattle raids (CMAJ)

September 10, 2012, Mason0 Comments

By Christopher Mason

Lira, Uganda

In amongst crops of corn, Erute Internally Displaced Persons Camp sits nearly empty save for a few women sorting beans on a mat and a young boy dancing barefoot across the red clay to the tinny music of a battery-powered radio.

This site was once bustling with up to 30 000 people who were among roughly 1.7 million moved to camps across northern Uganda for protection against rebel fighters waging a 20-year civil war.

Here at Erute, the playground equipment has been stripped, the water taps cut off and the health centre and school closed, all part of an effort to send people back home now that there is tentative peace between the rebels and government forces as a result of truce reached in August 2006.

The evacuation of the camps is a good news story — people returning home, lives rebuilding and peace at long last. But the government and international aid organizations are grappling with a challenge posed by this massive resettlement process.

Amidst the terrible conditions, loss of livelihood and faded hope came improved health care, thanks to a, literally, captive audience that allowed medical workers to make great gains in immunization rates and overall health education.

“It’s really a matter of the good, the bad, the ugly,” says Shannon Strother, UNICEF’s chief field officer for northern Uganda. “You had, for lack of a better word, a captured audience.”

The “bad” and the “ugly” aspects of health care in the north centred mainly on sicknesses that creep up anywhere there is a cramped, impoverished population, as well as an overstretched health care system where a health centre designed to serve 10 000 people often found itself serving 50 000 or more.

The “good” is what the officials are trying to hang on to now that people are returning home — the improved immunization rates, the health-conscious population who now know how to detect and respond to symptoms of cholera and other diseases, and mortality rates that have greatly improved.

“Prior to the end of the conflict we had access to 100% of the population 100% of the time,” Strother says. “These benefits are challenged by the return process.”

For most of the last 20 years, health care in northern Uganda was supported by international aid groups because the government’s resources were so limited (in large part because 90% of the north’s 4.5 million people were living in camps, leaving almost no tax base in the vast region). Now, the groups are working with the government to rebuild health centres, equip them with proper technology and supplies, and create incentives to get health workers back.

It is a challenging task given that, in 1 part of the north, 415 000 people are served by exactly 1 doctor.

The resettlement plan calls for people to first move to transition camps that are closer to their homes. Officials say that some families have been away from home so long that it will take a while to get their lives rebuilt.

This means that in the past 12 months the number of camps in northern Uganda has ballooned from 241 to 789. Officials openly admit they cannot keep up with the demands of serving a population that dispersed across such a large area in such a short time.

Back at Erute, over 1000 residents are still scattered about the large site.

Besides not having any access to schooling, there is also no health centre open in the camp, meaning the closest health services are in Lira, at least 20 km away.

“Most of those still here were abducted by rebels at one point and so are very reluctant to go back until they know for sure it is safe,” says David Ogwang, a resident at the camp.

Among them is 19-year-old Robbie Eria.

Eria does not mix conversation with eye contact. But he does, slowly and quietly, tell his story about having been abducted from his home by the Lord’s Resistance Army and forced to serve in their cause.

He lifts up his black t-shirt — the same shirt he uses to filter dirty water for drinking — to show a large scar on his chest. The Lord’s Resistance Army camp he was living in was attacked by the Ugandan army and a piece of shrapnel hit him in the chest.

Now, a few years later, Eria is free and 1 of the few who have refused to leave the internally displaced persons camp for home. Though his parents and older brother (who was also abducted by the rebels, along with another brother who was killed) have returned home, Eria stays at the camp, afraid of returning to where he was abducted.

“I’m lonely,” Eria says.

The government and aid workers are hoping this awkward transition period, with the focus shifting to resettlement while thousands still remain in the old camps, ends quickly.

“The people are moving out of the camps, we’re just following them,” said Eric Alain Ategbo, a nutrition specialist who has done a significant amount of surveying in the north.

Decades of conflict have had a different effect on another part of northern Uganda. Northeastern Uganda consists of a vast region called Karamoja that is notorious for violent cattle-raiding between tribes, which has led to countless deaths. There, medical workers face a violent culture of warring tribes, a total lack of infrastructure and until recently, indifference to the region on the part of the government and international aid organizations.

Karamoja has nearly 1 million people, served by a single surgeon. Its largest hospital, St. Kizito, has a ward specifically for gunshot victims.

Most of them are young men and most have casts on their legs because warriors will shoot legs first so that farmers are helpless while the cattle are being stolen. “On days when there is a gun battle, it is really a crisis in here,” said Dr. James Lemukol, the hospital’s medical superintendent.

He estimates that about 80% of the surgeries the hospital performs are gunshot-related. “Think of how much good we could be doing if we didn’t have to treat victims of violence.”

“There are 2 stories in the north,” says Strother. “There is Karamoja with the cattle-raiding and then there is the rest of Northern Uganda where the LRA conflict took place.”

Those 2 regions tell 2 different stories of health care as well: 1, in Karamoja, of a health care system that has to find a way to work amidst chronic violence, and another, in the rest of the north, of a health care system that has its fingers crossed that in a few years it can operate with some semblance of normalcy in an environment free of violence.

Photo credit: Christopher Mason

Published October 2008 by the Canadian Medical Association Journal

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6 Native Nations, and None Have a Word for Suburbia (New York Times)

September 10, 2012, Mason0 Comments

By Christopher Mason (New York Times)

CALEDONIA, Ontario, Aug. 10 — Blame it on the American Revolution.

At the time, six Indian tribes that had lived for centuries in what is now upstate New York sided with the British Crown, lost and were forced from their lands. For their troubles, however, Britain granted them a paradise rich in moose and deer, across the new border, in southern Ontario.

Today the game are largely gone. The wilderness has been transformed into suburban sprawl. The once pristine lands of the so-called Six Nations Reserve have been whittled away.

This year, one more housing development on the edge of town was one too many, and the Native Canadians decided to make a stand.

Since February, hundreds have blockaded roads, set bonfires, confronted the police with bags of rocks and lacrosse sticks, cut the maple leaf out of a Canadian flag and refused to obey court orders to vacate. During the height of tensions, a van was driven into a power station and set on fire, leaving residents in the dark for days.

The protests have become the knottiest of Canada’s many native land disputes and paralyzed the local economy.

“Some businesses are down 30, 40 percent,” said Neil Dring, who publishes a weekly newspaper here. “This has really hurt.”

For the Native Canadians, however, the dispute is a matter of mending a broken promise by the government to manage the land on their behalf. “Through the years, our people said, ‘You can come here, you can settle here,’ but that didn’t mean they could take over,” said Hazel Hill, who lives on the reserve.

Police officers brought in from all over the province now watch the occupied site around the clock, while town residents whose backyards border the land must show identification to be allowed down their street.

Confrontations have been laced with racial slurs and crude signs. Native Canadian protesters have surrounded the site with traditional flags, and many don fatigues when tensions are at their highest.

In early August, Native Canadians used a fire hose to repel crowds who marched to the site from the town to protest their refusal to obey a court order to leave the disputed land.

“People who live near the site are stressed beyond belief,” said Jason Clark, who lives in town. “They see flags flying and people wearing camouflage — it’s intimidating.”

A mile down the road from the site, downtown Caledonia is slow moving and rich in history. Canadian flags line the main street and businesses are a mix of restored heritage buildings and newer developments that have come with the town’s growing status as a bedroom community for cities like Hamilton and Brantford.

“We had a tremendous amount of housing growth in recent years,” Mr. Clark said. “But that’s come to a complete stop. That occupation is creating a lot of economic hardships in Caledonia.”

The police conducted a raid on the protesters in April, but they retreated when waves of Native Canadians arrived to reinforce the occupation.

“They really did us a favor,” Mrs. Hill said of the raid. “That’s when internal politics were put aside and everyone came together.”

The occupied land covers 100 acres among tens of thousands taken over by the government from the Native Canadians in the 19th century after a disagreement that lasted decades over whether the Native Canadians had the right to sell their land to British settlers.

The Native Canadians filed a lawsuit over the land in 1995, on behalf of the Six Nations: the Mohawk, Onondaga, Seneca, Cayuga, Oneida and Tuscarora. But, tired of waiting while housing developments encroached on the land, they took matters into their own hands.

A younger generation of Native Canadians has led a resurgence of indigenous culture across the country. Unlike many of their parents and grandparents, these Native Canadians did not attend residential schools, where Native Canadian students were often hit with a strap for speaking their own languages. Entire generations of culture were submerged.

The revival has not only restored pride; it has also opened old wounds over how the British and, later, Canadian governments negotiated land deals with chiefs.

In one such deal, chiefs had signed a document that the British interpreted as surrendering the land where Toronto now sits, but it was later disclosed that the chiefs had signed a blank piece of paper.

Native bands elsewhere are watching Caledonia, wondering if the protesters here have found a new way of forcing governments to settle land claims, or at least expedite them. The brash and confrontational nature of the dispute contrasts with the glacial system the Canadian government uses to settle land claims with its Native Canadian population.

Of the 29 claims filed by the Six Nations since the 1970’s, only one has been settled. There are some 770 outstanding claims across Canada, with more than twice as many claims coming in each year as are being settled.

“They’ve created a system to deal with these land disputes, but they take years in the courts,” Mrs. Hill said at the barricaded entrance to the occupation. “They’re the ones with the money who can afford that process. We decided it was time to deal with things differently.”

Whether their approach will work depends on politicians, the behavior of protesters on both sides, and the response by the police.

Nearly six months into the occupation, the Native Canadians have persuaded the provincial government to buy the disputed land from developers while forcing both sides to begin negotiating a settlement.

The question is whether, in the meantime, the Native Canadians and the townspeople can keep the peace.

“I’m concerned that at some point we’re going to see more violence,” said Mr. Clark, the Caledonia resident. “That’s not a threat, that’s just reality. People can only withstand so much.”

Photo credit: Donald Weber

Published: August 17, 2006, New York Times

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Gillard should keep an eye on Canada

September 10, 2012, Mason0 Comments

 

By Christopher Mason, Toronto

A nation grapples with a contentious takeover bid of its stock exchange, dividing its financial sector, rattling a shaky minority government and reigniting a heated debate about foreign investment.

Sound familiar?

It should, especially when this same nation also faces the threat of a housing bubble and an economy that, although escaping the worst of the global recession, is hardly surging.

While these issues are keeping minds busy in Australia, they are currently consuming Canada, which may serve as a warning beacon for political and business leaders.

Canada is approaching its fourth election in seven years on the back of these concerns, which came to a head after the conservative government fell last week on a decisive non-confidence vote. It didn’t help Canadian Prime Minister Stephen Harper was held in contempt of parliament for failing to fully disclose financial details about critical legislation.

But it was only a matter of time before Canada was thrown into its latest election campaign. All three opposition parties had already pledged to vote against Harper’s budget, which included $11 billion in unspecified spending cuts.

Foreign investment fallout

The election, on May 2, comes at a delicate time, not least because of unresolved questions about Canada’s foreign investment laws stemming from the government’s November rejection of BHP Billiton’s $38.6 billion bid for Canada’s Potash Corp.

Harper’s industry minister promised to clarify foreign investment laws to avoid an investment chill. But months later the review has yet to surface, further muddying Canada’s investment landscape.

In the midst of this, the federal government and four provincial governments are reviewing a proposed merger of the TMX Group, operators of the Toronto Stock Exchange, with the London Stock Exchange. The proposal is getting a rough ride from several corners of Canada’s business community and especially the provincial Ontario government, which fears the deal will sap talent and value from its financial capital, Toronto.

Earlier this month some of Canada’s largest institutions, including TD Bank, Canadian Imperial Bank of Commerce and National Bank of Canada, signed a petition against the merger. TD Bank chief executive Edmund Clark came out today saying TMX “can do better”.

Though pegged as a merger, the deal’s critics frame it as a takeover. LSE shareholders would hold 55 per cent of the newly-formed exchange and LSE chief executive Xavier Rolet would retain the top job.

The deal – which would create the world’s largest bourse and home to the vast majority of the world’s listed energy and resources companies – could also have implications for ASX Ltd’s proposed merger with the Singapore exchange. If the local deal isn’t allowed to proceed, the resource-heavy ASX could be drowned out by this much larger mining powerhouse – although it’s not clear whether Australian regulators are paying attention.

Threats of a housing bubble

Even through Canada escaped a US-style default crisis, several reports have warned that Canada’s housing market could be headed for trouble. Currently, national housing prices sit at about 10 per cent above pre-recession levels, which were already at all-time highs. In March, a Bank of Montreal report warned that housing prices were rising faster than personal incomes and were beginning to form a worrisome, destabilising trend.

A recent report by Capital Economics, picked up by the Unconventional Economist (Is Canadian housing the next domino?, March 2), also warned prices would fall between 25-35 per cent in the next three years as interest rates return to pre-recession levels.

These bubble warnings persist despite the Canadian government taking steps to reduce the risks – the mortgage eligibility criteria were toughened and tighter restrictions were placed on the amount Canadians could borrow against the value of their homes. These concerns, along with rising national debt levels and other economic worries, loom large on the campaign horizon.

Economic irks

Just like Australian government MPs, Harper has been trumpeting his nation’s performance in escaping the global recession relatively unscathed. But cracks are emerging here, too. Just one week prior to the non-confidence vote, the Canadian Taxpayers Federation released a report showing that Canada’s national debt had hit a new record high of $562 billion.

Michael Ignatieff, the leader of Canada’s Liberal Party – the only group with a chance of unseating Harper’s Conservatives – is trying to paint Harper as a poor steward of the economy. But Mr Harper has largely drowned-out the criticism with his accusation that Ignatieff wants to form a coalition with his fellow opposition parties, making the term “coalition” a dirty word in Canada despite being a widespread political reality throughout much of the rest of the world.

Australia’s own minority government, facing many of the same political and economic pressures, would be wise to keep an eye on its friends across the Pacific.

Published April 2, 2011 by Australia’s Business Spectator

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Where The Jobs Are (Maclean’s)

September 10, 2012, Mason0 Comments

Tough times don’t have to mean tough luck for M.B.A. grads, especially in Canada

By Christopher Mason

A funny thing happened to Jordan Sugar this spring, as he prepared to finish his M.B.A. degree at York University’s Schulich School of Business: he got a job. And not just any job—he got one in banking.

For Sugar, who was hired by BMO to work on its trading desk, that was something of a surprise. After all, classroom chatter around Schulich about job prospects had been every bit as depressing as the economic tragedy playing out on the front pages of newspapers. “Some graduates from 1999, 2000, 2001 came in to talk to my class about graduating amid the dot-com burst and I thought, ‘My God, I couldn’t imagine finding a job in that climate,’ ” recalls Sugar. “Then I saw Lehman Bros. go under and I thought, ‘Uh-oh.’ ”

If last year’s fall of global financial titans—traditional destinations for a big chunk of graduates—seemed to make M.B.A. job prospects disappear overnight, the ensuing global recession made the outlook even more grim. At least outside of Canada. Here, the picture has turned out to be far different. The country’s banking system has held up well, avoiding the need for the large-scale bailouts seen elsewhere. That strength has translated into a sustained job market for M.B.A.s: while American business schools report a drop of as much as 50 per cent in financial sector hiring, Canadian business schools say hiring levels remain strong, though down slightly from last year’s above-normal figures.

That means recent graduates like Sugar, who thought the dream of a banking job sank along with Bear Stearns, are finding that opportunities remain, especially for the most aggressive and talented graduates. “In all the doom and gloom, you want to hear some counter-stories out there, and Canada may be one of them,” says Joseph Palumbo, executive director of the Career Development Centre at York’s Schulich School of Business in Toronto.

It’s not all sunny, of course. Hiring by consultancies such as McKinsey, Deloitte & Touche and Boston Consulting Group has either dropped or remained flat—their clients tightened consulting budgets as the economy faltered. All in all, Canadian business schools report that hiring numbers so far have fallen between two and 15 per cent this year compared with 2008, when hiring was up about 10 per cent over 2007. Though firm stats will emerge this fall, schools say current hiring levels appear to be on par with those seen in 2005.

And while on the whole their performance so far in finding jobs for grads has Canadian business schools cheering, concern remains that the fretting by business schools south of the border might head their way. “The real losses in the financial sector, in New York and in London and throughout the rest of the world, have created a climate of fear that we’re acutely aware of here, even though the data in Canada does not indicate a downturn on any significant scale,” says Jeff Muzzerall, director of the Corporate Connections Centre at the Rotman School of Management at the University of Toronto.

The difference between Canada and the United States comes in large part from Canada’s banking sector. Finance can account for as much as 60 per cent of hiring at some business schools in southern Ontario, where the Big Five—Royal Bank, BMO, Toronto-Dominion, CIBC and Bank of Nova Scotia—remain among M.B.A. programs’ top 10 employers. If anything, the current economy has given Canada’s banks an edge in the global competition for top M.B.A. graduates (along with laid-off senior bankers from abroad). “It’s a great opportunity for organizations like us who are in a growth mode to pick up talent,” says Leslie Quinlan, vice-president of talent management at Toronto-Dominion Bank.

The key for M.B.A. grads now is flexibility. Investment banking is moribund, so those who had their hearts set on it are now considering retail banking or auditing. Some grads will launch their own start-ups, or choose jobs that prioritize quality of life over big paycheques. Muzzerall and others report growing interest among students in energy, non-profits and green technology. Students are also reconsidering government, in which interest had declined since the 1960s as pay and growth opportunities lagged behind the private sector; in the past year, the kind of stability that government work offers has reappeared as a top priority. “I’m not going to say it is full speed ahead, but because of the diversity of the economy, our students are finding opportunities,” says Gordon Fullerton, associate dean of master’s programs at the Sobey School of Business at Saint Mary’s University in Halifax.

Yet even in sectors where hiring is steady, employers are being very selective: they know competition for jobs is the fiercest it’s been in years. Increasingly, companies are looking for people who can provide big-picture thinking, experts say. Business schools have noticed.

They are bringing in professors from multiple streams to teach courses collaboratively, introducing students to the integrated management approach employers want. “Now [employers] say we need strong finance skills, the analysis, but—and here’s the difference—we’re not going to make an investment in somebody unless we feel they will be able to mature into a more senior position in the organization,” says David Edwards, director of the Business Career Centre at Queen’s University in Kingston, Ont.

The increasingly competitive, multi-skilled work environment is also pushing business schools to prefer students who have experience. “You’re just coming from a B.Com.? Go get a job,” Fullerton says he tells some students. “That’s a tough message to deliver, but I think in the long run statistics show employers are looking for folks who add value to the organization with work experience and an M.B.A.”

In the United States, business schools are playing it safe by preferring applicants who are most likely to find work in a troubled economy—which means admitting more people who are looking to advance within a sector or industry, rather than those who hope to use school to transition to a new career. Canadian business schools have traditionally been more flexible in helping students change career paths. But a more competitive environment may mean that schools reconsider their approach.

The shaken economy means many M.B.A. students will have to rethink their plans—and their roles in the emerging realities of business. But that’s nothing new. “Recessions are something we will always have,” says Marie-José Beaudin, executive director of career services at the Desautels Faculty of Management at McGill University in Montreal. “At the end of the day, it’s about thinking through market conditions and seeing where you fit.”

Jobs are only one part of the changing M.B.A. landscape. When historians look back on this recession and its impact on business education, they might find the downturn marked a return to relevance. Business schools in North America emerged in force in the years following the First World War, when young servicemen sought applicable skills with which to re-enter the workforce. Likewise, M.B.A. programs were born in Canada after the Second World War, when the need to adapt war assets and resources to peacetime prosperity created the need for advanced business training. Some experts say the past two decades have largely lacked galvanizing issues for business schools to tackle. “The power and relevance of an M.B.A. degree is unleashed when it finds meaning in something that is of supreme importance,” says Donald Thain, professor emeritus at the Ivey School of Business at the University of Western Ontario in London, Ont. Now, though, the recession has created just such a pressing need: “Essentially we’re flying blind. There is no current theory on which [government and business leaders] are relying as they attempt to turn around the problems in the American and global economy.”

That leaves the door open for M.B.A. programs to adapt their raisons d’etre—and for students to do the same. So, while the financial payoff of M.B.A. study might not be what it used to, consider this: what you learn might end up meaning a lot more.

Photo Credit: Havier Pierini/Getty Images

Published September 2009 by Maclean’s magazine

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