Monday, March 31, 2008

Looking Ahead: How Not to Repair Zimbabwe's Health Care System

My friend and fellow Nieman fellow Andrew Meldrum has an article about the deteriorated health care system in Zimbabwe in this week's Lancet. The full text is completely available (after free registration) and well worth reading. The core message, for me, is looking forward to a post-Mugabe future (keep your fingers crossed on the election results).

Meldrum, who was kicked out of Zimbabwe by the Mugabe government in 2003, warns about the unintended consequences of too much aid too fast:

Those who know Zimbabwe and its people have no doubt that it will rise phoenix-like from the ashes of the current crisis. To do so rapidly will require massive external support. There is already talk of a Zimbabwean rescue package, with assurances of millions of dollars of emergency aid awaiting an acceptable resolution of the political crisis. But health-care officials warn of the destructive capacity of a sudden surfeit of funds. Especially, there is a fear that any new political dispensation may surrender Zimbabwe's hard-won ownership of its development programme to the agenda of a well funded international donor agency.

Related story:
Are Donors Promoting Corruption in Malawi?

Here Come the Participatory Media

Persephone Miel at the Berkman Center tells me that the new buzz phrase for citizen journalism is participatory media. As I understand it, the idea is to evoke more of the collaboration between folks with various levels of expertise that is possible on the Internet--as opposed to some probably overdrawn caricature of the "pajamas media."

Miel is not so sure that the folks formerly known as citizen journalists are truly up to the task of covering the news. But then again, maybe neither are traditional journalists, as she writes on the Media Re:public blog about the incredibly shrinking shape of news.

Meanwhile, the City of New York subpoenaed the creator of Txtmob, which is a text-messaging service that many demonstrators used to coordinate efforts during the 2004 Republican Convention in New York City. What does that have to do with global health? Know any humanitarian relief organizations that rely on text messaging to coordinate efforts on the ground? The solid citizens of the global health community are not so unrelated to the fringe as they might think.

Are Donors Promoting Corruption in Malawi?

As larger amounts of money flow into global health, greater attention must be paid to tracking where the cash flows in both poor and rich countries. Although doesn't focus on global health per se, it provides an intriguing model for how that task might be accomplished.

I was in Washington, DC last week with my fellow Nieman global health fellows. Had drinks at the Mayflower Hotel with Charles Lewis, one of the co-founders of the Center for Public Integrity. (No sign of disgraced New York governor Elliot Spitzer).

It was great to hear how enthusiastic Lewis is about the prospects for non-profit investigative reporting. Also learned about a more recent project he had a hand in shaping--an outfit called Global Integrity--that Lewis says is giving Transparency International a run for its money.

Global Integrity, according to its website, is "an independent, non-profit organization tracking governance and corruption trends around the world. [The organization] works with local teams of researchers and journalists to monitor openness and accountability."

What most impressed me was how they are able to pull together official data from the World Bank, UN Development Program as well as local groups and non-government agencies. They are, in essence, creating a database of corruption indicators that draws on the full range of local as well as international inputs.

The result is an incredibly useful blend of qualitative and quantitative data. Individual country reports are concise and mercifully devoid of jargon--like the one on Malawi written by journalist Suzanne Marmion.

While the whole Malawi report is well-worth reading (it will take you maybe three minutes), there's one part that really made me sit up and take notice. Marmion writes:

When it comes to corruption, foreign donors are increasingly a part of the problem. Many donors show "results" by how much they have managed to spend in a country, not necessarily by how many people have benefited from the help. Inadvertently, this spending sets up an environment for corruption by providing incentives for simply using up money without showing any positive outcomes. Money either doesn't get spent or winds up being used to pay for expensive hotels and redundant workshops in a rush to use up funds by the end of the fiscal year.

Approximately three quarters of the government's income comes from foreign aid. The senior Malawian official in the Accountant General's office says that unlike government money, which is now centrally tracked, money donated to various public officials is not monitored. Nobody tracks which donor has paid whom, and for what.

Asked whether Malawi's problem is due more to corruption than to dysfunction, [David] Gilmour [the outgoing U.S. deputy chief of mission to Malawi] laughs and says, "No, unfortunately there's plenty of both."

And while the Malawian government today is trying to starve its corrupt members, a Malawian official says, "Now they're just eating from donors."

Sunday, March 30, 2008

New Design for Global Health Report

Signs of spring: crocuses, longer days and a new design for my Global Health blog. This one is called Tic Tac Blue. The old one was Denim.

Oh yeah. I've added some global health videos from YouTube in the right-hand column. Let me know what you think.

Nurses, Water, Toxic Chemicals in Iraq

Headlines that have caught my attention:

More Nurses Leaving UK for Australia "The Australian recruitment drive comes as the number of foreign nurses seeking work in the UK is falling." (BBC)

Water Utility in Malawi's Largest City At A Breaking Point ". . . access to [safe drinking] water has improved significantly [in Malawi] , from slightly over 47 percent in 1992 to 75 percent in 2006. But the state of affairs in Blantyre could overshadow this achievement." (

Iraq contractor Fights Suit Over Toxic Exposure "When the American team arrived in Iraq in the summer of 2003 to repair the Qarmat Ali water injection plant, supervisors told them the orange, sand-like substance strewn around the looted facility was just a "mild irritant," workers recall. . . . But the chemical turned out to be sodium dichromate, a substance so dangerous that even limited exposure greatly increases the risk of cancer." (Boston Globe)

Monday, March 24, 2008

Dangerous Chinese Factories: The Woman Behind the Story

If Loretta Tofani were a better businesswoman, we might never have learned just how incredibly unsafe working conditions are in the many Chinese factories that export furniture and other goods to the United States.

Tofani talked about her extraordinary odyssey at the Goldsmith investigative reporting seminar at Harvard's Kennedy School on Wednesday, March 19, 2008. The newspaper series she wrote--"American Imports, Chinese Deaths"--was a finalist for the Goldsmith Awards, whose recipients often go on to receive Pulitzer Prizes. The articles ran in the fall of 2007 in the Salt Lake Tribune.

When Tofani and her husband, a family physician, moved to Utah a few years ago, she gave up journalism to start a furniture importing business. (Tofani had been a longtime investigative reporter at the Philadelphia Inquirer.) In the course of setting up shop, she visited a lot of Chinese factories to see who she might tap as suppliers.

Tofani couldn't help noticing that the workers who sprayed oil-based paint on the assembled furniture lacked even the most basic protection to guard against breathing in the fumes--fumes that she suspected were full of lead.

And this wasn't happening in just a few odd factories. As a businesswoman, Tofani had access to many more places than she would have had as a journalist. In factory after factory, she kept noticing workers without protective masks and heard gruesome stories about workers who had lost fingers, hands and arms to dangerous machinery.

Eventually Tofani closed her business and devoted the next couple of years of her life to documenting the extent of the problem in China. And then, she started linking individual factories with poor safety records to the specific American businesses that imported their products.

Listening to Tofani tell her story, I realized how hard freelance investigative reporting is. She worked alone, with a few grants to cover some travel expenses. After her piece ran, she was offered a job with the Salt Lake Tribune but turned it down. She said the newspaper wanted her to turn around her investigative pieces in five weeks and she thought that wasn't enough time.

Paul Steiger, formerly of the Wall Street Journal, was also at the Goldman seminar. He publically offered Tofani a job at ProPublica, his new non-profit investigative news venture--but only if she'd move to New York City. (Note to self: ProPublica's New York-centric newsroom model would make a good subject for another post.)

Made me wonder just who's going to pay for investigative pieces like Tofani's? And what's the cost if we don't hear those stories? If for-profits and non-profits don't do it, are crowd-sourcing and crowd-funding up to the job?

And what about all those other business people who visit Chinese factories? Don't they notice how bad conditions are?

Read Tofani's own account: "How I got the story."

Monday, March 17, 2008

Amy O'Leary Teaches the NYTimes About Sound

My rough notes of a "how-to" session on audio at the Nieman narrative conference, held in Boston over the weekend. Could imagine the day when several folks who attend a talk will collaborate on a wiki that summarizes the content--next to a publicly available video. Would test the idea of whether three heads are better than one.

The talk was given by Amy O'Leary, who went to the New York Times as a multimedia producer from her previous life as a public radio journalist.

O’Leary talked about what sound can and cannot do. (Loved the title of her presentation: “Screech, Bang (Sigh)” in which sigh was a real sigh, not the word “sigh.”

She had us listen to several audio clips and really pay attention to how sound worked in each piece. Some were audio-only. Some were narrated slide shows. But in each, she made the point that what sound does best is add emotion and authenticity. It's not so good at analysis, data presentation or complicated context. (Have to leave something for print, I guess.)

Because audio clips are so linear, O'Leary said, the first 15 seconds determine whether or not someone will click away. So even if you have hours of tape, take the best quote (called a cut in radio parlance) and put it at the beginning of your piece—even if it doesn’t immediately pertain to the theme of the piece.

Structure is very important to audio—as in print (although O’Leary doesn’t think much of the traditional billboard paragraph—thinks it gives too much away). “Choose your best piece of tape first” and then “give people a reason to stay through to the end.”

Print journalists new to audio tend to pick stories with obvious sound—like a movie festival or cuckoo clock collector. They’re looking for “sound effects,” not the effects of sound. Audio forces you to be a better journalist because you have to listen to people and NOT INTERRUPT THEM. No m-hmms to show you’re listening either. Lots of shaking of the head up and down.

O’Leary thinks Internet audio pieces don’t succeed if they’re longer than 3 minutes (about 600 words). (Note to self, Brian Storm might differ on this.) But in that three minutes, you take out 1 min 30 seconds for your tape—what the source says plus ambient sounds—then take out another 30 seconds for identifications, that leaves you 60 seconds to write your narration, or about 200 words. Basically two short paragraphs. “Writing script is very much like haiku,” O'Leary notes.

Try to make slide shows standalone pieces of journalism, as opposed to simple recap of a longer written story.

A few quick gear, software, website recommendations. . .
Software: ProTools (PC), Soundtrack Pro (Mac); Audacity (free)
Field Recorder used at NYTimes: Edirol R-09
Shotgun mike Amy demonstrated: AudioTechnica 835B (discontinued)

A couple of "how-to" websites, with reviews of equipment by Jay Allison (Click on “Sound in the story” .pdf)

And that's the end of my notes. If you need absolute accuracy, you can buy a download of the whole presentation for $16 at the conference website. Hmmm, am I giving away the store here?

Related story:
Do-It-Yourself Journalism

Thursday, March 13, 2008

Shifting Focus on Malawi's Nurses

I'm breaking new ground--at least for me--in the way I'm preparing for my Malawi reporting trip. Journalists don't usually announce to the world what they're going to cover since someone else could do a rush job and "scoop" them. But having taken the leap of posting my proposal "At Work with Malawi's Nurses" on the blog, I've found I've gotten some very good feedback--mostly by email (people still don't seem comfortable making public comments or perhaps they don't believe I read them--I do).

At any rate, based on the responses so far, I think I need to broaden the theme of my reporting to include non-university trained or diploma nurses in Malawi. These are the men and women who follow a two-year course of study (three years for midwifery) but cannot transfer their credentials out of the country without further university study.

Still there are factors that keep diploma nurses out of rural hospitals and clinics. Pay is an obvious one but just as important, my email correspondents tell me, are the lack of resources with which to create good quality care, lack of schools for the nurses' children and lack of adequate housing.

This shift in focus on a story is not so new--even for someone trained in traditional journalism. When I worked at TIME magazine, I would commonly change direction on stories based on preliminary interviews. I've just never been so public about it before.

Sunday, March 2, 2008

How Big a Problem is the Brain Drain?

The more you learn, the harder it is to write. Chatted for half an hour on the phone last week with Michael Clemens of the Center for Global Development. He urged me to question my assumption that the brain drain of nurses, doctors and others plays a BIG role in the delivery of health care in sub-Saharan Africa.

According to Clemen's research on migration, even if you could somehow stop the movement of skilled workers from poorer to richer countries, that wouldn't necessarily improve health care in the poorest areas. First, Clemens told me, you have to ask where highly skilled registered nurses are needed. Then, you need to see if other less skilled folks could be trained to fill in the gaps. And finally, he said you should cast a broad net to see what are the biggest factors that keep that from happening.

International migration may be a convenient scapegoat for problems that are closer to home. Although Clemens couldn't give me specifics on Malawi, I will definitely be keeping my eyes--and my mind--open when I travel there in June.