Some quick articles
Feb. 15th, 2010 12:30 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
conuly
One on the effects of wi-fi on school buses in Arizona
Wi-Fi Turns Rowdy Bus Into Rolling Study Hall
By SAM DILLON
VAIL, Ariz. — Students endure hundreds of hours on yellow buses each year getting to and from school in this desert exurb of Tucson, and stir-crazy teenagers break the monotony by teasing, texting, flirting, shouting, climbing (over seats) and sometimes punching (seats or seatmates).
But on this chilly morning, as bus No. 92 rolls down a mountain highway just before dawn, high school students are quiet, typing on laptops.
Morning routines have been like this since the fall, when school officials mounted a mobile Internet router to bus No. 92’s sheet-metal frame, enabling students to surf the Web. The students call it the Internet Bus, and what began as a high-tech experiment has had an old-fashioned — and unexpected — result. Wi-Fi access has transformed what was often a boisterous bus ride into a rolling study hall, and behavioral problems have virtually disappeared.
“It’s made a big difference,” said J. J. Johnson, the bus’s driver. “Boys aren’t hitting each other, girls are busy, and there’s not so much jumping around.”
On this morning, John O’Connell, a junior at Empire High School here, is pecking feverishly at his MacBook, touching up an essay on World War I for his American history class. Across the aisle, 16-year-old Jennifer Renner e-mails her friend Patrick to meet her at the bus park in half an hour. Kyle Letarte, a sophomore, peers at his screen, awaiting acknowledgment from a teacher that he has just turned in his biology homework, electronically.
“Got it, thanks,” comes the reply from Michael Frank, Kyle’s teacher.
Internet buses may soon be hauling children to school in many other districts, particularly those with long bus routes. The company marketing the router, Autonet Mobile, says it has sold them to schools or districts in Florida, Missouri and Washington, D.C.
Karen Cator, director of education technologyat the federal Department of Education, said the buses were part of a wider effort to use technology to extend learning beyond classroom walls and the six-hour school day. The Vail District, with 18 schools and 10,000 students, is sprawled across 425 square miles of subdivision, mesquite and mountain ridges southeast of Tucson. Many parents work at local Raytheon and I.B.M. plants. Others are ranchers.
The district has taken technological initiatives before. In 2005, it inaugurated Empire High as a digital school, with the district issuing students laptops instead of textbooks, and more than 100 built-in wireless access points offering a powerful Internet signal in every classroom and even on the football field.
“We have enough wireless to make your fillings hurt,” says Matt Federoff, the district’s chief information officer.
District officials got the idea for wiring the bus during occasional drives on school business to Phoenix, two hours each way, when they realized that if they doubled up, one person could drive and the other could work using a laptop and a wireless card. They wondered if Internet access on a school bus would increase students’ academic productivity, too.
But the idea for the Internet Bus really took shape in the fall, when Mr. Federoff was at home, baby on his lap, and saw an advertisement in an electronics catalog offering a “Wi-Fi hotspot in your car.”
“I thought, what if you could put that in a bus?” he said. The router cost $200, and came with a $60 a month Internet service contract. An early test came in December, when bus No. 92 carried the boys’ varsity soccer team to a tournament nearly four hours away. The ride began at 4 a.m., so many players and coaches slept en route. But between games, with the bus in a parking lot adjacent to the soccer field, players and coaches sat with laptops, fielding e-mail messages and doing homework — basically turning the bus into a Wi-Fi cafe, said Cody Bingham, the bus driver for the trip.
Mariah Nunes, a sophomore who is a team manager, said she researched an essay on bicycle safety.
“I used my laptop for pretty much the whole ride,” Mariah said. “It was quieter than it normally would have been. Everybody was pumped about the games, and there were some rowdy boys. But the coach said, ‘Let’s all be quiet and do some homework.’ And it wasn’t too different from study hall.”
Ms. Bingham recalled, “That was the quietest ride I’ve ever had with high schoolers.”
Since then, district officials have been delighted to see the amount of homework getting done, morning and evening, as Mr. Johnson picks up and drops off students along the highway that climbs from Vail through the Santa Rita mountains to Sonoita. The drive takes about 70 minutes each way.
One recent afternoon, with a wintry rain pelting the bus, 18-year-old Jeanette Roelke used her laptop to finish and send in an assignment on tax policy for her American government class.
Students were not just doing homework, of course. Even though Dylan Powell, a freshman, had vowed to devote the ride home to an algebra assignment, he instead called up a digital keyboard using GarageBand, a music-making program, and spent the next half-hour with earphones on, pretending to be a rock star, banging on the keys of his laptop and swaying back and forth in his seat.
Two seats to the rear, Jerod Reyes, another freshman, was playing SAS, an online shooting game in which players fire a machine gun at attacking zombies.
Vail’s superintendent, Calvin Baker, says he knew from the start that some students would play computer games.
“That’s a whole lot better than having them bugging each other,” Mr. Baker said.
A ride through mountains on a drizzly afternoon can be unpredictable, even on the Internet Bus. Through the windows on the left, inky clouds suddenly parted above a ridge, revealing an arc of incandescent color.
“Dude, there’s a rainbow!” shouted Morghan Sonderer, a ninth grader.
A dozen students looked up from their laptops and cellphones, abandoning technology to stare in wonder at the eastern sky.
“It’s following us!” Morghan exclaimed.
“We’re being stalked by a rainbow!” Jerod said.
On a non-standard gender marriage in Malawi. It's not clear from the article if this is a same-sex marriage or if one of the partners is transgendered.
Interesting quote: Aninsia Kachepa, Mr. Chimbalanga’s older sister, wept into her blouse at the simple mention of her jailed brother. “I have never heard of this homosexuality, and I am still not understanding,” she said.
“Tell me, how is it physically possible, one man having sex with another?”
It's not as strange as some people think, I'm sure.
Same-Sex Couple Stir Fears of a ‘Gay Agenda’
By BARRY BEARAK
BLANTYRE, Malawi — Tiwonge Chimbalanga looked like a man but said he was a woman. He helped with the cooking and dressed in feminine wraparound skirts. Steven Monjeza was a quiet, sullen man often intoxicated on sorghum beer. He said he had never been happy until he finally met the right companion.
The two celebrated their engagement — their chinkhoswe, in the Chichewa language — with a party at a lodge here in Malawi’s commercial capital. It began cheerfully enough. But later, gawkers pushed their way inside, some shouting taunts, others just staring through despising eyes. Then the electricity failed. The band stopped playing, and the bride collapsed in tears.
Someone had tipped off a newspaper, The Nation, for this betrothal was extraordinary in a conservative African nation. The resulting front-page story began with the phrase “gay lovebirds,” adding that the chinkhoswe was “the first recorded public activity for homosexuals in the country.” Readers were reminded that homosexuality carried a sentence of 5 to 14 years in prison.
Two days later, on Dec. 28, the couple was arrested on charges of unnatural acts and gross indecency, and they have been in jail since, denied bail ostensibly to keep them safe.
Much of Malawi is riveted by the case. This is not just a matter of the state versus a same-sex couple; many here believe it is a matter of Malawi against the developed world. How else, they ask, could “gayism” have crept into a place where it never before existed?
“These immoral acts are not in our culture; they are coming from outside,” said Leckford Thotho, the minister of information and civic affairs. “Otherwise, why is there all this interest from around the world? Why is money being sent?”
The clergy, especially, has accused foreigners of infecting Malawi with sexual Satanism. The Rev. Zacc Kawalala, the leader of the Word Alive Ministry and a member of the national human rights commission, said: “The West has its gay agenda. It wants to look at Africa and say, ‘If you don’t accept homosexuality, you are primitive.’ But we’re not as wicked as the West.”
Of late, anti-homosexual sentiment has been intensifying in several African nations. A law proposed in Uganda would order a life sentence — and even death — for homosexuals. In Gambia, the president demanded that gay people leave the country, threatening them with beheading. The Senegalese penal code calls for one to five years in prison for homosexual behavior.
In Malawi, a deeply impoverished, landlocked nation of 14 million, some in government have called for the inclusion of gay men in the fight against AIDS. But this is but an empty gesture in a nation where homosexuality is outlawed. Gay men and lesbians hide in more than a closet: they secret themselves in a vault. There is no such thing as gay activism.
Nor would any be tolerated. On Jan. 30, the police arrested a man — Peter Sawali — for pasting up posters saying “Gay Rights Are Human Rights.”
He now faces up to four years in prison if convicted of conduct likely to disturb the peace. “You wouldn’t allow a poster that says ‘Let’s Rape the Women,’ would you?” asked a regional police spokesman, Davie Chingwalu.
Amnesty International, Human Rights Watch and more than 40 rights groups from across the world have condemned the Malawi arrests. Some organizations have started a legal defense fund.
But in Malawi, this support is seen by many as proof of conspiracy. Some 40 percent of the government’s budget comes from foreign aid, and it is thought that homosexuality is a hidden agenda of some of the donors.
The trial of Mr. Chimbalanga and Mr. Monjeza began on Jan. 11, with hundreds gathering outside the decrepit courtroom, hooting and jeering.
Jean Kamphale, Mr. Chimbalanga’s boss at a Blantyre lodge, testified that she accepted “Auntie Tiwo” as a woman and assigned her cooking and cleaning chores. But after the article in The Nation appeared, she made her employee disrobe and refused to let him stop until he was naked from the waist down and “that’s where the cat was let out of the bag.”
Three days later, Mr. Chimbalanga arrived in court noticeably ill. His lawyers said he had contracted malaria in the hideously overcrowded jail, though the defendant later blamed guards for trying to beat him into a confession.
As Mr. Chimbalanga fell to the floor and began to vomit, spectators mocked him. “Auntie Tiwo is pregnant,” some called out. Mr. Chimbalanga was led away, only to return with a mop and pail to clean up the mess.
The trial has since been suspended, first to allow Mr. Chimbalanga to recover and now because of a labor strike within the judiciary.
In an interview last week, Mr. Monjeza, 26, presented himself as a model of remorse. “I have never had sexual feelings for ladies, but I had them with Tiwo,” he said, his words translated from Chichewa. “I am regretting my actions now. I want to apologize. I am no longer in love with Tiwo.”
On the other hand, Mr. Chimbalanga, 33, was simply indignant. “I have done nothing wrong but fall in love and declare this love for my husband,” he said.
He explained later: “I have male genitals, but inside I am a complete woman. Maybe I cannot give birth to a child, but I menstruate every month — or most months — and I can do any household chores a woman can do.”
Mr. Chimbalanga’s real name is Mabvuto Stoneck Kachepa. His original home is Chimbalanga in the Thyolo district — 40 miles from Blantyre, past the mammoth tea plantations and deep into the lush, soggy hills — and he adopted that surname after he was banished in his teenage years by his uncle, the village headman.
“Menstruation through his penis” had begun by then, a condition that may have some extremely rare medical cause, some experts say, but could also be the imagined claim of a gay man in a repressed society desperate to think himself a woman.
In Chimbalanga, the teenager was widely presumed to be bewitched. Villagers blamed the uncle for this hex; he denied it vigorously and decided it was better if his nephew lived elsewhere.
Mr. Chimbalanga is the fifth of six children, and older siblings often escorted him to traditional healers in hopes of finding an herbal cure.
“But he was too bewitched,” said Jairos Kachepa, his brother.
In recent years, when Mr. Chimbalanga visited his family, he dressed as a woman and did woman’s work, fetching water and grinding corn with a pestle. Villagers say they thought this strange, but he was well liked.
Now, the arrest has shocked and confounded them. In Chimbalanga, homosexuality — let alone the complexities of transgender issues — have never before merited public contemplation.
Aninsia Kachepa, Mr. Chimbalanga’s older sister, wept into her blouse at the simple mention of her jailed brother. “I have never heard of this homosexuality, and I am still not understanding,” she said.
“Tell me, how is it physically possible, one man having sex with another?”
One I thought I posted before, but can't find about medicine in Cuba.
Melissa Rose Mitchell was discouraged. After taking the Medical College Admission Test, she was uneasy about applying to medical schools. In prep courses for the exams, she had glimpsed her future as a doctor, and she didn't like the environment she saw. "People were like, 'What kind of doctor do you want to be?' and it was all based on how much money you make," the Oakland resident recalled. "It was a really scary moment, because this thing that all my life I had wanted to do without question, all of a sudden I'm thinking, 'I don't know if I want to do this.'"
Mitchell had scraped together the money to prepare for and take the med-school admissions test, but even as she studied, she had begun to waver. "It had taken me over a year to save the $1,400 for the test and prep course and they said, 'We recommend that you apply to no less than twenty schools,' at about $200 each." And there were still the costs of plane tickets and a proper suit to interview at schools. She did well on the exams, but Mitchell was spending a lot of money to fulfill her goal of serving the poor.
But then her boyfriend saw a blurb in a church newsletter that appeared to assuage her growing worries. It was a unique offer to study in Cuba, the impoverished nation 90 miles from Florida that is internationally known for its training and use of doctors. She applied through the Interreligious Foundation for Community Organization in New York, a group whose mission is to "increase minority participation in medicine" and therefore increase the doctor-patient ratio for underserved areas.
Cuba began educating American medical students after members of the Congressional Black Caucus met with Fidel Castro in 2000. Congressman Bennie Thompson of Mississippi told Castro about areas in his district that suffer from extreme doctor shortages. The Cuban president responded by promising scholarships for 500 Americans to attend medical school in Cuba, under the umbrella of the Latin America School of Medicine. To qualify, the students would have to show aptitude and a commitment to work in underserved communities in the United States. Since then, 34 have graduated, and more than 160 are currently enrolled.
The Bay Area, it turns out, is something of a hub for the Cuba school of thought, where Cuba-trained students, unencumbered by the massive debt that plagues grads from US medical schools, have the luxury to do the kind of medicine that Cuba instructs — family medicine. The island's medical schools focus on nutrition and other preventative approaches. Cuba also is well known for its focus on the "social determinants of health."
The Cuban experience also may provide important lessons for our current health-care crisis. With a fifth of our per capita GDP, Cuba has health statistics comparable to those of industrialized nations. In the shabby, eroding, and commodity-deprived neighborhoods of Old Havana, Cubans also enjoy a better doctor-patient ratio than Americans: 59 doctors per 10,000 people compared to 26 for us.
Cuban life expectancy also matches that of the United States, its infant mortality rate is lower, and the island's HIV/AIDS transmission is among the lowest worldwide. Cuba's aggressive health-care delivery system also costs much less — around $200 per capita annually, compared to our $7,000. And it provides timely and primary care for every citizen — near universal accessibility. To the Cuban government, health care is a right.
This fact highlights a gap in the health-care reform initiative proposed by Congress and President Obama. Those currently without insurance, who will receive coverage with the bill, will feel the lack of family practitioners as basic care continues to be undervalued in favor of more profitable types of medicine.
At a White House forum early last year, the president spelled out the problem bluntly: "We're not producing enough primary-care physicians," he said, pointing to a daunting chain of obstacles. "The costs of medical education are so high that people feel that they've got to specialize."
According to the Association of American Medical Colleges, the average debt for a US medical school graduate in 2008 was $154,607. American doctors, as a result, feel forced to take up specialized practice, because ultimately the higher pay will ease their enormous student debt. Yet without enough primary care doctors, experts say, health-care costs grow exorbitant, end-stage care increases, and thousands of family practice residence positions go unfilled every year.
Doctors graduating in Cuba have no such excuse to specialize, and the island does not graduate members of an elite profession. Instead, it's a veritable doctor-producing machine with more than 70,000 physicians for a population of just 11 million.
And after medical school in Havana, Mitchell would return to the United States debt free.
Many students enter American medical schools wanting to do family care but get discouraged, said Dr. Richard Quint, retired faculty at UC San Francisco and a medical consultant to the Oakland nonprofit group Medical Education Cooperation with Cuba. American medical schools deem primary care as having secondary import, he contends. "The overall structure of our 'non-health system' is fragmented and skewed toward specialty practices," he said. "Faculty in medical schools make comments suggesting you shouldn't go into primary care because it's not stimulating or high-achieving enough." It also no secret that physicians are reimbursed highly for procedures and surgeries rather than for preventive medicine and diagnoses. And the need for primary care in underserved areas often doesn't make it into the textbooks or the classroom.
When it comes to preventative care, the shortcomings in American medical education mirror the failings in our health-care system as a whole. "There's nothing the Cubans are doing that people couldn't think of here — it's just they are looking upstream" at prevention, explained Dr. Lynn Berry, chronic disease program manager at Oakland's Highland Hospital, who has conducted research in Cuba.
Berry pointed out that Alameda County has "pretty strong" community health care. "We have La Clínica de La Raza, the Ethnic Health Institute, Native American Health Services," which emphasize prevention and education to avoid the costs, medical and financial, of end-stage care. But "ours is a market system," Berry said, a system "organized around insurance and payer source, not necessarily the long-term health of the patient."
Cuba redesigned its medical system out of financial necessity following the collapse of the Soviet Union. Faced with a supply crisis brought on by the lack of Soviet funding, Cuba revamped its medical education system towards primary care. By the mid-Nineties, they had established a comprehensive neighborhood-based family medicine standard: a consultario (neighborhood clinic) in every locale, and a revised medical school curriculum to embed family care into the model.
The island's health care starts with a top-down mandate for a "bottom-up" approach to health care. Too poor to rely on high-tech equipment or expensive, invasive procedures, the Cuban model stresses prevention and spreads health-care responsibility beyond doctors — into schools, work sites, and neighborhoods. A national network of polyclinics ensures the mandate. People in all walks of life are expected to cooperate in health publicity campaigns and other measures to prevent disease.
The United States' fifty-year-old embargo on goods to the island also has played a role in shaping Cuba's medical care system. The embargo prohibits or restricts the sale of some medical equipment and punishes other countries that deliver essential cargo. Drugs and medical supplies are sporadic, especially in Cuba's rural areas, where clinics work with outdated X-ray machines. And because US pharmaceutical companies develop most major new drugs, Cuban physicians don't have access to many new medicines on the world market. Countries like Spain and Venezuela donate, but routine medical supplies remain scarce or absent from some Cuban clinics.
Still, Dr. Davida Flattery, an internist at Highland Hospital, was struck by Cuba's "bottom-up" approach when she observed their health system last year. "What really impressed me about Cuba was their focus on the non-medical determinants of health," she said. It's standard in Cuba, she added, to engage the psycho-social factors of a patient — level of sanitation, presence of abuse or addiction, and food habits. Doctors and nurses, in fact, make home visits to evaluate these things personally.
Americans trained in Cuba see firsthand the glaring differences between the two medical education systems. Melissa Rose Mitchell learned, for example, that Cuba highlights rural medicine. "In lots of situations the professor will ask, 'What's the best test?' We'll say 'CT scan, ultrasound.' They'll say 'Well you don't have ultrasound, you're in the middle of nowhere, in the mountains, you have no electricity or phone. ... What are you going to do?'"
Many past and current students of the Latin American School of Medicine in Havana, where Mitchell attended, had lived or worked in poor and underserved neighborhoods in the United States, and were chosen to study in Cuba so they could take what they learned back home. And their Cuban education equipped them to deal with health problems of the poorest communities in the United States far better than if they had gone to Harvard.
Havana medical students, for example, are trained to stabilize people in places with no electricity or potable water. One might think those skills irrelevant in the wealthy United States, but a number of poor American communities have come to resemble sections of Third World countries — especially after a disaster (see Hurricane Katrina).
The lack of doctors in America's neediest communities is exactly what the Interreligious Foundation for Community Organization wanted to remedy as they began recruiting for the Cuban scholarships. The resulting program also is quite diverse — far more diverse group than any US med school. The majority of students in Latin American School of Medicine in Havana are African Americans from New York or California, 85 percent are minorities, and 73 percent are women.
And most of the students are trained as "médicos de la familia," or family practitioners. But, as the students saw, medical supply shortages plague the system, and despite diabetes intervention and screening programs in schools and workplaces across the country, the Cuban national diet remains high in fat and sugar. Like the US poor, Cubans don't have easy access to fresh fruits and vegetables — or the habit of eating them — and this hinders their health. Cuba's food distribution system from the countryside to the cities is substandard. The nation imports more than 50 percent of its food.
Mitchell said the training and experience suited her. "They train us just like they train Cubans," she said. "Every Cuban, regardless of specialty, has to do two years of family medicine. Until you can deal with basic, vital situations, you are not allowed to mess with other parts of the body."
After graduating last summer, Mitchell settled in Oakland to work and prepare for the boards, but she says her calling is rural medicine. She used her summer breaks from medical school, in fact, to work in a mobile health-care clinic serving rural populations outside of Birmingham, Alabama, a conservative city with stark wealth disparities. "Every two weeks or once a month, this clinic on wheels visited parts of the state where some of the houses did not have electricity or indoor plumbing. Not because it couldn't be gotten, but because people didn't have the money to invest in it." When asked if the poverty compared to that of rural Cuba, she responded: "The poverty was more intense" in some areas of rural Alabama than in rural Cuba, she said, "because there were no social services."
Yet back home Mitchell faced disapproval — even hostility — for deciding on a nonspecialized practice. "My first experience going home, my aunt and I had a heated argument — me saying I didn't want to specialize and if I did it would be family medicine or rural medicine. Her argument was anybody who had any sense would become a neurosurgeon or a cardiologist. But my image of a doctor is someone who can handle any situation that comes up."
And having witnessed the obstacles facing Cuba, the returning American doctors are scandalized with the state of health care at home. Mitchell works as a part-time medical assistant at a Bay Area clinic and doesn't have insurance herself. "There have definitely been a couple of times I've been sick and couldn't afford to see a doctor," she said.
"A friend did me a favor by seeing me, but I had to pay $60 for antibiotics — that was with the clinic's discount."
Before moving to Oakland as a teen, Pasha Jackson saw firsthand on the streets of South Central Los Angeles the power of nonmedical, psychosocial factors to spread disease — both physical and mental. Violence, joblessness, and addiction merge with poverty to leave many residents out of the health-care system. "What does primary care mean for the people around me?" he said. "It's self-medication. Junk and drinking. These people really need attention, and insurance will deny them for a list of reasons."
But Jackson didn't know he wanted to study medicine until he sustained a football injury. Recruited from City College of San Francisco by the University of Oklahoma, he went on to play for the San Francisco 49ers and Oakland Raiders. But academic advisors throughout high school and college, he said, actively discouraged his interest in science. "They said it was too hard," and that his best chances were with football.
Reassigned by the Raiders to NFL Europe, Jackson tore his left pectoral — "a huge injury for a linebacker," he noted. "Once I left the NFL my health care ended, and to go to Cuba I needed shots and checkups to travel internationally. I couldn't believe what I had to go through. After calling around to public clinics, I had to wait for weeks and miss a day of work to see a doctor that didn't want to see me."
Jackson spent a year recuperating and getting physical therapy. And during that time, the effects of Hurricane Katrina reminded him of the deep connection between poverty and disease. "I knew I didn't want to play football anymore," Jackson said. "In the NFL there's so much waste, the playing with the money and power. I saw how much a part it was of the capitalist system."
Disgusted with professional football, Jackson went to the Interreligious Foundation for Community Organization's web site and applied. The Cuba program "had me in Cuba, where I could learn Spanish; covered me financially; and got me back to science." With that, Pasha Jackson went socialist.
On summer break from his studies in Cuba, Jackson and more than a dozen other students from the Latin American School of Medicine visited deprived American communities to deliver basic health services and expand their own cultural competency. Los Angeles' Skid Row, a place with "ridiculous numbers of homeless people," was one stop on the trip, Jackson recalled. "Mora County [New Mexico] has hardly any doctors." They stopped at Pajarito Mesa, "where the Pueblo Indians live, with no potable water and no electricity. It shows you," Jackson said. "There's the Third World — right here. There are no national boundaries."
<"When the earthquake hit in Haiti, over 400 Cuban medical personnel were already there - they've been there for years," said Dr. Nelson Valdez, Professor Emeritus of Sociology at the University of New Mexico and Director of Cuba-L, which monitors news related to Cuba. According to Medical Education Cooperation with Cuba, some 700 Haitian medical students in Cuba study at the Santiago de Cuba campus of the Latin American Medical School. Cuba is sending doctors and students in droves to treat tens of thousands Haitians lying wounded in hospitals with zero or few doctors. "No one is reporting on the Cuban presence in Haiti," commented Valdez, though he said he wasn't surprised. "The additional doctors being sent are part of the same team that was offered to the United States by Cuba when hurricane Katrina hit." The assistance was refused. Valdez also said the Cuban doctors, solidly trained in disaster medicine, provide psychological as well as physical attention to victims.
The State Department announced that U.S. aid workers would cooperate with Cubans on the ground in Haiti. Those who've observed what we can learn from the Cuban medical approach -- scholars and physicians, new and veteran -- all agree that cooperation and conversation with Cuba, at least in this respect, might bring us all some relief.
I have one more coming, but it's long.
Wi-Fi Turns Rowdy Bus Into Rolling Study Hall
By SAM DILLON
VAIL, Ariz. — Students endure hundreds of hours on yellow buses each year getting to and from school in this desert exurb of Tucson, and stir-crazy teenagers break the monotony by teasing, texting, flirting, shouting, climbing (over seats) and sometimes punching (seats or seatmates).
But on this chilly morning, as bus No. 92 rolls down a mountain highway just before dawn, high school students are quiet, typing on laptops.
Morning routines have been like this since the fall, when school officials mounted a mobile Internet router to bus No. 92’s sheet-metal frame, enabling students to surf the Web. The students call it the Internet Bus, and what began as a high-tech experiment has had an old-fashioned — and unexpected — result. Wi-Fi access has transformed what was often a boisterous bus ride into a rolling study hall, and behavioral problems have virtually disappeared.
“It’s made a big difference,” said J. J. Johnson, the bus’s driver. “Boys aren’t hitting each other, girls are busy, and there’s not so much jumping around.”
On this morning, John O’Connell, a junior at Empire High School here, is pecking feverishly at his MacBook, touching up an essay on World War I for his American history class. Across the aisle, 16-year-old Jennifer Renner e-mails her friend Patrick to meet her at the bus park in half an hour. Kyle Letarte, a sophomore, peers at his screen, awaiting acknowledgment from a teacher that he has just turned in his biology homework, electronically.
“Got it, thanks,” comes the reply from Michael Frank, Kyle’s teacher.
Internet buses may soon be hauling children to school in many other districts, particularly those with long bus routes. The company marketing the router, Autonet Mobile, says it has sold them to schools or districts in Florida, Missouri and Washington, D.C.
Karen Cator, director of education technologyat the federal Department of Education, said the buses were part of a wider effort to use technology to extend learning beyond classroom walls and the six-hour school day. The Vail District, with 18 schools and 10,000 students, is sprawled across 425 square miles of subdivision, mesquite and mountain ridges southeast of Tucson. Many parents work at local Raytheon and I.B.M. plants. Others are ranchers.
The district has taken technological initiatives before. In 2005, it inaugurated Empire High as a digital school, with the district issuing students laptops instead of textbooks, and more than 100 built-in wireless access points offering a powerful Internet signal in every classroom and even on the football field.
“We have enough wireless to make your fillings hurt,” says Matt Federoff, the district’s chief information officer.
District officials got the idea for wiring the bus during occasional drives on school business to Phoenix, two hours each way, when they realized that if they doubled up, one person could drive and the other could work using a laptop and a wireless card. They wondered if Internet access on a school bus would increase students’ academic productivity, too.
But the idea for the Internet Bus really took shape in the fall, when Mr. Federoff was at home, baby on his lap, and saw an advertisement in an electronics catalog offering a “Wi-Fi hotspot in your car.”
“I thought, what if you could put that in a bus?” he said. The router cost $200, and came with a $60 a month Internet service contract. An early test came in December, when bus No. 92 carried the boys’ varsity soccer team to a tournament nearly four hours away. The ride began at 4 a.m., so many players and coaches slept en route. But between games, with the bus in a parking lot adjacent to the soccer field, players and coaches sat with laptops, fielding e-mail messages and doing homework — basically turning the bus into a Wi-Fi cafe, said Cody Bingham, the bus driver for the trip.
Mariah Nunes, a sophomore who is a team manager, said she researched an essay on bicycle safety.
“I used my laptop for pretty much the whole ride,” Mariah said. “It was quieter than it normally would have been. Everybody was pumped about the games, and there were some rowdy boys. But the coach said, ‘Let’s all be quiet and do some homework.’ And it wasn’t too different from study hall.”
Ms. Bingham recalled, “That was the quietest ride I’ve ever had with high schoolers.”
Since then, district officials have been delighted to see the amount of homework getting done, morning and evening, as Mr. Johnson picks up and drops off students along the highway that climbs from Vail through the Santa Rita mountains to Sonoita. The drive takes about 70 minutes each way.
One recent afternoon, with a wintry rain pelting the bus, 18-year-old Jeanette Roelke used her laptop to finish and send in an assignment on tax policy for her American government class.
Students were not just doing homework, of course. Even though Dylan Powell, a freshman, had vowed to devote the ride home to an algebra assignment, he instead called up a digital keyboard using GarageBand, a music-making program, and spent the next half-hour with earphones on, pretending to be a rock star, banging on the keys of his laptop and swaying back and forth in his seat.
Two seats to the rear, Jerod Reyes, another freshman, was playing SAS, an online shooting game in which players fire a machine gun at attacking zombies.
Vail’s superintendent, Calvin Baker, says he knew from the start that some students would play computer games.
“That’s a whole lot better than having them bugging each other,” Mr. Baker said.
A ride through mountains on a drizzly afternoon can be unpredictable, even on the Internet Bus. Through the windows on the left, inky clouds suddenly parted above a ridge, revealing an arc of incandescent color.
“Dude, there’s a rainbow!” shouted Morghan Sonderer, a ninth grader.
A dozen students looked up from their laptops and cellphones, abandoning technology to stare in wonder at the eastern sky.
“It’s following us!” Morghan exclaimed.
“We’re being stalked by a rainbow!” Jerod said.
On a non-standard gender marriage in Malawi. It's not clear from the article if this is a same-sex marriage or if one of the partners is transgendered.
Interesting quote: Aninsia Kachepa, Mr. Chimbalanga’s older sister, wept into her blouse at the simple mention of her jailed brother. “I have never heard of this homosexuality, and I am still not understanding,” she said.
“Tell me, how is it physically possible, one man having sex with another?”
It's not as strange as some people think, I'm sure.
Same-Sex Couple Stir Fears of a ‘Gay Agenda’
By BARRY BEARAK
BLANTYRE, Malawi — Tiwonge Chimbalanga looked like a man but said he was a woman. He helped with the cooking and dressed in feminine wraparound skirts. Steven Monjeza was a quiet, sullen man often intoxicated on sorghum beer. He said he had never been happy until he finally met the right companion.
The two celebrated their engagement — their chinkhoswe, in the Chichewa language — with a party at a lodge here in Malawi’s commercial capital. It began cheerfully enough. But later, gawkers pushed their way inside, some shouting taunts, others just staring through despising eyes. Then the electricity failed. The band stopped playing, and the bride collapsed in tears.
Someone had tipped off a newspaper, The Nation, for this betrothal was extraordinary in a conservative African nation. The resulting front-page story began with the phrase “gay lovebirds,” adding that the chinkhoswe was “the first recorded public activity for homosexuals in the country.” Readers were reminded that homosexuality carried a sentence of 5 to 14 years in prison.
Two days later, on Dec. 28, the couple was arrested on charges of unnatural acts and gross indecency, and they have been in jail since, denied bail ostensibly to keep them safe.
Much of Malawi is riveted by the case. This is not just a matter of the state versus a same-sex couple; many here believe it is a matter of Malawi against the developed world. How else, they ask, could “gayism” have crept into a place where it never before existed?
“These immoral acts are not in our culture; they are coming from outside,” said Leckford Thotho, the minister of information and civic affairs. “Otherwise, why is there all this interest from around the world? Why is money being sent?”
The clergy, especially, has accused foreigners of infecting Malawi with sexual Satanism. The Rev. Zacc Kawalala, the leader of the Word Alive Ministry and a member of the national human rights commission, said: “The West has its gay agenda. It wants to look at Africa and say, ‘If you don’t accept homosexuality, you are primitive.’ But we’re not as wicked as the West.”
Of late, anti-homosexual sentiment has been intensifying in several African nations. A law proposed in Uganda would order a life sentence — and even death — for homosexuals. In Gambia, the president demanded that gay people leave the country, threatening them with beheading. The Senegalese penal code calls for one to five years in prison for homosexual behavior.
In Malawi, a deeply impoverished, landlocked nation of 14 million, some in government have called for the inclusion of gay men in the fight against AIDS. But this is but an empty gesture in a nation where homosexuality is outlawed. Gay men and lesbians hide in more than a closet: they secret themselves in a vault. There is no such thing as gay activism.
Nor would any be tolerated. On Jan. 30, the police arrested a man — Peter Sawali — for pasting up posters saying “Gay Rights Are Human Rights.”
He now faces up to four years in prison if convicted of conduct likely to disturb the peace. “You wouldn’t allow a poster that says ‘Let’s Rape the Women,’ would you?” asked a regional police spokesman, Davie Chingwalu.
Amnesty International, Human Rights Watch and more than 40 rights groups from across the world have condemned the Malawi arrests. Some organizations have started a legal defense fund.
But in Malawi, this support is seen by many as proof of conspiracy. Some 40 percent of the government’s budget comes from foreign aid, and it is thought that homosexuality is a hidden agenda of some of the donors.
The trial of Mr. Chimbalanga and Mr. Monjeza began on Jan. 11, with hundreds gathering outside the decrepit courtroom, hooting and jeering.
Jean Kamphale, Mr. Chimbalanga’s boss at a Blantyre lodge, testified that she accepted “Auntie Tiwo” as a woman and assigned her cooking and cleaning chores. But after the article in The Nation appeared, she made her employee disrobe and refused to let him stop until he was naked from the waist down and “that’s where the cat was let out of the bag.”
Three days later, Mr. Chimbalanga arrived in court noticeably ill. His lawyers said he had contracted malaria in the hideously overcrowded jail, though the defendant later blamed guards for trying to beat him into a confession.
As Mr. Chimbalanga fell to the floor and began to vomit, spectators mocked him. “Auntie Tiwo is pregnant,” some called out. Mr. Chimbalanga was led away, only to return with a mop and pail to clean up the mess.
The trial has since been suspended, first to allow Mr. Chimbalanga to recover and now because of a labor strike within the judiciary.
In an interview last week, Mr. Monjeza, 26, presented himself as a model of remorse. “I have never had sexual feelings for ladies, but I had them with Tiwo,” he said, his words translated from Chichewa. “I am regretting my actions now. I want to apologize. I am no longer in love with Tiwo.”
On the other hand, Mr. Chimbalanga, 33, was simply indignant. “I have done nothing wrong but fall in love and declare this love for my husband,” he said.
He explained later: “I have male genitals, but inside I am a complete woman. Maybe I cannot give birth to a child, but I menstruate every month — or most months — and I can do any household chores a woman can do.”
Mr. Chimbalanga’s real name is Mabvuto Stoneck Kachepa. His original home is Chimbalanga in the Thyolo district — 40 miles from Blantyre, past the mammoth tea plantations and deep into the lush, soggy hills — and he adopted that surname after he was banished in his teenage years by his uncle, the village headman.
“Menstruation through his penis” had begun by then, a condition that may have some extremely rare medical cause, some experts say, but could also be the imagined claim of a gay man in a repressed society desperate to think himself a woman.
In Chimbalanga, the teenager was widely presumed to be bewitched. Villagers blamed the uncle for this hex; he denied it vigorously and decided it was better if his nephew lived elsewhere.
Mr. Chimbalanga is the fifth of six children, and older siblings often escorted him to traditional healers in hopes of finding an herbal cure.
“But he was too bewitched,” said Jairos Kachepa, his brother.
In recent years, when Mr. Chimbalanga visited his family, he dressed as a woman and did woman’s work, fetching water and grinding corn with a pestle. Villagers say they thought this strange, but he was well liked.
Now, the arrest has shocked and confounded them. In Chimbalanga, homosexuality — let alone the complexities of transgender issues — have never before merited public contemplation.
Aninsia Kachepa, Mr. Chimbalanga’s older sister, wept into her blouse at the simple mention of her jailed brother. “I have never heard of this homosexuality, and I am still not understanding,” she said.
“Tell me, how is it physically possible, one man having sex with another?”
One I thought I posted before, but can't find about medicine in Cuba.
Melissa Rose Mitchell was discouraged. After taking the Medical College Admission Test, she was uneasy about applying to medical schools. In prep courses for the exams, she had glimpsed her future as a doctor, and she didn't like the environment she saw. "People were like, 'What kind of doctor do you want to be?' and it was all based on how much money you make," the Oakland resident recalled. "It was a really scary moment, because this thing that all my life I had wanted to do without question, all of a sudden I'm thinking, 'I don't know if I want to do this.'"
Mitchell had scraped together the money to prepare for and take the med-school admissions test, but even as she studied, she had begun to waver. "It had taken me over a year to save the $1,400 for the test and prep course and they said, 'We recommend that you apply to no less than twenty schools,' at about $200 each." And there were still the costs of plane tickets and a proper suit to interview at schools. She did well on the exams, but Mitchell was spending a lot of money to fulfill her goal of serving the poor.
But then her boyfriend saw a blurb in a church newsletter that appeared to assuage her growing worries. It was a unique offer to study in Cuba, the impoverished nation 90 miles from Florida that is internationally known for its training and use of doctors. She applied through the Interreligious Foundation for Community Organization in New York, a group whose mission is to "increase minority participation in medicine" and therefore increase the doctor-patient ratio for underserved areas.
Cuba began educating American medical students after members of the Congressional Black Caucus met with Fidel Castro in 2000. Congressman Bennie Thompson of Mississippi told Castro about areas in his district that suffer from extreme doctor shortages. The Cuban president responded by promising scholarships for 500 Americans to attend medical school in Cuba, under the umbrella of the Latin America School of Medicine. To qualify, the students would have to show aptitude and a commitment to work in underserved communities in the United States. Since then, 34 have graduated, and more than 160 are currently enrolled.
The Bay Area, it turns out, is something of a hub for the Cuba school of thought, where Cuba-trained students, unencumbered by the massive debt that plagues grads from US medical schools, have the luxury to do the kind of medicine that Cuba instructs — family medicine. The island's medical schools focus on nutrition and other preventative approaches. Cuba also is well known for its focus on the "social determinants of health."
The Cuban experience also may provide important lessons for our current health-care crisis. With a fifth of our per capita GDP, Cuba has health statistics comparable to those of industrialized nations. In the shabby, eroding, and commodity-deprived neighborhoods of Old Havana, Cubans also enjoy a better doctor-patient ratio than Americans: 59 doctors per 10,000 people compared to 26 for us.
Cuban life expectancy also matches that of the United States, its infant mortality rate is lower, and the island's HIV/AIDS transmission is among the lowest worldwide. Cuba's aggressive health-care delivery system also costs much less — around $200 per capita annually, compared to our $7,000. And it provides timely and primary care for every citizen — near universal accessibility. To the Cuban government, health care is a right.
This fact highlights a gap in the health-care reform initiative proposed by Congress and President Obama. Those currently without insurance, who will receive coverage with the bill, will feel the lack of family practitioners as basic care continues to be undervalued in favor of more profitable types of medicine.
At a White House forum early last year, the president spelled out the problem bluntly: "We're not producing enough primary-care physicians," he said, pointing to a daunting chain of obstacles. "The costs of medical education are so high that people feel that they've got to specialize."
According to the Association of American Medical Colleges, the average debt for a US medical school graduate in 2008 was $154,607. American doctors, as a result, feel forced to take up specialized practice, because ultimately the higher pay will ease their enormous student debt. Yet without enough primary care doctors, experts say, health-care costs grow exorbitant, end-stage care increases, and thousands of family practice residence positions go unfilled every year.
Doctors graduating in Cuba have no such excuse to specialize, and the island does not graduate members of an elite profession. Instead, it's a veritable doctor-producing machine with more than 70,000 physicians for a population of just 11 million.
And after medical school in Havana, Mitchell would return to the United States debt free.
Many students enter American medical schools wanting to do family care but get discouraged, said Dr. Richard Quint, retired faculty at UC San Francisco and a medical consultant to the Oakland nonprofit group Medical Education Cooperation with Cuba. American medical schools deem primary care as having secondary import, he contends. "The overall structure of our 'non-health system' is fragmented and skewed toward specialty practices," he said. "Faculty in medical schools make comments suggesting you shouldn't go into primary care because it's not stimulating or high-achieving enough." It also no secret that physicians are reimbursed highly for procedures and surgeries rather than for preventive medicine and diagnoses. And the need for primary care in underserved areas often doesn't make it into the textbooks or the classroom.
When it comes to preventative care, the shortcomings in American medical education mirror the failings in our health-care system as a whole. "There's nothing the Cubans are doing that people couldn't think of here — it's just they are looking upstream" at prevention, explained Dr. Lynn Berry, chronic disease program manager at Oakland's Highland Hospital, who has conducted research in Cuba.
Berry pointed out that Alameda County has "pretty strong" community health care. "We have La Clínica de La Raza, the Ethnic Health Institute, Native American Health Services," which emphasize prevention and education to avoid the costs, medical and financial, of end-stage care. But "ours is a market system," Berry said, a system "organized around insurance and payer source, not necessarily the long-term health of the patient."
Cuba redesigned its medical system out of financial necessity following the collapse of the Soviet Union. Faced with a supply crisis brought on by the lack of Soviet funding, Cuba revamped its medical education system towards primary care. By the mid-Nineties, they had established a comprehensive neighborhood-based family medicine standard: a consultario (neighborhood clinic) in every locale, and a revised medical school curriculum to embed family care into the model.
The island's health care starts with a top-down mandate for a "bottom-up" approach to health care. Too poor to rely on high-tech equipment or expensive, invasive procedures, the Cuban model stresses prevention and spreads health-care responsibility beyond doctors — into schools, work sites, and neighborhoods. A national network of polyclinics ensures the mandate. People in all walks of life are expected to cooperate in health publicity campaigns and other measures to prevent disease.
The United States' fifty-year-old embargo on goods to the island also has played a role in shaping Cuba's medical care system. The embargo prohibits or restricts the sale of some medical equipment and punishes other countries that deliver essential cargo. Drugs and medical supplies are sporadic, especially in Cuba's rural areas, where clinics work with outdated X-ray machines. And because US pharmaceutical companies develop most major new drugs, Cuban physicians don't have access to many new medicines on the world market. Countries like Spain and Venezuela donate, but routine medical supplies remain scarce or absent from some Cuban clinics.
Still, Dr. Davida Flattery, an internist at Highland Hospital, was struck by Cuba's "bottom-up" approach when she observed their health system last year. "What really impressed me about Cuba was their focus on the non-medical determinants of health," she said. It's standard in Cuba, she added, to engage the psycho-social factors of a patient — level of sanitation, presence of abuse or addiction, and food habits. Doctors and nurses, in fact, make home visits to evaluate these things personally.
Americans trained in Cuba see firsthand the glaring differences between the two medical education systems. Melissa Rose Mitchell learned, for example, that Cuba highlights rural medicine. "In lots of situations the professor will ask, 'What's the best test?' We'll say 'CT scan, ultrasound.' They'll say 'Well you don't have ultrasound, you're in the middle of nowhere, in the mountains, you have no electricity or phone. ... What are you going to do?'"
Many past and current students of the Latin American School of Medicine in Havana, where Mitchell attended, had lived or worked in poor and underserved neighborhoods in the United States, and were chosen to study in Cuba so they could take what they learned back home. And their Cuban education equipped them to deal with health problems of the poorest communities in the United States far better than if they had gone to Harvard.
Havana medical students, for example, are trained to stabilize people in places with no electricity or potable water. One might think those skills irrelevant in the wealthy United States, but a number of poor American communities have come to resemble sections of Third World countries — especially after a disaster (see Hurricane Katrina).
The lack of doctors in America's neediest communities is exactly what the Interreligious Foundation for Community Organization wanted to remedy as they began recruiting for the Cuban scholarships. The resulting program also is quite diverse — far more diverse group than any US med school. The majority of students in Latin American School of Medicine in Havana are African Americans from New York or California, 85 percent are minorities, and 73 percent are women.
And most of the students are trained as "médicos de la familia," or family practitioners. But, as the students saw, medical supply shortages plague the system, and despite diabetes intervention and screening programs in schools and workplaces across the country, the Cuban national diet remains high in fat and sugar. Like the US poor, Cubans don't have easy access to fresh fruits and vegetables — or the habit of eating them — and this hinders their health. Cuba's food distribution system from the countryside to the cities is substandard. The nation imports more than 50 percent of its food.
Mitchell said the training and experience suited her. "They train us just like they train Cubans," she said. "Every Cuban, regardless of specialty, has to do two years of family medicine. Until you can deal with basic, vital situations, you are not allowed to mess with other parts of the body."
After graduating last summer, Mitchell settled in Oakland to work and prepare for the boards, but she says her calling is rural medicine. She used her summer breaks from medical school, in fact, to work in a mobile health-care clinic serving rural populations outside of Birmingham, Alabama, a conservative city with stark wealth disparities. "Every two weeks or once a month, this clinic on wheels visited parts of the state where some of the houses did not have electricity or indoor plumbing. Not because it couldn't be gotten, but because people didn't have the money to invest in it." When asked if the poverty compared to that of rural Cuba, she responded: "The poverty was more intense" in some areas of rural Alabama than in rural Cuba, she said, "because there were no social services."
Yet back home Mitchell faced disapproval — even hostility — for deciding on a nonspecialized practice. "My first experience going home, my aunt and I had a heated argument — me saying I didn't want to specialize and if I did it would be family medicine or rural medicine. Her argument was anybody who had any sense would become a neurosurgeon or a cardiologist. But my image of a doctor is someone who can handle any situation that comes up."
And having witnessed the obstacles facing Cuba, the returning American doctors are scandalized with the state of health care at home. Mitchell works as a part-time medical assistant at a Bay Area clinic and doesn't have insurance herself. "There have definitely been a couple of times I've been sick and couldn't afford to see a doctor," she said.
"A friend did me a favor by seeing me, but I had to pay $60 for antibiotics — that was with the clinic's discount."
Before moving to Oakland as a teen, Pasha Jackson saw firsthand on the streets of South Central Los Angeles the power of nonmedical, psychosocial factors to spread disease — both physical and mental. Violence, joblessness, and addiction merge with poverty to leave many residents out of the health-care system. "What does primary care mean for the people around me?" he said. "It's self-medication. Junk and drinking. These people really need attention, and insurance will deny them for a list of reasons."
But Jackson didn't know he wanted to study medicine until he sustained a football injury. Recruited from City College of San Francisco by the University of Oklahoma, he went on to play for the San Francisco 49ers and Oakland Raiders. But academic advisors throughout high school and college, he said, actively discouraged his interest in science. "They said it was too hard," and that his best chances were with football.
Reassigned by the Raiders to NFL Europe, Jackson tore his left pectoral — "a huge injury for a linebacker," he noted. "Once I left the NFL my health care ended, and to go to Cuba I needed shots and checkups to travel internationally. I couldn't believe what I had to go through. After calling around to public clinics, I had to wait for weeks and miss a day of work to see a doctor that didn't want to see me."
Jackson spent a year recuperating and getting physical therapy. And during that time, the effects of Hurricane Katrina reminded him of the deep connection between poverty and disease. "I knew I didn't want to play football anymore," Jackson said. "In the NFL there's so much waste, the playing with the money and power. I saw how much a part it was of the capitalist system."
Disgusted with professional football, Jackson went to the Interreligious Foundation for Community Organization's web site and applied. The Cuba program "had me in Cuba, where I could learn Spanish; covered me financially; and got me back to science." With that, Pasha Jackson went socialist.
On summer break from his studies in Cuba, Jackson and more than a dozen other students from the Latin American School of Medicine visited deprived American communities to deliver basic health services and expand their own cultural competency. Los Angeles' Skid Row, a place with "ridiculous numbers of homeless people," was one stop on the trip, Jackson recalled. "Mora County [New Mexico] has hardly any doctors." They stopped at Pajarito Mesa, "where the Pueblo Indians live, with no potable water and no electricity. It shows you," Jackson said. "There's the Third World — right here. There are no national boundaries."
<"When the earthquake hit in Haiti, over 400 Cuban medical personnel were already there - they've been there for years," said Dr. Nelson Valdez, Professor Emeritus of Sociology at the University of New Mexico and Director of Cuba-L, which monitors news related to Cuba. According to Medical Education Cooperation with Cuba, some 700 Haitian medical students in Cuba study at the Santiago de Cuba campus of the Latin American Medical School. Cuba is sending doctors and students in droves to treat tens of thousands Haitians lying wounded in hospitals with zero or few doctors. "No one is reporting on the Cuban presence in Haiti," commented Valdez, though he said he wasn't surprised. "The additional doctors being sent are part of the same team that was offered to the United States by Cuba when hurricane Katrina hit." The assistance was refused. Valdez also said the Cuban doctors, solidly trained in disaster medicine, provide psychological as well as physical attention to victims.
The State Department announced that U.S. aid workers would cooperate with Cubans on the ground in Haiti. Those who've observed what we can learn from the Cuban medical approach -- scholars and physicians, new and veteran -- all agree that cooperation and conversation with Cuba, at least in this respect, might bring us all some relief.
I have one more coming, but it's long.
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