Joining the tragic dots

As readers of The Growlery have noticed, I have been absent for just a heartbeat under four weeks now. Nothing to worry about; just the result of my having, yet again, overstretched and ended up for a while with too few hours in day or days in the week to keep every plate in the air. Thanks to all those who sent solicitous enquiries ... and apologies for the lateness or absence of responses. Apologies, too, to all those friends whose emails have gone unanswered, achievements unnoticed, birthdays and anniversaries unacknowledged...

Ploughing through the backlog, one of the highlights which I discovered that I had missed was a paper in the Journal of Trauma and Acute Care Surgery, coauthored by my long suffering friend (and fellow Melanie Safka fan) Barbara Claire. Barbara is a member of the Violence Prevention Research Program at UC Davis' Medical Center, which consistently does excellent work on causes of and contributory factors in violence related injury. She also manages to be president (also publisher and webmaster) of a historical society, a prime mover in a museum, rescuer of dogs in need, Charles Dickens enthusiast ... Amongst these and many other calls on her time, she finds time to heroically and single handedly sustain our friendship across the decades despite my abysmal failings as a correspondent. (Thank you, Barbara: I don't deserve you, but I'm so very glad you're still there.)

Anyway ... to return to the point: this research paper, which I have just belatedly read.

The paper is both instructive and depressing reading. One of the things which has occupied my excess time over the past month or so has been data collection and analysis for a group of charities dealing with a society thrown into a state of effective civil war. Injuries confronting overstretched (often overwhelmed) medical facilities in such a situation invariably include a very high proportion of what militaryspeak likes to call "collateral damage" casualties. Despite experience with that fact, and back of my mind knowledge that bystanders do get involved in criminal exchanges (the high profile cases of Jessica Crichlow and Thusha Kamaleswaran in London come to mind ), I have never really gotten around to joining up the dots between one context and the other. Reading this paper in its entirety gave me a great deal to think about; but it was a single background paragraph that suddenly made the emotional link.

“Stray bullet shootings contribute to a sense of insecurity and fear in affected communities. Children may be sent to stay with friends or relatives in lower risk neighborhoods after school and may be required to remain indoors after dark (and during the day, unless with an adult). They are taught to avoid crowds and people talking loudly, run when they see weapons, drop to the ground when they hear gunfire while outside, and take cover away from windows if indoors – in the bathtub, if possible. Adults become hypervigilant. They, too, stay indoors, during the day and at night. They may run errands in the morning or on weekends, when gunfire is less common.”

That could have been written about many communities recognised as being in fully blown civil war, including my focus of the last month. It could have been written about Beirut in the last quarter of the twentieth century, Bosnia after the break up of Jugoslavia, or Syria now. It could have been written about Belfast during the worst days of "The Troubles".

But it isn't. It's describing communities within a western liberal democracy assumed to be at peace, where the study nevertheless found that “stray bullet deaths accounted for 45% of all firearm homicides among children aged 10 years or younger”. It's left me very thoughtful.

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• Garen J Wintemute, Barbara E Claire, et al., "Epidemiology and clinical aspects of stray bullet shootings in the United States" in The Journal of Trauma and Acute Care Surgery, July 2012. 73(1): p. 215-223. [copy of the paper available here]

Case in point

A collection of case studies from recent science literature highlight the importance of statistics...

• Beating the drought: using GenStat to investigate drought tolerance in chick peas.

• Reading the future: multivariate data analysis of brain patterns using IDL gives improved prognosis for improved reading in dyslexia sufferers.

• Committing fluicide: OriginPro analyses the viricidal potential of hydrophobic polycations.

• Fishy business: Statistica analysis of otolith microchemistry data illuminates population relationships amongst Atlantic herring.

• Wears the diamonds?: Multiple linear regression in SPSS offers a way to better prediction of wear rates in industrial cutting tools.

• Learning from past mistakes: Pursuing future geopolitics through historical data with Wolfram Mathematica.

Bus stop

I met a very interesting person, today.

It was seven in the morning, and the air was bitterly cold as I arrived at the bus stop. My bus was due in ten minutes. The man already standing there with no hat told me that he had been waiting for half an hour, he had given up on the bus he'd come for and was now looking forward to the next.

We got chatting, as people do when they stand for any length of time together in the dark and the cold. We compared notes on this and that, and eventually got around to what we do.

He is a doctor, a GP working in a practice at the other end of two bus routes. That already puts him above me in the scale of things; the world needs doctors more than it needs mathematicians. But as we talked, there was more. He is Senegalese. He trained at the University of California medical school at Davis. He runs a free clinic in Senegal.

Hang on ... wind back a bit ... if he runs a free clinic in West Africa, what is he doing at a bus stop on the western edge of Europe?

He is, I learned, one of several doctors at the clinic. Since free clinics generate no income, and since this one is unfunded, money has to come from somewhere to pay its running costs and to feed the families of the staff (medical and otherwise). So, the doctors take it in turns to take contracts in developed economies. The income from these contracts goes to maintain the clinic, its staff, and their dependents. My bus stop companion is in his sixties and half way through a two year contract, a year away from his family whom he misses desperately and with another year to go.

That this system is able to work depends, of course, on the same asymmetry which makes it necessary: the yawning gulf between first and third world economies. This doctor, and his colleagues, live and work at one end of an economic gravity well where money is scarce so costs and incomes are low. They have found a way to exploit that same gradient, using it to make a first world salary run a clinic, pay operating costs (including salaries), and provide pension provision for old age.

I've seen a fair amount of quiet heroism in the face of third world poverty and health needs. In the field, I've carried bedpans or washed bandages or ... but then I've always scuttled back to my comfortable first world billet. I've supported campaigns to fund third world medicine ... but never for even a day to the extent that this man and his partners do, across whole lifetimes. Any of them could stay permanently in our more comfortable settings, bring their families with them, reap the rewards of the hard work which gained them the qualifications and expertise which they now possess ... but they don't.

I didn't get around to asking where the pump priming finance came from, to put him through a US medical school in the first place. Wherever it came from, though, it wasn't used to buy his way out of hardship; it has been ploughed back over a lifetime into his roots.

Four of the charity links at the top left of this page point to organisations concerned with the third world; two of them are medical; one is dedicated to helping communities meet long term health issues and thus escape a cycle which they can't afford to break on their own. If you have money which you are inclined to donate, any one of those charities (and many more besides) would be a worthy recipient – but, after my bus stop conversation, Health Poverty Action (formerly Health Unlimited) is the one that will get any extra that I have available this festive season. And if you want to combine a lifeline with present giving, they have a selection of ideas starting from as little as US$8/€6/£5 (a contribution to child health monitoring) running up by easy increments ($16/€12/£10, $24/€18/£15...) through a set of surgical instruments ($160/€120/£100) to the top whack installation of a life saving water system ($630/€470/£400).