Early Detection, Early Response

My friend Peter from FabHappy recently posted to Life in the Right Direction about the TED talk from 2006 by Larry Brilliant. Here at home, we watched the talk earlier and were surprised by much of what we saw. If you’ve not see it and don’t work in the field of global medicine, you will be amazed by the simple message: early detection, early response.

I commented on his post. ‘Cheap air travel may be a thing of the past. Imagine how Europe would cope if just 1% of the people living in China and India decided to take a European package holiday in 2021. Tourism may be the biggest class of business casualty.’ Maybe. Maybe not. It’s a possible consequence we’ve been discussing here at home, on sundowner social video calls with friends and family we’ve not otherwise seen for last the 29 days of curfew. Changes to global tourism was something Peter Frankopan mentioned in The New Silk Road (2018), the arrival of newly wealthy middle class tourists from Asia – that was before Covid.

Among  many other things, the Brilliant TED talk brought back personal memories of people lining up for free medical attention in Yangon in 1992. They were outside the International Airport in Mingaladon, to which I often jogged before dinner. I lived and worked in an office down by Inya Lake, so it was often good to have a mind-clearing run up the Pyay Road. I’d run past the Myanmar Golf Course and then turn for home at the airport. The worryingly young soldiers who stood on most intersections and indeed, guarded the road leading to our compound with bolt action rifles, often rusted-solid, wouldn’t restrict our movements for such exercise. Movement for foreigners were supposed to be for essential purposes only.  We were expected to remain politically isolated in our compounds for our eight week visits. We needed military passes to travel out of the city limits. I’m exaggerating very slightly. We hired local drivers so that we had ways to get about. Our errant behaviour was tolerated but we were watched.

Many curious things happened to this jogger while flaunting the political rules, and on one occasion, I saw many blind people lining up for medical attention. Not quite the massive John Singer Sargent Gassed that hangs in the Imperial War Museum in London, the scene in front of me had shoulder touching similarity, and many more afflicted than in the painting. I saw a fair share of suffering in Burma. So, honestly, this wasn’t the worst of it. Indeed, it wasn’t as hopeless as some horrors I witnessed given that there was a medical plane on the apron.

I can’t recall if the plane that was on the apron was from Orbis or some another global  initiative. My recollection is that the government allowed the visiting charity to examine and work on patients over the course of a few days. The big concession was that the military junta and the Tatmadaw allowed those patients onto the airfield. Fred Hollows was somehow involved, not personally but the plane was there as a consequence of his work, according to announcements made in the daily paper.  No matter the failing memory, you couldn’t believe what you read in the military controlled newspaper anyway. What does matter is that a global initiative was bringing some benefit to a very restrictive country.

And if you watch Larry Brilliant’s My wish: Help me stop pandemics, you should enjoy seeing how global action can really work to alleviate suffering and misery. Know that George W Bush recognised the need to prepare for pandemics and spoke of it publicly in 2005. Bill Gates was on stage in 2015 talking about the same but there was something about the messenger’s route to philanthropy that seemed to undermine his authority (a topic for another day). Early detection, early response.

A change in topic came to mind as I was typing.

"When the light is green you go. 
When the light is red you stop.
But what do you do
When the light turns blue
With orange and lavender spots?”
Shel Silverstein, A Light in the Attic, Harper & Row 1981

I once got into trouble because of this poem. We’d read it, and many more besides, to our kids at night, many times. One night in 1988 was different. I was really frustrated with some policies at the office and while reading aloud, I realised the poem was describing my professional challenge very well. We had big computers, very big. Very, very big for the day. And linked to computers elsewhere. And they too were very big. We distributed our data on magnetic tapes to the various sites and ascribed priorities to the work to be performed. Some runs could take weeks and we had a system that informed us of the cost of each and every run. And cost concious administrators made rules. So many rules that sometimes the rules got in the way. One of the rules was that the coding of the jobs had to be approved lest they might waste time. Time might be lost because the workflow was inefficient. Time might be lost because the code was wrong. Time was money was time. And then there was another challenge. Some parameters had ranges that were deemed scientifically risky in the wrong context. And their use required another level of supervisory approval.  But while I was qualified to make such decisions, as were some of my colleagues, we weren’t authorised to do so.  Which meant seeking permission from another group of experts.

So I proposed an alternative to remove this bottleneck. And in doing so, I included the poem because I thought that Shel Silverstein described the problem succinctly. The unintended consequence became obvious in my manager’s office. The management shouted and shook like the children they thought I had implied they were. Yet, a committee was formed and they decided a rule change was sensible. And the committee findings were brought to management who concurred. And of course, I was happy because the clever people who ran these things, came up with a way to improve our system. Perhaps one day I’ll tell you what happened when I brought a telephone answering  machine into my office (maybe I don’t need to, even the spellchecker joked ‘angering’ as I typed ‘answering’).

I’m on a roll. Imagine requesting an update on the likely timing of an approval for an important expenditure that involved healthcare. Imagine getting a letter in reply that corrected the misspellings without addressing the subject. Imagine that since the subject line was unchanged, the matter was deemed to have been addressed. Know that this was not government business. This was internal behaviour of one of the biggest companies in the world at the time. And all was done by letter. Postal letters. We got what we needed just before we left Africa. Five months too late. Around the same time two dozen live oysters were delivered by charter, then private plane and finally a helicopter to our camp because it was Christmas in the deep Sahara. Of course, the local cook had never seen an oyster before, so he shelled and fried whatever they were and served them with the fried eggs that most everyone liked for breakfast.

Remember. Early detection, early response.