A gang truce in Honduras, with a Canadian connection

Gang members, Adam Blackwell, in El Salvador jail
The big news in Honduras this week is a gang truce, with a Canadian connection. The deal was brokered by the Catholic archbishop and a Canadian diplomat who works with the Organization of American States and played a similar role in El Salvador.
It�s a bit surreal. The gang leaders have issued press releases, just like any political leaders. (Except from prison, and with bandanas over their faces.)
It�s also a positive step, despite lots of questions. The two main gangs - Mara Salvatrucha, or MS-13, and Mara 18, or M18, - have signed on. They pledged to stop recruiting new members and committing acts of violence.
The truce in El Salvador, also brokered by the church and Adam Blackwell, the Canadian who is the OAS �Secretary of Multidimensional Security,� has made a huge difference in the murder rate. The rate in El Salvador fell by 52 per cent after the truce, the government says. (The murder rate fell to 38 murders per hundred thousand people. The Honduran rate in 2012 was 87; Canada�s was 1.7.)
The El Salvador truce was hardly a panacea. Gang members are still criminals, and - as in Honduras - extortion is still central to their business model. If you have a business, or drive a taxi or bus, or sell fruits and vegetables, gang members collect a weekly �tax.� 
And truce or not, extortion only works when the victims fear violence and death if they don�t pay. 
The numbers - in either country - are staggering. An El Salvador business group did an informal survey of members, asking if they or their business had been affected by crime in the previous 12 months - extortion, kidnapping, thefts, assault. 
More than 70 per cent said yes; 55 per cent said they had been affected by crime more than once in the previous 12 months.
La Prensa reported last month that extortion is worth $63 million a year to the gangs, and that some 17,000 small businesses had just given up and shut down in the past year because of the gang�s demands.
And there are doubts that the impact will be as great in Honduras. Observers say the gangs are less well-organized, and the truce might be ignored on the street. And gangs here are claimed to be a smaller cause of violence than in El Salvador. A 2010 UN report found gangs were responsible for about 30 per cent of murders.
But people said much the same thing about the El Salvador truce.
Any reduction in the murder rate would be great news. The daily toll of some 20 dead bodies is terrible for families.
And the fact that Honduras has the highest murder rate in the world has become the only thing people know about the country. The news reports are grisly. Potential tourists don�t know that most murders are related to gangs, drugs or feuds, and crime is focused in poor urban neighbourhoods. Or that tourists are not targeted.
So perhaps only half the gang members will accept the truce. Based on the UN estimates, that would mean a 15-per-cent drop in the murder rate - almost 1,100 fewer murders in a year.
There are all sorts of issues still to be sorted. Gang members are worried about continuing police violence. Some Hondurans reject the idea that gangs might not face responsibility for past crimes as part of the deal.
And the government�s role and the future of gang members is unclear. Estimates vary wildly, but assume about 7,000 people are currently active gang members. They might stop killing each other, but without alternatives they aren�t likely to give up crime.
Still, even with all the caveats and unanswered questions, the truce is a good thing for Honduras.
Footnote: The two main gangs - Mara Salvatrucha, or MS-13, and Mara 18, or M18 - have their roots in Los Angeles, started by the children of a wave of Central American immigrants in the 1980s. They've grown into full-scale multinationals, in part because of a U.S. policy of deporting non-citizen offenders instead of dealing with them in the justice system. That's helped the gangs spread rapidly throughout this region.

For more information
Insight Crime has an excellent briefing on the truce here.

For-profit health care: When surgical complications are good for business

I believe market forces and the pursuit of profits often bring creativity and innovation.
But not so much for health care. The problem was nicely crystallized in a Business Week article I read years ago, profiling the star CEO of a hospital chain. He was lauded for increasing revenue per patient, a key indicator. A few more tests, an extra day in hospital, fees for every aspririn dispensed, and the corporation does well and the CEO gets a bonus.
The problem was set out more starkly in a Wall Street Journal I snagged in one of the airports on the way back to Copan Ruinas from Victoria. 
It reported on a study that found U.S. hospitals make more money when a surgical patient has complications after surgery. A lot more money.
Thus there was no economic incentive to reduce avoidable medical complications that cause thousands of deaths and add billions to health care costs.
In fact, market forces worked against reducing surgical complications.
The study was legit. It was reported in the Journal of the American Medical Association and done by researchers from the Harvard Medical School, Boston Consulting Group and Texas Health Resources.
They looked at more than 34,000 surgical patients in 12 hospitals owned by Texas Health Resources.
And they found surgical complications - many avoidable - were good for business. Infections, complications, strokes, they all boosted the hospitals� bottom line. The study found hospitals made an average $56,000 in profit from each privately insured patient who suffered complications, compared with an average $17,000 when the surgery went well. There were complications in about six per cent of surgeries, a fairly typical rate.
I�m not suggesting corporate execs, wringing their hands like Montgomery Burns, are plotting to have surgeons leave instruments inside patients or skimp on handwashing. (The latter surprisingly common.) The managers go home to their families too.
But proponents of private care can�t have it both ways. They argue market forces - the push for bigger profits - will �incentivize� improvements in care.
So they have to acknowledge market forces now discourage efforts to reduce complications.  
No managers would say they like surgical complications because they are profitable. 
But they might say that spending on projects to address other problems is a higher priority. It�s not easy to explain the benefits of investing in programs that will reduce the companies� profits.
Free-enterprise extremists likely have answers. The insurance companies, they might argue, should be pressing the hospitals to reduce surgical complications. The smart insurers would use the safest, lowest-cost hospitals, and cut premiums and attract more customers.
Except that isn�t happening. There are some 200,000 preventable deaths a year related to U.S. hospital stays. The rate of deaths from surgical complications has been declining, but slowly. 
The market isn�t working. Maybe the hospitals have too much power, or the insurers can charge what they like and have little incentive to push for better performance. It doesn�t really matter to the people who suffer as a result of avoidable complications, or everyone who pays higher health insurance premiums that flow to hospital shareholders.
There are still useful ways to encourage innovation through competition in a largely public system. (And we have an largely public system. Doctors are effectively Health Ministry employees with a great collective agreement.) 
Hospitals that find ways to deliver successful surgical outcomes could get extra funding, or financial incentives for participants. Why not? Everyone benefits if we can cut complications, or do four hip replacements for the cost of three. 
Meanwhile, proponents of private care face a problem. The current reality is that surgical complications are good for private hospitals in the U.S. And that is bad for patients.

'Research fishery' for Queen conch and the tragedy of the commons

Sometimes news stories just set off all kinds of alarm bells.
Honduras has apparently learned from Japan�s bogus scientific whaling program, which lets that country�s operators kill 900 whales a year - and sell the meat - in the name of science.
The Honduran government has announced a Queen conch fishery, justified as �a research and evaluation project for monitoring giant snail populations.�
It looks more like a way around restrictions on the fishery.
A lot of people have seen golden Queen conch shells, with their pink-tinged centres and classic spiral shape. They were a popular souvenir of Florida a generation ago, and thrived in waters from Florida to northern Brazil. 
They�re considered tasty, and are easy to harvest. Not good for them.
Queen conch aren�t on endangered lists yet, but CITES - the Convention on Trade in Endangered Species - has recommended an embargo on exports from Honduras, Haiti, and the Dominican Republic. CITES pitches the embargo as a way to support government conservation measures - if there is no market, there is no reason to grab the conch.
It�s loosely observed, and fishers still harvest both for export and local markets - conch soup, with coconut milk base, is a popular item on the Honduran coast. 
The government�s research fishery looks like a way to get around the export ban.
Honduras is going to let six ships capture 210 tonnes of Queen conch. About 100,000 conch. 
And 95 per cent of the catch is reserved for export, mostly to the U.S.
It�s hard not to be suspicious. If the government wanted to assess Queen conch stocks, it could co-operate with a university or look for grants for a survey. Grabbing 210 tonnes of a possibly endangered shellfish in the name of research seems dubious.
The whole tragedy of the commons theory is lived out vividly here. Serious poverty is a factor. So is the near-total absence of effectively enforced laws and regulations. Why should a small fisherman obey limits on Queen conch catches when people with influence can get access to a �research fishery�? (Or why should a campesino respect a forest reserve, or water source, when others are conducting illegal logging?)
Of course, North Americans shouldn�t be too judgmental of practices that evoke our relatively recent past. We moved to Copan Ruinas from British Columbia. That province built its current prosperity by logging old-growth forests. Wild salmon runs were sacrificed for quick profits for the fishing industry, developers and forest companies. It�s no different than grabbing the last of the Queen conches, except Hondurans are more legitimately desperate.
The theoretical argument for conservation is sound. Manage the resource and you will have sustainable economic activity long into the future. 
But the argument didn�t persuade British Columbians. Why should Hondurans, so much poorer, think it a good idea?
It�s great to talk about tourist potential and the economic value of preserving tropical jungles and deserted beaches and coral reefs and vast mangrove shorelines. The economic argument for conservation.
But not realistic. We were in La Moskitia, the vast biosphere in  southern Honduras, and it is spectacular - unspoiled nature, beaches, lagoons, fascinating cultures. But the roads are poor to nonexistent, there is no tourist infrastructure and travel is a challenge.
And the Honduran government�s total tourism promotion budget this year is $2.2 million. Destination BC has $49 million to promote one province.
Still, the alternative is grim. The newspaper reported last week that a company had cleared 50 acres of protected mangroves for a new shrimp farm. The story said nothing about investigations, or sanctions. The lesson is to join the gold rush, in conch or shrimp or logging or African palm plantations.
And La Moskitia includes the Rio Platano Biosphere Reserve, a UNESCO World Heritage Site. But since 2011, the reserve has been in UNESCO�s World Heritage in Danger list. Illegal logging and farming are factors, according to the UN agency. 
But so are the Honduran government�s lack of capacity and �general deterioration of law and order and the security situation in the region.� (It is a popular transit point for northbound cocaine shipments.)
Ultimately, for the Queen conch and La Moskitia and the mangroves and rain forest and so much more, that�s the greatest problem. There are solutions, and perhaps international partners to help. But only if the Honduran government can play a role..

Too broke, or too disorganized, to keep the national gallery open

The Honduran National Gallery of Art locked its doors this week.
The government hasn�t provided any money since January. Staff haven�t been paid since November. They finally quit coming to work, and now management has chained the doors and started packing away some of the works.
The gallery is good. We visited, looking to kill time in Tegucigalpa, the capital, and liked it.
It�s in a 450-year old convent, a beautiful two-storey building with an open courtyard. There are about six galleries, and they cover art in Honduras from pre-Columbian carvings, through the religious art of the Spanish era and into the contemporary scene. There is a nice auditorium, and gardens in the courtyard.
The displays are basic, but that adds to the power of some work, especially the religious paintings and spectacular silver from the colonial-era churches.
I gave it a glowing review on TripAdvisor.
It�s a bad sign, I think, when a government can�t make the budgeted payments to the national gallery. It�s not even big money; gallery managers say $45,000 would be enough to open the doors and get through the next four months. The total annual budget is about $135,000.
None of this is surprising. Stories of government employees going unpaid for months - teachers, health workers, anyone - are regular features in the newspapers. Sometimes, it seems the government simply can�t get its act together to issue the cheques. Sometimes there is no money. (Sometimes, I�m sure, the employees� claims are bogus.)
What�s surprising, for a North American, is that people keeping showing up for work for months without getting paid.
Mostly, that�s what happens when people really need a job and have no other prospects. You keep on heading into work, hoping some day that you�ll get some of that back pay and the regular wages will start flowing. Why not? There is nothing much else to do.
But it might also reflect a cultural value of just accepting life�s blows and keeping on. (Written down, that looks practically noble; in practice, it look more like learned helplessness.)
The failure to pay people also illustrates another problem. Hondurans talk a lot about �impunidad� - the ability of some people to ignore laws without consequences. 
Honduras has a fine set of laws and regulations. They just aren�t enforced.
There are legal minimum wages, for example, based on the nature of work and size and location of company. But employers can ignore them without fear of consequences. Or they can simply refuse to pay people for months at a time.
It�s new to be in a land where the government doesn�t have the money to pay the bills. Canadian governments, even in deficit years, can borrow whatever they need to cover budgeted costs.
The Honduras government can�t do that. Tax exemptions and evasion are widespread, so revenues are low. The domestic borrowing market has been tapped out, and foreign borrowing is difficult and interest rates are high. Some months, there just isn�t enough money to cover costs, or pay salaries. And, eventually, people get fed up.
A national art gallery isn�t essential. (Though Tegucigalpa has few attractions for visitors - a couple of other museums, a great nearby national park. The gallery could be a draw. And it is a refuge just a few blocks from the central square and the quite ratty downtown - the neglected office buildings call up the end years of the Soviet bloc.)
Government could even have decided to close the gallery�s doors to save money in tough times.
But it didn�t. The Finance Ministry just failed to send the promised money, month after month.
And, finally, the national gallery closed its doors, for who knows how long.

Four reasons the Liberals won, and the NDP lost

So why did the NDP lead in the polls evaporate?
Sure, the $17 million in taxpayers� money spent promoting the Liberals was a factor, as were the negative ads. 
From far away, I�d offer four more basic reasons.
Christy Clark and the Liberals ran a tidy campaign with a simple message. The Liberals, they said, would manage the economy better and protect jobs. They gave people something to vote for, in a vague and not particularly credible way.
They also ran gave people reasons not to vote for the NDP, arguing Adrian Dix was at best an unknown quantity and the party platform unclear. (And talking a lot of rubbish about the NDP as well.)
Adrian Dix and the New Democrats did not give people something to vote for. There was a platform, of course, and excellent positions on some issues, like banning corporate and union donations. But by the end of the campaign, the main message seemed to be that the New Democrats would be careful. That�s a laudable quality. But it�s not a substitute for a vision of what B.C. would be like in four years, or 10 years.
And the New Democrats failed to give people reasons not to vote for the Liberals. It�s welcome that the party pledged to avoid the kind of slimy attack ads that too often pollute politics. (Like the ones the Liberals used against Dix and Cummins.)
But it would have been completely legitimate to suggest that voters should be suspicious of the Liberal campaign, citing the example of the HST and the 2009 pre-election budget that turned out to be fiction. It would be just as legitimate to talk about the Basi-Virk payment, or growing secrecy, or attempts to limit the role of independent watchdogs like the auditor general and the representative for children and youth, or cronyism. Or the current budget, which falls somewhere between dubious and bogus.
Of course, everything is clear after the fact. And, as it said on a coffee mug a reporter gave me in my days as an editor, �Everything is easy for the man who doesn�t have to do it himself.�

Julia the banana seller: Putting a face to Honduras' poor

Julia P�rez Alvarado and part of her large family

On a good day, Julia P�rez Alvarado makes about $6 selling bananas in Tegucigalpa neighbourhoods. Not much for a single mom with eight children.
But pretty typical for the way many, or most, Hondurans scratch out a subsistence living. In fact, Alvarado�s take on good days is pretty typical wage for a laborer or household worker. 
La Tribuna has been doing regular stories on poor people around the city.
For me, they�re great. It feels pushy to start grilling strangers about their lives in bad Spanish. 
But I�ve been curious about the women who sell bananas outside the market in Copan, crouching on the sidewalk.
Statistics are important. This week, the Honduran national statistic�s agency reported 69 per cent of Hondurans live in poverty. About 24 per cent survive on less than $1 a day.
People�s stories are important too.
More children? 'Only God knows'
Alvarado�s business model is simple, according to the paper. She leaves her house - a shack really - at 5 a.m. each morning and walks an hour to a largish market. She buys 200 minimos - a variety of small bananas - for about $4, or two cents each. Then she walks kilometres selling them door-to-door in neighbourhoods for five cents each. (Which is the same as I pay at the market.)
Is she sells out, she makes $6. If she doesn�t sell at least 80 bananas, she loses money.
At 41, she has eight children, the oldest 23. She left her husband because he was jealous and beat here, she told La Tribuna, and a second man in her life turned out to be a louse.
�Men today don�t work, they go into the streets and find other women,� she said. �They stay for a while then they rush away  and don�t help me in anyway.�
Based on conversations with Hondurans, that seem a problem. About 34 per cent of households are headed by a single woman. That�s much greater than in Canada (about 13 per cent), and there is no structure for child support or safety net. 
You can survive on $6 a day, even with a family. The print edition of La Tribuna showed Alvarado�s house, which was two rooms, cobbled together out of sticks and corrugated tin, likely squatting on the land. So her housing is free
 Food, even for all those kids, would be manageable, at least in terms of enough calories (though not remotely adequate for nutrition). Tortillas are cheap - about five cents each - and filling. Beans are 30 cents a pound and rice about 60 cents. (Beans, corn tortillas and rice make up about 60 per cent of the calories consumed in a typical Honduran diet.) 
The problem is that people living that way are always on the edge of disaster. If Alvarado wrenches her knee and can�t walk to the market, or someone robs their house or the school demands kids pay fees, then things fall apart. (Alvarado told La Tribuna all her children in school, some at night and some in the day. That doesn�t actually guarantee they�re learning much.)
There is an obvious question. Why would anyone have eight children without any ability to provide for them? The online comments on the article included some pretty forceful expressions of the same question.
Religion, partly. The interviewer asked Alvarado if she was going to have more children. �I don�t know,� she said. �Only God knows that.� (Though she added �je, je, je,� which often means a person is joking.)
About half the population say they are Roman Catholic. That church says members can�t use any birth control measure except abstinence when women are most likely to conceive. That�s the equivalent of no effective birth control for poor people with little education. 
Religion aside,  there are issues of access and education. About one-quarter of births are to women under 18, a rate 26 per cent higher than the average for the region. A 2008 HDR report on Honduras found 46 per cent of first-time teen mothers had no education.
But even with no children, for many - maybe most - Hondurans, poverty is just reality, and disaster just one piece of bad luck away.

Speaking Spanish, and the challenge of criticism

It�s tough to serve up criticism in a second language.
Or it is for for me. I spent a day last week working with four other people on a funding proposal for a Honduran NGO. In Spanish. 
Luckily, one woman was making notes on her computer, which were projected on a screen in the meeting room. Instead of struggling to grasp spoken comments, I could read them. My personal effectiveness increased tenfold. (Another occasion to give heartfelt thanks for technology.)
Responding still wasn�t easy. While meetings leave me feeling like my head will explode, there is now a point - maybe 45 minutes in - when something in my brain clicks into Spanish mode. (That fades, like a superpower granted by a genie. By the six-hour mark, the simplest sentences are hard to decode.)
More importantly, I am prepared to sound stupid in order to participate.
That�s probably a triumph of ego. I don�t like to sound dumb in front of other people, or course. But, even more, I can�t resist offering ideas and comments. (The Honduran women from the development agency were encouraging, which helped.)
It�s a weird experience. I was good at meetings in Canada. I had insights, and usually an idea of the optimum outcome. I could help win support for good ideas, and might have even been a little pushy. Here, I am a struggling, well-intentioned amateur.
The hardest thing, I have realized, is to offer criticism. It�s difficult in a first language - look at how useless most managers are at offering guidance to employees on their job performance.
But it�s really challenging in a second language. In the meeting, the group came up with a lamish statement of the objectives for the project. 
In English, I could say �what a great start, let�s see what we can do to make it even better.� 
In Spanish, all I could say was �That�s very general and generic. We need to be more specific about how the project will bring the changes the funder wants.� It sounded judgmental even to me. (I don�t know why I felt the need to criticize the main objective as both general and generic. Either might have sufficed.)
When we offer criticism in our first language, it�s all about tone. We make people think the new ideas are actually their own, or create an imaginary consensus, or make an overwhelming case.
None of that is possible when you�re struggling to come up with a semi-coherent sentence. All subtleties are lost. 
It�s not just a problem in meetings. Our organization uses one taxi driver in Tegucigalpa to keep everyone safe. (We walk in Tegus, in the daytime and carrying nothing that would attract bad guys. But it is a dangerous city.)
He's great. Mostly. But if you call him, he will always say he is 10 minutes away. Then he doesn�t show up for an hour, which can be discouraging at the end of a difficult day.
After two one-hour late pickups at the end of the working day last week, I wanted to complain to him and and the staff who rely on him. I couldn�t judge how harsh I was being in my challenged Spanish - a pushover, or a crabby, time-obsessed gringo?
My Spanish efforts are already producing benefits. Hondurans like it when you can speak their language, even badly. And I�ve seen the weight lift off store staff when they realize I can communicate and they don�t have to launch into a stressful, crazed version of charades with yet another gringo.
I�m sure learning a new language is helping my brain.
I�m also learning a lot about humility and what it�s like to be scrabbling to make your voice heard. And I�m wondering how many great insights have been lost because people haven�t been given the space and time to explain them.

Photo radar and taxes and the power of political myths

It�s interesting the way political orthodoxy emerges, without much real evidence.
Take two examples - photo radar and irrational tax phobia.
Photo radar, it was clear during the leaders� debate, is seen as political poison. Asked about reinstating it, all four leaders said  no.
The evidence from around the world is conclusive - photo radar reduces crashes and health care costs and saves lives. In the six years that B.C. had photo radar, road deaths averaged 408 annually. In the previous six years, an average 534 people died on the roads. That�s 126 families spared the death of a loved one each year. (You can read more stats here.)
And the politicians can�t claim they�re reflecting the will of the people. A 2007 poll for the Canada Safety Council found 75 per cent of British Columbians supported photo radar on the highways - and 90 per cent in school zones.
So why the fear about an evidence-based public policy move - one accepted in Alberta? Maybe the opponents are considered passionate enough that they�re not worth riling. Maybe the politicians have bought into a myth of public opposition.
The more dramatic and damaging myth is around taxes.
Somehow, politicians have reached an agreement that they have to pretend all taxes are bad. If they plan increases, they offer elaborate apologies.
But the public isn�t stupid. Government services cost money, and have to be paid for. If you want a hospital bed, or a road, or a school for your children, then taxes have to be collected.
Further, people have indicated they�re willing to pay more for better services from government, just as they are in any other area of their life. A B.C. poll several years ago found 60 per cent of residents would pay more in property taxes to improve services. 
And an April poll for the Roundtable of Community Social Services of BC found 53 per cent of British Columbians would pay higher taxes to ensure better services in their community.
There is an important qualifier there - more money in return for better services. Not for convention centre or fast ferry overruns, or endless re-orgs or government advertising.
Still, it�s odd that politicians have largely accepted the myth that citizens reject all taxation, and allowed it to shape their policies and the public debate.


Bloglisting.net - The internets fastest growing blog directory Natural Health Blogs - BlogCatalog Blog Directory blogarama - the blog directory blog search directory


Health Information

Resource Tab: Disease  |  Diseases  |  Rare Disease  |  Flu  |  Flu Symptoms  |  Disorder  |  Tuberculosis  |  Anxiety  |  Lyme  |  Alzheimer  |  Crohn's  |  Cancer  |