This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.
The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.
I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.
The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.
In my blog, posted at the end of March, I described the surgery I underwent in Durban. I also talked about going out a couple of times, with friends, to a really delightful little bakery/pizza restaurant in the neighbourhood. It does not even have a liquor licence; and this does tend to mean the evening is cheaper as one takes one’s own wine. Among those friends was Jurgen Brauninger and his family. I wrote in that blog:
‘On a personal level it is interesting to see my cohort, friends and colleagues ageing into their 60s, for the most part with grace and dignity. It is however a shock to us all – but, as I said to one friend, ‘it is better than the alternative’.’
Within two weeks of these dinners we learned, out of the blue, that Jurgen was not well. He was suffering from pancreatic and liver cancer, and was having difficulty in eating. After various consultations he was scheduled for urgent surgery to ease pressure on his duodenum. While this was not a cure, it was expected to improve the quality of his life. The surgery was carried out on 26 April (by the same surgeon who did my hernia); Jurgen did not recover and died on 6 May.
I want to pay tribute to a dear friend and colleague, a talented musician, but above all a devoted family man. I know Tania, Hannah and Brigitte will be torn apart by grief. Sitting in Canada I have felt very distant, but no less sad. I wish I had deep and meaningful forethoughts about this but I don’t, I just know I will miss him enormously. Andrew Marvell’s lines “But at my back I always hear, Time’s wingéd chariot hurrying near”, were not written about death; they do seem very apt though.
The Brauningers lived a few houses up the road from us in Manor Gardens. Their children were similar ages to Rowan and Douglas. We celebrated many milestones together; Brigitte did the most amazing Easter lunches for the university crowd and others. The families went away together for a number of short holidays in the province. Everyone enjoying each other’s company, even braaing under umbrellas during a heavy rainstorm. Their home was an original ‘wood and iron’ house, this is one of the first Durban houses and relatively few are left standing. Jurgen, I and Ullie, one of his friends, purchased the house next door when it came on the market, in order to preserve it and the jungle of a garden for a little bit longer. Jurgen and Brigitte had just moved a few kilometers to a more modern house and were planning their retirement when this devastating event occurred. This has been a deeply sad time.
The month of April began in the Cape and ended in Canada via Norwich. In the first week we ran the scientific writing course in Stellenbosch in the Cape. There were 19 participants from across Africa. Tim Quinlan did most of the teaching and the event was excellent. We are beginning to see results in submitted and published manuscripts from earlier years. I hope the project will be renewed, but if it is not then we have achieved a great deal. As my travel was from the southern to the northern hemisphere, I experienced autumn one day and spring the next. In England the daffodils have bloomed and are past their best. In Canada, or at least in this part, they have yet to blossom and it is still decidedly chilly.
Of course visiting Cape Town is also a chance to see family. My brother and sister-in-law were away but I caught up with my aunt, various cousins and a niece for Sunday lunch. I felt that I had not talked properly to niece Sarah, and she was good enough to join me for lunch on the Monday before I flew back to the UK. We walked across from the City Lodge to a new restaurant right next door. It was good to have a decent conversation and catch up with family news. Because the flight from Cape Town is so late (after 11 pm), I only watched one film: The Great Buster, a biopic of filmmaker and comedian Buster Keaton. He was one of the few stars who transitioned successfully from silent films to sound. It was not demanding so was good to watch in the small hours.
I had a relatively short spell in England. My sister came up from London for Easter and her birthday. We went to a show at the Norwich Playhouse, where Rowan works. It was an amateur production of A Sound of Music. It was outstanding. There were a few wrong notes, but not many at all. The set was imaginative and the acting most impressive. I think amateur productions can be excellent because people really throw their hearts into the show.
November was bifurcated for me: the first half in Waterloo and the second in Norwich. I was fortunate in that I left Canada before it became consistently and miserably cold. Unfortunately, while Norwich is warmer, it has been grey, dank and damp. In both locations, when the sun shines in winter it can be quite magical. An interesting fact: there is almost exactly an hour more sunshine in Waterloo than there is Norwich. The sun rises at about the same ‘local’ time; at present 07:15ish, but sets an hour later in Waterloo. We still have three weeks to go to the solstice! The travel to the UK was partly paid for by AIDSpan the Nairobi based NGO that produces the Global Fund Observer. I am on the board and we met in London. It was a great meeting since all is well with the organisation.
The UK is preoccupied by Brexit. During the time I have been here there has been constant, but not very helpful, discussion. Theresa May has managed to negotiate an exit agreement, which was agreed on the 25th November. She still has to get this through Parliament. Once (if) that happens, then the real negotiations start. We briefly thought the issue of Gibraltar would derail the process, but that crisis was averted. Currently fishing rights are being flagged as deal-breaking. The United Kingdom has an exceptionally long coast line and hence extensive territorial waters. Brexit is exceptionally depressing; we are giving away the future.
The leaves are falling in Canada, and of course across the Northern Hemisphere, but that is an inference and an assumption. I have watched the trees from my apartment’s window and can confidently speak for them at least. The colours were amazing, but it is now coming to an end, indeed one tree already has completely bare branches. Soon the only green will be the conifers, and of course, the grass, when it is not covered by snow.
I do not indeed to spend much of this winter, 2018-2019, in Canada, I have done my time in this season here over the past four years. I feel the concept of ‘brass monkey’s cold’ is one I now grasp. Walking on ice and landing flat on my backside is also an experience I have had, as is dressing as one leaves one building and undressing on entering the next. I shall take a break.
It has been an interesting month though. In the last letter I talked about visiting my brother and seeing my extended family in the Cape in South Africa. In October he came to Canada for a few days while his wife Lynn was with friends in New York. We had planned to meet at Pearson airport and go up to Montreal for a couple of nights. Of course when one is working to a schedule things can and do go wrong. The last fast train from Toronto to Montreal was at 17:57. Derek’s plane was scheduled to arrive at 16:16, so we should have made it. Of course the flight was late, so we had to rethink the weekend. We did check what a flight would cost, and the answer was too much.
We took the airport train to Union station, bought tickets for the next day and then found a reasonable hotel near the station in Toronto for the night. The journey takes about 5 hours and is actually rather tedious, so it was a pity we had to go up on Friday and return on Saturday (Derek’s plane from Toronto was at midday on Sunday).
When I left Ontario in early May, the snow was gone but the temperature was not reliably warm! This was true of Norwich as well, although during the last week of May there were days when I was able to sit in my shed in the garden, wearing a short sleeved shirt, with the door open. It is actually surprisingly close and humid sometimes in this part of England. In a month the tennis at Wimbledon will begin. In order to meet traditions there should be strawberries available by then. The plants outside my door are in flower, so I will be able to watch the berries develop and ripen.
When I am here the dog comes and invites me to kick tennis balls across the lawn for her every few hours. This is a good way of giving her exercise. The other options are to drive to the forest, which takes time, or walk along hot and boring pavements. She is elderly now so she gives up the game before I do. Her sign that she has had enough is to go the side of the garden, have a drink, and then slink off behind the garage. She is getting deaf and a little short sighted. This means towards the end of the game, it is not so much ‘kicking balls for the dog’ but ‘kicking balls to the dog’.
The garden is a riot of colour. I don’t know very many of the plants, which is a pity, but the flowers are amazing and the plantings effective. The birds are singing their hearts out. When we first moved into the house the garden was quite barren, and there certainly was not the birdlife there is now. There are open containers of water placed strategically under various bushes for birds and insects. One was teeming with tadpoles. We have purposefully left ‘wild’ areas, and this is where the frogs hide out, so it is good to see the next generation in the making. A few evenings ago I went out after a heavy rain shower and saw two rather large frogs. Their visibility was due to a combination of the rain and the fact the light outside my office was on and attracting insects, a buffet.
For some reason I woke up at 5.30 this morning and, after realising that I would not get back to sleep, I came downstairs to catch up on correspondence. My monthly posting is late, so the first thing on the agenda was to get that done. I will be in Waterloo for until the end of May. I arrived in January and it was terribly cold. Yesterday, 1 May, the temperature climbed to 27°C. What a contrast. My apartment is on the side of the building that gets the sun. In the winter this is a blessing, in the summer it most certainly is not. Fortunately there are two sets of blinds, one of which keeps the worst of the sun out.
Over the winter there was quite a lot of snow, and at various points the contractors came in to clear it from the parking lot. The modus operandi seems to be to pile it in the visitors parking area, where until a week ago a huge snow bank took up four parking spaces. With the change in temperature it has been melting rapidly. When I look out of my window I can see a small grey pile that looks just like the stone chippings used on roads. It should be gone in the next 48 hours, then the contractors will have to come and sweep up what is left of the rubbish that somehow got into the snow. I’m quite puzzled by the glass which apparently came from a windscreen.
The past month has been one of some introspection. This post was written over the Easter weekend. On the Saturday I went to the Kitchener Farmer’s Market. When I first came to this dorpie (the Afrikaans word for a small town), I used to go every Saturday. I now manage with a visit every two weeks, the advantage of having a huge freezer (which came with the apartment, by the way) is manifest.
I have a very predictable route. I park in the underground area, go up to the level where the stalls are, and then follow a strict path. The first person I visit is Pat from Hamilton. He sells a range of olives and pickled vegetables. In my opinion his most interesting product is the olives stuffed with garlic. They are a real assault on the taste buds. We have got to know each other over the years and so first names are used. From there it’s a quick turnaround and across the aisle to the egg stand. This is run by an older couple who do not seem to have much of a sense of humour. I have yet to see them smile. If you can visualise the famous painting ‘American Gothic’ you will get the picture.
I then go to the fishmongers, right next to the butcher I use. Interestingly enough on Saturday they had none of the fish varieties that I would choose, they said their suppliers were out of stock. The fish I enjoy most when I am in Geneva, or indeed anywhere in Switzerland, is something called filet de lac, literally fish of the lake. I believe that this is caught in one of the great Lakes and now flown from Canada to Switzerland. I tried to buy a couple of different varieties to make an interesting fish stew.
It has been an interesting month in Canada. Most of February was extremely cold, in the minus numbers. However there was one day in mid-February when the temperature rose to 14°C, and again, at the end of the month, it was unseasonably warm. Up until then the ground was covered with a layer of snow, and as there were frequent falls, albeit not very much, it looked fresh and white. While it is beautiful, it makes the place looks sterile. This gives rise to a problem I had not anticipated for dog owners. One of the people in the apartment block lives on my floor. He has an excitable and energetic dog, and takes it out regularly to do its business. This means we occasionally meet, (the dog, owner and I), in the elevator. Apparently, he told me, if there are no smells, then the dog is less likely to perform. I suggested that he (the owner) could assist providing scent, this was not seen as a feasible option.
On the day that the temperature was so high, there were also the first signs of spring: amazing, jubilant birdsong. For some reason the sparrows really like hanging out on the side of the building, and in the bushes on the paths. They were chirping their little hearts out when I walked home for lunch. This reminded me of a nonsense rhyme my mother used to quote when we were children. I can’t find a definitive source for it, so I hope it is out of copyright.
Spring is sprung the grass is riz
I wonder where the birdie is
The bird is on the wing?
I always thought the wing was on the bird.
There is quite a lot of music in the town. I suggested to friends we go to the Huether Hotel to listen to jazz. I thought I had bought tickets for ‘The Tim Moher Octet’ playing ‘jazz and some “Celtic Jazz” originals with a sprinkling of favourite standards in this evening of eclectic music from funk, soft jazz, to straight ahead jazz tunes’. None of us was terribly impressed by the music. It turned out, on Monday, when I got an email saying “Don’t forget you have tickets for the Jazz Room this Friday”, that we had actually listened to ‘The Rob Gellner Tentet’! No wonder it was different from what we expected. Basically we went a week before we should have. And no one checked the tickets. Can you believe it! It was embarrassing. The Huether is no longer a hotel, but rather contains number of bars and restaurants, catering to most tastes. It is very old by Waterloo standards – parts of the building date from 1855.
Oh dear, the start of the winter term was not very promising. Even before it began I was aware that we were undersubscribed in terms of students for the Masters in International Public Policy. There should have been 15 domestic students plus a number of ‘African Leaders of Tomorrow’. For various reasons that are beyond my understanding we ended up with just nine Canadian students, fortunately there is one international and four African students, which increases the cohort size to fourteen. In my special course IP641: Economic Policy in an Interdependent World: The Case of Health, HIV and AIDS and Other Epidemics, there are just seven students. The Inter-disciplinary Seminar has the full complement but that is hardly surprising since attendance is compulsory.
I suspect that the basic problem has been the lack of certainty about the future of the Balsillie School. The funds for the organisation are held at Waterloo and Wilfrid Laurier Universities, but the Balsillie school is a partnership between the universities and the Centre for International Governance Innovation (CIGI). CIGI is the landlord for the BSIA, owning the magnificent building we are housed in. The ten year agreement that governed the money ran out in November last year. We ran on a ‘steady as you go’ type of extension and are assured will be renewed in the next few days. Unfortunately all the promises in the world cannot replace a signed agreement that sets out exactly what can and cannot be done. Hopefully we will, by the time you have read this blog, have certainty as to what is going on. While we think that things will continue without too much change, we need to see the signed agreement to know that this is indeed be the case.
The one activity that began well was the salon series. These are gatherings of up to 20 people that I convene in my apartment. The idea is that there is a guided conversation with a special guest who answers questions on their topic of expertise. The first one of the year was with David Wilson, a friend of long-standing who grew up and worked in Zimbabwe, before joining the World Bank. The second was with Peter Boehm, a senior Canadian civil servant, currently engaged in preparing for Canada hosting the G-7 meeting in June 2018.