Tuesday, 27 November 2012

(34): Gaza war coverage and media propaganda

A ceasefire agreement has been reached between Hamas and Israel. But one thing that was clear from the conflict was the propaganda angle. The western media in particular provided an Israeli angle that shows Palestine as the aggressor and Israel as the victim. But this approach is not new. The veteran journalists and war correspondent John Pilger has given us some food for thought on BBC’s coverage of the war. The article entitled “As Gaza is savaged again, understanding the BBC’s historical role is vital” was culled from John Pilger’s website. Enjoy! Jameel
In Peter Watkins’ remarkable BBC film, The War Game, which foresaw the aftermath of an attack on London with a one-megaton nuclear bomb, the narrator says: “On almost the entire subject of thermo-clear weapons, there is now practically total silence in the press, official publications and on TV. Is there hope to be found in this silence?”
The truth of this statement was equal to its irony. On 24 November, 1965, the BBC banned The War Game as “too horrifying for the medium of broadcasting”. This was false. The real reason was spelt out by the chairman of the BBC Board of Governors, Lord Normanbrook, in a secret letter to the Secretary to the Cabinet, Sir Burke Trend.
“[The War Game] is not designed as propaganda,” he wrote, “it is intended as a purely factual statement and is based on careful research into official material… But the showing of the film on television might have a significant effect on public attitudes towards the policy of the nuclear deterrent.” Following a screening attended by senior Whitehall officials, the film was banned because it told an intolerable truth. Sixteen years later, the then BBC director-general, Sir Ian Trethowan, renewed the ban, saying that he feared for the film’s effect on people of “limited mental intelligence”. Watkins’ brilliant work was eventually shown in 1985 to a late-night minority audience. It was introduced by Ludovic Kennedy who repeated the official lie.
What happened to The War Game is the function of the state broadcaster as a cornerstone of Britain’s ruling elite. With its outstanding production values, often fine popular drama, natural history and sporting coverage, the BBC enjoys wide appeal and, according to its managers and beneficiaries, “trust”. This “trust” may well apply to Springwatch and Sir David Attenborough, but there is no demonstrable basis for it in much of the news and so-called current affairs that claim to make sense of the world, especially the machinations of rampant power. There are honourable individual exceptions, but watch how these are tamed the longer they remain in the institution: a “defenestration”, as one senior BBC journalist describes it.
This is notably true in the Middle East where the Israeli state has successfully intimidated the BBC into presenting the theft of Palestinian land and the caging, torturing and killing of its people as an intractable “conflict” between equals. Standing in the rubble from an Israeli attack, one BBC journalist went further and referred to “Gaza’s strong culture of martyrdom”. So great is this distortion that young viewers of BBC News have told Glasgow University researchers they are left with the impression that Palestinians are the illegal colonisers of their own country. The current BBC “coverage” of Gaza’s genocidal misery reinforces this.
The BBC’s “Reithian values” of impartiality and independence are almost scriptural in their mythology. Soon after the corporation was founded in the 1920s by Lord John Reith, Britain was consumed by the General Strike. “Reith emerged as a kind of hero,” wrote the historian Patrick Renshaw, “who had acted responsibly and yet preserved the precious independence of the BBC. But though this myth persisted it has little basis in reality… the price of that independence was in fact doing what the government wanted done. [Prime Minister Stanley] Baldwin… saw that if they preserved the BBC’s independence, it would be much easier for them to get their way on important questions and use it to broadcast Government propaganda.”
Unknown to the public, Reith had been the prime minister’s speech writer. Ambitious to become Viceroy of India, he ensured the BBC became an evangelist of imperial power, with “impartiality” duly suspended whenever that power was threatened. This “principle” has applied to the BBC’s coverage of every colonial war of the modern era: from the covered-up genocide in Indonesia and suppression of eyewitness film of the American bombing of North Vietnam to support for the illegal Blair/Bush invasion of Iraq in 2003 and the now familiar echo of Israeli propaganda whenever that lawless state abuses its captive, Palestine. This reached a nadir in 2009 when, terrified of Israeli reaction, the BBC refused to broadcast a combined charities appeal for the people of Gaza, half of whom are children, most of them malnourished and traumatised by Israeli attacks. The United Nations Rapporteur, Richard Falk, has likened Israel’s blockade of Gaza to the Warsaw Ghetto under siege by the Nazis. Yet, to the BBC, Gaza – like the 2010 humanitarian relief flotilla murderously attacked by Israeli commandos – largely presents a public relations problem for Israel and its US sponsor.
Mark Regev, Israel’s chief propagandist, seemingly has a place reserved for him near the top of BBC news bulletins. In 2010, when I pointed this out to Fran Unsworth, now elevated to director of news, she strongly objected to the description of Regev as a propagandist, adding, “It’s not our job to go out and appoint the Palestinean spokesperson”.
With similar logic, Unsworth’s predecessor, Helen Boaden, described the BBC’s reporting of the criminal carnage in Iraq as based on the “fact that Bush has tried to export democracy and human rights to Iraq”. To prove her point, Boaden supplied six A4 pages of verifiable lies from Bush and Tony Blair. That ventriloquism is not journalism seemed not to occur to either woman.
What has changed at the BBC is the arrival of the cult of the corporate manager. George Entwistle, the briefly-appointed director general who said he knew nothing about Newsnight’s false accusations of child abuse against a Tory grandee, is to receive £450,000 of public money for agreeing to resign before he was sacked: the corporate way. This and the preceding Jimmy Savile scandal might have been scripted for the Daily Mail and the Murdoch press whose self-serving hatred of the BBC has long provided the corporation with its “embattled” fa├žade as the guardian of “public service broadcasting”. Understanding the BBC as a pre-eminent state propagandist and censor by omission – more often than not in tune with its right-wing enemies – is on no public agenda and it ought to be.
Newcastle upon Tyne

Tuesday, 20 November 2012

(33): Five reasons behind Israel's terror on Gaza

So the blood of Palestinians has become a political capital in the hands of Israel. By the time you finish reading this piece probably more people have died in the State of Palestine as a result of Israel’s bombardment. The terror unleashed on Gaza, which already is under siege by Israel has taken away attention from another terror taking place in Syria from television screens.
The question to be asked is why did Israel attack now, what will the Netanyahu government benefit by killing innocent civilians under the pretext that Hamas is firing rockets into Israel, ignoring the fact that the emergence of Hamas itself is a reaction to the occupation of Palestine by Israel? There are at least five possible reasons for the attack on Gaza.
The first is a political strategy to get Netanyahu re-elected in the January elections in Israel. Politicians in the so called advanced democracies for a long time have been using war as a way to get voters attention. They use conflict to shift public opinion to issues of national security rather than economic well being. Two examples here will be useful. Before the 2004 presidential election, the American economy was showing signs of decline, which is not good for an incumbent, more especially one like George Bush who inherited a healthy economy from Bill Clinton. The war on Iraq, though already in the agenda of some neoconservatives like Paul Wolfowitz and Donald Rumsfeld, was brought forward, linked to the war on terror, and Bush was re-elected. But it does not always work. Former French president, Nicholas Sarkozy used the attack on Libya and the ousting of Laurent Gbagbo in Ivory Coast in order to improve his approval rating, we know the rest of the story.
The second reason behind the attack is the reconstruction effort in Gaza. Since the 2008 assault on Gaza by Israel, there has been more sympathy for the people of Palestine, of recent there has been series of visits by foreign governments in order to reconstruct Gaza, the most recent being the visit by the Emir of Qatar who promised more investment and reconstruction. Much earlier than that, King Abdullah of Saudi Arabia has pledged on behalf of the Arab governments the sum of £1 billion dollars towards reconstruction in Gaza. Although the world will prefer to see more concrete steps towards ending the occupation from the Arab governments, at least the reconstruction can bring some relief to the people.
The Turkish president was also on his way to provide additional support. But in whatever form support will come, Israel sees it as detrimental to its interest. As King Abdullah of Jordan stated in his recent autobiography, the ultimate aim of Israel is to expel all Palestinians and occupy the remaining areas in West Bank and Gaza, and suggest Jordan as the new country of Palestinians; this even by the standard of King Abdullah, one of the Arab leaders who believe in the myth of two states solution, is unacceptable and could result in war.
The third reason why Israel hastened to launch this attack is the re-election of Barack Obama. Binyamin Netanyahu had openly supported the candidature of the Republican Party nominee Mitt Romney, because of the doubts he has about Obama’s approach to the Palestinian issue, even though supporting Israel by American presidents is like an article of faith. But Israel still doesn’t like the approach of presidents like Obama and Jimmy Carter, who although they are pro-Israel, they believe also that unquestionable support for Israel hurts American interest in the Middle East.
As such immediately after the re-election, Israel tied the hands of the  American president by starting an aggression, so instead of peace talks between the Palestinian Authority led by Mahmud Abbas and Israel, effort will now be made towards stopping the aggression, and by the time Obama spend two years in office without conducive atmosphere for peace talks, then he will become weak, because the US will enter an election mood, first, the midterm congressional election and then the presidential election, a time that politicians normally withhold their plan on foreign policy due its implication on their campaign.
The fourth reason is that Israel wants to test the military capability of Hamas, and the real foreign policy position of the Muslim brotherhood government in Egypt. The position of the Egyptian government is becoming clear now, the hands of Muhammad Mursi’s government are tied, refusing to support the people of Gaza will cause outrage among Egyptians. Open confrontation with Israel will attract economic problems from western governments, particularly the aid from the US which has been used to blackmail Egypt, and Mursi has not been in power long enough to put Egypt in the path of economic independence. 
The fifth reason is to link the response of Hamas with Iran, something the international media is already promoting. As reported by NewStatesman newspaper, on 16th November, BBC’s Today radio programme interviewed chief Rabbi Jonathan Sacks, at the end of the interview, unaware that he was still live on air, he was asked about the attack on Gaza, and he responded, “I think it's got to do with Iran, actually”.
Newcastle upon Tyne

Thursday, 15 November 2012

(32): Re: Misdiagnosing patients in the Nigerian healthcare system

The article last week on the above subject attracts a lot of attention, and I would like to share one of the reactions that provided another perspective, sent  by Dr Suleiman BM (mbskt@yahoo.co.uk ). Jameel
I decided to take some time out of my busy schedule to contribute on this important topic. First of all, I am a medical doctor. Wholly trained in Nigeria by the Nigerian educational and health system. I am a Pediatrician. Secondly, I have been a hospital administrator as a CMAC from February 2009 to Sept 2012. Thirdly I have been involved in the training of medical students during my fellowship years between 2003 and 2007. I hold two fellowships of the National Postgraduate Medical College of Nigeria and the West African Postgraduate Medical College.

The problem of misdiagnosis happens all over the world, no doubt. We are however more aware of our own immediate surroundings. If one is in the field of public health, he will recognise that virtually all African countries and most Asian countries have weak health systems and are therefore battling these problems.

One issue I have observed during my time as a resident doctor is the “quality” of students being admitted to study medicine. When the student is admitted because of who he knows, not merit, the result will surely be what we are now experiencing. But as a hospital administrator, I will tell you we see the quality of the products being churned out as house officers from our universities. Yes, I agree that the standards have fallen. But many are still good.
The bad ones are still few and with adequate supervision, you can polish most of them. Medicine is an apprenticeship programme. After you get the knowledge, you need to work with an experienced senior doctor to get the needed skills to practice adequately. That is where most of our governments have gotten it wrong when young graduates are allowed to function and practice alone without supervision. We do need to get back to the drawing board on the issue of adequate experience and on the job training.

We should not forget that all medical equipment are now essentially computers. One thing that is common with all computers is that they are shut down, not switched off. One big issue we face as administrators in provision of equipments in the hospital is constant breakdown because they are switched off many times a day by PHCN.
The health service sector cannot work in isolation. If power is not improved upon, we should forget about getting state of the art hospitals that are affordable. Go to Redington and Lagoon hospitals in Lagos. They are state of the art, but not affordable to generality of Nigerians. Have you ever wondered why hotel fare is more expensive in Abuja than in London? The government needs to generate power for us to progress; otherwise, progress will remain a dream.

However, more than 70% of cases presented to hospitals can be diagnosed by the bedside with minimal investigations. To me, the most important issue we need to address is with all of us Nigerians… attitude. We talk of empathy in healthcare sector as against sympathy. I was at the Nigerian High Commission in London on Monday. I saw a small Nigeria within London. Even the community surrounding the commission has not changed our ‘ways’.
We all need to work on our attitudes and love our brothers more than ourselves. I believe there is a hadith (saying of prophet Muhammad, upon whom be peace) related to that; “None of you is a believer until he loves for his brother what he loves for himself”, otherwise “your iman [belief] is not complete”. All health workers in particular need to change our attitude for our system to move forward.

I don’t know how many of us have been to a typical general hospital set up in Nigeria. I have worked in general hospital Katsina outpatient department as a young inexperienced doctor. I was presented with one hundred and fifty patients to see in one day. Even today, go and do a study in any general hospital. The story has not changed. I left general hospital because I could not cope with the work without cheating the system. I was feared for my iman. It is impossible for any doctor, no matter how good, to treat even hundred patients properly within one working day.

Like I said earlier, this is just a contribution, introducing the tip of the iceberg of the problems bedevilling the Nigerian health care delivery system. My advice, however, to all of us that feel we can contribute to the system is to go back home and see what we can do. I am in the UK for a master’s study. I will go back insha Allah when I finish. Some of us have decided we will remain in Nigeria and see what little difference we can make. And we can really do a lot.

Tuesday, 6 November 2012

(31): Misdiagnosing patients in the Nigerian healthcare system

After writing a piece in this column entitled “new hospitals, new corruption, new challenges”, the article elicited one of the highest responses, and many of the readers shared their experiences with me via email. One of the key issues that they drew my attention to was the issue of misdiagnosing the illnesses of patients, but once they travel to either Egypt, India or UK, they are told that, they have been wrongly diagnosed, and within a week or so after treatment they become normal. To address the reasons behind this problem, I have invited Dr Jaliya Braimah (jaliyaadda@hotmail.co.uk), a highly experienced medical doctor in Manchester with a comparative understanding of Nigerian and UK healthcare systems as a guest columnist. The original title of his article was “Reasons behind Misdiagnosis of Patients’ illnesses in the Healthcare systems of Nigeria”. Enjoy. Jameel

It is universally accepted that no healthcare (HC) sector in the world is spared the unfortunate issue of making a wrong diagnosis of diseases afflicting patients under its care. Although this article is on Nigeria, it should not be seen as purely an issue peculiar to the Nigerian HC system alone. However in developed countries at least, such events are the exceptions and whenever they occur, they are thoroughly investigated, lessons learnt from the mistakes and recompense given to victims where appropriate. There is no evidence at the moment that such investigations are a normal practice in Nigeria.

The main reason for writing this article is to highlight a few of the important reasons behind our doctors’ inability to make the correct diagnosis of diseases in Nigeria. For ease of discussion, I’ll like to separate this under three sections i.e. the ‘Doctors factors’, the ‘facilities factors’ and the ‘Patients factors’ although these three do overlap extensively.

Doctors’ factors

Nigerian universities have historically produced and still continue to produce some of the best medical graduates in the world. However, the recent economic/political climate has meant that the standard of training has become progressively worse. Overcrowding in our medical schools leading to very low teacher student ratio has resulted in sub-optimal training in most places. This has a direct impact on the quality of the graduates with increasing numbers becoming less able to attain the minimum standard required to cope with life as doctors. This phenomenon is true for both the undergraduate and post-graduate trainings. As a consequence the patients suffer. For example every case of fever is then treated as typhoid/malaria despite evidence to the contrary.

The 2nd most important reason for misdiagnosis is what I call the ‘I know it all syndrome’ where doctors find it impossible to simply say to a patient “I’m sorry I just do not know what is wrong with you”. Hence there is a failure to suggest referral to a colleague who may be better able to help. The old medical dictum of ‘First do no harm’ will remain relevant till the end of times! In fact, patients are better left alone with their illnesses than putting them through an intervention which may cause them more harm. In this regard the behaviour of this group of doctors is not any different from that of our traditional native ones (the Babalawos).

In addition, the art of making a correct diagnosis in Nigerian Hospitals depends largely only on physical examination of the patients at bed side because of limited lab/imaging support. No matter how well trained a doctor may be, if they find themselves in a hospital with little/no access to experienced colleagues, they will struggle to make correct diagnosis. This is the experience of many NYSC doctors who work (especially) in rural areas where cases often come in late and are therefore more complex to manage.

‘Facilities factors’

There is no doubting the fact that modern technological development has made a big impact on the tools available for investigating diseases more accurately. Except for a few centres, most of these tools are lacking in Nigerian hospitals. This is the reason why experience of using them is lacking which means doctors do not get trained to use them, hence the patient suffers as a consequence. It is also true that even in the few hospitals with these facilities, when patients undergo such investigations, the results are sometimes not interpreted correctly, thus emphasising the need to ask for help from more experienced colleagues.

‘Patients factors’

The fundamental reason why issues of poor diagnosis will persist for a long time is due to the largely uneducated nature of our population. This means that patients are not able to challenge any decisions made on their behalf because they perceive seeing a doctor as a privilege/favour rather than as a matter of constitutional rights! Doctors are seen as demi-gods who are to be worshipped as they can do no wrong.

Another factor to consider is the fact that the Nigerian society is one of the most unbalanced in the world in terms of the haves and the have-nots. This means that while our leaders are suffering from diseases of gluttony (like in Europe/US), the masses are still dying of essentially old fashioned largely preventable diseases of poverty. This is an area that needs to be remembered when treating patients from differing social classes.

Even among the elites, there is another problem which we need to be aware of. For example, how many of them will be happy (content) to be sent home only on paracetamol and the advice to drink lots of fluids and take some rest following a trivial (often viral) chest infection (such as flu) which by its very nature is self limiting?Haba man no antibiotics and no injection(s) for oga?  chineke god’. The expectation to ‘do something’ sometimes adds to the pressure on doctors leading them to make diagnosis which will not stake up to scrutiny. Sometimes doing nothing is best medicine but a number of the “shakers and movers” of our society prefer to be given a medical label. The fear of some doctors losing their customers can be overwhelming. The overall effect of it all is that the Nigerian healthcare system is defined by the over medicalisation of the rich and powerful, and a lack of even the most basic care for the many more!

Finally in this short article, I’ve tried to highlight areas that I think many who work and use the health sector in Nigeria will recognise, but this is by no means an exhaustive discussion. What is also clear is that I’ve done the easy bit i.e. identifying some of the reasons for this phenomenon without delving into the more difficult area of proffering possible solutions. Perhaps this is best left for another day? Let me know what you think.


Newcastle upon Tyne