The GOP's door of no return
For time beyond remembering, the people of Senegal have lost a battle with malaria, surrendering a portion of their children to fever, organ failure and death, until this terrible sacrifice seemed ordinary. The malaria-spreading mosquito is craftier than any beast of the field. After harvesting infected blood, it injects the malaria parasite in its next target. The developing parasites destroy red blood cells and overwhelm weak immune systems, particularly those of children.
But the mosquito has a weakness of its own. Once it draws blood, it must land to process its meal. If it stops on a wall sprayed with insecticide, or on a treated bed net, it dies, breaking the cycle of transmission.
A few years ago, Senegal began waking from its long malarial nightmare. It was the first African country to set the goal of universal bed net coverage, which it is likely to reach by the end of the year. It was the first to make widespread use of the rapid test for malaria, allowing an accurate diagnosis in 10 minutes. Senegal is conducting indoor spraying campaigns and providing effective, new combination drug treatments. Volunteers are going door to door in impoverished neighborhoods, instructing women in the proper use of nets.
The result? From 2005 to 2008, mortality among Senegalese children ages 6 and under dropped by a third, with reductions in malaria playing a major role. Some communities that had experienced 70 to 80 percent malaria prevalence during the high season of one year reported not a single case in the next.
It is a sophisticated, successful national effort. But it would not be possible without the help of the United States, provided through the Peace Corps, the President's Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
As I was visiting hospitals and health huts in Senegal, I was also receiving e-mailed updates on House GOP budget cuts. The Global Fund, down 40 percent. Child survival programs, which include anti-malaria efforts, down 10 percent. AIDS relief, down 8 percent. Development assistance, down 30 percent.
These reductions were intended to be symbolic, but what do they symbolize? Fiscal responsibility? Hardly. No one can reasonably claim that the budget crisis exists because America spends too much on bed nets and AIDS drugs. Our massive debt is mainly caused by a combination of entitlement commitments, an aging population and health cost inflation. Claiming courage or credit for irrelevant cuts in foreign assistance is a net subtraction from public seriousness on the deficit.
So, do these cuts symbolize the Republican rejection of fuzzy-headed liberalism? Actually, the main initiatives on malaria and AIDS were created under Republican leadership. They emphasize measured outcomes and accountability. If the goal of House Republicans is to squander the Republican legacy on global health, they are succeeding.
Many American politicians, new to governing, have not been exposed to a uniquely modern historical challenge. Dramatically unequal global development has left one part of the world in possession of technologies and techniques that can save millions of lives in other parts of the world. These interventions are relatively simple and inexpensive - a bed net, a daily pill, a vaccination. Particularly for a nation dedicated to universal human rights, this mortality gap brings responsibilities. It has led America to make commitments on malaria, AIDS and other diseases that should be honored. But aiding the developing world also expands a certain type of global influence - winning friends, and perhaps opening markets, in unexpected places. Here in Senegal, this is the reason the Chinese government constructs stadiums, builds schools and provides malaria drugs.
For Americans, however, a proper understanding of our global duties requires some historical imagination. For 300 years, Goree Island here in Senegal was one of the main embarkation points of slaves sent to the New World. It is the location of the "door of no return," a stone opening to the Atlantic where many Africans saw the last of their homeland and their families. To the left of that door is a small cell where enslaved children were kept, really stacked, in conditions that ensured the death of many.
Now America is engaged in an effort to save the lives of Senegalese children - not out of guilt but because it better represents who we are. This historical symmetry is not just coincidence; it is more like providence. It demonstrates the kind of nation we have become, and must remain.