Hi. I've started writing a semi-weekly TB Newsletter, if you're interested in that kind of thing. Here's the second letter--about public-private partnerships, leprosy, and my forthcoming big announcement about expanding access to tuberculosis care. You'll hear more about that on Thursday. Anyway, here's the newsletter. You can sign up here.
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In advance of the Big Announcement this Thursday, I made a vlogbrothers video today on how we end TB–with the comprehensive care plan often known as S-T-P, which is short for “Search, Treat, and Prevent.” But one thing I didn’t discuss in that video is the downstream benefits of comprehensive TB care.
Once you’ve hired community health workers to screen for TB, it becomes much easier to screen for other illnesses like diabetes, high blood pressure, and non-TB lung issues (especially lung cancer). TB is notoriously a disease of vicious cycles–a disease of malnutrition that makes malnutrition worse, a disease of poverty that makes poverty worse, and so on–but addressing TB can be a story of virtuous cycles: TB survivors become TB advocates, as I’ve seen with my friend Henry in Sierra Leone. More effective TB treatment leads to less stigmatization of the disease, as communities come to see the disease as curable and survivable rather than terrifying and deadly. And better access to TB care leads to a stronger overall healthcare system, because more community health workers are better connected to more primary healthcare clinics, which allows communities to better address all kinds of health problems.
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Mycobacterium tuberculosis is not the only bacteria of its family that causes a lot of human suffering; there is a closely related species called mycobacterium leprae that causes the disease known as Hansen's Disease, or more commonly leprosy. There are still around 200,000 cases of leprosy diagnosed each year around the world, and while the disease is curable, it also remains–especially if not caught and treated early–a significant driver of suffering and disability in our world.
There are many connections between TB and leprosy: Not only are the bacteria that cause these illnesses very similar, but patients have often expressed similarities in experience. TB patients who were encouraged or forced to live in sanitariums often compared themselves to lepers. One disheartening parallel between the diseases is that in both cases, those living with these illnesses are often abandoned by their families and must make new social connections within the new community of “leper” or “consumptive.” Also, both Hansen’s Disease and TB continue to exist largely because of systemic failures rather than due to a lack of knowledge or technology.
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I really recommend Dr. Salmaan Keshavjee’s TED talk about how we ended TB in the U.S., and how we can end it using the same strategy around the world.
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Last link from me today: I’ve been thinking a lot about the complex intersection between public and private investment (for reasons that will be clear on Thursday!) and I keep coming back to one infographic in an excellent paper (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256883) about the public money that was poured into the creation of the GeneXpert Machine, which can quickly and accurately test for TB. The GeneXpert machine has created a lot of profit for Danaher’s shareholders, and it has also created some societal benefit, but it could create a lot more societal benefit if it created less profit for Danaher’s shareholders. This tension seems to me one of the defining features of 21st century life. Anyway, here is the infographic:
That’s the money–over $250,000,000 of it–that came from taxpayers (mostly in the U.S. and Europe) to fund the creation of the GeneXpert Machine. And yet, this tech largely funded by the public is controlled entirely by private enterprise. I’m troubled by that model of value allocation, even if I still believe that private money and private enterprise have important roles to play in fueling innovation. But taking a quarter billion dollars of public money and then claiming total ownership over a technology, and using that ownership to deny the technology to the world’s poorest people, seems like a deeply flawed system of resource distribution to me.
I’ll see you on Thursday. I’m nervous and excited.
DFTBA,
John
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Overindulgent father Astarion who tells his children they’re allergic to any kind of jewellery that isn’t made of the highest grade Dwarven crafted gold.
It’s not even because Astarion might have a certain aversion to silver, no, he just raises his children to have standards, thank you very much.
And it doesn’t end with shiny things, oh no…
The Ancunín brood is known to be dressed in perfectly woven cotton, silk and soft leather clothes, no matter the occasion.
They’re seen playing with expensive toys, reading artfully illustrated books that certainly belong behind thick glass, not in children’s sticky hands.
There’s even talk that one of the children is not as naturally inclined to music as his parents claim him to be, surely his lyre must be enchanted—the instrument certainly looks extravagant enough!
And then there’s always this air of effortless haughtiness surrounding the Ancunín children whenever their nannies and servants are parading them through town as if they were perfect little dolls; objects to show off the wealth their parents acquired in quite the mysterious ways.
So, it’s no secret that Astarion and Tav are pampering their children—some might say they’re even spoiling them rotten.
And maybe they are, especially Astarion.
But he doesn’t see why he should raise them any other way, nor does he want to.
When it comes to his children, Astarion has his own standards, and as long as Tav agrees with him nothing really matters.
Because, these people, they don’t know anything about the Ancuníns.
They don’t know that it’s not unusual for Astarion to wash out dirt and mud and strawberry stains from comically small finery, leaving behind only the memories of a day spent playing in the garden, chasing after ducks, picking flowers, lazing in the sun…
That any holes and tears the children’s clothes might suffer are quickly mended, making them look as good as new in no time.
Nor do they know that Astarion doesn’t mind fashioning a brand new dress to match that of a favourite doll, either. Or to embroider a pretty vest with the likeness of that stray cat the children seem to adore, although their father would rather they don’t touch the mangy animal.
No, those people know nothing at all...
“Not tired!” Astarion’s youngest cries; the vehement denial of her father’s earlier accusation is cut short by a telltale yawn.
The room still smells of fragrant lavender oil and peaches even when the bath water has already grown tepid, just one or two degrees above what Astarion would consider too cold to be enjoyable.
Amused, he raises an eyebrow at the protesting toddler before he lifts her out of the copper bathtub with little effort.
By now, he knows every step of this game.
“Tut-tut, my dear child, what did mama and I say?” Astarion kneels, quickly wrapping a soft towel around the child to keep her warm. “We only tell lies outside of this house.”
Unfazed by her father’s gentle scolding, the girl crosses her arms that haven’t yet lost their puppy fat across her chest, reminding Astarion a little too much of a very displeased Tav.
Suppressing a sigh, he leans back to consider the pouting child, wondering what could possibly be upsetting her this time—the list is growing longer by the day, after all.
“What’s the matter, dear?” Astarion asks gently, hoping it’s something easily fixable as it’s growing rather late.
“Want apple!”
Decades ago, Astarion might’ve rolled his eyes—he knows exactly which stupid apple the child wants, it’s been haunting him all day—but once he started to treat his children’s problems as if they were his own, his life has grown somewhat easier.
“Why, let’s get an apple on our way to bed, then. Would that be alright, Your Highness?”
The girl promptly nods her head, allowing Astarion to pat her hair dry before dressing her in a clean night dress.
She rests her cheek against her father’s shoulder as he carries her first to the kitchen to grab a fragrant apple and a knife, then to her bedroom where they settle on the cosy window seat, just like they do every night.
Soft moonlight is pouring through the windows; the child giggles at the way the knife’s blade is catching the silver light as Astarion peels and cuts the apple into even pieces.
“Here you go,” he finally says, giving the slice of apple one last examining look before surrendering it to the impatient little hands reaching for it. “A sweet treat for my little sweet. Doesn’t it taste so much better when we don’t eat it off the floor, darling?” And when it’s not crawling with ants…
The appeased toddler nibbles at the juicy fruit as Astarion carefully combs through her still-damp curls.
Her hair’s getting long, he notices, knowing that taking care of it will become more time-consuming each day.
Once, Astarion would’ve thought this task tedious, brushing out hair that’s not his own, oiling and braiding it for no other reason than knowing his children enjoy him doing it.
But that’s why he loves doing it in the first place, he supposes.
Astarion can tell by his toddler’s heartbeat that sleep is about to claim her.
The half-eaten slice of apple is still clutched in her little fist as he cradles the child to his chest, slowly rising from the window seat to put her to bed.
He’s just about to lay the child down that the fruit drops to the floor, his daughter’s tiny hand clutching at his shirt instead.
“Thank you, papa,” she mumbles, more asleep than awake.
Astarion pauses.
He breathes in the clean, yet unique scent of the little girl that is forever engraved in his brain, the same way he knows under which exact constellation she was born. When she took her first steps, what her first word was. Soon, he will have to memorise her favourite colour, and what she likes to eat when dirty apples won’t be that appealing anymore.
By now, Astarion knows this game by heart, knows that with every year that passes, he has something new to learn about his children.
And sometimes he wonders what it’s like to grow up with clean bed sheets and full bellies. Sleep filled with naught but warmth and happy memories. Ever open doors and tears that are dried by tender kisses. Living in a house where mistakes and anger are welcomed, safe.
He wonders what it’s like for his children to know that their father’s love comes without conditions. Not now and not ever.
Sitting down on the bed, Astarion holds his youngest a little closer to his chest, unwilling to let go of her, yet.
He’s often accused of spoiling his children when most people can only just grasp the very surface of his love for them, the bare minimum of what he feels for his one and only, precious family.
These baseless accusations are as unimportant to Astarion as the people voicing them.
He’s raising his children to have standards, wants them to take their father’s love for granted, to accept nothing less but pure devotion.
It’s the only way Astarion knows how to love them, the only way that comes most naturally to him.
Astarion looks down at his little girl, now fast asleep, a gentle smile tugging at her lips.
After all these years—all these children—he’s still in awe watching them sleep in his arms as if no harm in the world could ever befall them.
And it won’t—not if Astarion can help it.
“No, thank you, my heart,” he whispers, pressing a kiss against the crown of the toddler’s head.
When it comes to his children, Astarion holds himself to the highest standard.
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Thoughts on the thunder wizard again.
Genuinely, I find Gale's relationship with Mystra to be fascinating when you consider all its facets. Unhealthy, imbalanced, definitely poisonous, but also very, very intricate with a lot of blurred edges to it. One of those things where you're both like "wow, what the hell, that's horrible" but also "that makes perfect sense for their characters, and while I would NEVER, I know why they would, and why it happened."
You've got a wizard who doesn't know what real love is, who thinks he's finally being shown it by the person he adores most. His greatest fantasy, his most potent joy, his most heartfelt aspirations, and they were all offered to him.
And he wants to see what all she's hiding from him, because of course he does. She's the keeper of all things forbidden to him. The empire of Netheril reached magical heights that will never be touched again, and all that knowledge is beyond her curtain. She loves him, right? Surely, if he proves himself enough, she'll let him grasp that power he so desperately wants.
And not even in the power-hungry sense! All that magic Mystra's locked up was accessible during Mystryl's reign. Think of all the answers to theories about the universe that are back there. Every question of "can this be done, and what would it do" would be answered, if he could just bargain hard enough.
She loves him, right?
Surely, if he proves himself enough...
And then, on the other hand, Mystra. Once Midnight, her human personality has been subsumed by the goddess of magic and her duty to the Weave. She has a responsibility to magic, she IS magic.
Then along comes this mortal boy who knows how to handle her Weave. Who doesn't try to wrestle with and dominate, who sings to it. He handles it with such ease and grace—it's not just that he could be Chosen, but he deserves it. To put her Weave in the hands of someone so intrinsically in tune with it, who understands its potential with a wonder like no other. Few enough can handle the raw power that comes with being Chosen, but this one? This one is perfect.
And he adores you. And you adore him, like one would a beautiful butterfly that's landed on their finger. And he's willing to be devoted to you in all things, not out of transaction like most of your worshipers are, but out of love for you, your craft, your magic. You're so deeply and utterly charmed by him.
And it's not like Mystra hasn't walked this path before.
She gives him what he desires, because what he desires is her. And, in a different way, she desires him. She wants him to be her representation in the world. She indulges his adoration with her own presence, and takes indulgence herself in mortal comforts. He's never satisfied with her answers, but who could blame him? She keeps a whole world away from mortals, because she knows what such unfettered power might bring about (again).
And the wizarding prodigy's ambition is lit (again).
And the height of power is reached for (again).
And she stops him (again, again, again).
She does care for him. She doesn't want to see her little butterfly burn himself, and she doesn't want to be the one to ruin those wings.
But then he's not a butterfly. He's a mortal, wielding a weapon of murder, of her murder, and he's brought it to her doorstep because she told him "no." And he's cut himself on it, he doesn't know what it is, but it's hurt him—and it's only a fraction of the hurt it could do to her. How dare he want her help after threatening her?
(He didn't mean to.)
(He only wanted to help.)
(He only wanted. How human.)
She doesn't help him. If he wants to pursue Karsus' weaponry, it's his responsibility, his hubris, that led him to injuring himself on it. She's furious. She's hurt. She's cold.
(What fools these mortals be.)
But then, there's a greater threat to her. Something that could drown the Material in Karsus' failings. And that little boy, who nicked himself on the sword he lifted, still wants her help.
It's a fair trade, isn't it? She'll forgive him, let him into her domain again, if he accepts his punishment and goes into battle for her. He picked up a sword, it's appropriate that he learns to use it in her name, right?
If he was telling the truth, he wouldn't hesitate. If he really wanted to serve her with the Netherese Orb, he would jump at the opportunity to do so. He would have to give up a few petty things in the process, ("petty," she calls mortality, as if family and home mean nothing, as if friends and love are finite. Because to her, they do mean nothing. Because to her, they are finite.) but it isn’t atonement without sacrifice, is it?
It's the tactical move. She's not above hurting one man to save a nation. It's not even the first time she's done it.
(Dornal Silverhand sends his regards.)
If he loves her, he'd die for her, because she'd let him into her paradise. If he doesn't love her, he won't, and she was justified in removing him from her grace.
He doesn't love her. Not anymore.
Does he hate her enough to try to take his dues?
Ambition has always been man's greatest folly.
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