WEBVTT

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Hello. Hi. Welcome back to Conversations

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with Stephen Kamugasa. This is the fourth

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podcast episode in our Genocide series. Today's

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guest is Dr. Helen Epstein, an American professor

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of human rights and public health with a

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special interest in Uganda and other countries

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in East Africa. Helen obtained a PhD in Molecular

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Biology from Cambridge University and an

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MSc in Public Health in Developing Countries

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from the London School of Hygiene and Tropical

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Medicine. Since 2010, Helen has been a visiting

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professor of Human Rights and Global Public

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Health at Bard College in New York. In 1993,

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Helen relocated to Uganda, where she worked

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on an AIDS vaccine research project and taught

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molecular biology in the medical school at

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Makerere University in Kampala. A vaccine

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against HIV remains elusive even now, and

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Helen witnessed firsthand the suffering caused

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by AIDS, which was the subject of her 2007

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book, The Invisible Cure, why we are losing

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the fight against AIDS in Africa. While working

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as a consultant in Uganda, Helen realized

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that despite massive donor investments in

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the health sector, the country's maternal

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and infant mortality rates weren't falling

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nearly as fast as those in other countries

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in the region. The reason wasn't hard to

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find. Uganda's institutions and leaderships

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were and remain highly corrupt and the international

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community has long turned a blind eye to

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the problem at the cost of thousands of lives

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each year. Ugandan activists and politicians

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who have tried to draw attention to corruption

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have suffered arrest, torture and worse.

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At the center of this troubling story is

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Uganda's strategic military partnership with

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Washington in the global war on terror, which

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Helen describes in her 2017 book, Another

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Fine Mess, America, Uganda, and the War on

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Terror. In this episode, we discuss the topic,

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Uganda in a Multipolar Brave New World Order.

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Dr. Helen Epstein, Welcome.

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Thanks so much, Stephen.

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On page 137 of your book, Another Fine Mess,

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you write, and I quote, I was first drawn

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to Uganda by its remarkable medical history.

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Well before colonial times, the people of

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this region had their own gods to distinguish

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plague from smallpox and perform cesarean

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sections, operations considered too difficult

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and dangerous by Europeans of the time. Helen,

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please tell us something about your childhood

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and education. And how did your early life

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experience ignite your curiosity, which subsequently

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led to stumbling upon Uganda's remarkable

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medical history?

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Yeah, thanks so much. I guess I had a pretty

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ordinary American childhood. I grew up in

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New York in an apartment in the city in the

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1960s. I was, but I always had a kind of

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wanderlust and my parents had a lot of books

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and they had a book about Africa. I think

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it was just pictures of animals, but it fascinated

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me. And I used to canoe down the Nile on

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their Ottoman chair with a vacuum cleaner

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pole as as a paddle. So when I found myself

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after graduate school working as a lab scientist,

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I kind of began to wonder, how did I end

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up here? Why am I not in Africa? And those

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were the days of the, this was the late 1980s,

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early 1990s, the days of the AIDS crisis,

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which really hasn't gone away. I mean, the

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disease is very much still there, but it's

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now being managed much better than it was.

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and back then the situation was really very

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dire. So I quit my job, which I didn't really

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like much anyway, and volunteered to help

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set up a little laboratory in Kampala at

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the main hospital, Belago, and did some experiments

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there. The team I was working for was trying

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to develop a prototype AIDS vaccine that

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was actually being tested in the United States,

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and they were trying to figure out whether

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it might work in Uganda too. Unfortunately,

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this was a long time ago, but it turned out

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the vaccine didn't even work in the United

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States, much less much less Uganda. So I

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think actually in the last year or so recently,

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there is now some sort of, it's not really

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a vaccine, but it does, it's a drug that

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offers long-term protection against HIV.

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And I think it's now being, they're trying

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to prepare to distribute it to people across

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in many parts of the world now, which is,

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which is very exciting. But back then there

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really was When I was really in the AIDS

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vaccine game, it was really clear that something

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else had to be done, and that's how I got

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interested in public health. Then within

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the topic of public health, I got particularly

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interested in the issue of corruption. For

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diplomatic reasons, international public

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health experts don't talk about it much,

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but in Uganda and, of course, other countries,

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it's a major reason for the massive loss

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of life and particularly of infants' children

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and mothers. That's what led me to an interest

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in Ugandan politics because really in the

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1990s during the Clinton administration and

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even more so during the George W. Bush administration

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in the early 2000s, the United States was

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pouring huge amounts of money into Uganda

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for health programs, which was a good thing

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in many, many ways. But the ruling elites

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were stealing practically every shilling

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that wasn't nailed down. And no one outside

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Uganda was saying anything about this. So

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I thought, let me try to draw some attention

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to the problem. And that's how I got interested

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in human rights, Ugandan politics, and so

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on. So here we are.

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On page 138 of your book, you write and I

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quote, Ugandan scientists helped pioneer

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treatment for childhood cancers and malnutrition

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and the mass immunization campaigns that

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UNICEF would later promote throughout the

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developing world. When Singapore was looking

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to reform its own healthcare system in the

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1960s, it sent a delegation to Uganda. What

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you say, Helen, doesn't align with the perception

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that many of us have of modern-day Uganda.

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Our listeners must be intrigued. Can you

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please say more about these programs?

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Well, even before colonial times, as you

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read, Uganda had a pretty sophisticated culture.

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Most of what we know is is from the historical

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record is about Uganda, but there were very

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sophisticated cultures throughout the country

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too. In Uganda, yeah, I was amazed. They

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were doing cesarean sections in the 1870s,

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which was pretty remarkable because they

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were not routine operations even in Britain

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at that time. and they were pretty dangerous

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to do and pretty scary. They used banana

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wine both as antiseptic and as anesthetic

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for the women, but it was pretty rough. For

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whatever reason, I think the British, when

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they arrived and took over the country, they

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actually recognized that there was something.

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They recognized the humanity in a sense or

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the culture of Ugandans in a way that they

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didn't necessarily normally do in their empire

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elsewhere. For some reason, they decided

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to try to turn Uganda into a kind of intellectual

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capital of their African empire. In the early

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scramble for Africa years, the late 19th

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century, early 20th century, when the British

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were first establishing their rule their

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officers did do some pretty terrible things

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in Uganda. They pitted tribes against each

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other. There were terrible massacres and

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so on. It was absolutely awful. But when

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things settled down around the sort of getting

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towards the mid-20th century, in parallel

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with, unfortunately, ongoing repression,

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the British did build a kind of very sophisticated

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medical and also educational system there.

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There was a Makerere, which is the main university

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in Uganda. It was really the Harvard of Africa

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then. The novelists V.S. Naipaul and Paul

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Theroux taught there. Attached to it was

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a very good hospital, Mulago, that Brits

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themselves, British people themselves went

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to. Researchers there pioneered these mass

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vaccination campaigns. They discovered the

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cause of a disease called Burkitt's lymphoma.

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They made other discoveries. They actually

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figured out how to deliver healthcare in

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poor countries. It was really quite remarkable.

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But what the British failed to do was create

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a culture of democracy, which would sustain

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those kinds of services. You really need,

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there really is evidence actually that in

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order to maintain a public health system,

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democracy is the best way of doing that because

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everyone, when people don't get the services

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they deserve, they actually have a voice

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and can say something about it. and politicians

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will take notice, which they don't do in

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dictatorships. They can ignore the voice

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of the people. But the British kind of set

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up Ugandan democracy to fail. They tried

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to create a parliamentary system that would

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manage the various tribal and regional interests

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of the people. But Uganda is an extremely

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diverse country ethnically. I like to think

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that democracy can still work in a place

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like that just as I like to think democracy

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can still work in the United States despite

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the challenges it's now facing. Democracy

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is a very, very fragile thing. When the British

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left Uganda in the early 1960s, they created

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two power centers. First, a prime minister

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who was Milton Abote at the time. president,

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who at that time was the traditional king

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of Uganda, the largest tribe in the country.

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And these two men despised each other and

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they clashed almost at once. And Uganda subsequently,

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one thing led to another and Uganda soon

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became a symbol of African dysfunction within

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just a few short years. And that's really

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where we are. Still, unfortunately, the situation

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has not much improved, even since the days

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of Idi Amin. We like to think that Idi Amin

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was the sort of apotheosis, the worst it

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can get as far as African governance goes.

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But in fact, the mayhem created under the

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current regime actually makes even the regime

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of Idi Amin look pretty good, to be honest.

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I'm afraid.

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Again, on page 138 of your book, you write,

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and I quote, today, this system is a shambles.

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Bats, snakes, and other wildlife have taken

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up residence in once functioning rural clinics.

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I have seen fecal material rain down from

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crumbling ceilings of operating theaters.

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power cuts and water shortages, in hospitals

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kill thousands of patients each year, and

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emergency operations on pregnant women are

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sometimes carried out by the light of torches

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made from burning grass. Helen, how important

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is leadership to the health of a country?

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And is it a reasonable and legitimate expectation

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that every person in any given nation state

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has a right to a public health infrastructure

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that is adequately resourced and operating

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properly?

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Well, a leadership is obviously crucial,

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I think. And as to whether it's reasonable

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for people to expect a functioning health

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system, well, I think so. I mean, Uganda,

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for example, has signed and ratified the

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UN Convention on Economic, Social and Cultural

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Rights. which among other things, commits

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the government to do everything within its

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means to improve the health of the people,

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especially the health of women and children.

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Uganda isn't doing that. It has the resources

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to do a much better job. Many of the medicines

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that are available in the Ugandan healthcare

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system are donated by rich countries when

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they aren't stolen by somebody there. But

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doctors and other medical staff aren't paid

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adequately or on time. Their equipment repairs

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aren't done. Buildings aren't maintained.

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It's really outrageous, really, and shouldn't

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ever happen. So, yeah, it's really a disgrace.

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And, you know, I thought things might get

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better when I wrote those words, now more

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than seven years ago, but it's, my understanding

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is things haven't gotten much better.

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You write the following on page 218 of your

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book regarding something called the Atlantic

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Charter, an idealistic agreement signed by

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Franklin Roosevelt and Winston Churchill

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on the eve of America's entry into World

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War II. And I quote, Roosevelt was almost

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certainly sincere about the sentiments contained

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in the Atlantic Charter. He had expressed

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similar views eight months earlier in his

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Four Freedoms speech, calling for freedom

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of speech and religion and freedom from fear

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and want everywhere in the world. It was

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this last phrase that worried FDR's advisors.

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That covers an awful lot of territory, Mr.

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President, speechwriter Harry Popkin said

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at the time. I don't know how interested

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the American people are going to be in the

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people of Java. I'm afraid they will have

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to be someday, Harry, the president replied.

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The world is getting so small that even the

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people in Java are getting to be our neighbors

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now. Please talk to us about the Atlantic

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Charter and Do the sentiments expressed in

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the Atlantic Charter apply equally to black

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Africans in a nation state such as Uganda?

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Should the American people care?

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Yeah. Americans have a lot of problems of

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their own right now, especially when it comes

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to their own, our own freedoms, actually.

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You know, books take a long time to see the

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light of day. Another fine mess from which

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that passage came was published in 2017,

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but it was mostly written in 2015 and 2016

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when Barack Obama was still the president

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and America was still seen to be the sort

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of reigning light of democracy in the world,

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or at least it was seen that way by many

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people. But I felt that America really hadn't

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been doing as good a job, at least since

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World War II, as it could have, and really

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lived up to its ideals or the ideals expressed

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by FDR in the Atlantic Charter and also in

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the For Freedom speech. After FDR died, we'd

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undermine democracy in Chile and Guatemala

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and Iran, participated in coups in all those

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countries. We'd messed up, we'd messed up

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Vietnam and Laos and Cambodia, Liberia and

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Congo. We'd backed the apartheid system in

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South Africa for far too long. Then there

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was Nicaragua and El Salvador, where we backed

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anti-democratic forces in those countries,

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and also not to mention Iraq and Afghanistan.

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And then, so when I arrived in Uganda and

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I realized we were supporting a corrupt dictatorship

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there too, it was depressing. Why were we

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doing this? FDR really was serious when in

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1941, he called for freedom everywhere. And

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I still agree with him, although it's kind

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of a lonely attitude. But I'm not sure human

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beings are capable of it. And I fear greatly

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that we, you know, we could destroy ourselves

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before we get there. Anyway, the bottom line

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is that Americans right now are preoccupied

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with their own problems, which of course

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have to do with our own democratic future,

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which seems to be in some peril. And I think

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the lesson is really that our leaders have

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never really believed in it. And if they

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can so easily undermine democracy elsewhere

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in other countries like Uganda, why not here

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too? In a way, we shouldn't be surprised

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by what's happening to us now, given what

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we've done overseas. And unfortunately, I

20:06.204 --> 20:08.566
don't think many Americans are caring much

20:08.626 --> 20:11.688
about Uganda, except a few of us here. But

20:11.748 --> 20:14.070
as long as we maintain a donor relationship

20:14.110 --> 20:16.872
with the country and partner with its military,

20:17.472 --> 20:19.453
we really have to care. I mean, as long as

20:19.814 --> 20:23.116
the Museveni regime is our ally, it's our

20:23.156 --> 20:25.998
responsibility too. That's my concern.

20:29.648 --> 20:34.412
Your book, Another Fine Mess, applies a scalpel

20:35.093 --> 20:38.556
to a festering wound, cutting deep to the

20:38.616 --> 20:42.919
very bone, as it were. In a chapter entitled

20:43.400 --> 20:47.383
Murder in Uganda, you write on page 182 the

20:47.403 --> 20:49.184
following, and I quote, since 2006, Irish,

20:49.224 --> 21:00.205
French, Italian, American, and Chinese companies

21:01.066 --> 21:04.268
had been scrambling for a foothold in what

21:04.348 --> 21:08.310
was estimated to be a 400 billion petroleum

21:08.451 --> 21:11.533
reserve in Western Uganda near the Congo

21:11.553 --> 21:16.356
border. In Africa, the discovery of oil typically

21:16.536 --> 21:19.458
amplifies corruption by swelling the rivers

21:19.518 --> 21:22.320
of patronage that keep leaders in power.

21:23.721 --> 21:26.303
There was every reason to believe Uganda

21:26.343 --> 21:30.470
would be no exception. Farther down in the

21:30.510 --> 21:35.332
chapter, you write on page 187, thus, and

21:35.412 --> 21:40.214
I quote, Alice had spoken to Cerinah earlier.

21:41.054 --> 21:44.076
She had seemed fine, but the man insisted

21:44.176 --> 21:47.337
she was at a hospital in a neighborhood called

21:47.697 --> 21:51.639
Nsambya. Because of the traffic, Alice couldn't

21:51.719 --> 21:54.841
get there quickly, so she called Cerinah's

21:55.101 --> 21:57.842
stepfather, who wove through the traffic

21:58.210 --> 22:01.511
on a hired motorcycle taxi. By the time he

22:01.571 --> 22:07.853
arrived, Cerinah was dead. Now, 400 billion

22:08.333 --> 22:13.074
in US dollars is a significant number. But

22:13.134 --> 22:16.455
Helen, are dead black Africans the price

22:16.515 --> 22:19.296
of doing business in the new world order,

22:19.996 --> 22:22.477
where great powers are vying against each

22:22.557 --> 22:26.198
other for access to natural resources on

22:26.238 --> 22:30.612
the African continent? And Helen, where does

22:30.793 --> 22:33.794
fighting climate change fit into the complicated

22:33.954 --> 22:37.496
balance of developing a poor African country,

22:37.677 --> 22:41.299
such as Uganda, while at the same time protecting

22:41.439 --> 22:43.620
her rich biodiversity?

22:46.061 --> 22:48.863
Thanks for that. Well, this is really the

22:48.903 --> 22:51.745
greatest challenge in that region of Africa

22:51.825 --> 22:55.264
right now. At the moment, Uganda is forging

22:55.324 --> 22:58.446
ahead with the East African crude oil pipeline,

22:59.126 --> 23:02.447
which will funnel oil from the west of Uganda

23:03.228 --> 23:05.529
and eventually from Eastern Congo and South

23:05.549 --> 23:08.450
Sudan as well via Tanzania to the coast.

23:09.211 --> 23:11.432
And in the process, it will destroy precious

23:11.572 --> 23:15.133
ecosystems, kill off wildlife, displace thousands

23:15.193 --> 23:18.135
of people. There's a war in Eastern Congo

23:18.215 --> 23:20.696
right now that few people know about, but

23:20.736 --> 23:22.617
a lot of people there are being killed in

23:22.677 --> 23:25.453
it. And it's partly about oil, which Uganda

23:25.493 --> 23:29.616
is trying to control. All that oil is also

23:29.676 --> 23:31.778
going to release tons and tons of carbon

23:31.818 --> 23:35.161
dioxide into the atmosphere, which will accelerate

23:35.181 --> 23:37.603
global warming and create more hurricanes,

23:38.183 --> 23:41.366
wildfires, deadly tornadoes and droughts

23:41.446 --> 23:45.549
and raise sea levels. There's a really inspiring

23:45.909 --> 23:48.651
campaign to stop the East African crude oil

23:48.752 --> 23:52.022
pipeline. and to target particularly the

23:52.102 --> 23:55.184
companies involved with it, including the

23:55.204 --> 23:58.986
multinational Total Energies, which is an

23:59.266 --> 24:02.408
American-French, Franco-American, largely

24:02.548 --> 24:05.389
multinational company, the Chinese National

24:05.569 --> 24:08.151
Overseas Oil Company, the Standard Bank of

24:08.211 --> 24:11.052
South Africa, the Industrial and Commercial

24:11.112 --> 24:14.554
Bank of China, and Sumitomo Mitsui Bank of

24:14.614 --> 24:18.216
Japan. Everyone needs to join the movement

24:19.097 --> 24:24.229
against that against that pipeline, not just

24:24.249 --> 24:27.712
to save Uganda, but to save the world. And

24:27.752 --> 24:30.354
also regarding the case of Cerinah Nebanda,

24:31.454 --> 24:34.176
the passage you read was about the young

24:34.376 --> 24:36.918
member of parliament, only 24 years old,

24:37.438 --> 24:40.320
who was a fearless campaigner against corruption,

24:40.381 --> 24:42.502
particularly in the oil sector in Uganda.

24:43.232 --> 24:45.914
She was only one of many prominent Ugandans

24:46.034 --> 24:48.355
who have died or been severely disabled,

24:49.155 --> 24:51.016
almost certainly at the hands of the Ugandan

24:51.056 --> 24:53.858
regime in recent years. Of course, there

24:53.878 --> 24:57.360
have been no transparent, independent investigations,

24:57.980 --> 25:00.141
but it's very dangerous to be an activist

25:00.201 --> 25:03.603
in Uganda. And that's why people from the

25:03.703 --> 25:06.805
outside world really need to step in and

25:06.825 --> 25:10.815
help out. especially regarding this very

25:10.895 --> 25:13.816
dangerous pipeline, which will not only destroy

25:13.856 --> 25:16.556
the world, but will also very much empower

25:16.756 --> 25:19.757
further the regime at the moment that's existing

25:19.797 --> 25:19.997
there.

25:21.597 --> 25:26.038
The title of our podcast is Uganda in a Multipolar

25:26.078 --> 25:31.399
Brave New World Order. On November 25th,

25:21.597 --> 25:34.579
2020, you published a powerful piece in the

25:34.699 --> 25:38.580
New York Review of Books entitled In Uganda,

25:39.412 --> 25:42.593
another Museveni crackdown in which you concluded

25:42.673 --> 25:46.734
thus, and I quote, of course, the diplomats

25:47.234 --> 25:50.075
see what's going on, but they must operate

25:50.115 --> 25:53.395
within a cruel system of foreign aid and

25:53.515 --> 25:57.316
subaltern military relationships in which

25:57.576 --> 26:01.097
rich countries hire poor armies to do their

26:01.257 --> 26:05.078
dirty work. Call it Cold War realpolitik

26:06.018 --> 26:09.775
or the global war on terror It amounts to

26:09.795 --> 26:13.938
a modern form of colonialism, even if Washington

26:13.998 --> 26:18.241
now terms it partnership. The donor cynicism

26:18.381 --> 26:21.624
boils down to the same kind of racism that

26:21.704 --> 26:25.547
prevailed in colonial times, born of vastly

26:25.647 --> 26:29.410
unequal power relations. In order to stuff

26:29.810 --> 26:33.233
a dictator's pockets so his forces will fight

26:33.253 --> 26:36.255
their wars, it is necessary to regard the

26:36.335 --> 26:41.844
lives of African people as expendable. Helen,

26:42.604 --> 26:46.685
given our podcast theme and the coming dark

26:46.905 --> 26:50.926
age of global lawlessness, is access to natural

26:50.946 --> 26:54.907
resources in Africa a critical national security

26:54.947 --> 26:58.928
concern for the US that supersedes all other

26:58.968 --> 27:02.989
considerations such as freedom, democracy,

27:03.129 --> 27:07.170
and the rule of law? And how, Helen, would

27:07.210 --> 27:11.101
you advise a little insignificant nobody

27:11.181 --> 27:15.004
like myself to help me influence the United

27:15.044 --> 27:18.407
States of America to reevaluate a foreign

27:18.487 --> 27:22.890
policy in the Great Lakes region of Africa?

27:25.092 --> 27:27.974
It's a tough one. It's a tough one. I think

27:28.014 --> 27:30.876
we all feel very small at the moment, given

27:30.916 --> 27:34.259
what's going on in the world. So I don't

27:34.299 --> 27:36.800
know, but keep doing what you're doing, talking

27:36.840 --> 27:40.398
to people and trying to get different viewpoints

27:40.538 --> 27:46.561
out there. Really, everyone must help where

27:46.701 --> 27:50.623
they can and do what they can. I think joining

27:50.663 --> 27:54.264
a campaign like Stop ECOP, or the East African

27:54.324 --> 28:00.207
Crude Oil Pipeline, would be a great place

28:00.247 --> 28:03.404
to start. Anyone can do that. Anyone. There

28:03.424 --> 28:05.746
are demonstrations going on all the time.

28:06.026 --> 28:08.548
Sign a petition. Join a demonstration. Become

28:08.588 --> 28:10.910
informed. Try to convince the people around

28:10.950 --> 28:13.812
you to care about the issue, too. It's something

28:13.833 --> 28:16.735
that affects everyone, especially the people

28:16.935 --> 28:20.137
of the future, wherever they live. It's really

28:20.177 --> 28:23.280
an existential problem. It's absolutely crucial.

28:24.661 --> 28:30.325
So I guess, yeah, that's the best advice

28:30.385 --> 28:31.026
I can think of.

28:32.249 --> 28:35.772
And finally, Helen, please advise our listeners

28:35.832 --> 28:38.255
where they may find your book, Another Fine

28:38.315 --> 28:38.615
Mess.

28:39.556 --> 28:41.878
Thanks so much. My book is available through

28:41.978 --> 28:44.821
Amazon.com and other online booksellers,

28:45.762 --> 28:47.904
or you can ask your local bookshop to order

28:47.984 --> 28:48.064
it.

28:49.385 --> 28:52.788
Dr. Helen Epstein, thank you very much for

28:52.889 --> 28:54.810
being a guest on this podcast.

28:55.911 --> 28:57.553
Many thanks for having me, Stephen.

28:58.717 --> 29:01.358
This podcast was brought to you by the Kamugasa

29:01.398 --> 29:03.838
Challenge in partnership with Democracy in

29:03.959 --> 29:07.319
Africa. Democracy in Africa is a platform

29:07.400 --> 29:10.460
dedicated to building a bridge between academics,

29:11.021 --> 29:13.721
policymakers, practitioners, and citizens.

29:14.762 --> 29:17.422
The fifth episode in the series is entitled,

29:18.143 --> 29:21.023
How Critical is Democracy in a Multipolar

29:21.123 --> 29:24.704
World? An interview with Professor Nick Cheeseman,

29:25.385 --> 29:28.831
a political scientist and Professor of Democracy

29:29.011 --> 29:31.892
and International Development at the University

29:31.952 --> 29:35.213
of Birmingham, specialising in democracy,

29:35.673 --> 29:39.813
elections and African politics. The podcast

29:39.833 --> 29:43.874
will go live on October 14th, 2024. If you

29:44.854 --> 29:48.135
enjoyed this podcast, please support us by

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subscribing to Conversations with Stephen

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29:54.792 --> 29:56.735
Thank you very much for taking the time to

29:56.775 --> 29:59.779
listen to this podcast. Until next time,

30:00.540 --> 30:01.000
goodbye.

