Pools of Perspective

I just found out that Rwanda does not have an Olympic-sized pool in the whole country. The. Whole. Country.

Their Olympic swim team coach says since their swimmers have to practice in smaller pools, they have trouble timing the turns.

Opposition Research

Somehow, I got assigned to write an "executive summary" (I really need to lose my distaste for business jargon...in my mind I picture an elderly Kentucky gentleman sitting on his front porch in a rocking chair, saying, "Now that's some high-falutin' language y'all are usin'" - now I am showing my cultural incompetence in two sectors...) about why meso-level funding is necessary for the development of the private health sector in Unnamed African Country A.

Now, this wouldn't be so bad except that as I was reading previous work done on this particular project (to wit, some "executive summaries" written by business school students in years past), this claim was made: the private health care sector in UACA is struggling to find staff as it competes with the public sector for human resources.

Competes with the public sector?

If you follow this train of thought to its conclusion, that would mean that if the private health sector got its way (was able to attract and retain staff), then the public health sector would be even more understaffed than it currently is. Which is, abysmally.

Now, even as the unmathematical bleeding heart preferential option for the poor crazy person that I am, I can see a role for the private health sector in developing countries. If done correctly, with the proper motives and without stealing health care from the poor. But all the documents I've been reading about this consortium of private health institutions in said UACA have not mentioned, once, a goal of improving the health of the poor. They are all primarily concerned with financial sustainability, growth, etc. It really makes me nervous to give the private health sector a foothold in a developing country when I see the mess that is the U.S. private healthcare system, and when I see from their own documents that they really don't give a crap about the poor.

That said, in the process of researching a defense of the private health sector, I came across the website-blog www.nextbillion.net. It promotes business as a means to social and economic progress in development, particularly for those at "the bottom of the economic pyramid." From the articles I've read in the past 20 minutes (especially in the health feed), it seems to be pretty committed innovative ideas that will really help the poor. I'm not so blog-savvy so I bet most people already know about this site, but I thought I'd share it for those who don't.

Also in defense of my assigned project, meso-level financing is important - it's been called the "missing middle" by those in the financial development world. It makes sense. I just don't like the privatized health care system we have here, and would be loathe to see other countries escape from desperate poverty, only to find themselves trapped in a terrible system of health inequality.
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Other random life-happenings:
-We made our first offer on a condo, and got rejected.
-I love microbiology, despite the rote memorization it entails.

You Don't Deserve A Liver

In ethics class last week, we were considering the shortage of liver donors and the decision of whether a better prioritization scheme for liver recipients is needed. More specifically, we debated the merits of whether people whose liver disease is "through no fault of their own" should categorically jump the queue, ahead of people whose liver disease is due to alcohol abuse. (Of course, to even be on the list you have to have been sober for six months to prove that you're not just going to damage your liver transplant with alcohol again - thus, we're talking about recovered alcoholics here).

The arguments in support of this view are that livers are a severely limited resource (unlike, it is claimed, health care dollars in general), and so there should be a way to prioritize who receives this precious commodity. Everyone should be entitled to one healthy liver in their lifetime, and alcoholics have already used theirs up, so to speak, whereas people who have a diseased liver (not through alcohol abuse) should get the chance to have a normal one.

It's further argued that while there are social and environmental factors involved in alcoholism (it is generally accepted by the medical community to not only be an addiction, but even a disease of sorts), there is still personal responsibility at play because the person with alcohol problems should seek treatment - and not seeking treatment is irresponsible, paid for by the denial of a liver transplant.

I was a bit flabbergasted when a straw poll of my tutorial found only two out of ten of us opposed to this method of distributing livers (in a case where all other factors - prognosis, age, etc. - are equal). There's something about making a moral judgment about whether a person deserves a liver that is abhorrent to me, both as a Christian and as a future physician.

It's abhorrent to me as a Christian because I am deeply aware that we are all extremely flawed beings, and we are all reliant on grace to absolve our unintentional and intentional misdeeds. And grace is abundant: there is no tally on the blackboard of all our past wrongdoings. One of the most beautiful pictures of God's absolute forgiveness is found in Psalm 103: "As far as the east is from the west, so far has he removed our transgressions from us." Not to over-dissect this verse, but the east is pretty far from the west. In fact, there is no association between them.

More than that, though, at the core of Jesus's message is that we are to look out for the weak, those who carry burdens, those who are beleagured. Is that not an apt description of alcoholics? And haven't recovered alcoholics gone through enough? They have showed remarkable perseverance and determination, that's for sure.

I understand that health policy decisions aren't made based on faith, but even on a secular basis, determining organ donation priority based on past behavior would be insidious to the medical profession. One of the foundations of doctoring is to treat patients regardless of moral assessments of their character. That's why we serve prisoners-of-war, genocidaires, and white supremacists. We say, "I will look past all the wretchedness I may see in you because you are a fellow human being, and you are suffering." If we start allocating livers based on perceived distinctions of character, we start playing God (worse, since I don't believe God would judge the way we judge).

Moreover, does it make sense to deny a liver to a recovered alcoholic with a loving family of young children, instead giving it to a man who cheats on his wife and beats her (but who isn't an alcoholic)? According to the policy of giving livers to people whose disease is "through no fault of their own," the second man should receive the liver, no matter how morally decrepit he otherwise is. Isolating alcoholism as the character flaw on which we base liver allocation seems at least a bit unfair. Yes, there is a direct correlation between alcoholism and cirrhosis, but that doesn't mean it should be punished by the medical profession any more than other questionable activities.

I'm not trying to romanticize alcoholism, which can be extremely devastating to both the patient and the loved ones, who may be severely hurt physically, emotionally, and finacially. I'm just saying, a recovered alcoholic has strugged through a lot already, and denying livers based on past alcoholism is not something I'd do as a doctor. And I hope that's true of most doctors.

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Note: I am young and my views are ever-evolving as I consider perspectives I haven't yet been exposed to. I would love to hear what others think about this, especially if you disagree. One thing I've learned in my medical ethics course is that I am often wrong, and I often change my mind. But these issues are so important to think through, whether as physicians, people of faith, or members of the community, even if we don't come to clear conclusions.

Photo: A cirrhotic liver, as seen in alcoholism.

Bodies

For my patient-doctor class on Monday, I shadowed one of my physician-professors, Dr. H, at the community health center where she works. She is a great clinical teacher who is gentle, dedicated to primary care, and invested in helping us learn.

The first patient we saw had come for her yearly physical. Her primary concern was wanting to lose weight, and we calculated her BMI to be about 31 (which puts her in the "obesity" category - even more troubling than the "overweight" category). Dr. H spent a lot of time counseling her on nutrition and exercise, and set her up with a nutritionist.

Everything went well, and then we got to the physical exam. During first year, we only learn how to take patient histories, but this was a special session where we were shadowing, not just practicing history-taking. So I proceeded to witness for the first time a Pap smear being performed.

My instinctive reaction was, "This is kinda gross." I suppose that it's natural to feel awkward the first time you look into someone else's vagina, yet I couldn't imagine doing this as a frequent part of my career. This, despite Dr. H's incredibly nurturing advice: always warm the speculum first, press it downwards as you go in to avoid the more sensitive spots, slide it in at an angle. Shoot, I thought. No more primary care for me. My mind frantically jumped about, thinking, What specialty should I go into to avoid grossness at all costs? Optho? Psych? Radiology?

Radiology?!? That is not why I went into medicine. I went into medicine precisely for the "grossness." I chose medicine because it requires getting you hands dirty with someone else's pain. I went into medicine because at its finest moments, it can be a very basic manifestation of compassion - taking someone else's burden and making it your own, standing with that person in their suffering, and fighting alongside them to give them relief. That means, at the very least, getting vis-ce-ral.

There's a talk that Chris Nichols gave at an InterVarsity retreat I went to in college. He spoke on the passage where Jesus talks to an outcast Samaritan woman who had some really painful problems and Jesus probes into her life and what she's truly searching for. Chris painted this image of how we all have these wounds that we hide from everyone else, wounds that we cover with bandages because we think that no one will ever love us if they see how ugly we are. Yet if we let Jesus take off those bandages, if we let him touch our wounds, he won't humiliate us. Instead, he heals us. It may hurt at first, but ultimately it will set us free.

That's the picture of doctoring that I want to emulate. I want to be a doctor that doesn't turn away from human suffering, human putridness, even human depravity. A doctor that embraces the rotten parts of human existence, and helps people be freed from their physical and spiritual burdens. I've got a long ways to go, I guess, if I can't even appreciate a Pap smear right now.

Perhaps what my experience speaks to, also, is that during first year we are so far removed from what medicine is all about - patients, bodies, touch - that we are uncomfortable when we encounter these things. Things like skin, hair, mucosa. Things that bring back (to really probe deeper psychologically) what we saw in anatomy lab.

A final note. None of the patients I've seen so far has a body like those that are so blatantly used on the glossy pages of magazine ads. None. Maybe as I become a real doctor and see more patients, I will stop thinking that the bodies I see in commercials are the norm. Unfortunately, the general public doesn't have the luxury of seeing the real norm, and thereby recalibrating their perception of what's normal.

A Sugar Fix, A Fix for Sugar

A Sugar Fix: Today, J.P. Licks was giving out free ice cream to celebrate Opening Day at Fenway. I didn't think I would go (largely due to #2 below), but on the way home I saw two med school friends at the end of the line so I decided to wait with them.

I had seen on the ads for JP Licks' free ice cream day that they were premiering some new flavors, four in honor of the beloved Red Sox. One of these flavors was "rice DICE Kream," described as "a new treat named for Daisuke Matsuzaka - short grained rice made into a delectable rice pudding ice cream." Rice pudding ice cream seemed intriuging to me, so I got half a scoop of that and half a scoop of coffee oreo. (One of the other new flavors, "Green Monster Tea," would have been a close runner-up).

rice DICE Kream turned out to be a very soothing flavor. The base is, I think, some kind of sweet cream ice cream. Embedded inside are grains of rice. I am ambivalent about how they did this - I wish the rice grains had been a bit more chewy and sticky, as they are in rice pudding, but I'm not really sure how they could have pulled it off. As it was, the grains were a teeny tiny tad hard, but not such that it disturbed from the overall smooth taste. A good try, but I think the next time I'm craving rice pudding, I'll go for the real thing (though I'd be hard pressed to find a place that serves it around here...).

A Fix for Sugar: I love medical school. For many reasons, one of which is being around upperclassmen. Today, for example, we had a panel of 3rd and 4th years to give us advice about the wards...it was hilarious to watch them interact and I was pleasantly surprised that even their hard-earned cynicism was quite mild, and mostly expressed for the purpose of entertainment.

But another perk of HMS is that we're classmates with dental students, who, amazingly, go to all the medical school classes and take all the exams - in addition to their own dental classes and exams. I don't know how they do it. So when one of the 4th year dental students who I know from HMS Writers Group asked me to be one of his subjects for his licensure exam, I agreed.

He took x-rays of my teeth and then did a quick exam (I have a follow-up visit for a more thorough exam). During the exam, he used this strange instrument that I had never seen before to measure the distance between my gums and my teeth. By the end, he had basically scared me into flossing every day. FLOSS EVERY DAY.

My previous small-town dentists have been older, amiable, teddy-bear-like white men who mildly suggest, "Try to floss more if you can," or leave it to the hygienists to admonish their patients. My response has usually been to floss once or twice the week after the exam, and then move on to more important things in life.

But this 4th-year student imbued a deep, quaking fear in me. Maybe it is because he had just learned about all the degenerative periodontal diseases you can get, or maybe because he is bright-eyed and bushy-tailed, or maybe because he cares deeply about prevention, but he was extremely effective in convincing me to move dental health up my priority list. Since that visit last week, I have flossed more than I usually do in a year.

How did he accomplish this?

1) He spoke urgently and earnestly. He looked me in the eye and said, "Either you get this permanent bottom retainer removed, or you start flossing under it every day. There are no other options." I, being trusting of my doctors, believed him. Since I have no plans of getting my retainer removed, I started flossing every day, using those obstinate floss threaders to get the floss under the metal.

2) He kept pressing the point (i.e., was long-winded). He talked about flossing during the x-rays, during the exam, and while we were just chatting. I got the point.

3) He used scare tactics. "They'll have to inject you with lido and then clean out all the debris between your gums and the teeth, and then hopefully it will heal." Basically, the threat of pain (and lidocaine injections, which are never fun), convinced me that prevention really is worth it.

4) He gave me a preview of the aforementioned threat of pain. The strange instrument that he used scraped against the exposed nerves near my gums, made the gums bleed, and made me flinch repeatedly. "Yeah, you're tasting blood right now. You know what that means? It means your gums are inflammed." Again...I got the point.

I'm not recommending all of these methods to impress the value of self-care upon your patients...but maybe some of them will be effective in convincing them to exercise, lose weight, or floss more. It worked on me :). He is going to be a great dentist.

Label:Art as Chart:Patient

I'm taking an elective this semester called "Training the Eye: Improving the Art of Physical Diagnosis." The premise is that to be good physicians, we need to develop better observation skills - and we can do that by learning how to really see art. Every Friday afternoon, we spend an hour at Boston's Museum of Fine Arts (a short walk from campus), and then come back for an hour of lecture.

Today was our first real day of class, and it was lovely to spend time in the MFA, basking in two paintings. The first was Grotto by the Seaside in the Kingdom of Naples with Banditti, Sunset by Joseph Wright of Derby, 1718. We spent a lot of time just saying what we could see in the piece, and then our leader (I think she's a curator at the MFA/Isabella Stewart Gardner Museum) read to us the museum label of the work. She told us that studies have been done where museum visitors are surreptiously followed, and it's been found that most patrons only look at the work of art for about 20 seconds - spending much more time reading the label. It's almost as if the painting becomes an illustration for the text on the label.

Dr. Khoshbin, one of the course directors, pointed out that this is analogous to how doctors often approach our patients. Before we go into their rooms, we'll read their charts and gather information from them. By the time we meet the patient, we have preformed opinions of what we should see, and we may miss a lot.

An intruiging thought. I also have to confess that I'm one of those people who loves to read the labels by the artwork. I always want to know what the painting means. But it's true - I miss out on the composition and color and perspective if I jump directly to the story - or really, the curator's interpretation of the story.

The second painting we saw was Manet's Execution of the Emperor Maximilian. It's an impressive piece, both in size and in content. With its firing squad and prominent white figure, it was quite reminiscent of Goya's The Third of May. Someone commented that it's not the kind of painting they'd like to hang in their bedroom. Maybe I'm strange, but I loved it. It's so powerful in connoting a deep moral outrage. Paintings can do that better than words sometimes. We need that for Darfur...(actually, sadly, I forgot that we already do have that - children (thus far) have survived the genocide were given crayons to occupy themselves while their parents talked with Human Rights Watch staff. Without instruction or guidance, the kids drew the violence that they had witnessed. It's heartbreaking).

On a final art-related note, the day this course was introduced to us, the instructors showed a painting of a sufferer of tuberculosis. The subject had a bandage over his chest where his ribs had been removed in a procedure known as a thoracoplasty (an old way of treating TB). My eyes widened when I saw this painting, because it was a validation that I hadn't been hallucinating when I met this boy named Fredi in Mexico the summer before college. Fredi had multi-drug resistant TB, and had a huge, gaping hole in the side of his chest due to a therapeutic procedure (now, I realize that it was a thoracoplasty - I couldn't believe he was still alive). The doctor had to clean out the wound with iodine, causing Fredi a TON of pain. Later, the physician told me Fredi would probably die, because they didn't have the drugs to treat his MDR-TB. It made a deep impression on me, especially after coming back to the States and learning that MDR-TB can be cured. In any case, I tracked that painting down. It's called TB in Harlem by Alice Neel, 1940. I want a copy of it, but can't seem to find one...

It gives me some measure of satisfaction that I'll be going to South Africa this summer to work on MDR-TB - particularly, helping with a pilot study of a community-based treatment initiative that will hopefully let many more people gain access to the life-saving drugs. I don't know what happened to Fredi all those years ago, but I pray that he survived.

Photo: TB in Harlem, by Alice Neel

Join the photo petition!

Save Darfur is organizing a photo petition to try to convince China to use its leverage in Sudan to get the Sudanese government to stop instigating the conflict-genocide in Darfur. It's a very easy way to voice your opposition to the genocide - all you need is a camera. You can make your own sign or download one here. Send the photos to photos@savedarfur.org and they will be posted on their website and used on Save Darfur's banner in the San Francisco rally on April 9th, when the Olympic Torch will make its only U.S. stop in that city. China cares a lot about being the host of this year's Summer Olympics, so hopefully this will make them nervous.

Top ten fabulous food discoveries of the past five years

After happening upon my friend's blog about all things edible and drinkable in Washington, D.C., I've been addicted to reading her tantalizing descriptions of that metropolis's restaurant fare. Since D.C. is a bit of a trek for dinner, I started searching for homegrown Beantown blogs of similar bent with which to tempt my palate. I was not disappointed.

My favorite so far is The Food Monkey, which gives student-budget-friendly updates on special deals (as well as covering more traditional, salivatory food blog material such as neighborhood-specific "Taste Of..." events). Another favorite is La Tartine Gourmand, a blog by a French ex-pat who also writes for the Boston Globe Food section. Perhaps more importantly, she is also a food stylist and photographer, so the pictures on her site are phenomenal. I think reading food blogs is my new preferred mode of procrastination. I don't have the time or inclination to eat out frequently, so this is a way to feast my eyes and mind, at least :).

In any case, with gastronomical delights on my mind, I decided to make a list of all the food-related epiphanies I've had since coming to Boston. (I know that's a long time, but keep in mind I was eating dorm food for four of the past five years). Perhaps it reveals my ignorance, since pretty much all of these things have existed for centuries, if not millenia. That is okay. These things are good.

1) Dan dan mian (Mandarin), dun dun mein (Cantonese). This is cheating, because I actually discovered it in Hong Kong this past New Year's Eve when we were out to dinner with my relatives. I'm told I've had it before (who knows), but it was a perfect finale to a week of dimsum and wonton soup in the formerly British territory. This Szechuanese dish is characteristically spicy, with noodles piled into an angrily-red hot sauce containing ground peanuts and sesame sauce, and garnished with thinly sliced cucumbers. Since coming back to Boston, I've already had it three times. Highbrows beware: I am decidedly not a food snob, and I actually like P.F. Chang's version of this dish (and I enjoy their rendering of #2 below, as well).

2) Eggplant. I used to hate this stuff. I guess this is also somewhat cheating, since I first became fond of it when I spent the summer in Shanxi Province, China. The two other interns and I would go around the corner to our favorite roadside eatery, sit down at an open-air table, and order hongshao qiezi (red braised eggplant). The eggplant served there was of the green variety (which I still haven't seen at a grocery store here) and hit the spot every time. (Let me also mention that this was the same restaurant where we stumbled upon a Chinese version of mashed potatoes, tudoni. The spuds are served smothered in meat sauce). In Boston, Taiwan Cafe serves a mean take on eggplant sauteed with basil, which we ordered when T. was visiting from NYC. Still haven't found a good hongshao qiezi though.

3) Chawanmushi. This is a delicate Japanese egg custard with Shiitake mushrooms, shrimp, scallops, and other seafood layered in. I had it for the first time at Ginza last week, and it was served in a tiny ceramic teacup. Thankfully, I wasn't at all hungry (having consumed CPK for lunch) or else that would not have been nearly enough to satisfy me (it's meant as an appetizer, but I orderded it as my main course). It was a lot of fun to eat, though, especially since it's something we wouldn't make at home.

4) Fisherman's Stew. Yi-An's dad found a great recipe for this in a New England cookbook that we subsequently snatched. This should really be called "white soup" because its distinguishing features are white pepper, white wine, and white fish. We make it with cod, but I think you can use other types as well. We add red bell peppers and mushrooms, buy a loaf of cheap but fresh Italian bread from Stop and Shop (see #5 below), and there's a fancy meal!

5) Bread and olive oil, at home. One of the best parts of eating out is the pre-meal snacking on fresh bread, especially if it's accompanied by olive oil. My favorite take on this by a restaurant is City Cafe in Rochester, MN (it's also the best eatery in town). Yi-An and I realized that it's supremely simple to replicate this in the comforts of our own apartment by getting a loaf of Italian bread from Stop and Shop (though I prefer Shaw's, which has a much better crust) and adding black pepper, red crushed pepper, and Parmesan to olive oil. Awesome.

7) Slow cookers. This has saved many a dinner for us this year. It's a lot easier to chop vegetables and throw everything into a crockpot in the morning than after a long day at work or at school. We have the Hamilton Beach Stay and Go slow cooker from Target. It was a wedding present, cost maybe $20 or $30, and is my favorite kitchen appliance, ever.

8) Taiwanese brunch. I never knew it existed, but it's like a Taiwanese version of Cantonese dimsum. Shangri-La in Belmont and Mary Chung's in Cambridge have tasty and slightly different renderings of this. I like the bowls of sweet soy milk (Yi-An prefers salty - yes, that exists), the xiao long bao (soup-filled dumplings that are really Shanghainese in origin), and the nian gao (glutinous rice cakes). My favorite Cantonese dimsum dish is fried turnip cakes, and Shangri-La makes an unusual version of this served with red hot sauce. There's also dozens of things we eat for which I don't know the names, but pretty much anything we order off the brunch menu turns out to be delicious.

9) Indian food at the Burlington mall food court. Burlington is north of Lexington, which is north of Arlington/Cambridge. There's a big mall there, and we go on weekends when they have their specials (we say we know it must be authentic because we see throngs of Indian people eating there). Our strategy is to observe what said Indian people are ordering, point to something that looks good on their trays, and ask for it. We've discovered dosa and samosa chaat that way. Yum.

10) Online recipes. Allrecipes.com (for day-to-day cooking) and Epicurious (when we have more time) are excellent resources. The ingredient search function on Allrecipes is helpful when we have random leftover jars of tahini sauce or sauerkraut and don't know what to do with them. The comments left by users inevitably improve upon the posted recipes - it's like a braintrust of food knowledge.

Uh, this was all actually an excuse to blog about something people actually like reading about. That is, blogging for entertainment value. Expect the next fabulous food discoveries update in another five years, since I probably won't eat out frequently enough to discover much annually.

Photos: Dan dan mian, chawanmushi, and samosa chaat

Settling

We're thinking about buying our first home - a one-bedroom condo - since the housing market is pretty good for buyers and since our rent money is just going down the drain currently. Still, everything close to the medical area is extremely expensive (we could buy a two-story house in the Midwest for this kind of money).

We're fortunate that we can even afford rent (or a mortgage), but thinking about settling into a home makes me want something with "value." Our current apartment is small (square footage in the high 400s) and while I like its coziness for now, it would be nice to have a slightly larger space so that we can host parties of more than 6 people at a time.

That's the kind of thought process that I've caught myself cycling through recently:

Wouldn't it be nice if we had...a big kitchen with sufficient cabinet space?...a dog?...a gym in our building?...a second bedroom?...a bigger living room?...an elevator?...

Though there's nothing inherently wrong with any of those things, I've also found myself looking at the gigantic mansions in Chestnut Hill and in Cambridge - the beautiful gardens, the stuccoed exteriors, the (false) sense of permanence and security and the (true) sense of luxury - and thinking, "Wouldn't it be nice to live in a house - not that extravagant - but a house nonetheless?"

It's endless, and for someone like me, pointless. I forget that we're buying a condo to save money in the long run - not to settle down here. Before this, I had never felt drawn to having more (except maybe with clothing, though you wouldn't know it given the way I dress!), but I've felt some not-so-subtle tugs recently with the homebuying process. Why not pay a higher condo fee for an in-building gym? Why not pay $20,000 extra for 100 more square feet?

The answer, of course, (besides the fact that we can barely afford a condo at all) is that this money really isn't ours. It's God's. It would be difficult for us to give away a tithe of our money if we locked ourselves into a pricey mortgage. And there are so many better, more urgent and more important things, that we could do with it.

I'm not sure what kind of place we'll end up with, but this process has definitely made me more aware how easy it is to get into the mindset of wanting nice things for myself, forgetting about how little most people in this world have. It reminds me of the passage that Brenda Salter McNeil spoke about at Urbana '06, Genesis 11:31-32, where this dude Terah was going on a journey to Canaan but instead he stopped at Haran and "settled" there. The next thing that happens to him is...he dies. Her point was that we shouldn't just settle down and settle for less -as it turns out, Terah's son, the famous Abraham, actually completed the journey to Canaan later on, and as promised, God blessed him abundantly.

So while Yi-An and I will be in Boston for some time as I complete my medical training, we know that it is just a step. Eventually, we'll be overseas, and I want to live a life here in the States that is in consanance with that. I hope that even as we settle down a bit temporarily, we won't settle.

After all, we really don't need granite countertops, do we?

Photo: A $7.95 million home for sale in Brookline, MA.

I don't trust Fidelity's Board of Trustees

I was so happy today when I got our mail. We're very minimally invested in a Fidelity fund, and they sent out a package to all shareholders on five proposals. We're supposed to vote on the proposals, and the last one is a shareholder proposal concerning "oversight procedures to screen out investments in companies that, in the judgment of the board, substantially contribute to genocide, patterns of extraordinary and egregious violations of human rights, or crimes against humanity."

Amazing. The anti-genocide activists (shouldn't we all be?) have actually gotten this on the ballot. This is an incredible testament to their indefatigable efforts, as they have faced tremendous opposition...as we shall shortly see.

It didn't take me long to figure out that the Board of Trustees is trying to do whatever it can to hinder the passage of this proposition. In fact, the cover page actually doesn't even describe the content of the shareholder proposal: unlike the other proposals, which are at least described in a phrase, the only description of this shareholder-initiated proposal is that the Trustees "recommend you vote against the proposal submitted by shareholders of certain funds." (Emphasis preserved from original).

I had to search through the packet to even find what this proposal entailed. When I found it, underneath the title was once again a warning from the Board of Trustees to vote "AGAINST" the proposal. (Again, emphasis preserved from the original). In fact, it almost sounded like the Board wanted people to harass the shareholders who created this proposition: it said that Fidelity will provide the names, addresses, and shareholdings of the proponents of this proposal.

The proposal itself is elegantly constructed, arguing that since "Fidelity portfolio managers make their investment decisions based on business and financial considerations...even in the face of egregious violations of human rights," it means that ordinary folks inadvertently invest in companies funding genocide (such as PetroChina). It cites a 2007 by KRC Research that found that 71% of respondents believe companies should take into consideration extreme human rights abuses when making investment decisions, rather than using only financial criteria.

This is followed by a "Statement of Opposition" from the Fidelity Funds Board of Trustees. They reply that investors "have other investment opportunities open to them should they wish to avoid investments in certain companies or countries." Basically, Fidelity will invest in anything legal, regardless of ethical implications. Its argument that there are other funds open to investors misses the point. The point is that Fidelity still has no conscience about its own funds, and also that most ordinary individuals don't know about PetroChina or Sinopec (let alone what their own portfolios look like!) so they don't realize they're supporting genocide.

On the voting card, there's one last deterrent. Right before Proposal #5, the line reads, "THE BOARD OF TRUSTEES RECOMMENDS A VOTE AGAINST THE FOLLOWING:" (again, emphasis preserved from original).

Incredible. For people who don't have the time to find the proposal buried in the middle of the packet, all they know about it is that it's not recommended by the trustees (who, by the way, are supposed to protect shareholder interests). And if they take to read the three lines of small print on the voting card, they may also figure out the proposal has to do with genocide.

At this point, I'm not too optimistic about the proposal itself, as it relies on entirely on the judgment of the Board - the same Board that is trying to destroy the proposal - to screen out investments that are ethically questionable. Obviously, this Board does not consider anything ethically questionable...so unfortunately, even if the proposal passes, the Board may just laugh and not change a thing.

But I'm still happy the proposal got on the docket. And I wrote this just so that the world knows that this is how Fidelity rolls.

Photo from dotherightthing.com.