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Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era
Cancer Res Treat. 2019;51(2):788-796
Cancer Res TreatJournal ArchiveCancer Res Treat. 2019;51(2)
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Publication date (electronic) : 2018 September 11
doi : https://doi.org/10.4143/crt.2018.120
Jin Hee Kim, PhD1, Kyungjoo Kim, MS2, Seo Jin Park, MS1, Jung-Yun Lee, MD, Ph3, Kidong Kim, MD, Ph4, Myong Cheol Lim, MD, Ph5,6,7,8, Jae Weon Kim, MD, Ph9
1Department of Nursing, Chosun University College of Medicine, Gwangju, Korea
2Department of Public Health, Korea University, Seoul, Korea
3Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
4Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
5Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
6Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Korea
7Cancer Healthcare Research Branch, Precision Medicine Branch, and Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Korea
8Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
9Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
Correspondence: Jung-Yun Lee, MD, PhD Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-2237 Fax: 82-2-313-8357 E-mail: jungyunlee@yuhs.ac
Received 2018 February 20; Accepted 2018 September 10.
Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer.
We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing.
We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85).
In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
Keywords: Uterine cervical neoplasms; Radical hysterectomy; Minimally invasive surgery; Laparoscopy
Originally described by Wertheim in the 1890s and subsequently re-popularized by Meigs in the 1950s, radical hysterectomy has long been established as a standard treatment for early-stage cervical cancer [1]. Although abdominal radical hysterectomy represented the standard surgical approach for many years, minimally invasive approaches have been widely adopted in gynecologic oncology over the past few decades [2,3].
Radical hysterectomy and pelvic lymphadenectomy are standard surgical treatments for early-stage cervical cancer. Despite the excellent 5-year overall survival rate [4,5], the surgical treatment resulted in substantial long-term morbidity, such as lower urinary track dysfunction, sexual dysfunction, and colorectal motility disorders [6-8]. Furthermore, the surgical approach was traditionally performed through laparotomy and associated with a high incidence of perioperative morbidity and mortality.
Laparoscopic radical hysterectomy was introduced to decrease the morbidity of the operative procedure. Numerous retrospective studies have compared laparoscopic and abdominal radical hysterectomy for cervical cancer, and showed that the laparoscopic approach is oncologically safe and associated with fewer postoperative complications and earlier recovery [9-16]. However, there have been concerns about the oncologic safety of laparoscopic radical hysterectomy due to difficulties in achieving a sufficient resection margin from the complex procedure itself. However, patient acceptance of minimally invasive surgery increases even in the absence of randomized phase III trials that show advantages to these procedures [17]. Currently, only one randomized clinical trial is evaluating laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early-stage cervical cancer [18].
Despite the common use of minimally invasive surgery operation for cervical cancer, there are no population-level data evaluating survival after the procedure in unselected patients. We performed a population-based analysis to compare the effectiveness between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer.
1. Data source
The Korean Health Insurance Review and Assessment Service (HIRA) database was used for the analysis. HIRA is an independent body established to review the claims data and assess the quality of health care. In Korea, since health insurance is applied to all citizens and it is a fee-for-service system, everyone's health information is coded and registered in the HIRA database. Therefore, this database captures inpatient and outpatient data on disease and services (procedures and operations) in a timely manner. Disease codes used in the HIRA database are standardized according to the Korean Classification of Disease, sixth version, which follows the International Classification of Diseases, 10th edition (ICD-10) [19]. Procedure and operation codes use HIRA's own code and are released yearly [20].
2. Cohort selection
Women 18 years and older who underwent radical hysterectomy for cervical cancer were identified from the HIRA database between January 1, 2011 and December 31, 2014. A multidisciplinary panel consisting of gynecologic oncologists (J.Y.L., K.K., M.C.L., and J.W.K.) and epidemiologists (J.H.K., K.K., and S.J.P.) identified the patients with newly diagnosed cervical cancer. Disagreements were resolved by consensus after discussion. Newly diagnosed cervical cancer in a patient with radical hysterectomy was defined by using the following criteria: the presence of an ICD-10 code for cervical cancer and HIRA operation codes for radical hysterectomy. ICD-10 codes for cervical cancer were C530, C531, C538, and C539. HIRA operation codes for radical hysterectomy were R4154 and R4155.
Patients were stratified into two groups based on the type of radical hysterectomy performed: abdominal or laparoscopic. To identify women who underwent the laparoscopic procedure, the database was searched to identify charges for laparoscopic materials (N0031001). In Korea, insurance does not cover the cost of robotic operation. Therefore, robotic operation could not be identified in this database.
3. Characteristics
Patient characteristics analyzed included age at operation, year of diagnosis, insurance status (Medicare or Medicaid), comorbidities (Charlson comorbidity index [21] score), and the extent of lymphadenectomy. Hospital characteristics analyzed included the hospital location (metropolitan or nonmetropolitan), hospital region (metropolitan area [Seoul/Gyeonggi Province], Middle [Chungcheong Province], East [Gangwon Province], South West [Jeolla Province], and South East [Gyeongsang Province]), and hospital size (tertiary general hospital, general hospital, hospital, or clinic).
4. Outcomes
The primary outcome was overall survival. Death was deemed to have occurred when patients did not use any medical service for 12 consecutive months after discharge. Additionally, perioperative morbidity and mortality were analyzed. Perioperative mortality was defined as in-hospital death. Perioperative morbidity and the use of blood transfusions were recorded. We used methods in previous studies in obtaining morbidity and survival data extraction from HIRA database [22,23]. To identify complications, diagnostic and procedure codes were used (S1 Table). Perioperative morbidity was classified into the following categories: (1) intraoperative complications (bladder injury, ureter injury, intestinal injury, and vascular injury); (2) postoperative complications (bladder dysfunction, lymphocele, lymphedema, bowel obstruction, and fistula); (3) surgical site complications (wound abscess, disruption, and incisional hernia); (4) medical complications (venous thromboembolism, myocardial infarction, cardiopulmonary arrest, respiratory failure, renal failure, bacteremia/sepsis, shock, pneumonia, delirium, acute pyelonephritis, and stroke). Blood transfusions during hospitalization for the operation were counted. For intraoperative complications among perioperative morbidities, the event that occurred during hospitalization for the operation was considered, whereas for postoperative complications, surgical site complications, medical complication, and events that occurred within 6 months postoperatively were considered. The aforementioned complications were assessed using the 6th revision of the Korean Standard Classification of Diseases based on ICD-10 and current procedural terminology codes (S1 Table).
The use of adjuvant vaginal brachytherapy, whole pelvic radiation, and chemotherapy during the 3 months postoperatively was noted for each patient.
The HIRA database includes an itemized, data-stamped log of all items billed to a patient, including drugs, laboratory and radiologic tests, and therapeutic services. Medical costs per person during hospitalization for the operation within 30 days, 90 days, and 6 months postoperatively were evaluated. This analysis did not consider uninsured benefits. All costs were reported in December 31, 2014 in United States (US) dollars with an exchange rate of 1 US dollar equaling 1,107 Korean won. Costs are reported as medians and interquartile ranges. This study also analyzed use of the intensive care unit service, 30-day reoperation, non-routine discharge, 30-day readmission, 30-day emergency room visit, and length of stay for the operation by capitalizing on the HIRA database.
5. Statistical analysis
Frequency distributions between categorical variables were compared using the chi-square test, and continuous variables were compared with the Student t test. The multivariable logistic regression that included patients and hospital characteristics was used to identify the factors that affect the use of laparoscopic radical hysterectomy.
The inverse probability of treatment weighting (IPTW) method based on the propensity score was applied to balance the observed confounders between the methods of operation. With this technique, weights for patients who underwent laparoscopic radical hysterectomy were the inverse of 1-propensity score, and weights for patients who had abdominal radical hysterectomy were the inverse of the propensity score [24]. The propensity score was the predicted probability of treatment, laparoscopic radical hysterectomy, or abdominal radical hysterectomy, in this analysis [25,26]. To calculate the propensity score, we used a logistic regression model that included patient characteristics (age at operation, year of diagnosis, insurance status, comorbidities, and the extent of lymphadenectomy), hospital characteristics (hospital location, hospital region, and hospital size), and two-way interaction terms. The predicted probability was estimated for each patient. After propensity score balancing, subsequent treatment, morbidity, and mortality were compared between the two groups. Overall mortality was evaluated between the two groups using the Kaplan-Meier method and Cox proportional hazard models. All statistical tests were two-sided. A p-value of < 0.05 was considered statistically significant. To perform all statistical analyses, SAS software ver. 9.1.3 (SAS Institute Inc., Cary, NC) was used.
6. Ethical statement
This study was approved by the institutional review board of Yonsei University Health System, Severance Hospital (approval No. 4-2016-0440). As HIRA database are publicly available, written informed consent was waived for this study.
We identified 6,335 patients, including 3,235 women (51.1%) who underwent abdominal radical hysterectomy and 3,100 (48.9%) who underwent laparoscopic radical hysterectomy. The use of laparoscopic surgery increased with time. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014 (p for trend=0.016) (Fig. 1). Table 1 shows the characteristics of women who underwent abdominal radical hysterectomy versus laparoscopic radical hysterectomy. When patients were stratified according to the surgical approach, statistically significant differences were observed with respect to age, year of diagnosis, insurance status, comorbidities, the extent of lymphadenectomy, and hospital region. After propensity score balancing, there was no significant difference in these variables between the two groups.
Trends in the use of laparoscopic and abdominal radical hysterectomy (2011-2014).
Characteristics of the cohort that underwent laparoscopic and abdominal radical hysterectomy
In a multivariable model for identifying predictors of undergoing laparoscopic operation, age was the strongest predictor associated with minimally invasive operation. Patients who were younger, had a more recent year of diagnosis, were hospitalized in a metropolitan area, and had a Medicare insurance status were more likely to undergo laparoscopic radical hysterectomy (p < 0.05 for all) (S2 Table). In contrast, patients with more medical comorbidities who were hospitalized at a small-sized hospital (a hospital or clinic) were less likely to undergo a laparoscopic radical hysterectomy (p < 0.05 for all) (S2 Table).
Laparoscopic radical hysterectomy had favorable morbidity profiles and a health care utilization index compared to abdominal radical hysterectomy (S3 Table). Compared with abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with fewer intraoperative complications (9.9% vs. 12.0%, p < 0.001), fewer postoperative complications (19.5% vs. 21.7%, p=0.002), and fewer surgical site complications (6.2% vs. 8.1%, p < 0.001). Regarding the health utilization index, the median length of stay was shorter with laparoscopic radical hysterectomy than with abdominal radical hysterectomy (p < 0.001). When focusing on inpatient outcomes, the median cost of care was higher with laparoscopic radical hysterectomy than with abdominal hysterectomy (US $4,421 vs. $4,147), although this difference was not statistically significant. When focusing on postoperative outcomes, patients undergoing laparoscopic radical hysterectomy had lower 30-day reoperation rates. In addition, patients undergoing laparoscopic radical hysterectomy were associated with a lower cost of care within 30 days, 90 days, and 6 months after discharge.
The overall rates of intraoperative complications (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.63 to 0.86), surgical site complications (OR, 0.73; 95% CI, 0.60 to 0.88), medical complications (OR, 0.88; 95% CI, 0.79 to 0.98), and blood transfusions (OR, 0.28; 95% CI, 0.25 to 0.31) were lower with laparoscopic radical hysterectomy than with abdominal radical hysterectomy (Table 2). After propensity score balancing, laparoscopic radical hysterectomy still had lower rates of intraoperative complications (OR, 0.80; 95% CI, 0.72 to 0.90), postoperative complications (OR, 0.87; 95% CI, 0.80 to 0.95), surgical site complications (OR, 0.75; 95% CI, 0.66 to 0.86), and blood transfusions (OR, 0.30; 95% CI, 0.28 to 0.33). In addition, the rate of use of adjuvant therapy was lower (OR, 0.63; 95% CI, 0.57 to 0.69) in patients who underwent laparoscopic radical hysterectomy than in those who underwent abdominal radical hysterectomy.
Comparison of morbidity between patients who underwent laparoscopic and abdominal radical hysterectomy for cervical cancer
Table 3 demonstrates the cumulative hazards of adverse outcomes in patients in receiving either laparoscopic or abdominal radical hysterectomy using unadjusted and adjusted multivariable analyses. Unadjusted Cox regression models showed that laparoscopic radical hysterectomy was associated with better overall survival (hazard ratio [HR], 0.52; 95% CI, 0.43 to 0.63). Additionally, laparoscopic radical hysterectomy was associated with better overall survival when adjusting for IPTW or IPTW and the covariates. When we performed sensitivity analysis for patients who underwent adjuvant therapy and no adjuvant therapy, the laparoscopic radical hysterectomy group had better survival than the abdominal radical hysterectomy group. This finding was pronounced in patients with no adjuvant therapy (HR, 0.52; 95% CI, 0.41 to 0.66) and the benefits of laparoscopy were marginal in patients with adjuvant therapy (HR, 0.85; 95% CI, 0.72 to 0.99). Likewise, survival statistically significantly improved among patients undergoing laparoscopic radical hysterectomy in all Kaplan-Meier analyses (Fig. 2).
Hazard ratios for clinical outcomes with laparoscopic versus abdominal radical hysterectomy
Overall survival with laparoscopic versus abdominal radical hysterectomy.
During the study period, approximately half of all radical hysterectomies performed in Korea were done laparoscopically. Using a cohort of patients treated in the postdissemination era, we showed that laparoscopic radical hysterectomy was associated with lower rates of complications, lower cost of care, and better survival outcomes than abdominal radical hysterectomy.
Despite limited evaluation of the comparative effectiveness between laparoscopic radical hysterectomy and abdominal radical hysterectomy, as well as the absence of randomized trials comparing the two techniques, minimally invasive surgery has been widely used for cervical cancer in the last decade in Korea. In 2011, 46.1% of radical hysterectomies for cervical cancer were performed minimally invasively. The rate of use of minimally invasive surgery in our study was higher than that in previous studies. Wright et al. [17] reported that only 15% of patients with cervical cancer underwent laparoscopic or robotic radical hysterectomy during 2006-2010 from a population-based database. The widespread use of laparoscopy in Korea has been attributed to patients' preference to minimally invasive operation, acceptance of new techniques from gynecologic oncologists, and increasing hospital competition due to patients' demands.
Several of our findings are noteworthy. First, discrepancies were found in the use of laparoscopic surgery in Korea. Not only age, year of diagnosis, and comorbidities but modifiable factors such as one's insurance status and the hospital region affects the use of laparoscopic radical hysterectomy. This finding was in line with that of other studies on hysterectomy for benign and oncologic indications, which showed significant disparities in the use of minimally invasive surgery [26].
Second, patients who underwent laparoscopic radical hysterectomy had a lower risk of intraoperative complications, postoperative complications, and surgical site complications even after propensity matching. An important benefit of minimally invasive surgery is lower rates of perioperative morbidity. Numerous prior retrospective studies comparing laparoscopic radical hysterectomy and laparotomy for cervical cancer have consistently shown lower complication rates [9-17]. Most of the studies were based on contemporaneous series of patients from a single institution. Using population-based database, Wright et al. [17] showed that minimally invasive radical hysterectomy had favorable morbidity profiles with a lower rate of complications than abdominal radical hysterectomy. In this study, only 284 of 1,894 patients (15%) underwent minimally invasive surgery between 2006 and 2010. In our study, differences in perioperative outcomes became more noticeable with 48.9% of patients who underwent laparoscopic radical hysterectomy, indicating wide use of minimally invasive surgery.
Third, laparoscopic radical hysterectomy was associated with a lower total cost of care within 6 months postoperatively than open radical hysterectomy. While decision analyses for radical hysterectomy are lacking, a modeling study of simple hysterectomy for endometrial cancer noted that the laparoscopic approach was the least expensive approach from a societal perspective followed by robotic and then abdominal hysterectomy [27]. These findings might result from favorable operative outcomes, such as lower complication rates, a shorter hospital stay, and fewer blood transfusions, of laparoscopic surgery. In addition, one possible explanation for these observations may reside in the characteristics of the population evaluated. The age at operation, comorbidities, and Medicare insurance status represent independent predictors of complications and use of the health care expenditure. Differences in patients' characteristics might affect these results.
Lastly, we found favorable outcomes in survival for laparoscopic radical hysterectomy compared to abdominal radical hysterectomy. Previous retrospective studies have shown non-inferior survival associated with laparoscopic operation compared with laparotomy [9,10,12,15]. However, these results were derived from experienced surgeons with a limited number of patients. In the Laparoscopic Approach to Cervical Cancer trial, 740 patients with cervical cancer and tumors less than 4 cm were randomly assigned to either minimally invasive surgery or laparotomy. Although this study started in January 2008, it is still recruiting participants. The slow recruitment for this study might be due to rarity of the tumor in western countries and patients' reluctance to participate in a study if they prefer minimally invasive operation. Therefore, large observational studies are needed to evaluate survival outcomes.
Encouragingly, we found better survival outcomes with laparoscopic radical hysterectomy than with abdominal radical hysterectomy, before propensity matching. As laparoscopic radical hysterectomy was associated with a lower risk of complications, this benefit may translate to a decrease in all-cause mortality. The incidence of serious complications, such as bowel obstruction, cardiopulmonary arrest, renal failure, and sepsis, was significantly lower with laparoscopic radical hysterectomy than with abdominal radical hysterectomy. This should be emphasized in clinical practice. However, selection bias in the choice of surgical procedure might affect the results. As adjuvant therapy is usually performed based on pathologic findings after radical hysterectomy, we found that adjuvant therapy, radiation and chemotherapy in women who underwent laparoscopic radical hysterectomy, was used less frequently. This suggests that surgeons tend to choose laparoscopic radical hysterectomy for small-volume tumors and select abdominal radical hysterectomy for large-volume tumors. Therefore, we tried to balance the two groups with propensity matching and adjusting adjuvant therapy, and we found the same results of better survival with laparoscopic radical hysterectomy than with abdominal radical hysterectomy. In addition, when we performed sensitivity analysis in patients who underwent adjuvant therapy and no adjuvant therapy, laparoscopic radical hysterectomy was associated with better survival. Although we included a large cohort of patients, we recognize several limitations. First, we lacked data on tumor characteristics such as the tumor size, stage, histology, and margin status. Differences in tumor characteristics may not only have led to selection bias in the choice of procedure, but also may have influenced procedure-associated morbidity.
Although we tried to balance confounders between treatments with propensity score matching, differences in adjuvant treatment still exists. Therefore, we did subgroup analysis according to adjuvant treatment. Second, as with any study of administrative data, we cannot capture individual patient and physician preferences that undoubtedly influenced the treatment decision-making. Third, claims data undercapture complications. Therefore, we categorized complications and tried to find events, using diagnostic codes and procedure codes. Lastly, the HIRA database was not intended to identify survival outcomes, so we could not obtain recurrence-free survival and determine death indirectly by relying on disqualification of the insurance status.
Two studies presented at the March 2018 Society of Gynecologic Oncology Annual Meeting on Women's Cancer, women with early cervical cancer treated by minimally invasive radical hysterectomy were shown to have a significantly higher risk of disease recurrence and poorer long-term survival than those of women treated by open surgery [28,29]. Our results were opposite those mentioned above. Some criticisms were raised for the results of Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial [30-32], we should wait for final results coming at least next 2 years. As clinicians confused to abandon laparoscopic surgery for early-stage cervical cancer, our results might be discussed with patients scheduled to undergo radical hysterectomy in Korea.
In summary, laparoscopic radical hysterectomy was associated with a lower risk of perioperative complications and has comparable outcomes with abdominal radical hysterectomy. However, the use of laparoscopic radical hysterectomy for cervical cancer has slowly increased since 2011 and now accounts for more than 50% of operations for this disease. Increasing the use of laparoscopic surgery in clinical practice may be an important and underused strategy to improve cervical cancer outcomes.
Electronic Supplementary Material
Supplementary materials are available at Cancer Research and Treatment website (http://www.e-crt.org).
Conflict of interest relevant to this article was not reported.
This study was supported by Bumsuk Academic Research Fund in 2016.
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Copyright © 2019 by the Korean Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Unadjusted
Inverse probability of treatment weightinga)
Abdominal RH
Laparoscopic RH
p-valueb)
p-valuec)
Total patients 6,335 (100) 3,235 (100) 3,100 (100) 3,171 (100) 3,166 (100)
Age at operation (yr)
≤ 39 1,265 (20.0) 587 (18.1) 678 (21.9) < 0.001 617 (19.5) 634 (20.0) 0.785
40-49 2,066 (32.6) 1,044 (32.3) 1,022 (33.0) 1,045 (33.0) 1,020 (32.2)
50-59 1,732 (27.3) 898 (27.8) 834 (26.9) 869 (27.4) 874 (27.6)
≥ 60 1,272 (20.1) 706 (21.8) 566 (18.3) 640 (20.2) 638 (20.2)
Year of diagnosis
2011 1,617 (25.5) 872 (27.0) 745 (24.0) 0.016 813 (25.6) 807 (25.5) 0.647
2012 1,572 (24.8) 806 (24.9) 766 (24.7) 777 (24.5) 800 (25.3)
Insurance status
Medicare 6,084 (96.0) 3,071 (94.9) 3,013 (97.2) < 0.001 3,044 (96.0) 3,041 (96.1) 0.910
Medicaid 251 (4.0) 164 (5.1) 87 (2.8) 127 (4.0) 125 (3.9)
Comorbidities (CCI score)
2 1,874 (29.6) 922 (28.5) 952 (30.7) < 0.001 941 (29.7) 934 (29.5) 0.988
3 1,502 (23.7) 703 (21.7) 799 (25.8) 749 (23.6) 744 (23.5)
4 775 (12.2) 364 (11.3) 411 (13.3) 390 (12.3) 388 (12.3)
≥ 5 2,184 (34.5) 1,246 (38.5) 938 (30.3) 1,091 (34.4) 1,100 (34.7)
Para-aortic lymphadenectomy
Yes 2,410 (38.0) 1,354 (41.9) 1,056 (34.1) < 0.001 1,198 (37.8) 1,191 (37.6) 0.827
No 3,925 (62.0) 1,881 (58.1) 2,044 (65.9) 1,973 (62.2) 1,975 (62.4)
Metropolitan 4,635 (73.2) 2,365 (73.1) 2,270 (73.2) 0.915 2,304 (72.7) 2,294 (72.5) 0.803
Nonmetropolitan 1,700 (26.8) 870 (26.9) 830 (26.8) 867 (27.3) 872 (27.5)
Hospital region
Metropolitan area 4,216 (66.6) 1,963 (60.7) 2,253 (72.7) < 0.001 2,114 (66.7) 2,109 (66.6) 0.869
Middle 259 (4.1) 136 (4.2) 123 (4.0) 131 (4.1) 133 (4.2)
East 57 (0.9) 47 (1.5) 10 (0.3) 28 (0.9) 34 (1.1)
South West 379 (6.0) 226 (7.0) 153 (4.9) 191 (6.0) 193 (6.1)
South East 1,424 (22.5) 863 (26.7) 561 (18.1) 707 (22.3) 697 (22.0)
Hospital volume
Tertiary general hospital 4,220 (66.6) 2,164 (66.9) 2,056 (66.3) 0.061 2,080 (65.6) 2,070 (65.4) 0.935
General hospital 2,097 (33.1) 1,057 (32.7) 1,040 (33.5) 1,082 (34.1) 1,086 (34.3)
Hospital and clinic 18 (0.3) 14 (0.4) 4 (0.1) 9 (0.3) 10 (0.3)
RH, radical hysterectomy; CCI, Charlson comorbidity index.
Frequency numbers were rounded to integers based on weight,
The p-values were derived from the chi-square test,
The p-values were derived from weighted survey logistic model.
Adjusted by IPTW
OR (95% CI)
Intraoperative complications 0.73 (0.63-0.86) < 0.001 0.80 (0.72-0.90) 0.008
Postoperative complications 0.97 (0.87-1.07) 0.525 0.87 (0.80-0.95) 0.002
Surgical site complications 0.73 (0.60-0.88) 0.001 0.75 (0.66-0.86) < 0.001
Medical complications 0.88 (0.79-0.98) 0.018 0.99 (0.90-1.08) 0.739
Blood transfusions 0.28 (0.25-0.31) < 0.001 0.30 (0.28-0.33) < 0.001
Postoperative adjuvant therapy 0.59 (0.52-0.67) < 0.001 0.63 (0.57-0.69) < 0.001
Radiation only 0.92 (0.76-1.11) 0.387 0.87 (0.76-0.99) 0.042
Chemotherapy only 0.48 (0.41-0.56) < 0.001 0.55 (0.49-0.61) < 0.001
CCRT 0.44 (0.39-0.49) < 0.001 0.47 (0.43-0.51) < 0.001
IPTW, inverse probability of treatment weighting; OR, odds ratio; CI, confidence interval; CCRT, concurrent chemoradiation.
Adjusted by IPTW and PoAT
Total 0.52 (0.43-0.63) < 0.001 0.61 (0.53-0.70) < 0.001 0.74 (0.64-0.85) < 0.001
With adjuvant therapy 0.71 (0.56-0.90) 0.005 0.85 (0.72-0.99) 0.046 - -
Without adjuvant therapy 0.48 (0.34-0.67) < 0.001 0.52 (0.41-0.66) < 0.001 - -
IPTW, inverse probability of treatment weighting; PoAT, postoperative adjuvant therapy; HR, hazard ratio; CI, confidence interval.


Paul Miller - The Pinwheel Group, Inc.
Paul D. Miller is an award-winning designer known for his skill and vision in creating corporate and brand identities and merchandising environments. Mr. Miller has conceived and executed a variety of successful programs for major multinationals, domestic corporations and not-for-profit organizations, including Rosenthal China, Gillette, Godiva, Masterfoods, NutraSweet, Clairol, Kodak, Revlon, Unilever, Electrolux, Wilson Sporting Goods and NY American Marketing Association, ITAC, NYIRN and Spec It Green. He has been on all sides of the desk: design & marketing consultant, corporate management, R&D and manufacturing.
Prior to re-starting his own firm he was with Southwood Industries, a Visual Merchandising Company, and a Strategic Partner of International Paper as EVP Marketing & Design, he was Creative Director of DIAM an international retail merchandising design and display manufacture and served as Corporate Design Director of the GAF Corporation Worldwide.


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His dog has been his trusted for the last five years.
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text:
Q: Convert array of char[] to bytes and then convert bytes to int and vise versa How to convert 4 characters "HERE" to a 4-byte integer that has the value 1163019592?
Here is what I tried:
int main()
{
    string s = "HERE";
    int n = s.length();

    int* number = new int[n + 1];
    char* cstr = new char[n+1];

    for (int i = 0; i < n; i++) {
        cstr[i] = s[i];
        number[i] = cstr[i];
        cout << number[i];
    }
}

but instead of 1163019592, I get 72698269.

A: Decimal 1163019592 is binary 01000101 01010010 01000101 01001000, which is hex 0x45 0x52 0x45 0x48.
"HERE" is bytes 0x48 0x45 0x52 0x45.
Same bytes, different order.
If you want "HERE" to equate to 1163019592 without regard to endian, try this:
int main()
{
    string s = "HERE";
    size_t n = s.length();

    uint32_t number = 0;

    for (int i = 0; i < n; i++) {
        number = (number << 8) | static_cast<uint8_t>(s[n-i-1]);
    }

    cout << number;
}

Live demo

redpajama_set_name: RedPajamaStackExchange


Lichen aureus is a distinct subtype of pigmented purpuric dermatosis. Clinically, it usually effects children or young adults and presents as persistent rust-coloured plaques on the lower extremities.
In lichen aureus, sections typically show a distinct pattern of infiltration in all types of pigmented purpuric dermatitis, with infiltration around the small vessels of the superficial plexus and minimal epidermal reaction (figure 1). At higher power, the infiltrate is mainly composed of lymphocytes with quite an impressive proportion of histiocytes (figure 2). The vessels may have some prominence of the endothelial cells but there is no evidence of vascular damage. A key feature of all types of pigmented purpuric dermatitis is the presence of haemosiderin within the superficial dermis, which results from chronic leakage of red blood cells from the vessels.
Perls' Prussian blue iron stain demonstrates the deposition of haemosiderin in the superficial dermis (figure 3).
Leukocytoclastic vasculitis — this shows convincing vessel damage with neutrophilic infiltration and fragmentation.


text:
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Tag Archives: cape town
Evidence shows that racial isolation drives down ANC support among White South Africans
This is from an excellent new paper by de Kadt and Sands in Political Behavior:
This study investigates how political behavior is shaped by one central outcome of segregation—racial isolation—in post-apartheid South Africa. We focus on the relationship between sustained white isolation-the probability of a white person encountering a non-white person in their local context (Massey and Denton 1988)-on white racial voting. South African elections have been marked by some degree of racial voting since the advent of democracy in 1994; white South Africans have typically voted for "white" parties such as the Democratic Party, the New National Party, the Freedom Front Plus, and the recently conglomerated Democratic Alliance. Scholars of the region have gone so far as to refer to South African elections as a "racial census" (Mattes 1995; Johnson and Schlemmer 1996; Lodge 1999; Ferree 2006, 2010). Our central contribution to this literature is to show that racial voting among white South Africans tends to increase as a function of local white isolation.
……. White South Africans living among other whites are less likely to vote across racial lines, measured as voting for the majority-black African National Congress. At the ward level, greater white isolation in post-apartheid South Africa, even conditional on ward demographics and economic status, leads to lower aggregate support for the ANC. At the individual level, whites living in areas of high white isolation, where inter-racial mixing is limited, are less likely to vote for the ANC than whites who live in less segregated areas.
You have to visit South Africa to appreciate the level of racial segregation in the "Rainbow Nation."
I wonder how vote choice among white South Africans will evolve if and when the ANC becomes threatened by parties to its left. Presumably, expressive voting for the DA and other smaller parties would not seem so attractive under such a scenario.
South Africans go to the polls next Wednesday, May 8, 2019 amidst entrenched racial divisions and dissatisfaction with the state of the country's democracy.
Posted By: Ken Opalo	Category: africa	Tags: african national congress, ANC, apartheid, cape town, DA, Daniel de kadt, Democratic Alliance, Helen Zille, Johannesburg, Julius Malema, Melissa Sands, Political Behavior, south africa, stellenbosch, Vote Choice
Litigating Nelson Mandela's legacy
This is from Sisonke Msimang over at Africa is a Country:
Today, many younger South Africans suggest that Mandela made too many compromises. Twenty-six years into the new era, there is a lively, angry, often chaotic debate about the role and place of the father of our nation.
When the student protests began a few years ago on South Africa's university campuses some of the young activists accused Nelson Mandela of betraying the revolution. They called him a sell-out. The elders were alarmed and hurt, but the young ones were convinced. I am of the generation that lies between the two: I was not old enough to fight for freedom but I am old enough to remember Mandela. I know that he was no sell-out.
I agree with one point the youth made however: the revolution was betrayed. I do not place the blame at Madiba's feet though. The blame for that lies squarely with the generation of leaders who followed him—my parent's generation. The freedom fighters whom I respected and loved in Lusaka and Nairobi, returned home. They put down their guns and they picked up their spoons and they began to eat. Many of them have not stopped eating since. I can think of only a handful of them who I would trust with my future.
Mandela's successors have all been lacking in one key respect or another. Thabo Mbeki's cerebral approach to government did little to inspire the ANC's rank and file. Jacob Zuma was a corrupt and ineffectual huckster masquerading as a populist. Cyril Ramaphosa is a multimillionaire who, while inspiring confidence among the business and middle classes, will struggle to earn the confidence of millions of South Africans who are either unemployed or underemployed.
The best hope for protecting Madiba's legacy would be an honest and good faith attempt at solving South Africa's structural problems — historical legacies of apartheid, lack of dependable (manufacturing) jobs, quality of education, and a fraying social sector (with crime topping the list).
Unfortunately for everyone involved, so far the country has oscillated between boardroom politicians scared stiff of the (forex) markets, and a cast of "populists" eager to exploit their control of the state for personal enrichment.
My view is that Mandela's legacy will survive the ongoing process of undoing the legacies of colonialism/apartheid. As Msimang points out, Mandela was not a pacifist saint but a strategic politician driven by his quest for the total liberation of South Africans. To that end he was willing to play politics or resort to armed resistance, as needed.
Posted By: Ken Opalo	Category: africa	Tags: africa is a country, apartheid, cape town, Colonialism, Johannesburg, Nelson Mandela, Pretoria, Sisonke Msimang, south africa, Thula Simpson, Umkhonto we Sizwe
On Zuma's Exit in South Africa
Sisonke Msimang has a nice take over at FP:
Zuma was elected president of the ANC in December 2007 in a bitter and bruising battle against Mbeki, the man who had sacked him just a few years earlier. The following year, the ANC recalled Mbeki, triggering his resignation as president of the country.
Zuma bested his opponent in 2007 by gathering a coalition of the wounded. At the time, there were various factions within the ANC that felt aggrieved by Mbeki's leadership style and by his economic conservatism. Many on the left within the party believed that in their haste to appease the markets and encourage international investment, the ANC's leaders had conceded too much terrain to big business in the years following apartheid.
Zuma was known as an affable but flawed man. Union leaders and young radicals opposed to Mbeki — men such as Julius Malema, who was then the head of the ANC's Youth League, and Zwelinzima Vavi, who headed the Congress of South African Trade Unions at the time — saw the man they were installing as malleable. They hoped Zuma would promote pro-labor and pro-poor policies, so they struck a Faustian bargain. Despite his obvious personal shortcomings, and the significant political liabilities he carried, they agreed to put him in power if he allowed them to run economic policy.
Being an economic conservative, albeit without Mbeki's professorial demeanor, I am curious to see how President Cyril Ramaphosa will navigate popular demands for a renegotiation of the post-apartheid settlement which he helped midwife. Also, as corruption in South Africa did not begin with Zuma (or the end of apartheid), it will likely not end with his departure. Perhaps the biggest challenge ahead for the ANC will be to temper expectations. If Ramaphosa is seen to be too close to South Africa's economic elite, it might elicit a populist backlash with dire economic and social consequences for South Africans.
Here's is Zuma's resignation letter.
Posted By: Ken Opalo	Category: africa	Tags: apartheid, cape town, Corruption, cyril ramaphosa, guptagate, guptas, Jacob Zuma, Johannesburg, marikana, nkandla, Pretoria, south africa, stellenbosch
Cape Town's Water is Running Out
This is from NASA:
And this is from the New York Times:
The Western Cape Province, where Cape Town is, has been in severe drought for three years. The water shortage has been amplified by the population boom here; more than a million new residents have arrived in the city in the past 15 years. The city's desperate attempts to build desalination plants and install new groundwater pumps may help, but these solutions seem to be the equivalent of building an extra lane on an already jammed highway. The underlying causes of the shortage are likely to continue to stress the system. Other cities in drought-prone regions should pay close attention.
…. There are many people who still aren't doing enough to curb usage, but in a city of high inequality and concentrated wealth and privilege, there's a leveling that's happening. Behaviors have changed quickly and on a broad scale. The city has published maps that indicate which households are above or below the recommended water consumption level. It's now commonplace to see an unflushed toilet in a fancy restaurant, per guidelines that advise, "When it's yellow, let it mellow." I find this motivating; it's evidence of a collective consciousness and effort.
Apparently, authorities knew of the impending crisis but did little to avert it — at least according to the Cape Times back in 1990.
Posted By: Ken Opalo	Category: africa	Tags: ANC, apartheid, apartheid south africa, Cape Times, cape town, Day Zero, Democratic Alliance, south africa, Water Crisis, Western Cape Province
What does it mean to be "tough on crime"?
This is from Alex Tabarrok over at MR:
Our focus on prisons over police may be crazy but it is consistent with what I called Gary Becker's Greatest Mistake, the idea that an optimal punishment system combines a low probability of being punished with a harsh punishment if caught. That theory runs counter to what I have called the good parenting theory of punishment in which optimal punishments are quick, clear, and consistent and because of that, need not be harsh.
We need to change what it means to be "tough on crime." Instead of longer sentences let's make "tough on crime" mean increasing the probability of capture for those who commit crimes.
More on this here.
In my public policy class this semester we read the sad story of Thabo Mbeki's capture by "dissident" scientists who sold him unconventional policy approaches to South Africa's AIDS epidemic. The lesson was that we should always be wary of allowing experts too much leeway in deciding actual policy. This means more debate (both among experts and by the public) and routine rigorous evaluation to strengthen the quality of feedback after policy rollouts.
Social Science is awesome. And may the credibility revolution live on. But the world certainly needs more humble social scientists.
Posted By: Ken Opalo	Category: africa	Tags: african politics, AIDS in South Africa, cape town, criminal justice, durban, Johannesburg, mass incarceration, Politics, Pretoria, public policy, south africa, thabo mbeki, tyranny of experts, United States, William Easterly
Who's responsible for South Africa's woes? Zuma or the ANC?
I raised this question in a post last year.
Friend of the blog and Harvard-trained historian Matthew Kustenbauder has this thoughtful response (posted with his permission. Emphases mine).
Interesting post on South Africa's recent rollercoaster and explanations for the economic downturn under Zuma's presidency. A few quick comments:
I agree South Africa's current woes may be attributed to ANC policies, not President Jacob Zuma alone. Take the issue of land, for example, about which Mr. Mngxitama is as passionate as he is wrong. As I pointed out previously on this blog, the politics of land redistribution in South Africa are tied to the ANC's historic decision to support and strengthen traditional authority in the former bantustans. In short, the ANC forged an alliance with traditional leaders to bolster its negotiating power with the apartheid government in the 1990s and, afterwards, to win elections. Mozambique served as a cautionary tale: civil war broke out after the socialist liberation government FRELIMO abolished chiefs and traditional forms of authority outright. The ANC's entrenchment of traditional chiefs and kings has had a ripple effect across South Africa, creating a drag on the rural economy, locking up productive agricultural land and capital assets, not to mention denying rural people equal justice under the law.
I also appreciate the argument, and agree to a degree, that both Mr. Zuma and Mr. Mbeki are ANC cadres. When the opposition Democratic Alliance argue that somehow the country was in good hands until Mr. Zuma came along, it is more a political manouver to appeal to the black middle classes, many of whom are embarrased by Mr. Zuma and favoured Mr. Mbeki, than it is a faithful rendering of the historical record. Thabo Mbeki was, despite his polished veneer, a disaster on many fronts, including but not limited to: unrepentant AIDS denialism, cadre deployment as an ANC policy, racial politics, silencing of internal opposition within the ANC, and a narrative that counterrevolutionary forces lurked within the media. These ideas and practices either began or were ramped up to become de facto party policy under Mr. Mbeki's presidency.
I disagree, however, that Zuma and Mbeki represent nothing more than two cadres of the same party. For one thing, the challenges facing South Africa today are different than those during the Mbeki years. At that time, South Africa still luxuriated in the glow of 1994's transition to democracy and the Madiba magic of Nelson Mandela had not yet worn off. Mbeki was a skilled orator with global leadership aspirations, the likes of which have not been seen in South Africa since Jan Smuts was Prime Minister during WWII. But it is not simply Zuma's halting English, or his multiple wives, countless offspring, traditionalism, patriarchy, and coziness with Russia, China, and Sudan that make South Africans uneasy.
What is so disturbing – and what Mbeki assiduously avoided – is Zuma's overt corruption. The most public evidence includes: Nkandla, the Gupta family's illegal landings at Waterkloof Airforce Base, a prolonged legal battle over spy tapes that implicate him in fraud dating all the way back to his time as Deputy President (for which Mbeki sacked him and Schabir Shaik was found guilty and went to jail), and the most recent dismissal of Nhlanhla Nene for standing in the way of sweetheart SAA and nuclear deals that would have yielded tenders for Zuma's friends and family. If Mbeki was a loyal cadre who represented the ANC's failed policies, Zuma is a loyal cadre who represents the ANC's descent into patronage, corruption, and jobs for pals hidden behind a façade of election-time slogans, "our glorious struggle history" and "A Better South Africa for All."
Andile Mngxitama, booted out of the EFF, and firebrands like him who drone on about the ANC's errant support of neoliberal policies and the tragedy of Mandela's compromise during the political settlement period have little appreciation for just how far South Africa has come since 1994. Nor do they grasp the direction in which South Africa must go – and must go soon – to avoid a[n] even more tragic tailspin.
To give just one example, a major problem in South Africa has not been, contra Mr. Mngxitama, that capitalism has been prioritised. Rather, grassroots capitalism has been far too constrained – not just by government overregulation but by monopoly capitalism sheltered by the state. This is a historical dynamic inherited from the apartheid-era National Party, one that the ANC never addressed, mainly because such arrangements benefitted the ANC so long as they controlled the levers of the state.
The number of state owned enterprises in South Africa – over 700 by the last count – is staggering for a country so small. Just one, South African Airways, has drained well over $2 billion in bail-outs from state coffers in two decades. The energy sector is even more dire: Eskom, another state owned enterprise, has a near complete monopoly over energy generation and a complete monopoly over its transmission. Due to a lack of capitalist competition, the country's electricity supply is not just overly expensive, it is also tightly constrained. Last year South Africans plunged into darkness, and for some time now manufacturers and other industrial electricity consumers have actually been paid by the state to reduce their operations.
The result is that South Africa's manufacturing sector is less competitive globally and unable to expand to create the jobs so desperately needed at home, where there is a 30% unemployment rate. There are countless similar examples, where state owned enterprises should have been privatised, or at the very least private companies should have been permitted to enter the market and compete. What must be remembered, however, is that the country's economic system, designed by the old National Party, is now controlled by and benefits the African National Congress.
Similarly, in the private sector, too many large companies have a monopoly, making the cost of entry for small companies far too expensive. Government labor regulations and aggressive trade union action ensures that only the largest companies with the deepest pockets can comply and survive. Large private companies – like the mining groups, agro-processing operations, banks, telecommunications companies, and industrial manufacturers – operate with few competitors. Relatively small players in sectors like the textile industry have closed their doors and relocated to countries where labour is more productive, regulations more lax, and costs are cheaper. Too few South African companies can compete globally.
There may be a kernel of truth in Mngxitama's claims, but his diagnosis is overly simplistic, ideological, and ahistorical.
Posted By: Ken Opalo	Category: africa	Tags: ANC, apartheid, Black Economic Empowerment, cape town, cyril rhamaposa, durban, gupta, jacon zuma, Johannesburg, Nelson Mandela, nkandla, Pretoria, south africa, thabo mbeki, tokyo sexwale, zupta
The political phenomenon that is South Africa's Julius Malema
Young South Africans are presently debating the merits of their country's post-apartheid settlement. Many feel that in a rush to secure a stable political and economy transition the ANC leadership did not bargain hard enough for structural changes in South Africa's political economy (here's Mbembe on the subject). No leader encapsulates this sense of post-apartheid disappointment better than Julius Malema, this week's guest on Lunch With the FT. Here is an excerpt:
Within a year of setting up the Economic Freedom Fighters, Malema's party had become a force in South African politics. "They used to say, it's cold outside the ANC, but we have made it very warm," he grins, vowing to topple the ruling party within a decade. "If Zuma can be a president of this country, anyone can," he scoffs, referring to a leader enveloped in sexual and political scandal.
When I challenge his assertion that the end of apartheid has changed nothing, he shifts seamlessly into crowd-pleasing rhetoric. "We are voting, but we can't eat that cross," he starts out quietly, referring to the right to vote that black South Africans won in 1994. "That cross has not taken our kids to school. That cross has not given our people the better life that was promised," he says, his voice rising. "That cross has not returned our land. That cross did not return the minerals. So, when you say to me we have ended apartheid, when there is a huge economic apartheid in this country, I don't know what you mean."
His own party, which draws inspiration from Marx and Frantz Fanon, a Caribbean-born revolutionary who advocated the violent overthrow of colonialism, promises to rectify the situation. It proposes seizing white-owned land, with minimum compensation, and nationalising mining companies and banks.
Malema deftly combines incendiary revolutionary rhetoric, street politics, and a mastery of the institutional game within the South African Parliament. For example, partially due to unrelenting pressure from the EFF and Malema in Parliament, President Jacob Zuma was recently forced to return state funds that were used to renovate his private home in Nkandla.
Not long ago Malema was a boorish rubble rouser with a dim political future after being expelled from the ANC. Political commentators argued that:
Malema without the ANC is nothing… The tradition and the history of the ANC, he needs that in order to be able to make his point. Without that he's very much isolated
But his image is slowly being rehabilitated. The ANC's failures and economic stagnation add fuel to the fire that is EFF's message of economic nationalism. Appearances at Chatham House, meetings with business leaders at home and abroad, and modest successes in Parliament further add to the emerging image of an insurgent party that knows the rules and can play by them (even if with a view of eventually changing the same rules).
Just today, Malema was in court in a bid to secure a ruling that President Zuma violated the constitution in his initial refusal to refund the Treasury over Nkandla, thereby opening a window for impeachment.
The most potent revolutionaries are those that have the added advantage of knowing how to play the institutional game. Watch this space.
Posted By: Ken Opalo	Category: africa	Tags: cape town, economic freedom fighter, Johannesburg, Julius Malema, mpumalanga, nkandla, nkandla-gate, Pretoria, south africa
On Zumaphobia and the policy failures of the ANC
A lot has been written about Jacob Zuma's failures as president of South Africa, most recently his odd decision to fire his widely respected finance minister, Nhanhla Nene. Zuma replaced Nene with an unknown ANC MP, David van Rooyen, only to replace van Rooyen with former finance minister Pravin Gordhan after intense pressure from the media and the markets.
Sources indicate that Mr. Nene was fired for holding the line on fiscal discipline.
Much of the analysis so far has focused on President Jacob Zuma — his increasing personalization of power within the ANC, corruption, and even his private life.
But in an interesting piece Andile Mngxitama questions this Zuma-centric narrative, instead focusing attention on wider policy failures within the ANC. Mngxitama argues (correctly, I believe) that:
Both Mbeki and Zuma are ANC cadres through and through and it's the party policy that determines what they do. Zuma has not strayed from the ANC policies and no one has yet made this claim in any meaningful way. So, if it's not policy that is the problem, how do we judge Zuma's performance?
The main problem is that his detractors fundamentally agree with the ANC policies and they have therefore chosen to find fault with Zuma the man and thereby rob us of a useful analysis of why things are falling apart. A shift from Zuma to policy would also show that his presidency is a product of policy; the template for things to fall apart was designed by his predecessors.
Zuma's sin, which has been missed by the analysts, who are too driven by "Zumaphobia", is that he has not been able or willing to halt the downward spiral, which is essentially a byproduct of ANC policies. The main policy plank of the ANC since it took over in 1994 has been correctly described as neoliberalism – the privileging of capitalism as the driver of society.
The implications of this policy direction are to increasingly remove the state from society and the economy and allow the profit motive to determine who gets what service. The state privatises assets and those it keeps are similarly managed as if they are capitalist entities.
The piece at times sounds anti-market. But don't let that distract you from its succinct understanding of the political economy challenges facing South Africa.
In 2008 the ANC recalled then President Thabo Mbeki. There is no reason to believe that President Jacob Zuma has totally eclipsed the party machinery. Indeed this has been made clear by his quick retreat after the brazen attempt to weaken the finance ministry.
Recent events in South Africa suggest that the party of Mandela is no longer(if it ever was) the voice of the people. But this outcome cannot be pinned on Zuma. The party elite, including Zuma, largely remain hostage to the post-apartheid political settlement. Meanwhile, the country's deplorable economic indicators are adding fuel to the fire that is the Economic Freedom Fighters (which is increasingly sounding more and more mainstream and in tune with the frustrations not just of South Africans, but younger Africans in general north of the Limpopo). On a recent tour of London the EFF leader, Julius Malema, held meetings with CEOs of companies with interests in South Africa — a signal that these companies appreciate the potency of his message of economic freedom.
Posted By: Ken Opalo	Category: africa	Tags: african national congress, ANC, andile Mngxitama, cape town, cyril ramaphosa, David van Rooyen, durban, economic freedom fighters, Jacob Zuma, Johannesburg, Julius Malema, Kwa Zulu Natal, limpopo, Lonmin, Lonmin shooting, marakana shooting, Nelson Mandela, Nhanhla Nene, Pravin Gordhan, Pretoria, south africa, thabo mbeki, Trevor Manuel
Africa's Billionaires in 2014
Only 9 out of 54 African countries are represented on the 2014 Forbes billionaires list. There are certainly more than 29 dollar billionaires on the Continent (most of the rest being in politics). Let's consider this list as representative of countries in which (for whatever reason) it is politically safe to be publicly super wealthy – which in and of itself says a lot about how far Nigeria has come.
Source: Forbes
Some will look at the list and scream inequality. I look at the list and see the proliferation of centres of economic and political power. And a potential source of much-needed intra-elite accountability in African politics. For more on this read Leonardo Arriola's excellent book on the role of private capital in African politics.
See also this FT story on the impact of currency movements on the wealth of Nigeria's super rich. Forbes also has a great profile of Aliko Dangote, Africa's richest man.
Posted By: Ken Opalo	Category: africa	Tags: abdulsamad rabiu, Abuja, african billionaires, Algeria, Algiers, Aliko Dangote, angola, Cabinda, Cairo, Calabar, cape town, Casablanca, Dar es Salaam, Dodoma, durban, Egypt, femi otedola, forolunsho alakija, ibadan, Isabel Dos Santos, Jinja, Johannesburg, Kampala, kano, lagos, leonardo arriola, Luanda, Maiduguri, mbabane, Mike adenuga, Morocco, Mswati, multi-ethnic coalitions, Nigeria, Onitsha, Port Harcourt, Pretoria, Rabat, south africa, Swaziland, tangier, tanzania, Uganda
Remembering Nelson Mandela and his legacy
Charles Kenny over at BloombergBusinessweek writes about Mandela's often forgotten economic legacy (Perhaps because of the continued entrenchment of economic inequality and injustice in South Africa):
South Africa's GDP growth rate, meanwhile, picked up considerably under Mandela. Economic growth rose from less than 1.5% between 1980 to 1994 to slightly under 3% between 1995 and 2003. Despite the sudden influx of internal migrants with the legal right to compete equally for jobs, average personal incomes for white South Africans increased by 62% between 1993 and 2008, according to University of Cape Town economist Murray Leibbrandt. Average incomes for Africans themselves increased even faster—by 93% over that same period.
The huffingtonpost has a collection of speeches to remember Mandela in his own words.
[youtube.com/watch?v=-Qj4e_q7_z4]
Richard Stengel over at Time explores the idea of Mandela the freedom fighter and leader who possessed almost mythical qualities in the eyes of many:
In many ways, the image of Nelson Mandela has become a kind of fairy tale: he is the last noble man, a figure of heroic achievement. Indeed, his life has -followed the narrative of the archetypal hero, of great suffering followed by redemption. But as he said to me and to many others over the years, "I am not a saint." And he wasn't. As a young revolutionary, he was fiery and rowdy. He originally wanted to exclude Indians and communists from the freedom struggle. He was the founder of Umkhonto we Sizwe (Spear of the Nation), the military wing of the African National Congress, and was considered South Africa's No 1. terrorist in the 1950s. He admired Gandhi, who started his own freedom struggle in South Africa in the 1890s, but as he explained to me, he regarded nonviolence as a tactic, not a principle. If it was the most successful means to the freedom of his people, he would embrace it. If it was not, he would abandon it. And he did. But like Gandhi, like Lincoln, like Churchill, he was doggedly, obstinately right about one -overarching thing, and he never lost sight of that.
Back in 2011 writing in the Journal Peter Godwin noted that Mandela's real legacy was his refusal to become life president, like many independence heroes before him on the Continent:
If anyone was well positioned to launch a political personality cult it was Mr. Mandela. His refusal to do so is probably his greatest legacy to his homeland. It set South Africa on a course different from most other African nations. Seventeen years into its post-apartheid incarnation, South Africa is already on its fourth president. This has radically reduced the danger of a single leader dominating the state.
As the world pays its last respects there will be nagging thoughts and questions of what next for South Africa. I am reminded of Eve Fairbanks' piece earlier this year in which she cautioned that a lot more needs to be done to ensure that all South Africans benefit from the freedoms (political, social and economic) that Mandela fought for:
Many South Africans under 40 feel little connection to the father of their nation. Articles about Mandela's many health scares late in life (at press time, the former president had been in a hospital on life support for more than a month, battling a lung infection) often feature laudatory quotes from two kinds of South Africans—whites and older blacks—while leaving out the voices of young blacks, who have a more ambivalent relationship with their founder-saint. Some even resent him.
The point here is that Mandela's legacy will only be protected if the government facilitates greater economic inclusion of young South Africans. Simply replacing Smiths, Krugers and Plaatjes with with politically connected Khumalos, Gcobanis, and Phumlanis in the economic sphere as has happened under BEE will not cut it.
The statues and all sorts of honors that will undoubtedly come from around the world will not matter if the Madiba legacy does not get to live in the hearts and minds of South Africans of all generations, now and in the years to come.
The man gave up a lot for his country. Now that he is gone, it is time for South Africans (and especially the leadership) to honor him by keeping his dream of a more just South Africa alive. This is the least they could do for a man who is arguably top of the list of the greatest Africans of the 20th century.
Rest in peace Madiba.
Posted By: Ken Opalo	Category: africa	Tags: apartheid south africa, cape town, Johannesburg, Nelson Mandela, south africa, south african pretoria
The 2013 Resource Governance Index
The 2013 Resource Governance Index (published by the Revenue Watch Institute) is out. The top performing African countries include Ghana, Liberia?, Zambia and South Africa, with partial fulfillment. The bottom performing countries are Equatorial Guinea, Zimbabwe, South Sudan, the Democratic Republic of Congo and Mozambique.
The 58 nations included in the report "produce 85 percent of the world's petroleum, 90 percent of diamonds and 80 percent of copper." Ghana, where we are doing some evaluation work on extractive sector transparency initiatives, is the best performing African country on the list.
And in related news, The Africa Progress Report was released last week. The report details the massive loss of revenue by African governments through mismanagement – either by commission and/or omission – of extractive resources. For instance:
The report details five deals between 2010 and 2012, which cost the Democratic Republic of the Congo over US$1.3 billion in revenues through the undervaluation of assets and sale to foreign investors. This sum represents twice the annual health and education budgets of a country with one of the worst child mortality rates in the world and seven million pupils out of school.
The DRC alone is estimated to have 24 trillion dollars worth of untapped mineral resources.
The most bizarre case of resource management in Africa is Equatorial Guinea, a coutnry that is ranked 43rd on the global per capital GNI index but ranks 136th on the Human Development Index (2011).
Below is a map showing flows related to Africa's vast resources:
Posted By: Ken Opalo	Category: africa	Tags: accra, african commodities, cape town, commodities in africa, Dan Gertler, Democratic Republic of COngo, drc, Ghana, Harare, international policy research & evaluation, international policy research and evaluation group, IPRE Group, Johannesburg, Joseph Kabila, Juba, kinshasa, Liberia, lusaka, malabo, maputo, mining in africa, mining news, monrovia, mozambique, oil in africa, Pretoria, resource governance in Africa, resource governance index, Revenue Watch, Revenue Watch Institute, RWI, south africa, south sudan, tanzania, Zambia, Zimbabwe
Georgetown MSFS Launches New Africa Scholarship
The application deadline is January 15, 2014. Spread the word.
Starting in fall 2014, the Master of Science in Foreign Service (MSFS) at Georgetown University is offering a full- tuition scholarship for a talented graduate student from sub-Saharan Africa.
MSFS is a two-year, full-time graduate degree program in international affairs. Students will take courses in international relations, international trade, international finance, statistics and analytical tools and history. In addition, students choose an area of concentration such as International Relations and Security, International Development or International Business.
Posted By: Ken Opalo	Category: africa	Tags: Abuja, accra, cape town, Cote d'Ivoire, dakar, georgetown, georgetown university, georgetwon msfs, georgetwon scholarships for africa, Ghana, graduate scholarships in the US, Johannesburg, Kenya, lagos, Liberia, master of science in foreign service, monrovia, Nairobi, Nigeria, Pretoria, Senegal, south africa, Washington DC, yamoussoukro
Haiti wants to join the African Union
Partisan stats: Of red-state moochers and blue state makers
Romney's elusive tax plan (funny)
Zuma's failed presidency and South Africa's labor unrest
Mo Ibrahim Prize goes unclaimed, again
Kenya might be seeing the origins of insurgency (More details on this soon)
Posted By: Ken Opalo	Category: africa	Tags: African Union, american politics, binders full of women, cape town, counterinsurgency, Haiti, insurgency, Jacob Zuma, Johannesburg, Kenya, Mitt Romney, mo ibrahim index, Mo Ibrahim Prize, moochers and makers, Pretoria, red states and blue states, romney's tax plan, south africa
The Atlantic has a nice piece on the legacy of Meles Zenawi, the ailing Ethiopian Premier.
The African Union elected South African Nkosazana Dlamini-Zuma to head its executive arm, the AU Commission. Ms Dlamini-Zuma is a former wife of the polygamist South African President Jacob Zuma. I hope that with Pretoria's success in having her elected to head the AU South Africa will take a more proactive role in leading the regional organization. As I have stated before, I think the organization needs "owners" in the form of diplomatically powerful custodians. Being the region's biggest economy, South Africa is well placed to provide strong leadership to the African Union, if it wanted to.
Still on the AU Summit, Ethiopian Prime Minister Meles Zenawi has been conspicuously absent, fueling speculation that he is critically ill. Rumors abound that Mr. Zenawi has left the country for a Belgian hospital – the Saint-Luc University Hospital in Brussels (where he is believed to be receiving treatment for an acute case of hematologic cancer). Some opposition groups have suggested that Mr. Zenawi may have died in hospital. The last time he was seen in public was on the 19th of June. Mr. Zenawi has led Ethiopia since 1991. His record has been a mixed bag of aggressive and ambitious development projects (with results, growth has averaged over 8.4% over the last ten years) and militarism and authoritarian tendencies that have seen many opposition members detained, exiled or killed.
And in Somalia, BloombergBusinessweek reports on the massive corruption in the Transitional Federal Government.
The nearly 200-page report lists numerous examples of money intended for Somalia's Transitional Federal Government (TFG) going missing, saying that for every $10 received, $7 never made it into state coffers.
The report, written by the U.N. Monitoring Group on Somalia and Eritrea and obtained by The Associated Press Monday, says government revenues aren't even clear: The Ministry of Finance reported revenues of $72 million in fiscal year 2011, while the accountant general reported revenues of $55 million.
The Somali Government remains an unrepresentative shell, propped up by African Union forces and barely in control anywhere outside of Mogadishu. No elections are in sight (and rightly so. I have never been a fan of rushed post-conflict elections. See Liberia circa 1997 for details), instead the UN and the AU are presiding over a process in which Somali power brokers will put together a list of electors to appoint the next parliament. The current government's mandate expires the 20th of August (next month).
Posted By: Ken Opalo	Category: africa	Tags: Addis Ababa, Africa Union, African Union, Al-Shabab, amison, burundi peacekeepers somalia, cape town, Eritrea, Ethiopia, health concerns for Meles Zenawi, hematologic cancer, Islamic Courts Union, Jacob Zuma, Johannesburg, kenyan invasio of somalia, Kismayu, meles zenawi, meles zenawi feared dead, meles zenawi health, meles zenawi ill, Meles Zenawi sickness, Mogadishu, Nkosazana Dlamini-Zuma, OAU, Organization of African Unity, Pretoria, Somalia, south africa, ugandan peacekeepers somalia, union of islamic courts
Follow the goings on in the DRC (especially this election season) over at Alex Engwete's blog.
Living under the shadow of Kony and his men in Eastern CAR.
On a related note, the Ugandan army's dirty war in the Congo and CAR.
Shame on the ANC. But there is still hope for cleaner politics in South Africa. The ANC is an over-size coalition with a high chance of internal breakup in the not so distant future. It might even occur sooner, over the Zuma succession. And this time it might not be a rather benign COPE affair. You can read more on the controversial bill over at the Economist.
Trying God? Churches claim to have cured HIV positive congregants. This goes beyond faith, it is naked exploitation. And a call for government involvement.
And lastly, a very dictator Christmas (via Blattman)
[youtube.com/watch?feature=player_embedded&v=38YWB8iX7OY]
Posted By: Ken Opalo	Category: africa	Tags: alex engwete, Bangui, cape town, Central African Republic, COPE, dictators, Economist, Faith and healing, Gaddafi, HIV/AIDS, iddi amin, Jacob Zuma, Joseph Kony, Kampala, kim jon il, Mugabe, Pretoria, SCOAN, south africa, Synagogue Church of All Nations, Uganda, Ugandan Army
Hongera Rachael!!! twitter.com/rachaelmclella… 8 hours ago
Very sad news. twitter.com/lindat_g/statu… 8 hours ago
Follow @kopalo
A Kenyan slum cartel commandeered a World Bank electrification project
Africa-China Fact of the Month
Fiscal capacity in African states
What's really driving African Students' enrollment in foreign universities?
These results raise the possibility that correlations between linguistic features and survey responses are actually spurious.
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Angus Deaton and Rwanda's Health Minister, Agnes Binagwaho, square off
Putin: 'everything will be okay' for U.S.-Israeli woman jailed in Russia January 23, 2020
President Vladimir Putin said during a visit to Israel on Thursday that he had given assurances to the mother of Naama Issachar, a U.S.-Israeli woman jailed in Russia, that "everything will be okay" for her.
Italian PM Conte pulls out of Davos trip amid political turmoil January 23, 2020
Passengers from China's Wuhan arriving in Rome checked for coronavirus: airport spokesman January 23, 2020
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In Louisiana, the incidence of cancer and other debilitating, sometimes terminal illness, is among the highest in the United States. While our community aggressively battles this alarming reality, it must also reach out to the sick and dying to address their needs–including the provision of spiritual guidance and comfort for them and their families.
God's people need to have a place that will provide comfort and peace–a place that will continue to nurture families even after the journey of their loved one is complete.
Sister Dulce Maria has prayed with and comforted the sick, terminally ill and their families. She has offered spiritual guidance to those who seek the Lord. She has been led to see the importance of having a place where God's suffering people and their families could find spiritual consolation and guidance.
To provide a haven where the sick and terminally ill can visit and be accompanied on their journey towards God. It will minister to the suffering and those who support them on their journey.
To provide opportunities for those who seek a deeper understanding of their faith through prayer and counsel.
To provide housing for the Mercedarian Sisters of the Blessed Sacrament who will be available to support and provide spiritual guidance for all those who seek comfort.
Many people suffer with terminal and debilitating illnesses. This ministry offers those people an opportunity to seek the Lord's help during this struggle. Prayers are offered to eliminate the diseases and pain associated with these illnesses and Sister Dulce intercedes to Our Lord asking for His healing and mercy.
Cypress Springs Mercedarian Prayer Center offers several opportunities for adults to further their spiritual lives. This includes Spirituality Classes for both men and women. Sister lectures and leads conversations on different topics that affect our everyday living (i.e. our roles as Christian adults); the importance of daily prayer; living as Disciples of Christ; and evangelizing just to name a few.
Cypress Springs Mercedarian Prayer Center offers several opportunities for growing in our spiritual life. There are Women's and Men's Spirituality groups that meet every month, Rosary groups that meet every Tuesday, retreats, Bible studies as well as our annual events such as St. Joseph Altar, LaPosada, guest speaker series, Passion Walk, Dining by Design. See our event calendar for additional information on all events.


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What fun monogrammed iPhone 6/6s PLUS Otterbox Commuter Cases! These are highly protective, nice cases that protect your beloved phone so well. These have an outer hard shell and an inner silicone shell giving you amazing protection from drops and fumbles!
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text:
Why Protect Against EMF
How The Amazing Diode Works
All of our products are tested by independent testing labs and experts in the field. Random testing is continued to guarantee you receive the most effective products available on the market.
Wayne Cook
Ener-G-Polari-T Products, was founded in 1964 by Wayne Cook, who spent his career researching the electrochemical, biomagnetic and psychoenergetic force fields around the human body and their relationship to health.
Through his research, Wayne developed a method of enhancing the body's natural bioelectrical field, thereby neutralizing the negative effects produced by random electromagnetic field radiation.
Ener-G-Polari-T Products is the result of Wayne's research, and was the first to develop an effective protective device for counteracting the harmful effects of low-level electromagnetic field radiation.. Ener-G-Polari-T continues its mission of protection from the ever-changing world we live in through being the first to develop new products, such as the Cell Phone and Circuit Breaker Diodes.
Wanda Cook
Wanda Cook incorporated Ener-G-Polari-T Products in 1996 and continues to carry on the research and product line that she and her late husband, Wayne Cook, were so devoted to. Wanda is currently President of Ener-G-Polari-T, Inc. and Center of Divine Energy. She is one of the foremost authorities on universal energies and their relationship and effect on the human body.
Wanda has hosted a radio talk show and has been a speaker at many National Health Shows over the years. Wanda is a consultant and expert in the energy field, as well as co-author of "Universal Truths." She has also written articles on the health effects of electromagnetic fields that have appeared in Explore! and Health Consciousness magazines.
If you need additional information on our products, contact Ener-G-Polari-T Products by email.
support@energpolarit.com
We strive to bring you the highest quality products on the market. We keep updating our Formula to accommodate the new technologies. Our products are handmade with loving care in Arizona.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Click here to read full policies and procedures.
Ted Talks EMF
How The Diode Works


text:
Q: Accessing / processing ArrayBuffer @ http client (websocket connection, JavaScript) I have a websocket connection between
•   Nodejs server (+ socket.io)
•   Browser
A message is emitted from the server to the browser (Udp message from an Arduino)
udpSocket.on("message", function (msg, rinfo) {
    for (i = 0; i < msg.length; i++) {
        console.log(msg.readInt8(i));
}
    console.log("");
    io.sockets.emit('message', msg);
});

Code in the browser (index.html):
A)
I started with:
socket.on('message', function(message) {
    document.getElementById("ko1").innerHTML = message;
})

 Arduino sends:

Result in browser : [object ArrayBuffer]
My conclusion : message is coming in, but must be handled in another way.
B)
Research learned that I have to use a DataView on the Array Buffer (https://developer.mozilla.org/en-US/docs/Web/JavaScript/Typed_arrays). My code:
socket.on('message', function(message) {
    var uint8 = new Uint8Array(message);
    document.getElementById("ko1").innerHTML = uint8[0];
})

Result : no data printed to the browser
Question: what am I doing wrong? I also tried other Data Views, but no success. It' s driving me mad. Please help.


Are you interested in learning about your options for your MetroLink violation? Did you know that this kind of violation is treated as a misdemeanor (and therefore not a regular ticket)? Are you aware of the benefits of hiring an attorney to help fix the ticket?
Whatever you do with a Metro ticket, you most certainly do not want to plead guilty!! A guilty plea will end up on your permanent record (and can therefore be accessed by a simple background check).
And if you have an unclean record, that can have a tremendous impact on whether or not you get a decent job (or even get an apartment)!! But things do not have to turn out this way! There is a much better route that can be taken!!!
If we are able to accomplish either of these goals, this would be far better than you pleading guilty to the ticket (which leads to the negative outcomes described above).
So give us a call today, and we can get your record straightened out!


text:
Super Ministers And Other Stories, By Reuben Abati
Nov 13, 2015 Our Reporter Opinion 0
"Have you congratulated our new Ministers?"
"I am still thinking about it, actually. I don't know whether to congratulate them or to commiserate or to pity some of them. They have merged Ministries that need not be merged. Some Permanent Secretaries are now floating. Six months and this is it?"
"What kind of talk is that? You have come again oh."
"I wonder too. At least you can see that round pegs have been put in round holes, and shame on all you doubting Thomases, our government is good to go."
""Who is talking politics? Can we discuss Nigeria and leave politics out of it? And please, leave that thing about pegs. Some pegs are neither round nor square, they are misshaped."
"Everything is political."
"I know. Very soon, you will also insist that that funny walking stick Ngige was carrying about, like the rod of Moses, is also political."
"Okay, what is your point?"
"I have said it before and I repeat it again. I still think whenever Ministers are to be screened by the Senate, their portfolios should be attached. It helps to prepare the prospective Minister mentally. It deepens the screening process, and makes it even more participatory."
"There is no such Constitutional requirement."
"Everything doesn't have to be in the Constitution."
"Okay we have heard. You have said it before. When next we are appointing Ministers, we will disclose their portfolios."
"What do you mean we?"
"Na we, now"
"Ehen!"
"See, I usually don't vote. But this last election, I got my PVC and I voted. Those PDP people already had their cup full. I voted for change."
"But the campaign is over, and I see too many of you still locked in an election mode."
"Na so e be. As I dey sef, I dey wait for 2019. Na for Baba side I dey."
"This Baba syndrome is a problem. It is breeding a culture of mass sycophancy, hypnotism and amnesia"
"Grammar!"
"When you elevate a government to a semi-divine status, you lose sight of your responsibility to hold government accountable. The ascribed, contrived, or self-imposed divinity of elected officials is a threat to democracy"
"I think you should be holding this conversation with your brother, Patrick Obahiagbon, I beg. Simple matter, you want to give somebody headache. One of these days, I will arrange a meeting between you and the Igodomigodo. Any little talk, somebody must look for dictionary. You too dey show. Na only you?"
"Leave am make e dey yarn. People who have become Ministers have become Ministers."
"Look at it this way, I know one of those old Ministers. The day he was given a portfolio, a very important one at that, the guy said he didn't know what the Ministry was all about. I was shocked."
"Well, I am not shocked."
"He ended up creating problems."
"So, what usually happens is that when a man takes a Ministry, he had no prior knowledge of, he spends the next six months trying to figure it out."
"That's why Baba has chosen experienced people who have been in government at senior levels."
"But one of them has said he is there to learn"
"You go and find out."
"If I may play the Devil's advocate, I think what the man means is that he is open to ideas. As human beings, we are always learning. At the retreat, the point was made clear that this is not a cabinet of learners, but drivers. People who are ready to move things forward."
"Were you there? Suppose they can't move anything."
"Someone told me. I have my contacts."
"You are just a bloody gossip. The truth is that some Ministers spend the whole time learning and moving nothing"
"I see noise-making has started already".
"We don't need noise. I want to see the change I asked for with my PVC."
"Fashola is the luckiest guy."
"Baba meta, himself."
"Power, Works, Housing. The Holy Trinity of Government."
"E remain make dem add Finance."
"Fashola is mai mhe-en."
"I don't envy him. I actually sympathise with him. I hope he has not been set up for demystification and disambulation."
"Why don't you speak like a normal human being?"
"Those three key portfolios make him a Super Minister."
"They should just have named him Co-ordinating Minister of the Economy."
"No. We don't need that. Every Minister is important."
"Fashola in that assignment, I tell you, will need the services of a doctor, a massager, and prayer warriors"
"Don't worry yourself. The man will do it. He performed in Lagos. The moment he left, Lagos shut down. See how Ambode is struggling with Fashola's big shoes. It is just Fashola's wife that I pity."
"What has his wife got to do with this? Please."
"You don't know? This one that they have made him a Baba Meta; I swear, when next the man shoots straight, his wife go born triplets! One for Power, one for Works, and the other for …"
"Amaechi wife, na twins that one go born."
"Are you guys alright?"
"Wait oh, e be like say na only one Baba give Amaechi. Transportation."
"Na two. Transport not Transportation. Baba has added …ation for Aviation. Amaechi is in charge of Transport. He is in charge of Aviation, add the two: Transportation. Him na Baba Ibeji."
"With control over 15 parastatals/agencies. God! You have his phone number?"
"No. I no get. But Baba didn't treat our brother, JFK well"
"He is in charge of Solid Minerals. That is a very strategic Ministry. It is like Agriculture. A developed Solid Minerals sector will further diversify the economy and increase non-oil revenue."
"But na only one they give am."
"Me, I thank God that he has a portfolio. I think PMB gave him Solid Minerals deliberately to please Fayose."
"What has Fayose got to do with this now?"
"Everything. You know he was the one who begged President Buhari to give Ekiti state, a solid ministry. He said Ekiti people don't want any yebuyebu Ministry but a very solid one."
"So, the President has shown that he listens, and he has given the people of Ekiti State, the Ministry of Solid Minerals!"
"You are not okay."
"Ekiti is solid. Whatever Fayemi is able to do in that Ministry, his efforts will be appreciated. But as for Amaechi and Fashola, well…"
"Who is in charge of Niger Delta? That is another strategic Ministry"
"Na Pastor they put there oh. Pastor Uguru."
"Me, I just hope the man knows that that is not a Ministry where you go and chop guguru oh. It is an important portfolio."
"If Uguru likes, let him chop guguru. As long as he does not chop alone, and the people of the Niger Delta get enough popcorn too."
"But wait a moment, is that not the same Pastor who during the Ministerial screening swore that God forbids him having anything to do with PDP members?"
"He didn't swear. He said it."
"He will probably need a one-on-one retreat with President Buhari. This is a government of nobody and a government of everybody."
"Hey! Even our critics are beginning to quote us as if they are quoting the Bible. Patapata we go win again o, winner! "
"Just tell your Uguru that he is not an APC Minister, but a Minister of the Federal Republic, whose doors must be open to everyone."
"Hen, hen. Are you looking for contract already, or a consultancy? Do I give you the man's number?"
"I don't need his number. I am making commonsense"
"Oh, you want to become another Ben Bruce, the commonsense Senator? He goes about saying he is making commonsense."
"He is right. We need commonsense"
"We don't need commonsense. Too much commonsense caused all our problems. What we need is uncommon sense, to get rid of common nonsense. Tell him."
"Who is in charge of Finance?"
"That's the Ogun State Ministry"
"What do you mean Ogun State Ministry? I am asking you who is the new Super Minister in charge of our money?"
"She is from Ogun State. Kemi Adeosun; she speaks fone."
"I hope she won't become a Madame No."
"Madam what?"
"Madam No Money.
"Nobody will try that with us. We will tell that person what to do"
"This is part of the problem with governance; too many people claiming to know what should be done. I don't remember PMB making you a Minister, adviser or errand boy. When these Ministers start failing, we will talk again."
"Leave us alone, I beg. It is our turn…"
Dr. Reuben Abati was Special Adviser on Media and Publicity to President Goodluck Jonathan
Saraki Asks Nigerians To Suggest New Policies For Govt
Facebook To Train Nigerian Senators On Use Of Social Media