Tag: Health

Blue is the New Green

Posted on July 7, 2014 in Economics, Government, Locations

Go Lean Commentary

First we said to “Go Green!”

Now we are saying to “Go Blue”, because Blue is the new Green. While ‘Green’ is indicative for all-things-environmental, ‘Blue’ refers specifically to Water.

There is money in Green; there is money in Blue too! The references to Blue waters apply equally to fCU Blog - Blue is the New Green - Photoresh water and seawater. When we consider all the waterscapes in the Caribbean, (1,063,000 square-miles of the Caribbean seas and thousands of islands in the archipelago – The Bahamas has over 700 alone), we realize how much opportunity exists.

This is the time to be proactive; and to facilitate the intersection of preparation and opportunity. (This is one definition of luck. This is how to create one’s own luck).

Considering all the opportunities, how can the Caribbean prepare its economic engines to harvest all the fruitage from these Blue market conditions? This is the theme of the book Go Lean…Caribbean, that the world is struggling to contend with monumental changes related to technology, globalization and most importantly Climate Change.

Early in the book, the pressing need to be aware and to adapt to Climate Change is pronounced in the Declaration of Interdependence (Page 11), with these words:

i. Whereas the earth’s climate has undeniably changed resulting in more severe tropical weather storms, it is necessary to prepare to insure the safety and security of life, property and systems of commerce in our geographical region. As nature recognizes no borders in the target of its destruction, we also must set aside border considerations in the preparation and response to these weather challenges.

The Caribbean needs Blue Technology solutions to sustain our own lives, liberties and systems of commerce. But the Go Lean book posits that we cannot just consume, we must also create, produce, and foster. So we must foster industrial solutions for the rest of the world. This subsequent magazine-article-summary highlights the progression in this new Blue Technology industry-space in these areas:
Sourcing
Treating
Storing
Conserving
Keeping it Clean
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VIDEO – The Blue Economy – https://youtu.be/7NqhVbCtqNk

Published on Jul 3, 2012 – The oceans have long been the centre of economic activity. People have been living near the sea, feeding themselves by fishing and making their livelihoods on the coast for thousands of years. The challenge today is harnessing the potential of this Blue Economy.

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Excerpts of Article by: Adam Bluestein

Forget for a moment about carbon emissions. The world is facing a more immediate crisis — it is running out of clean water. The prospect of widespread shortages is creating a new kind of new economy. Featured here are a number of entrepreneurial firms who are ahead of the curve, finding opportunity in the largest emerging market the world has seen in some time.

Analysts estimate that the world will need to invest as much as $1 trillion a year on [water] conservation technologies, infrastructure, and sanitation to meet demand through 2030. As in the past, most of the large capital-intensive projects will be done by the usual multinational corporations and engineering firms. But the extent of the problem and the demand for new technology to address it present — pardon the metaphor — a kind of perfect storm for entrepreneurs. “Small companies with intellectual property, significant know-how, and a product that’s scalable can stake out a niche below the radar of the large companies,” says Laura Shenkar, a water expert and consultant in San Francisco. “This is an opportunity that will generate Googles.”

There are a number of business roles that emerge from seizing the opportunities to develop solutions to water challenges:

Sourcing – Increasing the Supply

The well-documented experience around the world is that poverty comes from inadequate access to fundamental resources, like water. To assuage this threat, there are solutions in place now to deliver added fresh water by many means: irrigation canals, pipelines and tanker trucks/tanker ships (i.e. tanker ships between France and Algeria; Turkey and Israel). An emerging solution operated in the Middle East and India is small-scale barge-based desalination systems. These systems play an important role in increasing the supply of freshwater, especially after a natural disaster (storm or earthquake) when normal infrastructure may be crippled.

In general, desalination is an expensive option. Desalination, of course, is well-and-good for communities close to the ocean/seas and that can afford relatively expensive water. For everyone else, exploring inland pumping solutions is essential. An innovation comes from Deerfield Beach, Florida-based company Moving Water Industries. They produce SolarPedalFlo, a solar and pedal-powered pump that can singly provide filtered and chlorinated water for thousands of people every day.

Treating It

As the gold standard of disinfection for more than 100 years, chlorine kills bacteria, viruses, and other pathogens, and it has played a key role in eliminating diseases such as typhoid and cholera in the U.S. Chlorine’s benefits in water are twofold: it not only disinfects but also remains at a residual level in the water, preventing reinfection by viruses or bacteria during transport, storage, and distribution.

Water treatment is just a basic fact. While moving water is very power intensive, a huge energy user that it doesn’t make sense to continue to treat it one place, pump it, live with “losses and degradation”, and move it someplace else to dispose of it. This is depicted with a swimming pool. One would not fill it up and dump it out every time it is used. This defies logic.

But safety and security issues abound with Chlorine solutions, as it is a hazardous material to transport. An emerging solution is a compact generator, by MIOX, an Albuquerque, New Mexico-based outfit founded in 1994. Their equipment allows water treatment facilities to produce liquid chlorine on site. This solution uses only water, salt, and electricity, thus eliminating the need to store or transport hazardous chemicals.

In a developing country, the ability to treat one’s own water at home can be a matter of life and death. Those with limited means often purify water by boiling it or mixing it with iodine tablets. Those who can afford it use home water-purification systems. One of the companies capitalizing on demand for such systems is Eureka Forbes, India’s largest manufacturer of home water-purification systems. They have profited from their effort to make home water-purification systems much more affordable.

Storing It

It’s nice to imagine that water flows magically from a pristine reservoir or spring to your home faucet, but that’s simply not the case. As we have seen, it is disinfected and pumped along through a sprawling network of water mains and pipes. The U.S. water network (including Puerto Rico and the US Virgin Islands), much of it built in the 1950s and ’60s, will require some $277 billion worth of construction, upgrades, and replacement in the next 20 years, according to EPA (Environmental Protection Agency) estimates. With scarcity driving water agencies to fix leaks — by some estimates, about six billion gallons per day in the U.S. are lost through literal cracks in the system — companies making high-tech metering and leak-detection technologies are doing well for themselves.

Water Storage Tanks – After being treated, drinking water can spend as long as 100 days in the distribution system before reaching an end user. That’s not necessarily a bad thing, but when water sits in a tank too long, it begins to stagnate and settle into layers of different temperatures, as in a lake. In warmer layers at the top, the disinfectants used in treatment are burned off, which increases the potential for contamination. Even when the water is being used, poor tank design can create an uneven distribution of disinfectant and encourage uneven aging, allowing water at the bottom of a tank to be replenished more quickly than water at the top.

The traditional solution is to dump more disinfecting chemicals into the holding system, leading to the formation of chemical byproducts. Another solution is to use energy-intensive “operational cycling” – basically pumping moving water around from tank to tank.

An energy-efficient, inexpensive, and elegant solution is called the Lily Impeller (by San Rafael, California-based PAX Water Technologies, founded in 2006). It’s a spiral propeller that’s installed on the bottom of a storage tank; it can mix up to seven million gallons of water while drawing the same amount of energy as three 100-watt light bulbs.

Another solution is a floating solar-powered impeller, which could improve surface water to be treated for drinking or even provide basic wastewater remediation.

Conserving It

A basic example of water conservation is a water recycling system that would take used water from the bathroom sink, disinfect it, and reroute it to the toilet tank for flushing.

One option: The AQUS System uses standard plumbing parts and can be installed by a professional plumber in about two hours. Priced at $395 (before rebates), it can save up to 6,000 gallons of water a year in a two-person household.

Another option: water-free urinals – biodegradable liquid with a specific gravity lighter than water.

Utilities have found that offering customers rebates for things such as low-flow showerheads and toilets and efficient front-loading clothes washers has been a reliable and cost-effective way to curb water use, and the cost of energy to supply and treat water.

A final option: WeatherTRAK irrigation controllers – a (software-based) system that uses live weather data, rather than preset timers, to tell sprinklers when and how much to water crops, lawns, and commercial landscapes.

Keeping It Clean

Though drought is one of the more obvious consequences of Climate Change, water experts are equally worried about the problems caused by extreme storms and flooding that many, if not most, scientists believe are another consequence of global warming. Storm-water runoff has become a concern for its effect on surface and ground water, as well as the additional burden that it puts on already creaky wastewater treatment facilities.

One solution: Scottsdale, Arizona-based AbTech Industries, first used their Smart Sponges — made from a synthetic polymer — in 1997 to clean up oil spills from tankers at sea. In 1999, when they turned their attention to storm water, most regulation was focused on runoff from new construction. But billions of gallons of rain that come down on the roads and go into our flood-control devices could be contaminated on the way through. This company molds their sponge material into different shapes that would fit into street-level storm drains and catch basins, soaking up oil and debris and letting clean water pass through. They also developed a way to coat the sponges with an antimicrobial agent so they would disinfect water as well. Their next iteration, add the ability to capture heavy metals, herbicides, and pesticides.

Another solution for eliminating challenging pollutants from water, compared to the traditional approach using mechanical filters or chemicals, researchers have experimented with using genetically modified organisms to degrade water pollutants. This new technological solution, being commercialized by companies like Overland Park, Kansas-based Microvi Biotech (founded in 2004), is literally eating these pollutants up. Their company verbiage explains: “The idea of using biotechnology — using concepts from nature — to clean up water has proven very appealing”.

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Adam Bluestein is a Burlington, Vermont-based freelance writer.
INC Magazine for Entrepreneurs (Article posted November 1 2008; retrieved 07/07/2014) – http://www.inc.com/magazine/20081101/blue-is-the-new-green.html

The topics in this commentary are relevant and familiar. Prudent water management is vital for Caribbean life, our public safety and commerce systems. Tourism continues to be the primary economic driver in the region. While the motivation behind the Caribbean “Lean” is to diversify the economy, prudence dictates that we do not undermine current successful tourism engines. Since tourists come to the region for sand, surf and sun, there must be a “quality” sentinel for Caribbean water works, waterscapes and water eco-systems.

This point is detailed in the book Go Lean…Caribbean, a roadmap for the introduction and implementation of the technocratic Caribbean Union Trade Federation (CU). This roadmap has 3 prime directives:

  • Optimization of the economic engines in order to grow the regional economy.
  • Establishment of a security apparatus to protect the homeland and related economic engines.
  • Improve Caribbean governance to support these engines.

This Go Lean commentary delved into related subjects in these previous blogs:

https://goleancaribbean.com/blog/?p=1516 Floods in Minnesota, Drought in California – Why Not Share?
https://goleancaribbean.com/blog/?p=915 Go ‘Green’… Caribbean

Water is not cheap. It is only free when it rains. The effort to source, treat, store, conserve and keep water clean takes a big investment on the part of community and governmental institutions. While we commend and applaud the regional executions thus far, the Go Lean book recognizing that there is more heavy-lifting to do. Help is on the way! The Go Lean roadmap details a series of community ethos, strategies, tactics, implementations and advocacies to foster the progress in the wide field of Blue technology. The following list applies:

Community Ethos – Lean Operations Page 24
Community Ethos – Return on Investments Page 24
Community Ethos – Cooperatives Page 25
Community Ethos – Non-Government Organizations Page 25
Community Ethos – Ways to Impact the Future Page 26
Community Ethos – Impact the Greater Good Page 37
Anecdote – Pipeline Transport – Strategies, Tactics &   Implementations Page 43
Strategy – Build and foster local economic engines Page 45
Tactical – Fostering a Technocracy Page 82
Tactical – Separation of Powers – Public Works Page 82
Anecdote – “Lean” Environmental Quality Process Page 93
Implementation – Ways to Develop Pipeline Industry Page 107
Advocacy – Ways to Impact Public Works Page 175
Advocacy – Ways to Foster Cooperatives Page 176
Advocacy – Ways to Better Manage Natural Resources – Water   Resources Page 182
Advocacy – Ways to   Foster Technology Page 197
Advocacy – Ways to Impact Monopolies Page 202
Advocacy – Ways to Impact   Rural Living – Minimize Irrigation Downsides Page   235
Appendix – Pipeline   Maintenance Robots Page   283

Water needs are undeniable.

Fulfilling those needs is a great target for lean, agile operations, perfect for the CU technocracy. While its “good to be green”, being “blue” is not an option we can choose to ignore, as the Caribbean is mostly made up of islands – surrounded by water.

Go Blue. Go Green. Go Lean.

Now is the time for all of the Caribbean, the people, entrepreneurs, institutions and governments, to lean-in for the optimizations and opportunities described in the book Go Lean … Caribbean.

Download the book Go Lean … Caribbean – now!

 

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Marijuana in Jamaica – Puff Peace

Posted on June 18, 2014 in Ethos, Government, Locations

Go Lean Commentary

Weed 1Come to Jamaica and feel alright! – Advertising tag line sampling Bob Marley’s song: One Love.

Marijuana decriminalization is not a Jamaican issue… alone. Other countries have already addressed this debate; like Latin America[a] and Europe; legal in The Netherlands & Portugal, and decriminalized in Norway. In the US, Colorado is about to be joined by the State of Washington in allowing recreational use of the cannabis plant.

While medical marijuana originated in Jamaica (1970’s), many jurisdictions now allow marijuana to be legally distributed by medical professionals, with a prescription. Life imitates art, art imitates life. Hollywood has lampooned this practice many times in movies, TV shows and commentary. In the State of California, it is common-place to get a prescription for marijuana for “dubious” ailments like insomnia, appetite abatement, non-clinical depression, even sneezing. Without a doubt in California, the whole process is a farce! (See Comedian Bill Maher’s tongue-in-cheek commentary in Referenced VIDEO below[c]).

The world has changed; the acceptance of marijuana is changing.

The following news article addresses the issue of Marijuana decriminalization, (more so than legalization):

Port of Spain, Trinidad & Tobago – It would have seemed a lot more revolutionary just two years ago but for Jamaica, it is still a welcome whiff of sense. The island’s energy minister, Philip Paulwell, who also leads government business in parliament, has said he will find time this year to decriminalise possession of small amounts of marijuana. At a stroke, the move will cut the number of illicit smokes by as many as a million a week. It will also make a Jamaican break somewhat less nervy for ganja-puffing tourists.

Reform proposals have been knocking around for some time: a National Commission on Ganja recommended decriminalisation in 2001. But helped by moves towards legalisation in Uruguay and decriminalisation in the United States, momentum has been growing. A Cannabis Future Growers and Producers Association was launched last month, and a commercial company to support medical marijuana in December.

Selling for less than five dollars an ounce, ganja has a long history in Jamaica, going all the way back to 19th-century Indian immigrants. Cultivation and import have been illegal since 1913, but everyone’s granny remembers when the herb was quite openly on sale as a cure-all. Some of the early work on medicinal uses for marijuana was done in Jamaica in the 1970s and 1980s.

In practice, most small-time ganja users are not arrested or prosecuted. But for those who are, the consequences can be dire. A criminal record makes it hard to get a coveted American visa or to land jobs in Jamaica itself. For that reason alone, reform looks like a surefire vote-winner.

Decriminalisation will also unclog the courts and free up police time. But it won’t change the big picture. It will remain illegal to grow and trade marijuana in large quantities, something that suits the big players just fine. Full legalisation would knock the bottom out of the market, hurting the island’s powerful criminal gangs. It would also curtail the potential for extortion; seven police officers appeared in court this month to face allegations that they took a $2,750 bribe from a businessman in return for overlooking a ganja find on his premises.

Jamaicans are prone to waves of moral panic, but the proposal to decriminalise ganja has caused barely any waves. The foreign minister AJ Nicholson and the opposition leader, Andrew Holness, have expressed mild reservations; the vocal church lobby has been silent. Says a well-educated and dreadlocked Jamaican: “Most of them accept that there are people who do this, just like there are people who drink.” Such tolerant sentiments only go so far, however. The “abominable crime of buggery” carries a prison sentence of up to ten years, and the government has no plans to right that injustice.
The Economist Magazine; posted 06/13/2014; retrieved 06/18/2014 from: http://www.economist.com/blogs/americasview/2014/06/marijuana-jamaica?spc=scode&spv=xm&ah=9d7f7ab945510a56fa6d37c30b6f1709

Marijuana tourism or “ganja-puffing tourists” …
…these words jump off the page of this foregoing news article.

The book Go Lean…Caribbean anticipates the compelling issues associated with economic engines. The book serves as a roadmap for the introduction and implementation of the technocratic Caribbean Union Trade Federation (CU). This effort calls for the focus of the following 3 prime directives related to Trade:

  • Optimization of the economic engines in order to grow the regional economy to $800 Billion and create 2.2 million jobs.
  • Establishment of a security apparatus (including law enforcement enhancements) to protect the resultant economic engines.
  • Improve Caribbean governance to support these engines.

Weed 2But the subject of marijuana is bigger than Trade. There are moral, religious, legal and psychological (treatment) issues associated with this topic; and there is history – good and bad. Any jurisdiction decriminalizing the use of marijuana has to contend with the previous messaging to the community of: “Just say no to drugs”.

The book asserts that before the strategies, tactics, implementations and advocacies of a roadmap to elevate a society can be deployed, the affected society must first embrace a progressive community ethos. The book defines this “community ethos” as the fundamental character or spirit of a culture; the underlying sentiment that informs the beliefs, customs, or practices of society; dominant assumptions of a people or period. Think of the derivative term: “work ethic”.

Marijuana is a mood-altering drug; it has negative effects, one being preponderance for apathy, to tune out of any active engagement. In the US, even in the states where marijuana is legal, most firms/governments still screen staffers (new hires and veterans) and ban consumption of the drug. The reason is simple: Apathy does not make for industriousness. So this issue/drug presents a conundrum for the CU. The mission to grow the economy, promote industriousness, foster new jobs and new industries is pronounced early in the roadmap, detailed in the Declaration of Interdependence (Page 14) with this statement:

 xxvi.   Whereas the Caribbean region must have new jobs to empower the engines of the economy and create the income sources for prosperity, and encourage the next generation to forge their dreams right at home, the Federation must therefore foster the development of new industries … In addition, the Federation must invigorate the enterprises related to existing industries … impacting the region with more jobs.

According to the foregoing article, reconciling the history of marijuana/ganja will be a “tall order”:

ganja has a long history in Jamaica, going all the way back to 19th-century Indian immigrants.

The history of marijuana/ganja in the Caribbean in general and Jamaica in particular has generated a lot of proponents and opponents. Despite outlawing “the weed” for over 100 years, there is a vibrant black market economy associated with the drug. This reality challenges the security apparatus of the Caribbean’s legitimate governing entities. The Go Lean roadmap therefore features the necessary homeland security/law enforcement mitigations. This need was pronounced at the outset of the book (Page 12), recognizing that the problem of drug enforcement/interdiction may be too big for any one member-state alone:

xvi.   Whereas security of our homeland is inextricably linked to prosperity of the homeland, the economic and security interest of the region needs to be aligned under the same governance. Since economic crimes … can imperil the functioning of the wheels of commerce for all the citizenry, the accedence of this Federation must equip the security apparatus with the tools and techniques for predictive and proactive interdictions.

This issue of decriminalizing marijuana must now reconcile with the long history of criminal prosecutions, prison terms and probation/parole eco-system. Management of these attendant functions of criminology has been a consistent theme of the Go Lean roadmap, commencing with this statement in the same Declaration of Interdependence (Page 12):

x.   Whereas we are surrounded and allied to nations of larger proportions in land mass, populations, and treasuries, elements in their societies may have ill-intent in their pursuits, at the expense of the safety and security of our citizens. We must therefore appoint “new guards” to ensure our public safety and threats against our society, both domestic and foreign. The Federation must employ the latest advances and best practices of criminology and penology to assuage continuous threats against public safety. The Federation must allow for facilitations of detention for convicted felons of federal crimes, and should over-build prisons to house trustees from other jurisdictions.

The Go Lean book envisions the CU as a confederation of the 30 member-states of the Caribbean to do the heavy-lifting of empowering and elevating the Caribbean society by creating a “single market” for the region. Among the many benefits of this roadmap is the economies-of-scale for leveraging regional security solutions, like the upheavals of marijuana decriminalization.

Despite the many economic benefits researched for decriminalizing drugs, as measured in the mature market of the US [b], this roadmap and supporting blogs are NOT proposing this measure for the Caribbean … per se. This is presented here as a political issue; the CU strives to maintain an apolitical stance.

There is security risk on both sides of this issue. The book details the community ethos, strategies, tactics, implementations and advocacies to monitor, manage and mitigate the security risks to Caribbean society. The following is a sample list:

Community Ethos – Deferred Gratification Page 21
Community Ethos – Job Multiplier Page 22
Community Ethos – Privacy versus Public Protection Page 23
Community Ethos – Light Up the Dark Places Page 23
Community Ethos – Ways to Impact Research & Development Page 30
Community Ethos – Ways to Impact the Greater Good Page 37
Strategy – Vision – Integration of Single Market Economy Page 45
Strategy – Agents of Change – Globalization Page 57
Tactical – Fostering a Technocracy Page 64
Tactical – Separation of Powers – Homeland Security Page 75
Tactical – Separation of Powers – Justice Department Page 77
Implementation – Security Initiatives at Start-up Page 103
Advocacy – Ways to Grow the Economy Page 151
Advocacy – Ways to Ways to Mitigate Black Markets Page 165
Advocacy – Ways to Improve Governance Page 168
Advocacy – Ways to Better Manage the Social Contract Page 170
Advocacy – Ways to Impact Justice Page 177
Advocacy – Ways to Remediate and Mitigate Crime Page 178
Advocacy – Ways to Improve Homeland Security Page 180
Advocacy – Ways to Impact the Prison Industrial Complex Page 211

Now is the time for all of the Caribbean, the people and governing institutions, to lean-in for the empowerments described in the book Go Lean … Caribbean. For us to send the invitation to the wide-world to ”come to Caribbean and feel alright”, but we must first put “our house” in order.

The world’s acceptance of marijuana has changed. While this is true, this change has created opportunities and also challenges. There is plenty of work yet to be done; heavy-lifting.

Download the book Go Lean … Caribbean – now!

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Referenced Citations:

a.  Marijuana is legal to some degree in 8 Latin America countries (Argentina, Brazil, Columbia, Costa Rica, Ecuador, Honduras, Mexico and Uruguay).

b.  A Harvard economist, Jeffery Miron, estimated that ending the war on drugs would inject 76.8 billion dollars into the US economy in 2010 alone.[1] He estimates that the government would save $41.3 billion for law enforcement and the government would gain up to $46.7 billion in tax revenue.[2] Since President Nixon began the war on drugs, the federal drug-fighting budget has increased from $100 million in 1970 to $15.1 billion in 2010, with a total cost estimated near 1 trillion dollars over 40 years.[3] In the same time period an estimated 37 million nonviolent drug offenders have been incarcerated. $121 billion was spent to arrest these offenders and $450 billion to incarcerate them.[3]

1.       Debusmann, Bernd (12/03/2008). “Einstein, Insanity and the War on Drugs”. Reuter. Retrieved 04/01/2012 from: http://blogs.reuters.com/great-debate/2008/12/03/einstein-insanity-and-the-war-on-drugs/.

2.       Miron, Jeffrey A.; Katherine Waldock. “The Budgetary Impact of Ending Drug Prohibition”. The Cato Institute.  Retrieved 05/03/2010 from: http://www.cato.org/publications/white-paper/budgetary-impact-ending-drug-prohibition

3.       The Associated Press (05/13/2010). “After 40 years, $1 trillion, US War on Drugs Has Failed to Meet Any of its Goals”. The Associated Press. Retrieved 04/01/2012 from: http://www.foxnews.com/world/2010/05/13/ap-impact-years-trillion-war-drugs-failed-meet-goals/.

c.  Referenced VIDEO:

 

Post by Bill Maher.
On Friday night’s episode of “Real Time,” Bill Maher offered some advice to viewers and to the state of Colorado about how to use marijuana safely and effectively, which we need to do, he said, because “after all, we’re pretending it’s medicine…

 

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[Top]

Painful and rapid spread of new virus in Caribbean

Posted on May 23, 2014 in Economics, Government

Go Lean Commentary

“Crap happens”, declares the book Go Lean…Caribbean (Page 23).

Virus 1The Chikungunya virus scare in the foregoing news article represents the sum of all fears for the Caribbean in terms of tourism and public health threats. This emphatically highlights the need for a regional security pact for Caribbean assurances.

The virus in this article has been identified in the Dominican Republic, Dominica, Saint Martin, and French Guiana; therefore, this is a cross-border threat. This re-enforces that there is a need for a super-national disease-medical sentinel in this security pact.

While other security pacts (for example NATO – North Atlantic Treaty Organization) may be based on defense against military aggression, the Caribbean security pact must focus more on public safety measures. This is one of the prime directives of the proposed Caribbean Union Trade Federation (CU). Naturally, the focus starts with economics, but the resultant engines can be seriously impacted by public safety/health threats. The book Go Lean… Caribbean, serves as a roadmap for the introduction and implementation of that regional sentinel, the CU. The complete prime directives are described as:

  • Optimize the economic engines of the Caribbean to elevate the regional economy.
  • Establish a security apparatus to protect the resultant economic engines.
  • Improve Caribbean governance to support these engines.

The Go Lean roadmap immediately calls for the establishment of a Homeland Security Department, with an agency to practice the arts and sciences of Emergency Management. The emergencies include natural disasters like hurricanes, earthquakes, tsunamis, volcanoes, flooding, forest fires, and droughts. Emergencies also include the man-made variety as in industrial accidents (oil spills, factory accidents and chemical spills), explosions, terroristic attacks and prison riots. The type of emergency described in the foregoing article requires a hybrid response of the Emergency Management agency and the CU’s Department of Health Disease Control & Management agency. Medical expertise would be required to contend with systemic threats of epidemic illness and infectious diseases.

The CU does not possess sovereignty for Caribbean member-states; so CU participation must be invited. This is why the CU is described as a deputized proxy organization. This invitation is equivalent to dialing “911”, a declaration of an emergency – thus granting a timed lease of limited authority to the CU agency, terminating with an “all clear” determination.

By: Ben Fox, AP

SAN CRISTOBAL, Dominican Republic (AP) — They suffer searing headaches, a burning fever and so much pain in their joints they can barely walk or use their hands. It’s like having a terrible flu combined with an abrupt case of arthritis.

Hospitals and clinics throughout the Caribbean are seeing thousands of people with the same symptoms, victims of a virus with a long and unfamiliar name that has been spread rapidly by mosquitoes across the islands after the first locally transmitted case was confirmed in December.

“You feel it in your bones, your fingers and your hands. It’s like everything is coming apart,” said 34-year-old Sahira Francisco as she and her daughter waited for treatment at a hospital in San Cristobal, a town in the southern Dominican Republic that has seen a surge of the cases in recent days.

The virus is chikungunya, derived from an African word that loosely translates as “contorted with pain.” People encountering it in the Caribbean for the first time say the description is fitting. While the virus is rarely fatal it is extremely debilitating.

“It is terrible, I have never in my life gotten such an illness,” said Maria Norde, a 66-year-old woman confined to bed at her home on the lush eastern Caribbean island of Dominica. “All my joints are in pain.”

Outbreaks of the virus have long made people miserable in Africa and Asia. But it is new to the Caribbean, with the first locally transmitted case documented in December in French St. Martin, likely brought in by an infected air traveler. Health officials are now working feverishly to educate the public about the illness, knock down the mosquito population, and deal with an onslaught of cases.

Authorities are attempting to control mosquitoes throughout the Caribbean, from dense urban neighborhoods to beach resorts. There have been no confirmed cases of local transmission of chikungunya on the U.S. mainland, but experts say the high number of travelers to the region means that could change as early as this summer.

So far, there are no signs the virus is keeping visitors away though some Caribbean officials warn it might if it is not controlled. “We need to come together and deal with this disease,” said Dominica Tourism Minister Ian Douglas.

One thing is certain: The virus has found fertile ground in the Caribbean. The Pan American Health Organization reports more than 55,000 suspected and confirmed cases since December throughout the islands. It has also reached French Guiana, the first confirmed transmission on the South American mainland.

The Pan American Health Organization says seven people in the Caribbean with chikungunya have died during the outbreak but they had underlying health issues that likely contributed to their death.

“It’s building up like a snowball because of the constant movement of people,” said Jacqueline Medina, a specialist at the Instituto Technologico university in the Dominican Republic, where some hospitals report more than 100 new cases per day.

Virus 3Chikungunya was identified in Africa in 1953 and is found throughout the tropics of the Eastern Hemisphere. It is spread by two species of mosquitoes, aedes aegypti and aedes albopictus. It’s also a traveler-borne virus under the right circumstances.

It can spread to a new area if someone has it circulating in their system during a relatively short period of time, roughly 2-3 days before the onset of symptoms to 5 days after, and then arrives to an area with the right kind of mosquitoes.

For years, there have been sporadic cases of travelers diagnosed with chikungunya but without local transmission. In 2007, there was an outbreak in northern Italy, so health authorities figured it was just a matter of time before it spread to the Western Hemisphere, said Dr. Roger Nasci, of the U.S. Centers for Disease Control and Prevention.

“With the increase in travelers the likelihood that something like this would happen goes up and eventually it did,” said Nasci, chief of a CDC branch that tracks insect-borne diseases. “We ended up with somebody at the right time and the right place infecting mosquitoes.”

The two species of mosquitoes that spread chikungunya are found in the southern and eastern United States and the first local transmissions could occur this summer given the large number of U.S. travelers to the Caribbean, Nasci said. Already, the Florida Department of Health has reported at least four imported cases from travelers to Haiti, the Dominican Republic and Dominica.

“What we’re seeing now is an increase in the number of infected travelers coming from the Caribbean, which is expected because there’s a lot of U.S. travel, a lot of vacation travel, a lot of work travel,” he said.

Around the Caribbean, local authorities have been spraying fogs of pesticides and urging people to remove standing pools of water where mosquitoes breed.

An estimated 60-90 percent of those infected show symptoms, compared to around 20 percent for dengue, which is common in the region. There is no vaccine and the only cure is treatment for the pain and fluid loss.

One consolation for those suffering from the illness is that unlike dengue, which has several variants, people only seem to get chikungunya once.

“The evidence suggests that once you get it and recover, once your immune system clears the virus you are immune for life,” Nasci said.

Associated Press writers Ben Fox in Miami; P. Solomon Banda in Fort Collins, Colorado; David McFadden in Kingston, Jamaica; and Carlisle Jno Baptiste in Roseau, Dominica, contributed to this report.

Associated Press News Wire (Retrieved 05-22-2014) –          http://news.yahoo.com/painful-rapid-spread-virus-caribbean-040106421.html

The Go Lean roadmap immediately calls for the coordination of security monitoring and mitigation in the Caribbean; referring to viruses as well. This point is declared early in the Go Lean book, commencing with this opening pronouncement in the Declaration of Interdependence (Page 12), as follows:

xvi. Whereas security of our homeland is inextricably linked to prosperity of the homeland, the economic and security interest of the region needs to be aligned under the same governance. …[to ensure] the functioning of the wheels of commerce for all the citizenry, the accedence of this Federation must equip the security apparatus with the tools and techniques for predictive and proactive interdictions.

Go Lean … Caribbean therefore constitutes a change for the Caribbean. This is a roadmap to consolidate 30 member-states of 4 different languages and 5 colonial legacies (American, British, Dutch, French, Spanish) into a Trade Federation with the tools/techniques to bring immediate change to the region to benefit one and all member-states. This includes the monitoring/tracking/studying the origins of common and emerging viruses. This empowered CU agency will liaison with foreign entities with the same scope, like the Pan American Health Organization, US’s Center for Disease Control (CDC) and the World Health Organization (WHO).

Virus 2A lot is at stake!

Tourism is the primary economic driver in the region. The realization, or even the unsubstantiated rumor, of viral outbreaks can imperil the tourism product. We must therefore take proactive steps to protect our economic engines. But, we must not curtail freedom of movement among our visitors. We are, in effect, extending an “Open House” to the world to come enjoy our hospitality. Come… they will. So there are additional responsibilities for the stewards of the Caribbean economy, to impact the Greater Good. The CU invites this role, to promote this community ethos.

The book details that there must first be adoption of such a community ethos, the appropriate attitude/spirit to forge change in the region. Go Lean details this and other ethos; plus the executions of the following strategies, tactics, implementations and advocacies to impact the region’s public health:

Community Ethos – Privacy versus Public Protection Page 23
Community Ethos – “Crap” Happens Page 23
Community Ethos – Lean Operations Page 24
Community Ethos – Cooperatives Page 24
Community Ethos – Non-Government Organizations Page 25
Community Ethos – Ways to Improve Sharing Page 35
Community Ethos – Impact the Greater Good Page 37
Strategy – Vision – Non-Sovereign “Unified” Proxy Entity Page 45
Strategy – Customers – Residents & Visitors Page 47
Strategy – Agents of Change – Globalization Page 57
Tactical – Confederating a Permanent Union Page 63
Tactical – Fostering a Technocracy Page 64
Separation of Powers – Emergency Management Page 76
Separation of Powers – Disease Control & Management Page 86
Implementation – Ways to Pay for Change Page 101
Implementation – Security Initiatives at Start-up Page 103
Implementation – Ways to Deliver Page 109
Implementation – Ways to Foster International Aid Page 115
Implementation – Ways to Benefit from Globalization Page 119
Planning – Ways to Improve Failed-State Indices Page 134
Planning – Ways to Measure Progress Page 148
Advocacy – Ways to Grow the Economy Page 151
Advocacy – Ways to Improve Healthcare Page 156
Advocacy – Ways to Improve Governance Page 168
Advocacy – Ways to Better Manage the Social Contract Page 170
Advocacy – Ways to Foster Cooperatives Page 176
Advocacy – Ways to Improve for Natural Disasters Page 184
Advocacy – Ways to Improve Emergency Management Page 196

The foregoing news article introduces the threats of the Chikungunya virus. This is today’s issue. New issues will emerge tomorrow and the days after. This establishes that there is need for a permanent union – a sentinel – to provide efficient stewardship for Caribbean economy, security and governing engine. Change has come to the region.

How would the region pay for this change, these elevations? The Caribbean Union Trade Federation hereby submits for this job, no payment necessary! The region is hereby urged to lean-in to this Go Lean roadmap, to fulfill the vision of making the Caribbean region a better place to live, work and play.

Download the Book- Go Lean…Caribbean Now!!!

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Inflation Matters

Posted on May 21, 2014 in Economics

Go Lean Commentary

Inflation 1Money matters in modern life.

So if money matters, then inflation is a consistent consideration for money matters. Think of a Union collective bargaining negotiations; it may be important to peg wage increases to the rate of inflation. The same consideration would apply to pensions and other national safety nets.

The book Go Lean… Caribbean, serves as a roadmap for the introduction and implementation of the Caribbean Union Trade Federation (CU). The CU is to take oversight of much of the region’s inflation monitoring/metering. In fact, Go Lean roadmap has 3 prime directives:

  • Optimization of the economic engines in order to grow the regional economy.
  • Establishment of a security apparatus to protect the resultant economic engines.
  • Improve Caribbean governance to support these engines.

This book is written with the approach that “we manage what we measure”. The CU will measure all aspects of Caribbean inflation and manage the consequential implications. According to the foregoing encyclopedia reference, the measurement method of a Consumer Price Index (CPI) needs a regional administrator, as there can be regional deviations from city-to-city, island-to-island. The CU oversight is a professional, technocratic administration of this important economic metric. This point is detailed in the Go Lean book (Page 153), identifying “Ways to Control Inflation”.

Encyclopedia Definition

In economics, inflation is a sustained increase in the general price level of goods and services in an economy over a period of time. When the general price level rises, each unit of currency buys fewer goods and services. Consequently, inflation reflects a reduction in the purchasing power per unit of money – a loss of real value in the medium of exchange and unit of account within the economy. A chief measure of price inflation is the inflation rate, the annualized percentage change in a general price index (normally the consumer price index) over time.[a]

Consumer Price Index

The consumer price index (CPI) measures changes in the price level of a market basket of consumer goods and services purchased by households. The CPI in the United States is defined by the Bureau of Labor Statistics (a unit of the Labor Department) as “a measure of the average change over time in the prices paid by urban consumers for a market basket of consumer goods and services.”[b]

The CPI is a statistical estimate constructed using the prices of a sample of representative items whose prices are collected periodically. Sub-indexes and sub-sub-indexes are computed for different categories and sub-categories of goods and services, being combined to produce the overall index with weights reflecting their shares in the total of the consumer expenditures covered by the index. It is one of several price indices calculated by most national statistical agencies. The annual percentage change in a CPI is used as a measure of inflation. A CPI can be used to index (i.e., adjust for the effect of inflation) the real value of wages, salaries, pensions, for regulating prices and for deflating monetary magnitudes to show changes in real values. In most countries, the CPI is, along with the population census and the USA National Income and Product Accounts, one of the most closely watched national economic statistics.

Is the CPI a cost-of-living index?

The CPI frequently is called a cost-of-living index, but it differs in important ways from a complete cost-of-living measure. BLS has for some time used a cost-of-living framework in making practical decisions about questions that arise in constructing the CPI. A cost-of-living index is a conceptual measurement goal, however, and not a straightforward alternative to the CPI. A cost-of-living index would measure changes over time in the amount that consumers need to spend to reach a certain utility level or standard of living. Both the CPI and a cost-of-living index would reflect changes in the prices of goods and services, such as food and clothing that are directly purchased in the marketplace; but a complete cost-of-living index would go beyond this role to also take into account changes in other governmental or environmental factors that affect consumers’ well-being. It is very difficult to determine the proper treatment of public goods, such as safety and education, and other broad concerns, such as health, water quality, and crime, that would constitute a complete cost-of-living framework.

What goods and services does the CPI cover?

Inflation 2The CPI represents all goods and services purchased for consumption by the reference population (U or W) BLS has classified all expenditure items into more than 200 categories, arranged into eight major groups. Major groups and examples of categories in each are as follows:

  • FOOD AND BEVERAGES (breakfast cereal, milk, coffee, chicken, wine, full service meals, snacks)
  • HOUSING (rent of primary residence, owners’ equivalent rent, fuel oil, bedroom furniture)
  • APPAREL (men’s shirts and sweaters, women’s dresses, jewelry)
  • TRANSPORTATION (new vehicles, airline fares, gasoline, motor vehicle insurance)
  • MEDICAL CARE (prescription drugs and medical supplies, physicians’ services, eyeglasses and eye care, hospital services)
  • RECREATION (televisions, toys, pets and pet products, sports equipment, admissions);
  • EDUCATION AND COMMUNICATION (college tuition, postage, telephone services, computer software and accessories);
  • OTHER GOODS AND SERVICES (tobacco and smoking products, haircuts and other personal services, funeral expenses).

Also included within these major groups are various government-charged user fees, such as water and sewerage charges, auto registration fees, and vehicle tolls. In addition, the CPI includes taxes (such as sales and excise taxes) that are directly associated with the prices of specific goods and services. However, the CPI excludes taxes (such as income and Social Security taxes) not directly associated with the purchase of consumer goods and services.

Chained CPI in the United States

In the United States, several different consumer price indices are routinely computed by the Bureau of Labor Statistics (BLS). These include the CPI-U (for all urban consumers), CPI-W (for Urban Wage Earners and Clerical Workers), CPI-E (for the elderly), and C-CPI-U (chained CPI for all urban consumers). These are all built in two stages. First, the BLS collects data to estimate 8,018 separate item-area indices reflecting the prices of 211 categories of consumption items in 38 geographical areas. In the second stage, weighted averages are computed of these 8,018 item-area indices. The different indices differ only in the weights applied to the different 8,018 item-area indices. The weights for CPI-U and CPI-W are held constant for 24 months, changing in January of even-numbered years.

The weights for C-CPI-U are updated each month to reflect changes in consumption patterns in the last month.

In January of each year, Social Security (America’s Old Age Pension) recipients receive a cost of living adjustment (COLA) “to ensure that the purchasing power of Social Security and Supplemental Security Income (SSI) benefits is not eroded by inflation. It is based on the percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W)”[f]. The use of CPI-W conflicts with this purpose, because the elderly consume substantially more health care goods and services than younger people. [d] In recent years, inflation in health care has substantially exceeded inflation in the rest of the economy. Since the weight on health care in CPI-W is much less than the consumption patterns of the elderly, this COLA does not adequately compensate them for the real increases in the costs of the items they buy. [g]

The BLS does track a consumer price index for the elderly (CPI-E). But it is not used, in part because the social security trust fund is forecasted to run out of money in roughly 40 years, and using the CPI-E instead of CPI-W would shorten that by roughly 5 years.[h]

Wikipedia Online Encyclopedia – Retrieved 05-20-2014 http://en.wikipedia.org/wiki/Inflation

Citation References:

a. Mankiw, N. Gregory (2002). Macroeconomics (5th Ed.). Worth Publications. ISBN 978-0716752370. Retrieved May 2014.

b. Consumer Price Index. Bureau of Labor Statistics. Retrieved September 10, 2010 from: http://www.bls.gov/cpi/cpifaq.htm.

c. Losey, Stephen (31 December 2012). “Chained CPI proposal off table for now, lawmakers say”. Federal Times. Retrieved 3 January 2013 from: http://www.federaltimes.com/article/20121231/BENEFITS02/312310001/Chained-CPI-proposal-off-table-now-lawmakers-say?odyssey=tab%7Ctopnews%7Ctext%7CCongress.

d. Robert, Reich (April 4, 2013). “What’s the ‘Chained CPI,’ Why It’s Bad for Social Security and Why the White House Shouldn’t Be Touting It (VIDEO)”. Huffington Post. Retrieved April 11, 2013: http://www.huffingtonpost.com/robert-reich/chained-cpi_b_3016471.html

e. Gibson, Ginger (April 9, 2013). “Republicans applaud chained CPI in Obama budget”. Politico. Retrieved April 11, 2013 from: http://www.politico.com/story/2013/04/republicans-applaud-chained-cpi-in-obama-budget-89831.html.

f. “Cost-Of-Living Adjustment (COLA) Information For 2013”. Cost-Of-Living Adjustment (Social Security Administration). Retrieved April 11, 2013 from: http://www.ssa.gov/cola/

g. Wikipedia treatment for the Consumer Price Index. Retrieved May 20, 2014 from: http://en.wikipedia.org/wiki/Consumer_price_index

h. Hobijn, Bart; Lagakos, David (May 2003). “Social Security and the Consumer Price Index for the Elderly”. Current Issues in Economics and Finance (Federal Reserve Bank of New York) 9 (5): 1–6. Retrieved April 11, 2013 from: http://www.newyorkfed.org/research/current_issues/ci9-5/ci9-5.html.

The approach of a CPI (or a Retail Price Index) is not exclusively American; other societies use the same methodology. But the American model is one from which the Caribbean should apply learned lessons; we would NOT want to fall into the American pitfalls of purposefully eliminating significant items from measurement because of political leanings. For example, the US does not include health care in the measurement of the official CPI, even though it may amount to 40% of some families’ spending. This point is highlighted in this article:

Former White House Chief of Staff Erskine Bowles and former U.S. Senator Alan K. Simpson suggested a transition to using a “chained CPI” in 2010, when they headed the White House’s deficit-reduction commission.[c] They stated that it was a more accurate measure of inflation than the current system and switching from the current system could save the government more than $290 billion over the decade following their report.[c] “The chained CPI is usually 0.25 to 0.30 percentage points lower each year, on average, than the standard CPI measurements.”[c]

However, the National Active and Retired Federal Employees Associations said that the chained CPI does not account for seniors citizens’ health care costs.[c] Robert Reich, former United States Secretary of Labor under President Clinton, noted that typical seniors spend between 20 and 40 percent of their income on health care, far more than most Americans. “Besides, Social Security isn’t in serious trouble. The Social Security trust fund is flush for at least two decades. If we want to ensure it’s there beyond that, there’s an easy fix – just lift the ceiling on income subject to Social Security taxes, which is now $113,700.”[d]

Replacing the current cost-of-living adjustment calculation with the chained CPI was considered, but not adopted, as part of a deficit-reduction proposal to avert the sequestration cuts, or fiscal cliff, in January 2013,[c] but President Obama included it in his April 2013 budget proposal.[e]

Go Lean … Caribbean introduces the CU to take oversight of much of the Caribbean economic, security and governing functionality, covering the realities of healthcare and inflation issues. In summary, this roadmap promotes the Caribbean as a better place to live, work and play for residents and retirees alike. In fact the Go Lean roadmap advocates inviting the aging Diaspora to return to the Caribbean for their “golden years”, this means proactively anticipating pension/medical needs of senior citizens.

Change has come to the Caribbean. The people, institutions and governance of the region are all urged to “lean-in” to this roadmap for change. We need to accurately measure inflation and the stressors that impact it. Rather than “hiding” the facts, as the Americans do, the CU will “manage what we measure”. There are effective tools available to mitigate the risks of inflation, and the integrity of social safety nets (like increasing retirement age or the income ceiling for pension taxes).

The benefits of this roadmap, emergence of an $800 Billion regional economy and 2.2 million new jobs, become imperiled if we ignore important economic indicators, and hide-away from effective solutions. Ignorance and avoidance are not traits of a solution-oriented ethos; they are not technocratic. On the other hand, the CU purports to be a true technocracy!

The following list details the strategies, tactics, implementations and advocacies to impact the CU technocracy:

Community Ethos – Lean Operations Page 24
Community Ethos – Impact the Greater Good Page 37
Strategy – Customers/Stakeholders – Diaspora Page 47
Strategy – Agents of Change – Aging Diaspora Page 57
Tactical – Fostering a Technocracy Page 64
Separation of Powers – Commerce Department Page 78
Separation of Powers – MediCare Administration Page 86
Advocacy – Ways to Measure Progress Page 133
Advocacy – Ways to Grow the Economy Page 151
Advocacy – Ways to Control Inflation Page 153
Advocacy – Ways to Improve Healthcare Page 156
Advocacy – Ways to Impact Entitlements Page 158
Advocacy – Ways to Improve Governance Page 168
Advocacy – Ways to Manage the Social Contract Page 170
Advocacy – Ways to Impact the Diaspora Page 217
Advocacy – Ways to Impact Retirement Page 221
Advocacy – Ways to Improve Elder-Care Page 225
Appendix – Controlling Inflation – Technical Details Page 318

The foregoing encyclopedic source conveys that much depends on accurate measurement of inflation indices. Inflation is what it is!  Measurement and management of inflation (and its effects) is an art and a science for the CU to master. The Go Lean roadmap “leaves no stone un-turned” for the optimization of the economic elevation of the Caribbean.

Inflation does matter! A prudent, lean, economic stewardship matters more!

Download the Book- Go lean…Caribbean Now!!!

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Turks and Caicos Premier’s disclosures raises conflict questions

Posted on May 2, 2014 in Ethos, Government, Strategy, Tactical

Go Lean Commentary

Money IssuesThese are the lyrics of a previously popular Bahamian folk song:

Show & Tell what your family got
Show & Tell what your family got, from the top of your head to the tip of your toe.
Mr. MP, Mr. Senator…
Oh, Mr. MP, let me see your money. Show the world you ain’t no crook. Let me see your bank book.
My people, oh my people. You know I “is” your MP. But “yinna” does hardly see me, how you expect to see my money.
— Chorus –
Different strokes for different folks
Different egg got different yokes
Different man take different stand
Dog like road and cat like sand
Show & Tell – Eddie Minnis
(MP = Member of Parliament)

This above song tells the story of the introduction of a Financial Disclosure law in the Bahamas in the 1970’s. The concept of open financial disclosures, as is related in the song and below news article, encountered resistance and apprehension. The above song duly captured the public fears and scrutiny of the process.

The advantage of public disclosures is that it mitigates corruption and bribery temptation in the government contract bidding process. The disadvantage is that capable, competent technocrats may shy away from public service because their business – personal and family finances – is “put out there in the streets”.

Personal financial disclosure requirements are standard among the First World, but scorned in the Third World. It is what it is! See the story here:

By: Caribbean News Now contributor
PROVIDENCIALES, Turks and Caicos Islands — The recent publication of an extract from Turks and Caicos Islands (TCI) Premier Rufus Ewing’s statement of registrable interests has raised conflict of interest questions regarding a controversial healthcare contract with Interhealth Canada.

Under the heading “Income Sources”, line item number two in Ewing’s statement lists “Salaries, benefits and allowances – Interhealth Canada TCI Ltd”.

Under section 25 of the Integrity Commission Ordinance 2008, all persons in public life (including members of the House of Assembly) are required to file with the Integrity Commission declarations of their incomes, assets and liabilities and those of their spouses and dependent children once every two years. This is otherwise referred to as “Section 25 Declaration”, and it is strictly confidential and may not be divulged to any person. Any breach of this confidentiality by any member of the commission or a third party and attracts stiff criminal sanctions under the ordinance.

However, the published excerpt of the Register has nothing to do with the section 25 Declaration of Financial Affairs but relates to an additional requirement under the constitution and the ordinance for members of the House of Assembly to file with the commission, once every year, statements of registrable interests of themselves and those of their spouses and dependent children.

According to Eugene Otuonye QC, director of the Integrity Commission, the published extract of Ewing’s statement of registrable interests appears genuine. He also pointed out that the register of such interests is available in the public domain and is not therefore confidential.

Otuonye went on to say that it is common and public knowledge that Dr. Dawn Perry, a gynecologist and the spouse of Premier Ewing, is legitimately employed in her own right at the Cheshire Hall Medical Centre (Interhealth Canada). She receives salaries, allowances and benefits for being so employed and these are part of the interests that the Ewing has disclosed to the public as part of his registrable interests.

However, as one observer commented, the mere fact that Ewing’s household is receiving a financial benefit from Interhealth Canada is bound to raise presumptions of a conflict of interest and may therefore explain, amongst other things, an apparent ongoing reluctance on the part of Ewing and his government to conduct or release the findings of either a financial and/or clinical audit of the operations of Interhealth Canada.

In addressing this issue, Otuonye said that any conflict of interest (perceived or actual) this scenario may present is a matter for the premier to manage within and guided by the existing legal framework, including the standing orders of the House of the Assembly and the code of conduct for persons in public life.

“As guardian of the code of conduct, the commission is interested not only in how a conflict of interest is managed but in providing such assistance as would enable the relevant conflict of interest to be effectively managed. The commission is committed to this responsibility,” he said.

It is not clear at this time how Ewing is managing this conflict of interest, whether real or perceived, except to try to distance himself from the health portfolio, which may be ineffectual given that he is ultimately the head of the elected government.

The financial cost of the $120 million debt for building two small hospitals at a cost of $4 million dollars per bed and outsourcing secondary healthcare to Interhealth Canada that together will cost the TCI around $1 billion over the course of 20 years has been the subject of ongoing controversy and concern since the contract was signed in 2009.

In response to Ewing’s earlier attempts in 2012 to distance himself from what was described by former chief financial officer Hugh McGarel Groves as a “financial disaster”, former TCI government CEO Patrick Boyle pointed out that Ewing had a “central role in developing the policy that led to the creation of the NHIP [National Health Insurance Plan]”.

A sworn statement by former health minister Karen Delancy also confirmed that Ewing made relevant decisions without consulting her and agreed the hospital construction contract without the benefit of competitive bids.

According to earlier reports, a number of civil servants (believed to be five) received payments of as much as $20,000 each — described as an “honorarium” — for doing a “good job” in negotiating and concluding the health care contract with Interhealth Canada. As then director of medical services, Ewing was said to be one of the five civil servants that received such payments.

The opposition Peoples Democratic Movement (PDM) has called for a review of the Interhealth Canada contract and the release of the relevant audits.

What has magnified the problem is that the Ewing-led government continues to raise taxes and fees while ignoring numerous calls for renegotiating the Interhealth Canada contract at a lower cost and refinancing the hospital mortgage, which is reported to have an exceptionally high rate of interest of 12%. The potential savings from such renegotiated healthcare costs could eliminate and/or reduce the need for the increase in taxation.
Source: http://www.caribbeannewsnow.com/topstory-Turks-and-Caicos-premier%27s-statement-of-interests-raises-conflict-questions-20931.html

Turks and Caicos Premier'sThe book Go Lean … Caribbean focuses on economic issues, governance and optimizing the civil service administration for the Caribbean region and for the 30 member-states. This book is a roadmap for the introduction and implementation of the Caribbean Union Trade Federation (CU), proffered as a super-national administration, a federal government for these states. There are 3 prime directives of the CU:

  1. Optimize the economic engines so as to grow the regional economy to $800 Billion and create 2.2 million new jobs.
  2. Establish a security apparatus (including persecution of economic and public integrity crimes) so as to mitigate the eventual emergence of “bad actors”.
  3. Improve Caribbean governance.

The tactical plan for this roadmap is a separation-of-powers for this federal government versus the governmental administrations of the member-states. Based on issues and cases similar to the foregoing news story, there is the need for accountability of public integrity.

(We are not levelling any accusation of towards Mr. Rufus Ewing, the Premier of the Turks & Caicos Islands. This commentary is simply in response, and as an analysis of the foregoing news article. There is due-process and an assumption of innocence).

There is also a CU mission to marshal against encroachments of Failed-State indicators. Any allegation of corruption or appearance of conflicts-of-interest by a Head of Government may undermine faith in that jurisdiction’s government. This might dissuade Foreign Direct Investors or efforts to repatriate the Diaspora or invite empowering immigrants. There must be a continuous sentinel; this role is assumed by applicable CU agencies.

This function is paramount in the vision of the Caribbean Union Trade Federation. The specific public integrity requirement is pronounced early in the Go Lean roadmap, in the opening Declaration of Interdependence (Page 12) with these statements:

xi. Whereas all men are entitled to the benefits of good governance in a free society, “new guards” must be enacted to dissuade the emergence of incompetence, corruption, nepotism and cronyism at the peril of the people’s best interest. The Federation must guarantee the executions of a social contract between government and the governed.

xii. Whereas the legacy in recent times in individual states may be that of ineffectual governance with no redress to higher authority, the accedence of this Federation will ensure accountability and escalation of the human and civil rights of the people for good governance, justice assurances, due process and the rule of law. As such, any threats of a “failed state” status for any member state must enact emergency measures on behalf of the Federation to protect the human, civil and property rights of the citizens, residents, allies, trading partners, and visitors of the affected member state and the Federation as a whole.

The people may cry: “How dare you, Caribbean Union, get into our business here in the TCI? This is not your concern”.

This argument is true, based on the status quo, but change has come to the Caribbean. The CU treaty compels a Security Pact for all the member-states, enacted even with the legacy sovereign countries of the United Kingdom, United States of America, Kingdom of the Netherlands and the Republic of France – the CU serves as their proxy. But this CU administration is executed by the Caribbean, for the Caribbean. The pronouncement continues:

xvi. Whereas security of our homeland is inextricably linked to prosperity of the homeland, the economic and security interest of the region needs to be aligned under the same governance. Since economic crimes … can imperil the functioning of the wheels of commerce for all the citizenry, the accedence of this Federation must equip the security apparatus with the tools and techniques for predictive and proactive interdictions.

The goal of the CU is to elevate Caribbean life, culture, economy, security and governing engine. Federal authorities would therefore have jurisdiction under a Good Governance mandate to review this case in consideration of the allegations. This is new for the region.  This new community ethos in this case is lean government.

The CU roadmap affects economics, security and governance. Based on the blatant needs depicted in the forgoing news article, the CU solutions will impact change in the region. These solutions are detailed in this book Go Lean … Caribbean as new community ethos, strategies, tactics, implementations and advocates; as follows:

Community Ethos – Privacy versus Public Protection Page 23
Community Ethos – Whistleblower Protection Page 23
Community Ethos – Witness Security & Protection Page 23
Community Ethos – Light Up the Dark Places Page 23
Community Ethos – Lean Operations Page 24
Community Ethos – Ways to Improve Negotiations Page 32
Community Ethos – Ways to Impact the Greater Good Page 37
Strategy – Repatriating Caribbean Diaspora Page 47
Strategy – Inviting Foreign Direct Investments Page 48
Strategy – Promoting Good/Clean Government Image Page 48
Tactical – Fostering a Technocracy Page 64
Tactical – Separation of Powers – Justice / District Attorneys Page 90
Implementation – Assemble – UK Territories Oversight Page 96
Implementation – Security Initiatives at Start-up Page 103
Implementation – Reasons to Repatriate Page 118
Implementation – Ways to Promote Independence Page 120
Planning – Ways to Improve Failed-State Indices Page 134
Advocacy – Ways to Improve Healthcare Page 156
Advocacy – Ways to Improve Governance Page 168
Advocacy – Ways to Better Manage the Social Contract Page 170
Advocacy – Ways to Improve Leadership Page 171
Advocacy – 10 Ways to Impact Justice Page 177
Advocacy – Ways to Improve Communications Page 186
Advocacy – Ways to Impact British Territories Page 245

The Go Lean roadmap will make the Caribbean a better place to live work, and play. The role of government is not divorced from this process, rather the member-states governing administrations are primary stakeholders, customers of the CU.

Change has come to the Caribbean. This is illustrated as a moving freight train. It cannot – must not – be stopped. Everyone must be “on board”. 🙂

Download the book Go Lean … Caribbean – now!

 

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Advocates push for junk-food tax

Posted on April 22, 2014 in Economics, Ethos, Government

Go Lean Commentary

Junk FoodThe forgoing article focuses on an important issue for the Caribbean. Diabetes is a scourge to the region; it is among the leading causes of death. Though death is the final destination of all humans, quality of life is a fitting goal for optimization. Diabetes is a degenerative disease; it grievously affects the quality of life; over time, its sufferers are afflicted with ailments like kidney failures, amputations and blindness. In addition to the personal discomforts, these treatments exact a huge toll on a community’s economics. For this matter, this subject is in scope for the Caribbean Union Trade Federation (CU).

The book, Go Lean … Caribbean, serves as a roadmap for the introduction and implementation of the CU. This technocratic agency will assume oversight to optimize the region’s:

(1) economy,

(2) security apparatus, and

(3) governing engines.

The subject of diabetes disease management is in scope for all 3 of these prime directives. The importance and linkage of the topics for diabetes, healthcare and economics are undeniable. But there are security threats as well, as advanced diabetes dispositions increase the need for organ transplantations, inducing many to venture into the illegal organ trade markets. Finally, the strain on governments to service this population and develop mitigation plans is a constant priority – or should be.

By: FELICIA FONSECA

Flagstaff, Arizona — Facing a high prevalence of diabetes, many American Indian tribes are returning to their roots with community and home gardens, cooking classes that incorporate traditional foods, and running programs to encourage healthy lifestyles.

The latest effort on the Navajo Nation, the country’s largest reservation, is to use the tax system to push people to ditch junk food.

Navajo President Ben Shelly earlier this year vetoed measures to enact a 2 percent sales tax on tax on chips, cookies and sodas, and to eliminate the tax on fresh fruit and vegetables. This week, tribal lawmakers have a chance to resurrect the proposals, and supporters are optimistic they’ll be among the first in the country to succeed.

Elected officials across the U.S. have taken aim at sugary drinks with proposed bans, size limits, tax hikes and warning labels, though their efforts have not gained widespread traction. In Mexico, lawmakers approved a junk food tax and a tax on soft drinks last year as part of that government’s campaign to fight obesity.

Shelly said he supports the intent of the proposals on the Navajo Nation but questioned how the higher tax on snacks high in fat, sugar and salt would be enacted and regulated. Supporters of the tax say it is another tool in their fight for the health of the people.

“If we can encourage our people to make healthier choices and work on the prevention side, we increase the life span of our children, we improve their quality of life,” said professional golfer Notah Begay III, who is among supporters.

American Indians and Alaska Natives as a whole have the highest age-adjusted prevalence of diabetes among U.S. racial and ethnic groups, according to the American Diabetes Association. They are more than twice as likely as non-Hispanic whites to have the disease that was the fourth leading cause of death in the Navajo area from 2003 to 2005, according to the Indian Health Service.

Native children ages 10 to 19 are nine times as likely to be diagnosed with Type 2 diabetes, the IHS said.

The proposed Navajo Nation tax wouldn’t add significantly to the price of junk food, but buying food on the reservation presents obstacles that don’t exist in most of urban America. The reservation is a vast 27,000 square miles with few grocery stores and a population with an unemployment rate of around 50 percent. Thousands of people live without electricity and have no way of storing perishable food items for too long.

“They have a tendency to purchase what’s available, and it’s not always the best food,” said Leslie Wheelock, director of tribal relations for the U.S. Department of Agriculture.

Wheelock said the diabetes issue in tribal communities is one that has been overlooked in the past or not taken as seriously as it could be. It has roots in the federal government taking over American Indian lands and introducing food that tribal members weren’t used to, she said.

To help remedy that, the USDA runs a program that distributes nutritional food to 276 tribes. Grants from the agency have gone toward gardening lessons for children within the Seneca Nation of Indians in New York, culturally relevant exercise programs for the Spirit Lake Tribe in North Dakota and food demonstrations using fresh fruit and vegetables on the Zuni reservations in New Mexico.

The Dine Community Advocacy Alliance, which has been pushing for the Navajo Nation junk food tax, estimates it will result in at least $1 million a year in revenue that could go toward wellness centers, community parks, walking trails and picnic grounds in tribal communities in Utah, New Mexico and Arizona. It would expire at the end of 2018.

Tribal lawmakers will vote this week on overturning Shelly’s vetoes. Regardless of whether that legislation passes, “we have to keep stepping up to the plate,” alliance member Gloria Begay said.

No other sales tax on the Navajo Nation specifically targets the spending habits of consumers. Alcohol is sold in a few places on the reservation but isn’t taxed. Retailers and distributors pay a tobacco tax.

Opponents of the junk food tax argue it would burden customers and drive revenue off the reservation. Mike Gardner, executive director of the Arizona Beverage Association, said the lack of specifics in the legislation as to what exactly will be taxed could mean fruit juice and nutritional shakes would be lumped in the same category as sodas.

“I don’t think they mean that, but that’s what will happen,” Gardner said. “It’s a little loose, a little vague. It’s going to create problems for retailers and … it doesn’t solve the problem.”

a. By the numbers:

Total population of Navajo Nation: 250,000

Unemployment rate: 44%

Families living in poverty: 30.5%

People living with diabetes: 55,000

Source: Partners In Health (PIH), a 501(c)(3) nonprofit corporation headquartered in Boston, Massachusetts. (http://www.pih.org/country/navajo-nation/about)

Associated Press (AP) News Wire Service (Retrieved 04/22/2014) –
http://news.yahoo.com/advocates-push-junk-food-tax-navajo-nation-155642994.html

The roadmap commences with a Declaration of Interdependence. In Verse IX (Page 11) it pronounces:

Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.

The foregoing article highlights diabetes disease management in the controlled population of the Native American Reservation for the Navajo Nation in Arizona [a]. In fact, Go Lean posits that the Caribbean can benefit greatly from a consideration of the examples, samples and lessons from Native American tribes and their experiences. This is included in the book as “10 Lessons from Indian Reservations” (Page 141). As for this issue, Go Lean also recognizes that food choices and the preponderance of junk food could imperil community wellness; (Page 162). We must therefore take heed to these lessons.

The CU mission is to implement the complete eco-system to re-boot health delivery in the region. Applying strategies to win the battles of globalization, the Go Lean roadmap urges the Caribbean region to not only consume; we must create and contribute as well. In that vein, there are many tactics, implementations and advocacies to facilitate the vision for R&D, incubation, entrepreneurship and many other areas related to medical tourism. These are detailed here:

Community Ethos – Deferred Gratification Page 21
Community Ethos – Intelligence Gathering Page 23
Community Ethos – “Bad Things” Happen Page 23
Community Ethos – Lean Operations Page 24
Community Ethos – Return on Investments Page 24
Community Ethos – Non-Government Org’s. Page 25
Help Entrepreneurship Page 28
Impact Research and Development Page 30
Promote Happiness Page 36
Impact the Greater Good Page 37
Separation of Powers – Health Department Page 86
Steps to Implement Self-Governing Entities Page 105
Ways to Benefit from Globalization Page 119
Improve Healthcare Page 155
Impact Entitlements Page 158
Better Manage Food Consumption Page 162
Better Manage the Social Contract Page 170
Foster Cooperatives Page 176
Ways to Improve Organ Transplantations Page 214
Impact Foundations Page 219
Improve Elder-Care Page 225
Impact Persons with Disabilities Page 228

The roadmap addresses the obstacles for full implementation of the CU objectives. Like most communities, there are cost constraints, as the foregoing article reports on a special tax to fund junk food mitigations. How will the CU pay for its strategic and tactical initiatives?

The book addresses this issue in full detail in these advocacies:

Ways to Pay for Change Page 101
10 Revenue Sources for Administration Page 172

Change has come to the Caribbean. Both the people and institutions of the region are urged to “lean-in” for this change. As described in the book Go Lean … Caribbean, the benefits of this roadmap are too important; improving health deliveries is not just economic, more important, it’s about saving lives.

Download the Book- Go Lean…Caribbean Now!!!

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Cuban cancer medication registered in 28 countries

Posted on April 17, 2014 in Economics, Ethos, Government, Implementation, Strategy, Tactical

Go Lean Commentary

Medicine 2While the below news article is about great cancer and diabetes drugs developed in the Caribbean, this commentary has an underlying theme about “American Exceptionalism”.

American exceptionalism is the theory that the United States is qualitatively different from other nation states.[a] In this view, US exceptionalism stems from its emergence from a revolution, becoming what political scientist Seymour Martin Lipset called “the first new nation” and developing a uniquely American ideology, “Americanism”, based on liberty, egalitarianism, individualism, republicanism, populism and laissez-faire. This ideology itself is often referred to as “American exceptionalism.”[b]

Although the term does not necessarily imply superiority, many neoconservative and other American conservative writers have promoted its use in that sense. To them, the US is like the Biblical “City upon a Hill”[c][d]

This subject matter aligns with the publication Go Lean … Caribbean, which serves as a roadmap for the introduction and implementation of the Caribbean Union Trade Federation (CU). The Go Lean roadmap maintains that other peoples (nations) have dreams as well; the American Dream is not the only aspiration to hope for. This foregoing article presses the point about innovation in cancer and diabetes drugs – that emerged from Cuba.

Posted: March 29, 2014

HAVANA, Cuba – Nimotuzumab, a Cuban monoclonal antibody humanized to treat cancer, is registered in 28 countries, mainly in South America, Africa and Asia, in addition to Cuba.

Specialists at the Center of Molecular Immunology, an institution of the BioCubaFarma Business Group, said that the product has shown its effectiveness in various cases of malignant tumours.

Indicated for tumours in the head and neck in advanced stages, brain tumours and of the esophagus, Nimotuzumab is also used in other oncological ailments of the colon, rectum and liver, and in lung cancer among other locations.

The monoclonal antibody and its results will be the focus, on March 25-27, of the eighth global scientific meeting on Nimotuzumab – Nimomeeting 2014.

With Havana’s Convention Center as its venue, the forum will bring together over 200 experts from some 20 nations, as well as about 20 international biopharmaceutical companies interested in sharing experiences about the medication, the therapeutics of which are used in the medical specialties of oncology, oncopediatrics, radiotherapy, pediatrics and neurosurgery, among others.

Meanwhile, Cuba is trying to take its diabetic foot ulcer drug known as Heberprot-P into the European market.

Heberprot-P is a product based on human growth factor currently being administered in some 20 countries, mostly in Latin America.

According to the marketing director of the Havana-based Genetic Engineer and Biotechnology Center, Ernesto Lopez, the pre-clinical stage of the product, known in Europe as Epipropt, was carried out with good toxicological and safety results.

In Spain, with an estimate 40,000 patients needing the Cuban drug, tests were carried out with no negative toxic results. The product has been developed since 2012 for research studies in other European nations.

According to studies, amputation of lower limbs was reduced fourfold, with the surgical procedure in Europe currently costing over 50,000 Euros, and treatment of the condition some 20,000 Euros.

It is the amputation of lower limbs as a direct consequence of diabetic foot ulcer that the Cuban medication avoids with a period of treatment of only six to seven months.

Along with the therapeutic action on serious ulcers, the treatment has demonstrated a preventive nature in countries like Cuba, Venezuela, and Ecuador.

Source: Caribbean News Now Online Newspaper – Retrieved 04-13-2014 http://www.caribbeannewsnow.com/topstory-Cuban-cancer-medication-registered-in-28-countries-20429.html

While the Go Lean book strategizes a roadmap for economic empowerment, it clearly relates that healthcare, disease management, cancer treatments and medicines are germane to the Caribbean quest for health, wealth and happiness. At the outset of the Go Lean book, in the Declaration of Interdependence (Page 10 & 11 respectively), these points are pronounced:

Preamble: While our rights to exercise good governance and promote a more perfect society are the natural assumptions among the powers of the earth, no one other than ourselves can be held accountable for our failure to succeed if we do not try to promote the opportunities that a democratic society fosters.

ix. Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.

Cuba is not on friendly terms with the United States. A trade embargo was implemented in 1962 as a temporary measure to dissuade the island’s socialist leanings. Now, after 52 years, the embargo continues. Generations of Cubans and generations of Americans have come and gone without witnessing a normalized relationship between Cuba and its largest neighbor, the US. Millions too have died of the scourge of cancer, estimated by one source as afflicting 1-out-of-3 Americans [e]

(Personal note: the primary author of the book Go Lean … Caribbean was inspired to write this roadmap, after his sister died after a 32-year battle with cancer – See Dedication Page 2).

MedicineThe scourge of cancer and the realities of diabetes were not the motivation for composing the book Go Lean … Caribbean. But rather, the bigger goal of elevating Caribbean society. The Caribbean Union Trade Federation has the prime directive of optimizing the economic, security and governing engines of the region. The foregoing article depicts the benefits that can emerge as a result of innovation in science, technology, engineering and medicine (STEM). Cuba will be able to trade these advance medicines globally to the markets needing their therapeutic benefits. This is a win-win!

Under the Go Lean roadmap, more such developments will emerge … from all corners of the Caribbean. There are also obvious tangential benefits to the people of the Caribbean regarding public health administration and wellness.

The following list details the strategies, tactics, implementations and advocacies to optimize the region’s health deliveries:

Community Ethos – Cooperatives Page 25
Community Ethos – Non-Government Organizations Page 25
10 Ways to Impact Research and Development Page 30
10 Ways to Impact the Greater Good Page 37
Separation of Powers – Patent, Standards, & Copyrights Office Page 78
Separation of Powers – Health Department Page 86
Separation of Powers – Drug Administration Page 87
10 Ways to Implement Self-Government Entities Page 105
10 Trade Mission Objectives Page 116
10 Ways to Benefit from Globalization Page 119
10 Ways to Improve Healthcare Page 156
10 Ways to Impact Cancer Page 157
10 Ways to Impact Entitlements Page 158
10 Ways to Better Manage the Social Contract Page 170
10 Ways Foster Cooperatives Page 176
10 Ways to Improve Organ Transplants Page 214
10 Ways to Improve Elder-Care Page 225
10 Ways to Impact Persons with Disabilities Page 228
10 Ways to Re-boot Cuba Page 236

The foregoing article establishes that many patients around the world will benefit from medical innovations fostered in the Caribbean, in Cuba. The Go Lean roadmap posits that there are a lot of benefits the Caribbean can/will make to facilitate a better life for populations throughout the world. Executing these plans, following the roadmap, will be better for the Caribbean population too.

The United States of America should take heed.

Download the book Go Lean … Caribbean – now!

———

Appendix – References

a. Winfried Fluck; Donald E. Pease; John Carlos Rowe (2011). Re-Framing the Transnational Turn in American Studies. UPNE. p. 207. Retrived 4/16/2014 from: http://books.google.com/books?id=ccz81DWudCAC&pg=PA207

b. American Exceptionalism: A Double-Edged Sword. Seymour Martin Lipset. New York, N.Y.: W.W. Norton & Co., Inc. 1996. Page 18. ISBN 0-393-03725-8.

c. Harold Koh, “America’s Jekyll-and-Hyde Exceptionalism”, in Michael Ignatieff, ed., American Exceptionalism and Human Rights, p. 112

d. A “City upon a Hill” is a phrase from the Bible parable of Salt and Light in Jesus’s Sermon on the Mount. In Matthew 5:14, he tells his listeners, “You are the light of the world. A city that is set on a hill cannot be hidden.” It has become popular with American politicians.

e. Website http://www.preventcancer.com/losing/ – Retrieved Nov. 2013 / Wikipedia.org general subject treatment for the War on Cancer – Retrieved Nov. 2013.

 

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Low-cost Dominican surgeries spark warnings by US

Posted on April 1, 2014 in Economics, Ethos, Industries, Strategy, Tactical

Go Lean Commentary

CU Blog - Low-cost Dominican surgeries spark warnings by US - PhotoTo the family of Beverly Brignoni, according to the foregoing news article, the publishers of the book Go Lean … Caribbean, SFE Foundation, extend condolences for the loss of their dearly departed loved one. This article – as follows – shows the down-side of medical tourism, an accidental death from an apparent lax oversight in a cosmetic surgery clinic.

By: Ben Fox and Ezequiel Abiu Lopez
Beverly Brignoni was a young New Yorker seeking a less expensive way to enhance her appearance and she did what many other people are now doing: travel to the Dominican Republic for cosmetic surgery; (see undated “selfie” photo posted to her Instagram account, courtesy of the Brignoni family).

It went horribly wrong. The 28-year-old died Feb. 20 from what the doctor told her family was a massive pulmonary embolism while getting a tummy tuck and liposuction at a clinic in the Dominican capital recommended by friends. Family members want local authorities to investigate.

“We want to know exactly what happened,” said Bernadette Lamboy, Brignoni’s godmother. “We want to know if there was negligence.”

The district attorney’s office for Santo Domingo says it has not yet begun an investigation because it has not received a formal complaint from Brignoni’s relatives. Family members say they plan to make one.

Shortly after Brignoni’s death, the Health Ministry inspected the Vista del Jardin Medical Center where she was treated and ordered the operating room temporarily closed, citing the presence of bacteria and violations of bio-sanitary regulations. The doctor who performed the procedure and the clinic have not responded to requests for comment.

Brignoni’s death is unusual, but it is not isolated. Concerns about the booming cosmetic surgery business in the Dominican Republic are enough of an issue that the State Department has posted a warning on its page for travel to that country, noting that in several cases U.S. citizens have suffered serious complications or died.

The U.S. Centers for Disease Control issued an alert March 7 after health authorities in the United States reported that at least 19 women in five states had developed serious mycobacterial wound infections over the previous 12 months following cosmetic procedures in the Dominican Republic such as liposuction, tummy tucks and breast implants.

There were no reported deaths in those cases, but treatment for these types of infections, which have been caused in the past by contaminated medical equipment, tend to involve long courses of antibiotics and can require new surgery to remove infected tissue and drain fluid, said Dr. Douglas Esposito, a CDC medical officer.

“Some of these patients end up going through one or more surgeries and various travels through the medical system,” Esposito said. “They take a long time typically to get better.”

The Dominican Republic, like countries such as Mexico, Costa Rica and Thailand, has promoted itself as a destination for medical tourism, so-called because people will often tack on a few days at a resort after undergoing surgery. The main allure is much lower costs along with the promise that conditions will be on par with what a patient

would encounter at home.

In 2013, there were more than 1,000 cosmetic procedures performed in the Dominican Republic, 60 percent of them on foreigners, according to the country’s Plastic Surgery Society.

The Internet is flooded with advertisements and testimonials from people who say they have had successful procedures in the Dominican Republic, and an industry of “recovery houses” has sprung up to serve clients, along with promoters who canvass for clients in the United States. The price is often about a third of the cost in the United States.

Dr. Braun Graham, a plastic surgeon in Sarasota, Florida, says he done corrective surgery on people for what he says were inferior procedures abroad. He warns that even if a foreign doctor is talented, nurses and support staff may lack adequate training.

“Clearly, the cost savings is certainly not worth the increased risk of a fatal complication,” said Graham, past president for Florida Society of Plastic Surgeons.

Brignoni was referred to the Vista del Jardin Medical Center by several acquaintances in the New York borough of the Bronx where she lived, said Lamboy and Lenny Ulloa, the father of the 4-year-old daughter she left behind.

“Supposedly, it was a high-end clinic, one of the best in the city,” Ulloa said.

The doctor who performed Brignoni’s procedure, Guillermo Lorenzo, is certified by the Plastic Surgery Society, but there

are at least 300 surgeons performing cosmetic procedures who are not, said Dr. Severo Mercedes, the organization’s director. He said the government knows about the problem but has not taken any action. “We complain but we can’t go after anyone because we’re not law enforcement,” Mercedes said.

The number of people pursuing treatment in the Dominican Republic doesn’t seem to have been affected by negative reports, including a previous CDC warning about a cluster of 12 infections in 2003-04.

In one recent case, the Dominican government in February closed a widely advertised clinic known as “Efecto Brush,” for operating without a license. Prosecutors opened a criminal case after at least six women accused the clinic of fraud and negligence. The director, Franklin Polanco, is free while awaiting trial. He denies wrongdoing.

There was also the case of Dr. Hector Cabral. New York prosecutors accused him of conducting examinations of women in health spas and beauty parlors in that state in 2006-09 without a license, then operating on them in the Dominican Republic, leaving some disfigured. Cabral pleaded guilty to one count of unauthorized practice of medicine in October 2011 and returned to the Dominican Republic, where he still practices.

In 2009, Dominican authorities charged Dr. Johan Tapia Bueno with illegally practicing plastic surgery at his apartment after several women, including a local television personality, accused him of malpractice that left them with infections. Awaiting trial, he has pleaded innocent to charges that include fraud.

Juan Linares, a lawyer hired by Brignoni’s boyfriend, said he is still awaiting an autopsy report.

Because she arrived in the country late at night on a delayed flight and was on the operating table early the next morning, a main concern is whether she received an adequate medical evaluation before the procedure. Graham, the Florida surgeon, said sitting on a plane for several hours can cause blood to stagnate in the legs and increase the risk of an embolism.

Brignoni paid the Dominican clinic $6,300 for a combination of liposuction, tummy tuck and breast surgery. Lamboy said she had decided not to have the work done on her breasts and was expecting a partial refund. The woman, who worked as a property manager, had lost about 80 pounds about a year earlier after gastric bypass surgery.

Brignoni was clearly excited about the procedure. Her final post on Facebook was a photo she took of her hands holding her passport and boarding pass for the flight from New York to Santo Domingo.

“She wanted it so bad,” her godmother said. “It felt like she was going to have a better outlook on life, getting this done.”

Associated Press writer Ben Fox reported this story from Miami and Ezequiel Abiu Lopez reported in Santo Domingo.

Source: Associated Press (AP); retrieved 03/31/2014 from: http://news.yahoo.com/low-cost-dominican-surgeries-spark-warnings-us-042418398.html

This is a very important issue for the planning and execution of the new inter-governmental agency: Caribbean Union Trade Federation (CU). First of all, someone died – life is too precious to skim over this issue with indifference. The Go Lean book serves as a roadmap to introduce and implement the CU, so as to re-boot the region’s economic engines, including avenues of medical tourism.

There are also peripheral issues associated with this news story, many of which are examined, as missions, in great details in the Go Lean book. The issues/missions are:

  • Image: Confidence in the competence of service providers is sometimes based on reputation and branding. This is para-mount in medical fields. While the Caribbean is home to many excellent medical schools, facilities and practitioners, there is no regional “sentinel” role-player. The CU mandate is to zealously protect and promote the image and branding for industrial developments. So now when the media portrays “negative” depiction of Caribbean life, culture and people, there is no formal response mechanism. But with the CU’s implementation, there will be an entity to effectuate an anti-defamation response and better manage the region’s image.
  • Health Administration: The Go Lean roadmap recognizes healthcare as a basic need for the people of the Caribbean. As such, there is the acknowledgement that health delivery systems generate excessive costs and risks for a community. As a planning tool, the roadmap commences with a Declaration of Interdependence, pronouncing regional integration (Page 11) as the strategy for optimized benefits:
      IX.   Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.
  • Self-Government Entities: The foregoing news story involves a clinic regulated by a Caribbean member-state, the Dominican Republic. The Go Lean roadmap institutes an arrangement for medical/research campuses as SGE’s (Self-Governing Entities) that are only regulated by the CU federal authorities. Had this tragedy occurred on such a facility, the response would have been immediate and comprehensive, employing best-practices of trauma medicine arts and sciences, thusly requiring a post-mortem lessons-learned process that would be fully transparent and accountable.
  • Lean Government: The Go Lean roadmap also extends optimizations to the member-states governments, requiring a separation-of-powers dictum to transfer oversight and administration of certain state functions to federal authorities. This includes standards, licensing and administration of healthcare facilities. The application of best-practices would most assuredly minimize the risk of medical negligence.
  • US Exceptionalism: The Go Lean roadmap maintains that other countries have their own version of the American Dream. The quest for life, liberty and the pursuit of happiness is not exclusively American. Whereas there are millions of negligent deaths in the US hospitals/clinics every year, one American dying in a Caribbean facility does not constitute an exceptional event; bad things do happen to good people … everywhere, in the US, in the Caribbean and in the Dominican Republic. Having a tourism-based regional economy means we always want to extend hospitality to our American guests, but embarking on medical tourism, also means assuming some degree of risks, for the facilities, the doctors and most importantly the patients.

The foregoing article crystalizes the need for the CU Trade Federation, a super-national administration to regulate, protect, promote and foster quality delivery of the most vital public services. The publishers of the Go Lean roadmap will hereby “sit back”, observe-and-report on the manifestations of this case, hoping for the quest for justice and accountability to be fulfilled. And remembering the unconscionable loss of the beautiful 28-year-old woman, Beverly Brignoni; RIP.

Download the book Go Lean … Caribbean – now!

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PR’s Comprehensive Cancer Center Project Breaks Ground

Posted on March 24, 2014 in Economics, Ethos, Industries, Strategy

Go Lean Commentary

imgresThe forgoing article touches on a critical mission and motivation of the Caribbean Union Trade Federation (CU): to impact the battle against cancer. The roadmap for the implementation of the CU, Go Lean … Caribbean highlights that 1 in every 3 Americans are at risk of cancer, so surely the Caribbean rate of affliction cannot be far behind. Therefore the Caribbean region must prepare. Cancer treatments are expensive! Some treatments can cost $20,000 – $30,000 each month for 4 – 6 month stretches. Our population, like many other societies, continues to age, get sick and battle cancer, so we cannot be ill-prepared. Lives are at stake!

The CU mission is to prepare in advance for cancer: to install the mechanisms to garner as much cost-savings as possible while delivering the highest quality of care and health-related services for our people. And while we are making efforts to save lives of Caribbean citizens, Diaspora and visitors, we also want to exploit any economic opportunities.

By: The Caribbean Journal staff

A major new hospital project has broken ground in Puerto Rico, Governor Alejandro Garcia Padilla announced.

The new Comprehensive Cancer Center Hospital project is being built with an investment of $196 million. The 12-floor facility will include eight operating rooms and 72 beds.

Construction on the project, which is located in Rio Piedras, is projected to last around 30 months, with a completion date set for April 2016.

The government said the project could create more than 1,300 direct and indirect jobs during construction and 750 once the hospital is up and running.

“These types of centers are characterized by scientific excellence and the capacity to integrate a diversity of research approaches to investigating the problem,” Garcia Padilla said in a statement. “They have a key role in advancing the cause of reducing deaths from cancer.”

The Governor said the hospital is aiming to be a “primary source for discoveries about the nature of cancer and the development of new approaches to prevention, diagnosis and therapy.”

Construction of the hospital had initially been slated to begin in 2010.

“The ultimate recovery of Puerto Rico depends on economic development and the jobs we create,” the Governor said.

Source: http://www.caribjournal.com/2014/02/19/puerto-rico-comprehensive-cancer-center-project-breaks-ground/

The Go Lean roadmap takes a strategic approach. There is the need for cancer and medical research, so the CU promotes and invites the establishment of medical research parks, laboratories and campuses as Self-Governing Entities (SGE). These bordered facilitates, similar to the PR project depicted above in the artist rendition, would only submit to CU jurisdiction and authorities – no FDA regulations! This freedom allows for more latitude and creativity in the pursuit of cancer cures and treatments.

Without a doubt, this strategy of SGE’s fulfills many CU objectives. In addition to the life-saving potential of local cancer research, the CU seeks to improve the environment for academic and occupational endeavors for STEM (Science, Technology, Engineering & Medical) professionals. The region would now offer an alternative to the debilitating brain drain. In fact, the opposite would occur: the region invites empowering immigrants to help facilitate this vision. The Go Lean … Caribbean roadmap describes that the Diaspora and their legacies (foreign-born children), would see a Welcome Mat to “come in from the cold” – welcome home – to a better place to live, work, learn, heal and play.

Download the Book- Go Lean…Caribbean Now!!!

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Tim Armstrong, the CEO of AOL – Health-care Concerns

Posted on March 24, 2014 in Economics, Industries, Planning

Go Lean Commentary

Medical Management Services_AOL InsuranceIn the forgoing article, Tim Armstrong, the comments of the CEO of America Online (AOL) resulted in outcry around the country! There were allegations of scapegoats, privacy violations and various sins in making this announcement. What gives this CEO the right to highlight these families’ struggles? Well, can you say two million dollars? This man is not a Director of a Hospital refusing care. No, he is the CEO of the company paying the bills. Two million dollars taken out of the budget and the CEO cannot comment on it? Why are his actions being chastised?

By: Michael F. Cannon, Contributor

Unless you’ve been living under a rock, you’ve heard about AOL CEO Tim Armstrong’s strikingly insensitive comments about why the company is cutting its retirement benefits:

“As a C.E.O. and as a management team, we had to decide, do we pass the $7.1 million of Obamacare costs to our employees? Or do we try to eat as much of that as possible and cut other benefits?…”

“Two things that happened in 2012”, he continued, “we had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan”.

Perhaps Armstrong felt commendations were in order. After all, the company’s health plan did pay a ton of money to keep those kids alive. Not as much as his annual salary, but still. And though you could be forgiven for missing it, he was actually announcing he had decided not to drop AOL’s “distressed babies” benefit.

But it’s hard to muster an “Attaboy!” when Armstrong is effectively blaming extremely premature infants, who are clinging desperately to life, for the cuts he chose to make in his employees’ retirement benefits. We’re still paying to keep these precious little angels alive, he assured his employees. But if any of you are mad about your pay cut, you know who to blame.

One of those babies has a mommy who wasn’t about to take that lying down.

In October 2012, only five months pregnant, Deanna Fei went into labor. Her daughter arrived via caesarian section weighing only 1 pound, 9 ounces, and spent the next three months in a neo-natal intensive care unit. Fei, a novelist, wrote at Slate about the anguish she and her family endured.

She also had choice words for her husband’s boss.

“Let’s set aside the fact that Armstrong—who took home $12 million in pay in 2012—felt the need to announce a cut in employee benefits on the very day that he touted the best quarterly earnings in years,” she wrote. It was “a cruel violation” to make her child “a scapegoat for cutting benefits.”

There was “the whiff of judgment in Armstrong’s statement, as if we selfishly gobbled up an obscenely large slice of the collective health care pie” when in fact “we experienced exactly the kind of unforeseeable, unpreventable medical crisis that any health plan is supposed to cover. Isn’t that the whole point of health insurance?”

“While he’s at it, why not call out the women who got cancer? The parents of kids with asthma?”

I’m totally with Fei. I still remember the panic I felt when our first child (41 weeks) took about one minute to start breathing on his own and our second (37.5 weeks) was born a little too pale. I cannot imagine visiting my child every day in a NICU for three months, much less the added trauma that mommies suffer in those cases. And I would be just as outraged by the indignity of having my spouse’s employer use our experience as a scapegoat, or claim that we are indirectly responsible for someone else’s pay cut.

Fei and her family owe no one an apology. Full stop. They paid their premiums. They used their coverage for its intended purpose. Their situation is exactly why health insurance exists.

It is also possible to sympathize with Armstrong. He has a duty to AOL shareholders to keep the company profitable. Part of that responsibility is to decide how much to pay AOL employees – and how to divide that sum among salary, health benefits, retirement benefits, and other forms of compensation. Someone’s going to be angry at him no matter what he decides. And in this case, he decided not to let those cuts fall on health benefits. Assuming he’s doing right by AOL’s shareholders, who probably include many AOL employees, he owes no one an apology for his $12 million salary. To be sure, he owes Fei and her family an apology – which he has issued and she has accepted.

How did we get to this point, where Fei’s husband’s boss knows how much it cost to save their baby’s life and can telegraph that figure to his coworkers and the world? Where an offhand comment by your employer can add to your grief by exposing your family’s medical history to your coworkers, and possibly make you a target of resentment?

The answer is that even before ObamaCare, America has had a health care sector dominated by government involvement. Yes, this capitalist’s insensitive comments are an example of government failure.

Ninety percent of Americans with private health insurance get that coverage through an employer. This state of affairs wasn’t brought to you by the free market. In a market where we all get to make our own choices, what responsible parent in their right mind would voluntarily choose for their family a type of health insurance that disappears when you get sick and cannot work anymore? Or when the factory closes? A type of health insurance where, if you have a high-cost condition, you are more likely to end up uninsured than if you bought coverage directly from an insurance carrier?

The reason more than 100 million Americans make the otherwise irrational decision to enroll in an employer-sponsored plan is that around 70 years ago, the federal government created an enormous tax preference for those plans that is not available if you buy more secure coverage directly from an insurer on the “individual” market. The upshot of that tax preference is that if consumers purchase health insurance themselves, they can spend up to twice as much for the same coverage. Economists have chronicled how the tax exclusion for employer-sponsored health insurance increases health care spending and thus the cost of health insurance, as well as how it reduces consumers’ health insurance choices. Yet the federal government makes it economically rational for 90 percent of consumers to purchase an inferior product that creates so many harmful effects.

Another harmful effect of this government policy is that the Tim Armstrongs of the world have far too much (read: any) influence over your family’s health insurance and medical decisions. (What if Armstrong had chosen to pare back AOL’s distressed-baby benefit?) They also end up knowing far too much (read: anything) about your family’s most emotionally difficult moments.

I won’t pretend private health insurance companies aren’t also obligated to serve shareholders or always have their customers’ best interests at heart. But how often do you hear the CEOs of insurance companies publicly say the sort of boneheaded thing Armstrong did? Not very. Even though they have to make comparable tradeoffs between covered benefits, affordable premiums, and profits, they don’t do what Armstrong did. They’re in the business, so they know better. When insurance companies say boneheaded things about their high-cost customers, they tend to do so quietly. You know, in internal memoranda. If I’m overlooking instances of insurance company executives doing what Armstrong did, please let me know in the comments.

Even if the CEO of, say, Aetna mentions they had a couple of million dollar babies last year, it wouldn’t expose those families the way it does when CEOs say it about their company-sponsored health plans. If everyone were making their own coverage choices, your coworkers would have no idea where you buy your health insurance unless you wanted them to know. And that’s as it should be. You would also have the option of leaving Aetna for another carrier that wasn’t so boneheaded, or if only because you don’t like the tradeoffs they are making between benefits, premiums, and profitability. Switching health plans is much harder when it might require switching jobs.

The federal government has let this boneheaded tax preference for employer-sponsored health insurance sit undisturbed for seven decades, even as it led to privacy violations and fueled the problem of pre-existing conditions. That should make us even more wary of the government’s latest brilliant health care idea.

How long will it take Congress to fix the more boneheaded elements of ObamaCare? Seventy years? More?

Source: http://www.forbes.com/sites/michaelcannon/2014/02/10/aol-chief-tim-armstrongs-insensitivity-argues-against-obamacare-not-for-it/

As the chief executive of the company, it was his job to pursue what he thought was in the best interest of the company. Would it have been preferred that instead, he simply laid-off some employees?

Many people were upset over his choice of the word “distressed babies”. Was he wrong? These babies were born early (pre-mature), with a $2 million price tag. And those bills were paid.

Had this been Joe-the-Plumber complaining that he lost his job because two distressed babies cost the company two million dollars, he would have gotten national sympathy and the news would have been about the failure of health care or Obama Care more exactly. Instead, this discussion is about the CEO of America Online. This is a BIG company, BIG business, BIG money – and so, this is a BIG deal.

From the perspective of the roadmap for this implementation of the Caribbean Union Trade Federation, this issue of Tim Armstrong-AOL-Health-Plan is also a BIG opportunity.

Something is wrong in this whole scenario!

It is “off-whack & off-kilter” that it costs families and communities so much for healthcare. There is no way we can afford this kind of price dynamics in the Caribbean. Nor do we want to leave our pregnant mothers and premature babies completely abandoned. No one wants to have a society like that. If so, there will be no opportunity to invite the Diaspora back home, nor dissuade families from abandoning their Caribbean homeland for foreign shores – the “push-and-pull” factors would be too great.

So where emotions may trump economics, economics are not eliminated just because we have emotional leanings. The article portrays the economic truths: “the tradeoffs … between benefits, premiums, and profitability.”

The Go Lean…Caribbean roadmap posits that the member-states need a larger pool for health insurance benefits, premiums, and profitability. The market size of 42 million is a viable solution. Plus new financial products like re-insurance sidecars in an energized securities/capital market, thanks to the Caribbean Dollar and a technocratic Caribbean Central Bank.

The roadmap also calls for strategic and tactical solutions for big money treatments, like cancer, by facilitating medical research campuses and medical tourism under the guise of Self-Governing Entities.

Lastly, the Go Lean roadmap promotes the practice of predictive wellness programs and disease management schemes, tackling head-on the root causes of so many medical distress and costs enablers.

Download the book, Go Lean … Caribbean and add your commentary.

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