6 ms·

How the world’s health organizations failed to stop the Ebola disaster

47 points by rpm4321 12y ago

alinenache 12y ago
http://waltherpragerandphilosophy1.blogspot.ro/2014/07/fearful-communities.html http://waltherpragerandphilosophy1.blogspot.ro/2014/07/fearf...
powera 12y ago
Sometimes I worry that the epidemics (or potential epidemics, rather) will continue until eventually our incompetence in large-scale organization overtakes all of the 20th century innovations in medicine.
001sky 12y ago
There was a good point made in a nother piece that ebola is highly infectious, but not so much readily contagious. Its worth considering the subtle distintion to appreciate how difficult it is to deal with. It spreads somewhat rapidly nonetheless because of the problems that trace amounts of contaminats cause. Not because the cantaminants themselves are necessarily widespred or pervasive in the environment. http://www.washingtonpost.com/news/to-your-health/wp/2014/10/03/can-you-catch-ebola-from-an-infected-blanket/ http://www.washingtonpost.com/news/to-your-health/wp/2014/10...
a8da6b0c91d 12y ago
http://atoday.org/adventist-mission-doctor-speaks-ebola-crisis-foreign-aid.html http://atoday.org/adventist-mission-doctor-speaks-ebola-cris... This doc claims the "health organizations" and aid helped cause of the epidemic. Weird diseases happen so often in that part of the world the west africans know how to deal with it. They quarantine an outbreak village and have the surrounding villages drop off food until the infections burn out. But recently everybody got so excited for the foreign goodies that materialize when you say "ebola," traditional quarantine procedure went out the window.
- HarryHirsch 12y ago
  You read other stuff from that website, like this http://atoday.org/god-create-evolution.html http://atoday.org/god-create-evolution.html or that http://atoday.org/wilson-ii-president-adventist-general-conference-believe-earth-billions-years-old.html http://atoday.org/wilson-ii-president-adventist-general-conf..., and suddenly you are unsure if you are dealing with trolls or kooks.
  - ams6110 12y ago
    Maybe, but it's hard to argue logically against the notion that strict quarantine would be effective, if brutal way of containing the outbreak. Building large central makeshift treatment centers only encourages sick people to travel and infect new populations.
    - HarryHirsch 12y ago
      strict quarantine would be effective, if brutal way of containing the outbreak With a lengthy incubation time, and in an area that's just emerging from several decades of civil war quarantine isn't going to happen. The best hope is that there will soon be a vaccine, preferably before the plague reaches Calcutta, Karachi, Jakarta or Johannesburg. It's not unrealistic, the virus mutates only slowly, and India did get on top of smallpox; there is historical precedent for this approach to work. Quarantine has never been successful during wartime. The Attic plague happened in the middle of a war.
    - jonah 12y ago
      But was that indeed the case that the local healthcare systems were implementing and successfully enforcing quarantines in previous situations? Also, It's not the western cultural mindset to let it "burn out" when they could go in and "save" each person...
  - blakeja 12y ago
    So people with a different set of beliefs from your own are "trolls and kooks". Man I get tired of seeing this kind intolerance, lack of respect, call it what you will. Regardless of your feelings about the rest of the site, I do not think the doctor's points are in any way invalidated if you actually read what he has to say, as some others here have already pointed out.
yeison 12y ago
According to this article, it seems like a lot of health care workers are catching the disease. Even the westerners who are familiar with the transmission mechanism of the disease. Therefore, isn't possible that we are underestimating how easily the disease can spread?
- ams6110 12y ago
  It is possible but also keep in mind that they are for the most part working in horribly primitive, unsanitary conditions, lacking supplies and basic utilities.
  - danieltillett 12y ago
    That is the description of the whole health infrastructure of west Africa before this outbreak.
- adevine 12y ago
  I read another article that explained how Ebola is very infectious (meaning that very few virions are needed to establish an infection), but not particularly transmissible (i.e. it's not airborne, and thus much less contagious than something like the flu or measles). While westerners are becoming infected, I don't think it's that hard to see how the extremely poor health care facilities in West Africa would make it very difficult to follow proper protocol, even if you knew what you were doing.
  - crpatino 12y ago
    Even in US settings, compliance with basic hygiene protocols may be below 50% [1]. This happens mostly in overcrowded facilities where personnel has been cut to run at or near capacity most of the time. The most salient factor is indirect contact. Health care workers are aware that they must wash their hands after having contact with a sick patient, but it is extremely hard to remember to take similar steps after touching any surface such patient might have touched himself, even if it looks clean to the bare eye. [1] http://prosperouswaydown.com/ebola-game-changer/ http://prosperouswaydown.com/ebola-game-changer/
danieltillett 12y ago
What I want to know is why anyone think this outbreak is going to be brought under controls anytime soon. Looking at the size of the outbreak and with with the R0 well over 2 since August there is nothing that makes me think it is not going to hit the predicted 1.5 million infections by January. Then what?
- skmurphy 12y ago
  I think we will see an infected person make it out of West Africa at a rate of one per month to one per week. We have one case in Dallas and a case earlier this summer in Nigeria. Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater. On July 20 Patrick Sawyer entered Nigeria in an infected state and infected at least 20 people, 8 of whom died. See http://www.washingtonpost.com/news/to-your-health/wp/2014/09/30/nigerias-ebola-outbreak-may-be-coming-to-an-end/ http://www.washingtonpost.com/news/to-your-health/wp/2014/09... On Sept 20 Thomas Duncan arrived in Dallas, and was subsequently diagnosed with Ebola. At least 15 people are at high risk for contracting the disease and another 100 had some risk of exposure. If you take two cases in two months it's not an unreasonable estimate that at least one person a month will escape the quarantine protocols. The protocols are likely to get better but the number of infected people trying to leave is likely to be substantially higher in each month going forward for at least three to six months. If the numbers hit the upper end the current CDC estimate (1.5 million infected) then it's likely the "escape rate" will be much higher, hence an estimate of one per week.
  - danieltillett 12y ago
    >Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater. It sure is. The problem is there are already 10,000s of people in Liberia and surrounding countries that are infected right now. How are the surrounding country going to keep out the ten to hundreds of thousands of people fleeing if the case numbers reach 1.5 million since the borders between these countries are completely porous? We need to get really serious about controlling this outbreak (full scale mobilisation) and not just hope everything is going to turn out OK.
fractallyte 12y ago
Liberia has a government. It receives vast amounts of foreign aid. So when the article says: "West Africa was ill-equipped for an Ebola disaster because civil war and chronic poverty had undermined local health systems and there were few doctors and nurses", this is missing the point. Corruption undermined the health systems, and much more besides. Those responsible for this disaster are the Liberian officials who collect a minimum of $449 million annually from overseas donors, but somehow can't seem to manage their nation with it. (But their personal bank accounts are probably very healthy.) There have been previous outbreaks of Ebola in the region, so no one is unfamiliar with it. With a growing and expanding population, it was not a case of 'if', but 'when'; there is no excuse. When this is all over, a number of individuals - from Liberian government and donor nations - should be prosecuted for corruption, negligence, and possibly even crimes against humanity.
- swombat 12y ago
  Liberia population: ~4m Budget you declare: $449m UK population: 63m Budget of the NHS: £109b = $174b People employed by NHS: 1.35m people To match the NHS, Liberia would need $11b, almost 25 times the amount of aid it's receiving. Hell, that's 5 times the GDP of Liberia at the moment. It would also need to train 85,000 medical professionals (doctors and nurses mostly) - all that in a country that's just emerging out of war (basically 20 years of civil war ending 9 years ago), has low education levels (60% literacy - 4 in 10 people you meet can't read and write), zero infrastructure, etc. Let's not forget that the NHS has been receiving that sort of funding for many decades - today's infrastructure builds on yesterday's infrastructure, etc. I put it to you that the NHS would be brought to its knees by 3000 Ebola cases to deal with. If we ever let it get that bad in the UK, the only way we're getting out of that is through a complete country shutdown (if that's even possible in our supermarket-driven world - people would starve; starving people tend to do stupid things to get food). Blame corruption all you want (though ironically, Liberia had elections that were widely regarded as fair, and that resulted in electing a highly qualified, female president, in 2005), but I think in Liberia's case it is totally fair to say that with or without corruption this country is extremely ill-equipped to deal with an Ebola epidemic. Links: https://en.wikipedia.org/wiki/Liberia https://en.wikipedia.org/wiki/Liberia http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.asp...
q2 12y ago
Couple of points: ( If there are any downvotes, please provide reasons for downvote, Thanks.) 1. I understand this is an article about the impact of Ebola virus. But why does the article highlighted the religious beliefs of the doctors/persons involved? If we remove that religious aspect from the article, how the integrity/message of this article's content will be impacted? I think, there is subtle religious propaganda in the article which is unnecessary to convey the virus, its impact and required global effective response. 2. Effectiveness of Govt. organizations (excluding armed forces who are trained) in majority of nations, especially in developing countries is doubtful.Organizations like WHO, UN, World bank, IMF also have similar characteristics on effectiveness, unfortunately but with no other alternatives. 3. I am not sure about testing arrangements at US airports. Since US hosts people from majority of nations who may have travel plans to other nations, i.e. some sort of hub, virus can reach other nations quickly, if US authorities fail to respond properly. Hope arrangements are made to test people who are coming into US. My guess is, testing doctors/nurses, checking customs/security officials ...etc i.e. all employees at the interfaces i.e. shipping ports, airports need to be wearing spacesuit sort of dresses as mentioned in the article so that they themselves won't be infected and become carriers of virus. This applies to all other countries including in Europe, China ...etc. Is it happening? 4. What about the effectiveness of other forms of medicine like Homeopathy/Ayurveda ...etc on this virus? I think we need to have alternative options of medicines/treatments, given the danger and magnitude of the problem to humanity ...etc.
- ghshephard 12y ago
  You might be downvoted because your suggestions are a little overboard at this point, in particular, "Hope arrangements are made to test people who are coming into US. My guess is, testing doctors/nurses, checking customs/security officials ...etc i.e. all employees at the interfaces i.e. shipping ports, airports need to be wearing spacesuit sort of dresses as mentioned in the article so that they themselves won't be infected and become carriers of virus." The Risk/Reward of spending money on hazmat gear for every screener who has to work secondary (presumably you are suggesting that we would only screen people who had just come from an ebola active area) is pretty weak.
  - 12y ago
lotsofmangos 12y ago
Donation pages for Médecins Sans Frontières: http://www.msf.org.uk/make-a-donation http://www.msf.org.uk/make-a-donation https://donate.doctorswithoutborders.org/ https://donate.doctorswithoutborders.org/
- bainsfather 12y ago
  MSF are a great organisation - very efficient and clear-headed in what they do - ~"ok, here's how much money we spend, how do we help the most people?" And in the past they have even said ~"actually, for disaster x, we cannot efficiently help any more people, please stop donating money" - not many charities would be that honest. If you want to donate your money, MSF will likely do the most good with it.
tokenadult 12y ago
I read through the comments here, and read through the article, and I guess it's hard for people who mostly deal with first-world problems to wrap their minds around what it's like to live in a much poorer place. "West Africa was ill-equipped for an Ebola disaster because civil war and chronic poverty had undermined local health systems and there were few doctors and nurses. Health workers in the region had never experienced an Ebola outbreak and didn't know what they were seeing in those first critical months." Yes. The ebola virus had previously appeared in other parts of Africa, and previous outbreaks have always fizzled out. There are so many urgent health problems in west Africa that at first ebola didn't look like it needed an all-hands-on-deck response. One part of that "there were few doctors and nurses" in west Africa has to do with the brain drain. People with medical training in west Africa are well positioned to emigrate to other countries. In the six years of my late dad's life when he was completely paralyzed from the neck down, one of the long-term care facilities where he stayed for quite a while was staffed mostly by Liberian immigrants, with various job classifications. The Liberian immigrant community here in Minnesota (and the Tibetan immigrant community, and several other groups of immigrants) is mostly employed in hospital and nursing home work, with the more skilled immigrants of course making MUCH better incomes than they could in their home countries. Our gain is another country's loss in the short term. (Eventually, interchange of people through immigration helps both the sending and receiving countries, because ideas and trade ties flow both ways, but those networks take time to build up, and freedom and stability in the developing country to have best effect.) The stark differences between life in a barely developing country and life in a developed country are hard for people to imagine if they haven't experienced them. Not many participants here on Hacker News have first-hand experience with this.

47 points by rpm4321 12y ago

http://waltherpragerandphilosophy1.blogspot.ro/2014/07/fearful-communities.html http://waltherpragerandphilosophy1.blogspot.ro/2014/07/fearf...

powera 12y ago

Sometimes I worry that the epidemics (or potential epidemics, rather) will continue until eventually our incompetence in large-scale organization overtakes all of the 20th century innovations in medicine.

001sky 12y ago

There was a good point made in a nother piece that ebola is highly infectious, but not so much readily contagious. Its worth considering the subtle distintion to appreciate how difficult it is to deal with. It spreads somewhat rapidly nonetheless because of the problems that trace amounts of contaminats cause. Not because the cantaminants themselves are necessarily widespred or pervasive in the environment. http://www.washingtonpost.com/news/to-your-health/wp/2014/10/03/can-you-catch-ebola-from-an-infected-blanket/ http://www.washingtonpost.com/news/to-your-health/wp/2014/10...

a8da6b0c91d 12y ago

http://atoday.org/adventist-mission-doctor-speaks-ebola-crisis-foreign-aid.html http://atoday.org/adventist-mission-doctor-speaks-ebola-cris... This doc claims the "health organizations" and aid helped cause of the epidemic. Weird diseases happen so often in that part of the world the west africans know how to deal with it. They quarantine an outbreak village and have the surrounding villages drop off food until the infections burn out. But recently everybody got so excited for the foreign goodies that materialize when you say "ebola," traditional quarantine procedure went out the window.

HarryHirsch 12y ago
You read other stuff from that website, like this http://atoday.org/god-create-evolution.html http://atoday.org/god-create-evolution.html or that http://atoday.org/wilson-ii-president-adventist-general-conference-believe-earth-billions-years-old.html http://atoday.org/wilson-ii-president-adventist-general-conf..., and suddenly you are unsure if you are dealing with trolls or kooks.
- ams6110 12y ago
  Maybe, but it's hard to argue logically against the notion that strict quarantine would be effective, if brutal way of containing the outbreak. Building large central makeshift treatment centers only encourages sick people to travel and infect new populations.
  - HarryHirsch 12y ago
    strict quarantine would be effective, if brutal way of containing the outbreak With a lengthy incubation time, and in an area that's just emerging from several decades of civil war quarantine isn't going to happen. The best hope is that there will soon be a vaccine, preferably before the plague reaches Calcutta, Karachi, Jakarta or Johannesburg. It's not unrealistic, the virus mutates only slowly, and India did get on top of smallpox; there is historical precedent for this approach to work. Quarantine has never been successful during wartime. The Attic plague happened in the middle of a war.
  - jonah 12y ago
    But was that indeed the case that the local healthcare systems were implementing and successfully enforcing quarantines in previous situations? Also, It's not the western cultural mindset to let it "burn out" when they could go in and "save" each person...
- blakeja 12y ago
  So people with a different set of beliefs from your own are "trolls and kooks". Man I get tired of seeing this kind intolerance, lack of respect, call it what you will. Regardless of your feelings about the rest of the site, I do not think the doctor's points are in any way invalidated if you actually read what he has to say, as some others here have already pointed out.

yeison 12y ago

According to this article, it seems like a lot of health care workers are catching the disease. Even the westerners who are familiar with the transmission mechanism of the disease. Therefore, isn't possible that we are underestimating how easily the disease can spread?

ams6110 12y ago
It is possible but also keep in mind that they are for the most part working in horribly primitive, unsanitary conditions, lacking supplies and basic utilities.
- danieltillett 12y ago
  That is the description of the whole health infrastructure of west Africa before this outbreak.
adevine 12y ago
I read another article that explained how Ebola is very infectious (meaning that very few virions are needed to establish an infection), but not particularly transmissible (i.e. it's not airborne, and thus much less contagious than something like the flu or measles). While westerners are becoming infected, I don't think it's that hard to see how the extremely poor health care facilities in West Africa would make it very difficult to follow proper protocol, even if you knew what you were doing.
- crpatino 12y ago
  Even in US settings, compliance with basic hygiene protocols may be below 50% [1]. This happens mostly in overcrowded facilities where personnel has been cut to run at or near capacity most of the time. The most salient factor is indirect contact. Health care workers are aware that they must wash their hands after having contact with a sick patient, but it is extremely hard to remember to take similar steps after touching any surface such patient might have touched himself, even if it looks clean to the bare eye. [1] http://prosperouswaydown.com/ebola-game-changer/ http://prosperouswaydown.com/ebola-game-changer/

danieltillett 12y ago

What I want to know is why anyone think this outbreak is going to be brought under controls anytime soon. Looking at the size of the outbreak and with with the R0 well over 2 since August there is nothing that makes me think it is not going to hit the predicted 1.5 million infections by January. Then what?

skmurphy 12y ago
I think we will see an infected person make it out of West Africa at a rate of one per month to one per week. We have one case in Dallas and a case earlier this summer in Nigeria. Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater. On July 20 Patrick Sawyer entered Nigeria in an infected state and infected at least 20 people, 8 of whom died. See http://www.washingtonpost.com/news/to-your-health/wp/2014/09/30/nigerias-ebola-outbreak-may-be-coming-to-an-end/ http://www.washingtonpost.com/news/to-your-health/wp/2014/09... On Sept 20 Thomas Duncan arrived in Dallas, and was subsequently diagnosed with Ebola. At least 15 people are at high risk for contracting the disease and another 100 had some risk of exposure. If you take two cases in two months it's not an unreasonable estimate that at least one person a month will escape the quarantine protocols. The protocols are likely to get better but the number of infected people trying to leave is likely to be substantially higher in each month going forward for at least three to six months. If the numbers hit the upper end the current CDC estimate (1.5 million infected) then it's likely the "escape rate" will be much higher, hence an estimate of one per week.
- danieltillett 12y ago
  >Both were contained but as the number of infected people goes up in West Africa the pressure to leave is going to be greater. It sure is. The problem is there are already 10,000s of people in Liberia and surrounding countries that are infected right now. How are the surrounding country going to keep out the ten to hundreds of thousands of people fleeing if the case numbers reach 1.5 million since the borders between these countries are completely porous? We need to get really serious about controlling this outbreak (full scale mobilisation) and not just hope everything is going to turn out OK.

fractallyte 12y ago

Liberia has a government. It receives vast amounts of foreign aid. So when the article says: "West Africa was ill-equipped for an Ebola disaster because civil war and chronic poverty had undermined local health systems and there were few doctors and nurses", this is missing the point. Corruption undermined the health systems, and much more besides. Those responsible for this disaster are the Liberian officials who collect a minimum of $449 million annually from overseas donors, but somehow can't seem to manage their nation with it. (But their personal bank accounts are probably very healthy.) There have been previous outbreaks of Ebola in the region, so no one is unfamiliar with it. With a growing and expanding population, it was not a case of 'if', but 'when'; there is no excuse. When this is all over, a number of individuals - from Liberian government and donor nations - should be prosecuted for corruption, negligence, and possibly even crimes against humanity.

swombat 12y ago
Liberia population: ~4m Budget you declare: $449m UK population: 63m Budget of the NHS: £109b = $174b People employed by NHS: 1.35m people To match the NHS, Liberia would need $11b, almost 25 times the amount of aid it's receiving. Hell, that's 5 times the GDP of Liberia at the moment. It would also need to train 85,000 medical professionals (doctors and nurses mostly) - all that in a country that's just emerging out of war (basically 20 years of civil war ending 9 years ago), has low education levels (60% literacy - 4 in 10 people you meet can't read and write), zero infrastructure, etc. Let's not forget that the NHS has been receiving that sort of funding for many decades - today's infrastructure builds on yesterday's infrastructure, etc. I put it to you that the NHS would be brought to its knees by 3000 Ebola cases to deal with. If we ever let it get that bad in the UK, the only way we're getting out of that is through a complete country shutdown (if that's even possible in our supermarket-driven world - people would starve; starving people tend to do stupid things to get food). Blame corruption all you want (though ironically, Liberia had elections that were widely regarded as fair, and that resulted in electing a highly qualified, female president, in 2005), but I think in Liberia's case it is totally fair to say that with or without corruption this country is extremely ill-equipped to deal with an Ebola epidemic. Links: https://en.wikipedia.org/wiki/Liberia https://en.wikipedia.org/wiki/Liberia http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.asp...

q2 12y ago

Couple of points: ( If there are any downvotes, please provide reasons for downvote, Thanks.) 1. I understand this is an article about the impact of Ebola virus. But why does the article highlighted the religious beliefs of the doctors/persons involved? If we remove that religious aspect from the article, how the integrity/message of this article's content will be impacted? I think, there is subtle religious propaganda in the article which is unnecessary to convey the virus, its impact and required global effective response. 2. Effectiveness of Govt. organizations (excluding armed forces who are trained) in majority of nations, especially in developing countries is doubtful.Organizations like WHO, UN, World bank, IMF also have similar characteristics on effectiveness, unfortunately but with no other alternatives. 3. I am not sure about testing arrangements at US airports. Since US hosts people from majority of nations who may have travel plans to other nations, i.e. some sort of hub, virus can reach other nations quickly, if US authorities fail to respond properly. Hope arrangements are made to test people who are coming into US. My guess is, testing doctors/nurses, checking customs/security officials ...etc i.e. all employees at the interfaces i.e. shipping ports, airports need to be wearing spacesuit sort of dresses as mentioned in the article so that they themselves won't be infected and become carriers of virus. This applies to all other countries including in Europe, China ...etc. Is it happening? 4. What about the effectiveness of other forms of medicine like Homeopathy/Ayurveda ...etc on this virus? I think we need to have alternative options of medicines/treatments, given the danger and magnitude of the problem to humanity ...etc.

ghshephard 12y ago
You might be downvoted because your suggestions are a little overboard at this point, in particular, "Hope arrangements are made to test people who are coming into US. My guess is, testing doctors/nurses, checking customs/security officials ...etc i.e. all employees at the interfaces i.e. shipping ports, airports need to be wearing spacesuit sort of dresses as mentioned in the article so that they themselves won't be infected and become carriers of virus." The Risk/Reward of spending money on hazmat gear for every screener who has to work secondary (presumably you are suggesting that we would only screen people who had just come from an ebola active area) is pretty weak.
- 12y ago

lotsofmangos 12y ago

Donation pages for Médecins Sans Frontières: http://www.msf.org.uk/make-a-donation http://www.msf.org.uk/make-a-donation https://donate.doctorswithoutborders.org/ https://donate.doctorswithoutborders.org/

bainsfather 12y ago
MSF are a great organisation - very efficient and clear-headed in what they do - ~"ok, here's how much money we spend, how do we help the most people?" And in the past they have even said ~"actually, for disaster x, we cannot efficiently help any more people, please stop donating money" - not many charities would be that honest. If you want to donate your money, MSF will likely do the most good with it.

tokenadult 12y ago

I read through the comments here, and read through the article, and I guess it's hard for people who mostly deal with first-world problems to wrap their minds around what it's like to live in a much poorer place. "West Africa was ill-equipped for an Ebola disaster because civil war and chronic poverty had undermined local health systems and there were few doctors and nurses. Health workers in the region had never experienced an Ebola outbreak and didn't know what they were seeing in those first critical months." Yes. The ebola virus had previously appeared in other parts of Africa, and previous outbreaks have always fizzled out. There are so many urgent health problems in west Africa that at first ebola didn't look like it needed an all-hands-on-deck response. One part of that "there were few doctors and nurses" in west Africa has to do with the brain drain. People with medical training in west Africa are well positioned to emigrate to other countries. In the six years of my late dad's life when he was completely paralyzed from the neck down, one of the long-term care facilities where he stayed for quite a while was staffed mostly by Liberian immigrants, with various job classifications. The Liberian immigrant community here in Minnesota (and the Tibetan immigrant community, and several other groups of immigrants) is mostly employed in hospital and nursing home work, with the more skilled immigrants of course making MUCH better incomes than they could in their home countries. Our gain is another country's loss in the short term. (Eventually, interchange of people through immigration helps both the sending and receiving countries, because ideas and trade ties flow both ways, but those networks take time to build up, and freedom and stability in the developing country to have best effect.) The stark differences between life in a barely developing country and life in a developed country are hard for people to imagine if they haven't experienced them. Not many participants here on Hacker News have first-hand experience with this.