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NickLaing

CEO and Co-Founder @ OneDay Health
13990 karmaJoined Working (6-15 years)Gulu, Ugandaonedayhealth.org

Bio

Participation
1

I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 53 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 

Comments
1799

Thanks for the update, and the reasons for the name change make s lot of sense

Instinctively i don't love the new name. The word "coefficient" sounds mathsy/nerdy/complicated, while most people don't know what the word coefficient actually means. The reasoning behind the name does resonate through and i can understand the appeal.

But my instincts are probably wrong though if you've been working with an agency and the team likes it too.

All the best for the future Coefficient Giving!

Thanks @mal_graham🔸  this is super helpful and makes more sense now. I think it would make your argument far more complete if you put something like your third and fourth paragraphs here in your main article. 

And no I'm personally not worried about interventions being ecologically inert. 

As a side note its interesting that you aren't putting much effort into making interventions happen yet - my loose advice would be to get started trying some things. I get that you're trying to build a field, but to have real-world proof of this tractability it might be better to try something sooner rather than later? Otherwise it will remain theory. I'm not too fussed about arguing whether an intervention will be difficult or not - in general I think we are likely to underestimate how difficult an intervention might be.

Show me a couple of relatively easy wins (even small-ish ones) an I'll be right on board :).

NickLaing
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70% disagree

I'm 80% to the intervention, 20% to research. I would love MORE  money than now to go towards researching effectiveness (I'm guessing its a lot less than 20% on the margin right now)

I was shocked though after reading the recent animal welfare post at how mixed the evidence base seems to be as to the benefits of commonly touted interventions. I'm dubious about interventions that might move a chicken from a very net-negative life to a slightly-less net-negative life. I naively assumed that cage-free was better than it seems to be. After seeing @Lewis Bollard's TED talk I kind of assumed that cage-free interventions at least probably moved chickens to a net-positive life?

I would love as well to be more certain about animal sentience and suffering, but I'm skeptical that many research suggestions I've seen will make much progress, as I don't believe we can have much confidence in sentience'pain from only observing behaviour. I still think this area deserves more than the meagre funding it gets though.

My apologies @Vasco Grilo🔸 I was lazy there and didn't read the whole article properly. Thanks for pointing out the important areas. Working memory and operant conditioning don't carry any weight with me personally, I struggle to connect those with a meaningfully increased chance of pain experience. For example the portia spider has a very advanced working memory for very specific tasks which makes sense evolutionary, as do many other organisms, but i can't imagine why these specific evolutionary advantages would also lead to sentience?

"Finally, higher order cognitive processes such as episodic memory and self-recognition, can yield insights into animal awareness. These have not been studied in S.P.U.D. subjects, and this would likely be impossible"

These higher order processes would be most convincing for me than the memory stuff, especially deeper levels of self recognition which I feel like could maybe be tested? 

Perhaps a silly question, but I thought the mirror/parasite mirror test was related to "self recognition", but you seem to mention that as something different.

I appreciate this paragraph, especially the extreme uncertainty and the welfare of fish being potentially close to zero even if sentient.

"I speculate carp have around 50 % (= (0.70 + 0.40)/2) chance of being sentient, but I have little reason to expect my intuitions are calibrated. I feel like anything from 0.1 % to 90 % is reasonable. In any case, I can see the welfare of fish being very close to 0 even if they are sentient. So I would rather prioritise decreasing uncertainty about their sentience and intensity of their experiences over investing in interventions helping fish."

What kind of research do you think could decrease uncertainty about their sentience? I'm assuming you mean behavioural research? I think this kind of research is helpful to reduce uncertainty but doesn't necessarily address fundamental questions about how brains work.

NickLaing
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40% agree

I think the world is more likely to not end then end, when TAI comes in so I feel like I have to vote agree here?

And one quick query from the main article

"Shelton, Constance (CJ), and Latifah in Latifah’s farm where she now grows Irish potatoes and cabbage. She invested $300 in her farm, and has been able to increase her profits from $5/week to $30/week. She plans to expand into mushroom farming next."

Profits (not gross sales) of $30 a week subsistence farming in Rural Rwanda seem close to impossible. I imagine this is what she told you? Perhaps this was just during harvest season or something, then it would make more sense.

Perhaps not completely impossible though if she's unlocked a particular market!

This is super interesting stuff thanks for posting!

The first thing that jumped out at me was that you are reading and analysing people's messages that come through the chatbot. I'm sure they consented (as much as this is possible to truly consent with the level of education, and the cash incentive) and its all anonymised but it still seems weird. 

I have so many ethical questions about this. None of them I think necessarily mean something like this isn't worth trying, but I think it's worth discussing. Here's just a couple off the top of my head

  1. What do you do if they have a conversation about harming themselves or others? Do you react and do something about it or do you leave it be? Would people then be aware that what they type could illicit some kind of external response?
  2. When they ask something like ""What business has quick profits" for which there is obviously no good answer, what does the bot do? I hope it doesn't try and give business advice. When I asked Claude sonnet, the first answer it gave was 

"Poultry farming is one of the most cited options. It has high demand for eggs and chicken meat, with startup capital of around 1–2.5 million RWF and potential returns in 2–3 months if well managed."

In many rural contexts this might be a decent idea, but without proper disease treatment, housing, protection from theft etc. this advice could be a huge liability. 


Also Who are you that you answer me?" is pretty haunting. I concur.

I think there's a huge amount to be gained potentially by trying chatbots in these settings, but its a bit of an ethical minefield and its a new fronteir for sure.

 

On this question "‘is there a hyper-competent person waking up every day feeling accountable for making sure this gets solved?’ for many Global health issues there are 30-50 people like that. Only with newer more niche ones like lead might there be 1 or a handful.

These are great examples from the past. I love the old-school "heros" you mention and wish we had more today. Even with those "DRI's" you meantion of the past, I would imagine they were reall ymuch more part of a bigger global team, and in many cases the public figurehead rather than "the" responsible person.

I appreciate that @Mo Putera but Im not at all that. Your 100% right that I'm sold out for getting good healthcare to everyone, but there are probably >5000 people in the GHD world who both have a better track record and more power to move the needle on access to high quality healthcare than I. You probably get the wrong idea from me posting too much on the forum :D :D :D , I run a smallish growing org that rolls out a decent model that may or may not get more traction.

Even our One Nurse in One room model as great as I might think it is, is only likely to be useful and perhaps the "best option" to provide remote healthcare in a handful of countries. Many Sub-Saharan African countries already finding (or have found) their own way to solve the problem which is great - even if its less efficient.

I think there are surprisingly few examples of "DRIs" who really own an issue in Global health. I actually wish there were more. There is the odd huge name like the late Paul Farmer would be the best example of what you are talking about. He helped move the needle and policy on a lot on many things, such as
- MDR TB treatment rollout
- TB directly observed treatment (along the lines of what Spiro - New TB charity raising seed funds does.
- Community Health worker normalisation

On your systemic change question, I think systemic change in Global health is a multifaceted long-term grind. It takes a lot of effort, money,  people working hard and good long term relationships and connections with the WHO and governments to make lasting change. The community Health worker movement is one of the best examples of successfully driven systemic change. It took 20+ years had a LOT of big names behind the campaign to get serious traction. This included Paul Farmer who I mentioned, plus big time advocates like President Sirleaf from Liberia. Plus tens of other people who are sold out spend their whole life on the issue. And they have a great advocacy org CHIC who co-ordinates and advocates led by another great woman Madeleine who recently posted here on the forum. There was no one Directly responsible" person - instead perhaps 20-50  hugely capable people co-ordinating and making this happen.

What I don't think can work to create large-scale meaningful systemic change is funding a 3 year project through a big NGO which tries to do just that. Better to fund movements or organisations that already have committment and momentum. In some ways similar to your "DRI" idea, but unfortunately not as simple as funding 1 person.

Your "VAWG" example is a good one, because like with the community health worker movement there are hundreds of founders working on that issue who are dedicated to their work and as far as I know no one person who stands out as a clear leader of the movement Many of them are obsessive and brillian, but they won't be directly responsible for the field in general. Maybe in their country or for their specific intervention, but not for the entire field. 

I don't know much about this field and I could be wrong, but I feel they haven't yet co-ordinated and built a "coalition" of groups working on it with a super capable leader can be key to creating more systemic change

And I might be missing what you really mean by "DRI" here, but I'm just not sure that the principle applies outside of a handful of very niche interventions like the no-more-lead crew.

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