World Toilet Expo 2007; Chung Sung-Jun/Getty Images

This spring, Beijing Olympic organizers went to extraordinary lengths to ensure athletes had the most comfortable sanitation facilities. When foreign athletes at test events complained about the squat-style toilets at key venues, such as the Bird's Nest and Water Cube, officials initiated "toilet alteration projects" (as an organizer described it to Reuters) to replace as many as possible with sit-down commodes.

If only others around the world were so lucky -- to have hygienic toilet facilities of any type.

In this International Year of Sanitation, some 2.5 billion people don't have access to improved sanitation, according to a recent progress report (big pdf). So, in this week's FP List, "The Hardest Places in the World to Find a Bathroom," we highlight five countries, by geographic region, where safe sanitation is in short supply. Yes, there's a "yuck" factor, but sanitation is crucial for public health and is likely one of the most important health advances ever.

Some meandering Googling for research on Alzheimer's drugs led me to the Web site of the Alzheimer's Association's International Conference on Alzheimer's Disease 2008 (ICAD), which took place two weeks ago in Chicago.

And it struck me as just a little odd that the conference's home page advertises its very own cocktail: The ICADian -- part Stoli Blackberry, part Creme de Cassis, a little Chambord, some lime juice, and a splash of cranberry. Fun!

Now, don't get me wrong. I'm the last person to scold anyone for greasing a conference agenda -- tedious or otherwise -- with a little booze. It's simply that the ICADian's prominent placement on the home page provides for a wee bit of (tasteless) humor...

Japan's heaviest sumo wrestler has pledged to his fans that he will gain even more weight. Yamamotoyama currently weighs in at 511 pounds, but the 24-year-old's goal is to tip the scales at 531, surpassing the previous Japanese record holder, retired wrestler Susanoumi, who reached 529 pounds.

Yamamotoyama is reported to have once devoured 146 pieces of sushi in a single sitting, so packing on another 20 pounds seems doable. But he might be setting himself up for a difficult situation 16 years from now. This year, Japan enacted a policy that requires citizens ages 40 to 74 to undergo mandatory "fat checks." Those with waists more than 34 inches will be put on special exercise programs. It's part of an effort to keep citizens' bulging bottoms from breaking the government's budget, as reported in the FP article, "Bulging Bottom Lines."

Surely, though, there must be a special sumo exemption?

The Harvard Medical School and Children's Hospital Boston recently unveiled HealthMap, a Google Maps mashup that aggregates news about disease outbreaks from around the world, allowing users to track potential epidemics. There are still relatively few stories on the map, but its creators hope that it may one day allow the public to notice disease trends that are often hinted at in the media before researchers are able to connect the dots. For instance, early signs of the 2002 SARS outbreak were reported in Chinese newspapers well before the extent of the outbreak became clear.

There's a lot of room for improvement on this one, but it could soon be a game-changer for global public health.

(Hat tip: The Private Sector Development Blog)

STUART PRICE/AFP/Getty Images

To get high, some South African drug addicts have reached a new low.

Durban's provincial health department recently reported an alarming level of thefts of Stocrin, an antiretroviral drug treatment used to treat AIDS. Drug users reportedly crush the Stocrin with marijuana to get an extra-potent yet extra-dangerous high. The mixture breaks down the body's immune system "and eventually leads to death," according to Anwar Jeera, the head of a South African rehabilitation centre. But the ones most hurt by the thefts are of course South Africa's AIDS patients, many of whom have been ambushed by drug thieves on their way home from the hospital. In a country where five and a half million people suffer from AIDS, a crime-induced shortage of the life-saving antiretroviral treatments -- which 478,000 South Africans are registered to use -- is very bad news indeed.

In December 2006, Jeremiah S. Johnson, 25, began serving as a Peace Corps volunteer in Rozdilna, Ukraine, a town near the border with Moldova. When he started, he was HIV negative. In January of this year, he had a midservice medical exam in Kiev and agreed to an HIV test. It came back positive. The Peace Corps told him to pack his bags and return to the United States.

Johnson says the Peace Corps director for Ukraine told him he had to go home because Ukraine doesn't allow HIV-positive foreigners to work there. (If so, this isn't unique. As blogger Andrew Sullivan has pointed out repeatedly, the United States has its own fair share of restrictions on HIV-positive immigrants and tourists.)

Back in Washington, Johnson had an end-of-service medical exam and received written notification that he was being "medically separated" from the Peace Corps. He contacted the American Civil Liberties Union (ACLU), and the organization sent a demand letter to the Peace Corps saying that it is violating the Rehabilitation Act, which prohibits discrimination based on disability. (The State Department, by the way, changed its policies just this February to permit HIV-positive Americans, on a case-by-case basis, to work in the Foreign Service.)

Johnson doesn't have any physical symptoms of HIV. He and the ACLU say the Peace Corps did not assess him to determine if he could continue serving with reasonable accommodations. Additionally, his requests to be assigned to another country were denied.

What do you all think? A few questions come to mind:

• How easy would it be for Johnson to receive medical monitoring of his condition in a poor country (granted, the medical infrastructure in some Peace Corps countries, such as Romania and Bulgaria, is probably stronger than in, say, Burkina Faso and Guinea)?
• What if living in an underdeveloped country aggravated his condition -- would there be liability issues?
• Does how he contracted HIV -- for example, if he was injecting recreational drugs -- make a difference (the manner in which he became HIV positive hasn't been disclosed)?

For more on controversies about the Peace Corps, check out "Think Again: Peace Corps" and some of the reactions the piece prompted.

Turkmenistan's President Gurbanguly Berdymukhammedov hopes he has made an offer the women of his country can't refuse. For the simple task of birthing eight or more children (yes, eight or more), women will receive a one-time bonus of $250.

But wait! There's more: They'll also receive free dental care, free utilities, and free public transportation for life. With eight kids, free diapers or, better yet, a free vacation might be more appropriate.

Berdymukhammedov is partly correcting for the mistakes of his predecessor, Saparmurat Niyazov, who, during his 15-year reign of insanity, renamed the months of the year, banned beards, and forced schools to exclusively teach the "spiritual guide" -- the Ruhnama -- that he'd written for citizens. Among Niyazov's many other bright ideas were abolishing free healthcare, firing thousands of healthcare workers, and closing all hospitals outside of the country's capital. As a result, child mortality in Turkmenistan has spiked dramatically in recent years, leaving the new president to offer what incentives he can to keep new generations of Turkmen coming.

www.belikeothers.com

Last fall, Passport noted that more sex-change surgeries are performed in Iran than in any other country except Thailand. Ayatollah Khomeini approved them for "diagnosed transsexuals" 25 years ago, and today the Iranian government will pay up to half the cost for those in financial need. Former FP researcher David Francis wrote, "In a country that shuns homosexuality, this makes perverse sense, as after a sex-change operation, one technically isn't attracted to one's own sex and therefore isn't gay."

Now, Iranian-born, American-raised, director Tanaz Eshaghian has made a provocative documentary, Be Like Others, about young Iranian men who undergo sex-change surgery. It premiered earlier this year at the Sundance and Berlin film festivals. Check out some clips here, including one of a 20-year-old man who laughingly remarks, "It's so difficult," in reference to wearing a head scarf outside.

The U.S. Army is paying Disney $800,000 to turn frowns upside down at Walter Reed Hospital. Can it be long before Disney is helping to win hearts and minds in Iraq and Afghanistan, too?

Toys. Pet food. Dumplings. None of these potentially dangerous products with Chinese components has really scared me thus far. But this LA Times story sent a chill down my spine:

The Food and Drug Administration is investigating whether an ingredient from China may be the source of problems with a blood thinner linked to hundreds of reports of severe allergic reactions and possibly several deaths. [...]

As with food ingredients, China in recent years has become a major exporter of active pharmaceutical ingredients. Medicine Economic News, citing China's customs statistics, reported that the nation's exports of heparin and its components totaled $57.8 million in the first half of 2007, a 13.7% increase from the same period a year earlier. The Guangzhou-based publication said 49 companies exported heparin and its ingredients.

Baxter announced Monday that it was suspending manufacture of multiple-dose vials of heparin. The injectable drug, which is derived from pig intestines, is used to prevent dangerous blood clots from forming during certain types of surgery, including heart bypass. Baxter accounts for about half the U.S. market for the drug.

Assuming the FDA's suspicions are confirmed, how many other commonly used drugs have ingredients made in China? We know there have been problems with fake anti-malaria pills and fake glycerin used in cough syrup. Anything else out there?

SEAN GALLUP/Getty Images

The excitement aroused by the World Cup soccer tournament in Germany in 2006 may have increased that country's birthrate as much as 15 percent nine months later. But the intensely emotional matches have now also been correlated with a spike in the number of cardiac emergencies.

A study published Thursday in the New England Journal of Medicine examined the number of cardiac emergencies in the greater Munich area in the summer of 2006. It compared that number with the numbers in similar periods in 2003 and 2005, and for several weeks before and after the 2006 World Cup.

On days when the German team played, the incidence of cardiac emergencies was 2.66 times higher than during the comparison periods. For men, the incidence was 3.26 times higher; for women, it was 1.82 times higher. People with a history of heart disease were particularly affected.

The study's authors say emotional stress was the main trigger, but they add that sleep deprivation, excessive consumption of junk food and alcohol, and smoking might also be contributing factors. They suggest that spectators with heart problems should take preventive measures, such as consulting their doctors about increased medication dosages during intense sports events.

So should Americans be worried about this weekend's Super Bowl? Study author Gerhard Steinbeck says:

It's reasonable to think that something quite similar might happen.

Though if the Vegas odds-makers have it right, the greater danger on Sunday may turn out to be irate New York Giants fans.

There's a sad new chapter in the sad story of the state of the U.S. military's mental health care, as I've been writing about here at Passport. Lt. Elizabeth Whiteside, the 25-year-old Army reservist who was facing a court martial for pointing a gun at a superior, then shooting herself last year in Iraq, attempted suicide again on Monday, as reported by the Washington Post Thursday. Her mental health had been in better condition lately, as she went public with her story, but she began to deteriorate as her case dragged on. Ironically, she learned on Wednesday, as she was recovering in the hospital, that all the charges against her were dismissed.

Record numbers of soldiers returning from Iraq and Afghanistan have committed suicide. Last year, 121 cases were recorded—20 percent more than 2006.  Thankfully, Whiteside has not been added to those numbers. Let's hope she never is. And let's hope that any soldier who needs quality one-on-one care gets exactly what America owes him or her.

JASON SMITH/Getty Images for NASCAR

Last month I blogged about the case of Lt. Elizabeth Whiteside, an Army reservist facing court martial because she tried to commit suicide while serving in Iraq. Her story was part of the Washington Post's outstanding series, "Walter Reed and Beyond," about the lives of vets returning from Iraq and Afghanistan.

Now, the New York Times is doing its part to cover the care of vets, this time from a different angle. The Times' series, "War Torn," is about veterans who have been charged with killings after returning home. The first part of the series discussed the trend in general, noting that there have been 121 cases of such tragic incidents and touching on some of those cases. The second part of the series appeared on the front page of Sunday's paper. It tells the tragic tale of the killing of 22-year-old Nicole Marie Speirs by 21-year-old Marine Lance Cpl. Walter Rollo Smith, the father of their infant twins, who was suffering from post-traumatic stress disorder (PTSD) from his war experiences in Iraq.

Speirs's parents view the situation as a fatal incident of domestic violence. They worry that people are using her death to make a statement against the war. They hold Smith responsible for his actions. He doesn't disagree:

I can't completely, honestly say that, yes, PTSD was the sole cause of what I did. I don't want to use it as a crutch. I'd feel like I was copping out of something I claim responsibility for. But I know for a fact that before I went to Iraq, there's no way I would have taken somebody else's life.”

Reading his account, it's hard not to wonder if Speirs's death could indeed have been prevented, if only Smith hadn't fallen through the cracks. A formerly squeaky clean Mormon, Smith returned to Utah smoking, drinking, doubting God, and distraught over having killed civilians in Iraq. The Marines sent him to Quantico for a marksmanship course, and while on the firing range, he began to hallucinate about his experiences in Iraq. He had what can only be described as a breakdown. The Marines diagnosed him with PTSD, then discharged him, leaving him to seek treatment from veterans' hospitals.

But it's hard for someone who's having mental difficulties to have the wherewithal to manage his or her own treatment. After Smith's discharge, he intermittently sought help. He attended a group therapy session at a VA hospital, but never returned because none of the other attendees had similar war experiences to his. For awhile he took medication for anxiety, but stopped taking the pills when they didn't work. He attempted suicide. He once called the cops and asked for help because he was having homicidal thoughts. But ultimately, he was left to deal with his mental health on his own. And so one day he disconnected, and drowned the mother of his children.

Read the entire story to learn more of the compelling details. But the bottom line is that this is a senseless tragedy. A young man with no history of violence, not even old enough to buy a beer, was sent into a war zone to fight for his country. And when he returned, troubled, he didn't get the care that he needed. Now, a young mother is dead, and he's in prison. There are no winners here.

AIZAR RALDES/AFP/Getty Images

Last May, FIFA (the Federation of International Football Associations) prohibited international soccer matches from being played at more than 2,500 meters (8,200 feet) above sea level. The reduced oxygen levels at higher elevations were thought to put teams from low-altitude countries at a disadvantage.

Now, a study published in the British Medical Journal supports the ban's proponents. The scores and results from 1,460 international soccer matches played at varying elevations in 10 South American countries over the past 100 years were analyzed. After statistically controlling for differences in team ability, it found that not only did high-altitude teams have an advantage playing at high elevations, but they also had an advantage playing at low elevations.

The finding itself is not too surprising. After all, athletes often train at high elevations in order to gain an edge on the competition. But now, we can quantify that edge. The researchers found that for every 1,000 meters in elevation difference between two teams that played on the high-altitude team's turf, the goal difference in a match increased by about half a goal in favor of the high-altitude team. Additionally, while the chances of the home team winning are 54 percent for teams from the same altitude, this number increases to 83 percent when the altitude difference is 3,695 meters (as in the case of high-elevation Bolivia as home team versus sea-level Brazil) and plummets to 21 percent when the difference is -3,695 meters (as in Brazil as home team versus Bolivia).

We shouldn't feel too bad for the Brazilians, though—they've won four out of the past five Copa América tournaments. As for the Bolivians, their last championship was in 1963.

It always makes me depressed to think about how little attention the vast majority of Americans pay to the rest of the world. Passport readers are, of course, an exception. But I'm reminded of how isolationist the general American public can be whenever I stumble across stories like this, Time magazine's Top 10 Underreported Stories of the year. Of the 10 stories on the list, seven of them have to do with international developments (OK, this item is arguably a domestic story, but I'm including it in my tally because it's about nukes). And of those seven stories, only one of them was a surprise to me: Brazil's announcement that it had made the largest oil discovery since 2000. (I'm chalking up missing this story to the fact that it happened around Thanksgiving time, when I wasn't paying attention to the news as I should.)

Granted, it's my job to pay attention to what's going on in the world. But honestly, should it really be new news to people that the U.N. reduced its estimates of those afflicted with AIDS, or that tensions are getting worse between Ethiopia and Eritrea?

At any rate, I suppose I should be grateful that Time is bringing its readers' attention back to these important topics. But for stories that really went underreported, check out FP's The Top Ten Stories You Missed in 2007. And make your family and friends add "pay more attention to international news" to their list of New Year's resolutions.

JOSE CENDON/AFP/Getty Images

As you probably know, earlier this week FP posted the Top Ten Stories You Missed in 2007, our roundup of the most important news stories that flew under the radar this year.

But we're not the only ones keeping an eye out for little-noticed items and trends. Doctors Without Borders also posts an annual list. Theirs is of the Top 10 Most Underreported Humanitarian Stories of 2007. Click here to see it. Sadly, of the those 10 stories, four of them are directly about Africa. Two others, tuberculosis and malnutrition, concern the continent as well. As usual, Africa got shafted and ignored this year.

When you heard the words "sex tourism," one image usually comes to mind: a sleazy, older white man with a beer in one hand and an underage Asian girl in the other, strolling along some beach in Thailand. But now a new kind of sex tourism is on the rise. According to a recent Reuters story, older white women are now flocking to Kenya to seek out sex with younger African men. There are no official statistics, but locals in Mombasa tell Reuters they estimate one out of five single foreign female tourists are in search of sex.

Some argue that this is more acceptable than traditional sex tourism. As one commentator at Salon points out, the men are usually physically stronger and able to dominate their female "escorts" if necessary. Besides the swapping of gender roles, there's one other key difference between these women and the typical male sex tourist—what the women are doing is not illegal. That's because the guys they hook up with are adults, and the sex is consensual.  As one 56-year-old British woman told Reuters:

It's a social arrangement. I buy him a nice shirt and we go out for dinner. For as long as he stays with me he doesn't pay for anything, and I get what I want -- a good time. How is that different from a man buying a young girl dinner?"

Well, yeah, I suppose it's not that different; it's equally unsavory. No matter what, it's incredibly stupid to have casual sex with strangers in a country with a 6.9 percent AIDS rate. Moreover, there's still a major power differential. It's still about wealthy Westerners preying on the poor. 

BRENDAN SMIALOWSKI/AFP/Getty Images

If you missed the front-page story in the Washington Post on Sunday about 1st Lt. Elizabeth Whiteside, read it now, pronto. I haven't been this outraged since the last time I read an entry in the newspaper's outstanding ongoing investigative series, "Walter Reed and Beyond," which is about the lives of soldiers returning from Iraq and Afghanistan.

This time, reporters Dana Priest and Anne Hull tell the tale of the 25-year-old Army reservist, a valedictorian of her high school who had earned nothing but accolades during her seven-year career in the military. She once worked as an officer, but faces a court martial because of an attempted suicide when she was serving in Iraq. If tried and convicted, she could face life in prison.  

The short version of the story is this: Whiteside, who was nicknamed the "Trauma Mama" by the medics she supervised in Iraq, worked at the detainee prison where Saddam Hussein was held. While there, she and another female experienced tensions with a male superior officer. She ate only one meal a day and slept in shifts. There's no doubt the atmosphere was stressful. Whiteside began to have panic attacks. Then, when Saddam Hussein was taken from the prison to be executed, violent riots broke out inside the prison. Whiteside ushered doctors to safety, conducted triage, and performed exemplary service. The next day, she experienced what she calls a "psychotic break." In clear distress, she requested to see a mental health nurse. When the nurse checked in on her later in the day, Whiteside waved her gun and eventually shot herself in the stomach.

After being sent to Walter Reed, where ironically she had once worked as an officer, the Army's own psychiatrists diagnosed her with severe major depressive disorder and a personality disorder. Then, a new team stepped in: the Warrior Transition Brigade. Made up of officers with combat experience and whose ostensible aim was to help patient recovery, the team drew up criminal charges against Whiteside. They said she was using her mental illness as an excuse. Whiteside offered to resign, but would have to forfeit the benefits that she's earned in her military career. Her alternative is to face these charges, with the prospect of life in prison.

Her treatment by the Army right now is a total travesty. Combat is hard enough for someone without a predisposition to mental illness. And mental-health issues are hard enough to deal with in civilian life under ideal conditions, never mind in a war zone. Mental illness is a serious medical problem, just as serious as any physical medical condition, and Whiteside ought to be treated as any other wounded soldier. It would be a complete shame if this case is allowed to continue. Kudos to the Washington Post for bringing attention to this important issue.

TARIQ MAHMOOD/AFP/Getty Images

A riddle:

• It's a sign of manhood, but it's not a mustache.
• It's another name for safety, but, no, it's not a helmet.

These are the first two lines of a four-line riddle that's part of a media contest in India that aims to get men talking about sex. Launched in time for World AIDS Day on December 1, the campaign hopes the riddle is intriguing enough that it actually gets men to talk with their friends about topics that can be rather awkward to discuss. 

Many HIV/AIDS prevention campaigns simply tell people to talk about sexual health, but this one actually stimulates people to do so. Additionally, to be eligible to win a prize, people have to call in and actually say the one-word answer to the riddle—no text-messaging the answer allowed! Prizes, such as mobile phones with free minutes, continue the theme of promoting talking.

The contest, sponsored by the BBC World Service Trust, targets men in four southern Indian states that have higher HIV rates. Why men? Research shows that if you can get men to talk about sex and condoms, they're more likely to be consistent condom users. (Did I just give away the answer to the riddle?)

CHRIS HONDROS/Getty Images News

Since 2005, 69 Nigerian kids have been paralyzed by polio, and, surprising to many, these kids indirectly contracted the disease from the vaccine itself.

How? The oral polio vaccine contains a weakened form of the polio virus. Vaccinated kids pass the virus into the water, where unvaccinated kids can pick up the virus by playing in or drinking the water. Normally, this exposure gives unvaccinated kids some protection against polio. But in very rare circumstances, the virus can mutate into a dangerous form, causing the actual disease in unvaccinated kids.

Since this manner of contracting polio only happens when not enough kids are vaccinated, the solution is to vaccinate an even higher fraction of youngsters. But that could prove to be very challenging in Nigeria.

In 2003, there was a boycott of vaccination programs for nearly a year—which caused polio to jump to 12 new countries in 18 months—because some Muslim leaders in Nigeria said that the polio vaccine was a Western plot to sterilize Muslims. The belief reflects a general mistrust and skepticism of Western medicine that exists in many developing countries, where many believe that vaccines and drugs will sterilize people or infect them with HIV as part of a Western conspiracy to reduce the populations of certain races or religions. An earlier FP List, "The World's Stupidest Fatwas," mentions how some rural Pakistani mullahs have issued fatwas against the polio vaccine.

Stupid is still the right word. As the Nigeria case shows, the latest polio outbreak proved how these fatwas can be self-fulfilling prophecies: By boycotting the "dangerous" vaccine, some kids actually got sick from it, proving how "dangerous" the vaccine indeed is.

The only thing sadder may be health officials' delayed response. The World Health Organization and U.S. Centers for Disease Control have known about the Nigerian outbreak since last year, but they kept silent about it until now. One specialist has said that the delayed reporting may have delayed a medical response.