On old Al-Ardha there was a nation of deltas and rivers, a low-lying land that had made its history and its culture at one with the sea. Rich nations far away from this tidebound kingdom polluted and ruined Al-Ardha, and as the seas of the warming world rose this nation that had lived at peace with the brine for 1000 years was inundated and ruined.

The people of this nation had a proud tradition of ship-breaking, taking the terrestrial ships of other nations and reducing them to their bones and parts, repurposing them and selling them. When the people of the First Horizon went into space the people of this nation followed, taking their ship-breaking skills to the Dark between the stars and becoming consummate recyclers of the ships of the richer nations that were ruining the surface. But for all their labours, when the people of the First Horizon sent out their generation ships to colonize the second and third Horizons, the people of this proud riverine kingdom were not included. Watching their own land sink beneath the waves of their dying world, they decided to build their own generation ship, fashioning a mighty vessel to take them to the Third Horizon and preparing it with loving care over decades to send out to the stars.

As they finished their ship, however, the people of the First Horizon discovered the portals, and generation ships were no longer necessary. The river-folk of this drowning land saw their chance, and quickly redesigned their ship to travel through the portals. They set off through the portals with the rest of Al-Ardha’s fleet, arriving in the Third Horizon and becoming part of the wave of migration known as the Firstcome.

This nation’s ship was called অটুট, Atuta, in their language. In the language of the Third Horizon this would be interpreted as the Unbroken. While the other Firstcome ships had been designed for the portals, the Unbroken had been designed as a generation ship, and it dwarfed the other Firstcome ships. 4km long, carrying some 500,000 people and a wealth of equipment and materiel, the Unbroken was twice the size of the next largest ship in the Firstcome fleet, and carried far more people than any of the other ships in the fleet. When the Firstcome arrived in the Third Horizon a mad scramble began to find new planets and places to settle, but the people of the Unbroken, being themselves victims of colonialism, refused to join the frenzied competition for land and resources that characterized that first wave of settlement. Instead they traveled the Horizon looking for a place to rest. By dint of the skill of their captains, long honed in a land that had grown with the sea and leapt into the sky, they were able to navigate the unstable portals of the Dabaran circle, and were among the first to arrive in the Dabaran system. While some of those who came with them chose to settle planets in the system the people of the Unbroken decided to make their fate in the stars, doing what they had done in the First Horizon. They brought the Unbroken to rest in a far orbit in the Dabaran system, and turned the huge ship into a massive space station, hundreds of years before the arrival of the Zenith. The massive engines that had powered it were repurposed into material for factories and shipyards, and the Shipbuilders of Dabaran began their trade.

Over the next generations, before the portal wars collapsed the portals and destroyed the connection to Al-Ardha, the people of that drowning nation set out on many small ships to the Third Horizon to join their pioneers from the Unbroken, bringing their ship-breaking yards and their factories and their culture to the Third Horizon. Over those generations another million people joined the original settlers, and the original space station grew in size, the Unbroken now surrounded by platforms and barges and dormitory stations and factories. The complex grew, and in this complex developed the largest, most productive and well-known of the Horizon’s shipyards: the Dabaran Shipyards. These shipyards could do anything: repurposing, renovating, scrapping, salvaging and building. They took old ships and reduced them to their components, recycling the parts into new ships for clients all across the Horizon. They refurbished and repurposed ships, adding and removing modules, changing shapes, grafting in new components, redesigning anything they were asked to do. And using the components they stripped from other ships, or materials brought in from distant systems, they build new ships to order. Mira could make faster, more beautiful ships; the freighters of Darkos were unparalleled for their solidity; Harima’s ships were faster and more luxurious; but if you wanted versatility in your design, at a reasonable price, or just wanted a simple, all-purpose ship with no problems and no fuss, the shipyards of Dabaran could build it for you. Everyone in the Horizon knows about Dabaran ships, but somehow they pass through every system unheralded, unnoticed and without awe or disgust. They are the workhorses of the Horizon, the vessels that all the people of the systems of the Horizon do not even know they depend on. These are the many progeny of the shipyards of Dabaran.

A ship being broken, viewed from the deck of the Legion destroyer Azure Sky

Over the years the shipbuilders of Dabaran have become synonymous with the system itself. Their language, Dabari, is spoken on all its planets, and the industry of ship building dominates the economy of the whole system. Over time the shipbuilders themselves have become associated with the system, and so they themselves are called Dabarani. Some live on the surface of the Dabaran system’s planets, but the majority – perhaps 2 million in total – live in the many stations and satellites of the shipbuilding community, which is generally referred to as Atuta by its residents. Atuta is a huge, thriving complex of interconnected spaceships, space stations, platforms, barges and habitats, linked by a complex network of transport tubes, docking stations, and tiny fliers and transports that swarm around the habitats themselves. Even a lifetime spent on Atuta is insufficient to understand its many communities, souks, gardens and factories, and to visit Atuta is to understand what the Horizon could be like if only everyone were as industrious, as busy and as energetic as the Dabarani. People from all over the Horizon come here to trade ships and ship parts, to do business in the hectic and confused bazaars and marketplaces, and to make money from the shipping industry. In particular the agents of the Nomad Federation and the Free League swarm to Atuta to do business, and it is a stronghold of these factions. The Legion have a presence here as well, ostensibly to ensure security but in reality to ensure a steady supply of spare parts and new ships for their expanding empire. Far out from the centre of the Horizon, Atuta is a hub of commerce and industry.

The Dabarani build ships, and they also break them. But they do not, officially, break or refurbish illegal ships, and it is an unwise adventurer who brings a stolen ship to the Dabarani to be refitted or scrapped. However, a large industry of hackers and criminals has grown around Atuta, laundering the names and registrations of stolen ships so that they can be merged into the industrial landscape and repurposed or scrapped by its official industry. The Dabarani ruling council claim to be ignorant of any such crimes, and promise to punish them with extreme prejudice if caught, but everyone knows that in reality they tolerate these people in their midst in exchange for the business they bring. Some say the Legion maintain a presence here so they can watch this business, and keep track of all the ships that are being stolen and scrapped – and the people doing it. Others say that the Dabarani are nothing more than the permanent home base of the Nomad Federation, who sometimes need to trade in stolen and salvaged ships, but the truth is simpler: Atuta is open for business, and any business can be done here for the right price, if you are careful and you do not cross the Legion or the leadership of Atuta. If you have a stolen ship all you need to do is find one of the many Data Djinn who work at the fringes of Atuta, laundering ship licenses, and then you are free to take your new, “clean” ship into Artuta to pay the Dabarani to modify it.

With commercial influence and power has come cultural independence, and the Dabarani have retained many unique cultural practices over the years. The hull of the Unbroken itself remains largely untouched, but within it has been renovated to reflect its new purpose as the centre of Dabrani culture. The old hangars, vast spaces designed to hold the many courier ships and shuttles of the original generation ship, have been turned into a complex of gardens and shrines, with at its centre a huge hall for reflection and revelation. Most of the ship’s stasis pods have long since been stripped away and turned into parts for an expanded medical bay, but a few remain, converted into tombs to hold the remains of the Nabi, the navigators, captains and engineers who guided Dabarani society through the first generation of its growth in the Third Horizon. The Unbroken also bristles with ancient Firstcome weapons, installed during the portal wars, and although quiescent now represents a potent military force if roused to action. The Dabarani also follow a variant of the Church of the Icons, in which the Icons are not revered as gods but as messengers of an ineffable elder god. While others in the Third Horizon hold all the Icons as equal, the Dabarani revere the Messenger above all, seeing him as the original conduit for the wisdom of the ancient god, and like to quote from a book of his ideas that they claim he brought with him from the First Horizon (and which the other Firstcome lost).

This is Atuta, the Unbroken, the home of the last refugees of a drowning land, its best pilots and its most industrious shipbuilders. The entire Horizon is connected by its labour, and the entire Horizon can be found here, in Atuta.

Dhaka by night

I’m currently on an extended work trip to Bangladesh, teaching a couple of intensive seminars on epidemiology and related topics in Dhaka. This is the second time I have come here, and I plan to write a separate post soon on my impressions of this country – there is a lot to say about it. For those of you who don’t know, Bangladesh is a Muslim-majority country of 170 million people neighbouring India, and is very poor. It is currently ranked 136th out of 189 countries on the Human Development Index, putting it in about the bottom third of national wealth globally. Per capita GDP is about 1,800 USD, with huge inequality. Although the government of Bangladesh is angling to have the country ranked as a lower middle-income country it is still very poor, with no serious functioning health insurance system, limited skilled employment and a weak industrial sector outside of an extremely well-performing garment sector. Even the Tuk-tuks are imported from India. Bangladesh is something of a success story in health, outperforming expectations for its HDI and in particular making huge gains on maternal and child health. Nonetheless, life here is tough for all but its wealthiest residents. For example a basic garment worker job, which is a sought after thing here, pays about 80USD per month. I learnt this from my local colleagues, who are running a project on the health of these women, and I also helped interview a senior researcher position for a local organization, which was looking to pay a person with a master’s degree and several publications about $500 per month. It’s not a rich place! In particular there is a very large population of unskilled and/or illiterate young people, who are not able to engage in the garment sector or any higher-paid work, and for whom employment opportunities are limited. So it is that these people go to quite outrageous lengths to earn money, including some quite entertaining scams. Here I report on two, one of which I was told about and one of which I and my colleagues almost became entangled in.

Dhaka city centre, with metro works (I think)

The Elephant Man

I took a few hours after work this week to visit a tailor that my colleague Doughty S recommends. This tailor could make me a tailor-made suit, three shirts and a pair of trousers for a mere 170 USD, so is probably worth the two hour slog I had to endure to get there, and the 3 hour slog home. Did I mention that traffic in Dhaka is insane? Traffic in Dhaka is literally insane. It’s exhausting, depressing and soul-destroying, a problem of many cities in developing nations, and about this I will write more in my report on Bangladesh. At one point, driving relatively fast for the time of day, we passed an elephant standing by the side of the road, eating grass from a building site while its rider lounged about atop its broad back. It wasn’t huge as elephants go, but it was still big and more to the point I have never in my life seen an elephant just ambling along in public doing its thing. So I naturally declared “elephant!” and tried (and failed) to get a photo from the car that was suddenly and perversely actually moving for once.

My colleague Doughty S informed me that this elephant wasn’t a working elephant in the sense that it lifts and carries and drags things like an elephant should; rather, it was an essential participant in a money-making scam. Basically the dude on top of the elephant will manoeuvre it in front of your car, forcing you to stop, and then refuse to move the elephant until you pay him. Since it’s an elephant, you probably aren’t going to try and hit it; and if you’re in Dhaka traffic you probably won’t be able to outmanoeuvre it; and you can’t reach the dude to punch him since he’s on an elephant. It’s really a quite foolproof way of extorting a bit of money from passing motorists. So the scam unfolds, but on this occasion we were fortunate enough to be on the opposite side of the road, so no elephant extortion came our way.

Doughty S also told me that the same people who ride the elephant also sometimes have a box with a snake in that they threaten to curse you with unless you cough up some money. But I think we can all agree the elephant scam is way more elegant.

The Sand Gang in action

The Sand Gang

This is a devilishly cunning plan that seems worth far less than the effort and risk required to pull it off, but you have to admire the chutzpah of its architects. I spent two days at a resort town, Cox’s Bazar, during the break between seminars, to unwind a little and get some beach air. Cox’s Bazar is a kind of peninsula, with a single road heading south along the beach side, and over a line of hills the Rohingya refugee camps. The Rohingya fled violence in Myanmar to camps near Coxs Bazar, and there is now a huge industry of aid groups and Bangladesh army tending to their needs[1]. Most of the aid workers stay in Coxs Bazar, and every morning they drive along the road south to the camp. However, recently the government closed a 200m section of road near the hotels for repairs, and now there is no road south from the southern part of the town. Rather than head north and around, the aid workers drive onto the beach in their white SUVs and use the beach as a short cut, as do all the locals who live in the southern stretch of Coxs Bazar. It’s ridiculous that there is only one road and that it has been closed now, but this is Bangladesh so everyone just rolls with the punches.

So, when our time came to do a little beach tourism our driver took us onto the beach – me, Doughty S, his wife and child, in a rundown old van without seatbelts, along the beach and up to the part of the beach where we are to rejoin the road – where we found a couple of cars bogged down, and a queue of cars waiting to get up the hill. You can see the scene pictured above. We sat here for perhaps 10 or 15 minutes waiting our chance to drive up the hill but it seemed every time we tried to gun the engine and go up the hill someone let a tuk-tuk down in front of us, or someone cut in, or a group of people got in our way. Doughty S got out of the car and went up to direct traffic, and we watched as various cars floundered and then got pushed up the hill of sand by gangs of eager men. Eventually a gap appeared, our driver took a risk, and even though a woman in a sari and a tuk-tuk nearly cut us off we gunned up the sand hill, the driver throwing the car left and right with ferocious energy until we bounced up a huge lump and onto smoother, firmer sand, then onto the road where Doughty S rejoined us.

Doughty S reported to us the real story of the floundering cars: a kind of local syndicate of young men had set up a scheme where every time a car attempted to take the hill at speed someone would step in front of it, or they would direct a car coming in the opposite direction into its path. They made sure that children were the ones stepping in front of the car, so that it was guaranteed to slow down, though not so carelessly as to make it stop entirely. Its power gone the car would then hit the bank and flounder, and then the men would offer to push it out for a small fee. The fee was about 30 taka (30 cents or so) for a Tuk-tuk, up to perhaps 100 taka for a car like ours. Many of the drivers were not locals or were not used to driving on sand, and were easy marks; somehow the UN vehicles were never affected by this scam, and neither was the military truck that was just rolling away when we arrived. They obviously knew how to select their targets. Doughty S also told us some drivers suspected the sand gang had sabotaged the road to start with, undermining the sand bank.

Dhaka traffic comes to the bazar

By the time we returned from our tourism trip, the sand gang had also managed to expand to the other slope near our hotel, where I witnessed the traffic jam above. When you see a picture of Bangladesh traffic it is important to remember it’s not just a throng of cars; it’s also a cacophony of horns, because everyone uses their horn all the time for everything, and even the small jam pictured above was raising an enormous racket. Needless to say, we jumped out here and walked the rest of the way to our hotel.

Libertarian dreams

There is a cyberpunk air to Dhaka, in the sense that there is no smooth and ordered government-run system and everything is a chaotic mesh of competing businesses and money makers. There are no traffic lights or traffic police, no road rules, most of the time not even any lanes, and in the chaos of the traffic it’s every man for himself. With a weak state and a populace with limited work opportunities and not much money there is a big atmosphere of scamming, grift and graft. Funnily enough despite this lack of oversight no enterprising soul has managed to set up a toll road, or offer some advanced business plan that can cut through the dust haze and klaxon roar to somehow make money distilling all this essence of chaos down to pure profit. It just remains barely controlled chaos, mostly held together not by profit motives so much as by the common decency people usually show each other despite their situation. It’s a bit of a cliche to tell libertarians that if they want a world without a government they should move to Somalia or something, but I think for your everyday Bangladeshi worker that’s pretty much what they face: undiluted libertarianism. Out of pocket payments for healthcare and rubbish disposal, a completely uncontrolled transport system with very little public investment, a government sector where everyone accepts that services are purchased not given, and some dude with an elephant making a living (of some dubious kind) by extorting motorists. This is the reality of unimpeded libertarianism: the elephant man and the sand gang. If you want to see where it takes you, come and enjoy the traffic in Dhaka… but look out for the elephants!


fn1: The Rohingya are a sad story but I don’t get the impression that anyone here resents them. The Bangladesh army set up camps early, and have done what they can given their resources, and the town is generally welcoming of the aid workers and happy to take their money. Bangladeshis I speak to are universally proud of the social harmony in their country, “unlike India,” and don’t consider for example Hindus or tribal people (who apparently live around here) to be lesser people. The government wants to send the Rohingya back but seems willing to not force them while they are still at risk, and although it’s not a pleasant situation everyone seems to be doing what they can. I wonder if the Rohingya have elephants …?

This week a student and I published an article in PLOS ONE examining the relationship between healthcare-related expenditure and financial catastrophe in Bangladesh. Because PLOS ONE is an open access journal it is possible to read the entire article free online, here. Our study was a statistical analysis of data from a probability-sampled survey of households in Rajshahi, an urban area in Northwest Bangladesh. We collected data on their self-reported illness, household consumption and healthcare-related payments, and used it to estimate the prevalence and risks of financial catastrophe.

Bangladesh doesn’t really have any effective risk-pooling mechanisms, and a large portion of all health financing is derived from direct payments by individuals, usually referred to as out-of-pocket (OOP) payments. The lack of risk-pooling mechanisms mean that households with limited savings are at risk of financial catastrophe from unexpected healthcare costs, and may have to use a wide range of quite unpleasant coping mechanisms to deal with the costs. Our research project aimed to identify the drivers of costs, factors associated with financial catastrophe, and the coping mechanisms used to deal with high costs.

These kinds of research projects have a lot of challenges, and are necessarily flawed as a result. In low-income nations like Bangladesh it is difficult to assess wealth directly, since households often obtain income in kind or through bartering or intensive production (family gardens, etc); and often official income is not declared in order to avoid taxes or other costs. This is usually dealt with through assessing household consumption, rather than income, adjusting for fixed and productive assets. It’s also difficult to assess illness, which is usually done through self-report, and obviously also medical expenses can be hard to keep track of. There is an extensive body of literature on how to deal with those problems though, and we used mostly quite standard methods to handle them. Despite the obvious limitations in such a survey, I think this one presents fairly robust results.

We found a high prevalence of financial catastrophe, with an average of 11% of household consumption spent on healthcare and 9% of households facing financial catastrophe under our definition. Financial catastrophe was much more likely in the poorest households, even though these households spent considerably less on healthcare, and financial catastrophe was also associated with inpatient service use. Chronic illness was associated with higher OOP payments. Bangladesh is currently passing through the “epidemiological transition,” in which chronic non-communicable disease (NCD) prevalence is rising, but infectious diseases remain a significant problem, so the finding that chronic illness is associated with increased OOP payments is concerning: with a baseline proportion of their income already consumed by such illnesses, households will be less able to adapt to unexpected sudden illness or injury, both of which are relatively common in low-income countries compared to high-income countries.

Our findings suggest that Bangladesh needs to move rapidly to implement and scale-up risk-pooling mechanisms; deal with problems in public facilities that mean they don’t seem to be protective against financial catastrophe even though they are ostensibly free or heavily-subsidized; and prioritize NCDs in its health policy agenda. We’re currently conducting more research on disease-specific costs, coping mechanisms, and other aspects of the health-financing challenges facing Bangladesh. Other countries in Asia are moving towards universal health coverage (UHC) and Bangladesh lags some of them; but with care, a little reform, and some coordinated action to target NCDs, there’s no reason that despite its poverty Bangladesh can’t follow in the footsteps of other countries like Vietnam in reducing risk of financial catastrophe and improving healthcare access for the poorest members of its population.

As an aside, 9% is a very high prevalence of financial catastrophe, but I’d be interested to see how it compared with the USA (which also doesn’t have widespread and effective risk-pooling mechanisms). I don’t think the research is done the same way for US systems as in low-income countries, but there appears to be some evidence that financial catastrophe can be high, at least amongst the poor. For example, this New England Journal of Medicine article suggests that Medicare provides limited protection against financial catastrophe, and shows figures indicating that 4% of recipients pay >$5,000 on medical expenses in any one year, which would probably qualify them for financial catastrophe (since most Medicare users have low incomes). I would be interested to see the rates of financial catastrophe amongst the uninsured in the USA, and to compare them before and after Obamacare is introduced, but I don’t think research on the topic is done in the same way in the high-income countries, so I doubt it will be possible. Although health insurance (private or public) is supposed to protect against unexpected medical expenses, it can still be ineffective, and furthermore access to health insurance enables people to purchase healthcare they might otherwise have neglected, which could put them at risk of financial catastrophe where the insurance system fails to provide adequate coverage. Obamacare is going to extend no-frills coverage to the currently uninsured, but this doesn’t mean they’ll get benefits sufficient to prevent financial catastrophe, so it will be interesting to see whether it meets both of the goals of a health-financing system (improving access and reducing financial risk), just one of them, or neither. And if it fails on either or both of those goals, does this mean that Bangladesh will achieve effective UHC before the USA? That would be interesting … but first Bangladesh needs to start the move toward UHC, and hopefully this research will provide useful information and a little impetus in support of that process …