1) Chris Blattman with a critical analysis of food riots in Mozambique and another reminder that the simplest explanation is usually not the right one.
2) From my fellow Fellows in Burundi: Simone’s reflections on courage, Gerard’s first day at Kigutu, and Fidele’s story of his own recent experience with health care in Bujumbura. So very fortunate to be here with them!
1) Warning labels for lousy science writing – via Elizabeth Pisani @ The Wisdom of Whores.
2) Andrew Revkin argues that the “top billion” – probably you, definitely me – also need Millennium Development goals to deal with grotesque overconsumption, for our own good and everyone else’s.
3) A reminder from “Lessons I’ve Learned” that life is both easier and harder than you think in Cambodia.
4) Saundra at Good Intentions are Not Enough has some links to organizations working to break the silence on failures in NGO work; understandable but ultimately harmful to doing better work and not repeating mistakes. On the same vein, a recent NYT article on FailFare, as hosted by the World Bank, where NGOs are encouraged to talk about failure in a gentle, casual environment (i.e., finger food and wine).
1) Good Intentions Are Not Enough draws a crisp parallel between business and non-profits, rejecting the donor mantra that paying for overhead is bad. The keys:
Imagine walking into Wendy’s or Burger King (or whatever fast food restaurant you frequent) and insisting that you will only pay for whatever is actually on your hamburger . . . you refuse to pay for staff wages, building rental, electricity, the iconic golden arches . . . In aid it’s the aid recipients that have to deal with the lousy service, bad location, or restrictive business hours because donors only want to pay for what’s on the burger.“
Solution? fund orgs you trust and then, you know . . . trust them.
2) MIT Open Courseware. I just think it’s lovely to have a chance to learn or review without the cost of a course. Requires self-motivation and fast internet, but still . . . My particular poison this week is the Poverty Action Lab’s course on evaluating social programs. But there may be something else for you. Mmm. Knowledge.
3) Jina Moore for change.org with a lovely, brief summary of what it means to be a lesser-known country, in the case of Guinea Bissau.
4) Conflict Health on why the deaths of aid workers mean so much in strategic terms.
Attacks on health workers are not random. The provision of health services, whether by governments or NGOs is a physical manifestation of legitimate governance.
Filed under: Development, Global Health Corps, Leadership, Public Health, Words of Wisdom
God bless the GHC staff for providing a tiny notebook at the start of training; mine was my constant companion for most of the two weeks . . . paging through it, here were the thoughts that moved me enough to take note – if not to always write down who said them. Quotes have a high rate of human error – I haven’t learned shorthand yet – but the gist is hopefully captured.
Deogratias, founder of Village Health Works: Where people are dehumanized by misery, they are dehumanized and can act like animals . . . you need to address the root causes of misery, not the consequences.
Deo also quoted FDR: . . . the test of our progress is not whether we add more to the abudance of those who have much; it is whether we provide enough for those who have too little.
Ed Cardoza urged us have a “hermeneutic of generosity” for one another, that is to trust that “every human is trying to be a good person doing a good thing.”
“Be aware of how people survive.” Unattributed – I’m not even sure what session it’s from – but lovely to me.
Lenny Mendonca of McKinsey & Co told us to be “tri-sector athletes” – to be fluent in private, public, and non-profit sectors to work well in any one of them.
Rebecca Onje, Founder of Project Health: Nothing drives me crazier than people elbowing each other out of the way to serve poor families . . . like we’re running out? Like there’s a short supply?
Condoleezza Rice: It is an enriching experience to consider why you have so much, rather than why someone else has so little.
James March, Professor Emeritus at Stanford GSB, on the message of War and Peace: Heroes only imagine that they accomplish things. History is created by millions of little people doing their jobs (well).
This post originally kicked off as a response to misreading the Elite Aid post at Tales from the Hood – the idea put forward that we ought not accept non-elite humanitarian aid workers anymore than we would accept non-elite neurosurgeons (or contract lawyers). Disaster response differs from longer range development work pretty starkly in personnel needs among other ways, and I was responding as if the suggestion applied to the latter. Be that as it may, my thoughts:
The first thought I had was that neurosurgeons are expensive – because they are well-trained and because they are rare. The second thought is that, because of the expensiveness, and the rareness, not everyone who needs a neurosurgeon gets one. Far from it. It’s not a model I’d want to replicate with development work.
Which isn’t to say that the solution is to set loose a horde of ill-prepared folks to cut into brains, or, in development terms, to establish, manage, fund and monitor programming. There is a fair amount of work that must be done by people with training and experience. Based on the gaps in the system, it seems like there aren’t enough of them, or there are some serious distribution errors (or, likely, both).
1) Train more people. Not just school.
I’m part of the 20something brigade who threw ourselves into studying development, public health, and related fields in/after college. There are schools to do that, some better than others, both for Americans and folks in other countries. But once we’re finished with school, we need field experience, real work under good mentorship, and that’s harder to get, especially if you can’t self-fund it. My MPH would have been infinitely improved if there were a third year of it with something like a residency program where I was in one place the whole time with academic support. Would be fabulous if said residency would be eligible for student loan coverage, (self-funding is not impossible, but why not reduce the barriers of entry to the field while we’re at it?). Eventually the current crop of capable staff will get tired – they’d do well to help us apply knowledge and learn from experience with a minimum of damage done to projects so we can eventually take over.
2) Is there a role for task shifting?
The post also brought into mind task-shifting, a method used or suggested in health systems where there is a limited supply of the most educated and skilled – straining away tasks that can be done effectively by generalists, nurses, community health workers and others so that the specialists focus their time and energy on the tasks that truly only they can do. I’m wondering if a similar thought system might be brought up to the beleaguered aid elites. What development tasks must be done by highly educated, experienced folks, and what could they pass down the line to mentees, less-educated individuals, and/or short-term volunteers?
Which leads back to the question of what development workers ought to do with this upswell of energy and intention among people who want to engage at less than a career level. Do we have any obligation to direct it, if only so it doesn’t get in the way and do harm? Some future post, perhaps.
1. Chris Blattman on why aid is not so depressing afterall. Of note, that we should learn from our failures but only denounce ourselves as idiots when we do them more than once – well, that’s my spin on this:
Failure happens. In all big systems. Hollywood brought us Star Wars Episode One. The private sector brought us Google Wave. Western medicine brought us bleeding. In aid, the state of our knowledge is a little closer to bleeding than web programming. That’s actually what makes studying aid so different: we’re going to learn a tremendous amount in our lifetimes.
2. Belated, but on the good news front, an analysis of Rwanda’s recent success in reducing birth rate. 5.5 kids per woman is still pretty high, but at least heading in the right direction in a densely populated country.
3. William Easterly showing his soft underbelly on the big question: What can I do to end global poverty? The answer: take your energy, learn something specific, accept a small role in a big task. Lovely, true, and needed advice.
I’ve been reengaging my international brain lately, with an eye toward Burundi and surrounding countries. A few favorite reads:
Texas in Africa: Thoughtful analysis and useful links to other news.
Aid Watch: NYU Development Economist William Easterly’s blog. He and other writers have a definite angle but lay out their arguments well.
Wronging Rights: What might happen if the bloggers at Jezebel wrote a blog about human rights. Not frequent postings but well written and refreshingly funny when they do.
Sustainable Peace by Piece: A Burundi specific blog from a staff member at the Friends Women Association in Bujumbura.
Very interesting article out of the Lancet this month.
Full disclosure, I haven’t finished it, but this sentence in the abstract made my stomach turn a bit.
More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo).
With a total of 1.6 billion people shared among them, these six countries make up about 24% of the global population; still, although I don’t have stats at hand about percentage of live births, that burden of suffering seems grotesquely disproportionate.
Passed by state, likely to be signed into law by governor (also likely to be challenged in court).
The bill requires that doctors conduct screenings of women to determine whether they were coerced into abortions, and whether they have physical or mental risk factors that might lead to problems post abortion.
If this bill were actually written with any care for women’s health, wouldn’t these questions also be asked of any woman carrying a child to term: Have you been forced into it? What factors do you have that may put you at risk for mental or physical problems during and after the pregnancy?
I hope, actually, that most competent health providers would have these conversations with their patients even without a bill to guide them. The difference here is that it explicitly gives patients the right to sue doctors if they aren’t ‘screened’ – and later have emotional or physical problems they attribute to their abortion. Again, doing this for abortions and not for pregnancy (given that babies carried to term are still way more common than babies aborted) indicates that it’s not about concern for the woman’s health but about reducing the number of abortions by a) making the process more difficult and shaming for women than it already is and b) providing extra cause for physicians to be afraid to perform abortions (although as long as they’ve kept good files on the conversation they had outlining the risks, they should be at no increased risk of losing money beyond the time and expense of defending against a civil court case).
I’m not sure why I felt the need to write 300 words proving this has nothing to do with women’s health. No one is really pretending it does (unless that’s their argument when this bill is challenged). I’m just annoyed and this is my way of dealing.
Also, I like this paragraph a lot:
“Supporters say it simply puts abortions in line with other medical procedures in which patients are screened for possible problems. . . The measure is unusual, however, in spelling out what factors doctors must consider when doing the screenings. Schleppenbach said that’s because doctors otherwise would turn to other abortion providers to set the standards for the medical community.”
Last I checked, in most states only doctors can provide abortions, and in some places nurses. So I’m sort of curious who these nefarious ‘other abortion providers’ are.
Hmph.
Kristof wrote another editorial about the ongoing violence in the DR Congo. It’s graphic, and horrifying, which is fine, because we should be horrified.
He wrote one a week or so ago that I didn’t publicize, because the theme (why are we talking so much about Haiti and not about the Congo?) is a frustrating one to me – we SHOULD be paying attention to Haiti. But I share his absolute frustration that something so evil has been happening for so long without intervention or even much concern on the part of the global community (including myself in that).
