Thursday, August 30, 2012

My Summer Reading List

For those who have been following along this summer, if you are interested in learning more about development, aid, public health in the developing world, problems in the poor countries of the world more generally, and how it all impacts us, here is a list of the (relevant) books I read during my time in Madagascar, as well as the ones that are next on my reading list.

·         The Bottom Billion: Why the Poorest Countries Are Failing and What Can Be Done About It, by Paul Collier
o    A brilliant economist’s thoughts on why the 60 countries that are home to about a billion of the poorest people on earth are not actually developing but stagnant, and should be approached as such, rather than lumping the world into two categories (developed vs. developing).

·         Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, by Abhijit Banerjee and Esther Duflo
o   Chock full of interesting studies and very well-written book on the various reasons that the poor stay poor, specifically looking at the cultural mindsets that we as first-world citizens may not even think could exist, and how we can help break the cycle.

·         Half the Sky: Turning Oppression Into Opportunity for Women Worldwide, by Nicholas Kristof and Sheryl WuDunn
o   An incredibly moving book written by two Pullitzer-winning NY Times journalists about the myriad ways that women are being oppressed and abused throughout the world and some of the heroic efforts currently underway to fight the problem. Lots of detailed stories of individual women in many countries, and some concrete suggestions for how to get involved.

·         Nudge: Improving Decisions About Health, Wealth, and Happiness, by Richard Thaler and Cass Sunstein
o   This book isn’t about the developing world but it applies equally anywhere. For me it helped to solidify my thoughts about public health interventions, as it gives some insight into how people make decisions and shows you that we don’t always make the best decisions for ourselves. If you are in a position – government, health care worker, even just a voter – to influence people to make better decisions for their own good and that of others (such as quitting smoking or getting vaccinated, for example), this is an interesting read.

·         The Science of Evil: On Empathy and the Origins of Cruelty, by Simon Baron-Cohen
o   A very interesting look at the biological origins of empathy, examining the range from the overly empathic psychotherapist to the autistic person (lacking in empathy but with potentially positive consequences) to the psychopath (lacking in empathy and with negative consequences). I hadn’t intended this book to be relevant to my time in Madagascar, but it helped give me some perspective to think about maternal instincts and how mothers could be willing to let their children starve to death even when they have another option.

·         Code of the Street: Decency, Violence, and the Moral Life of the Inner City, by Elijah Anderson
o   I happened on this book a bit randomly. It is a sociological study by a UPenn professor who spent a lot of time interviewing poor, inner-city blacks in Philadelphia about their beliefs and practices. It is an interesting look into the culture of the inner city, and somewhat surprisingly I found a lot of parallels between what Anderson describes and the culture in sub-Saharan Africa.

·         The Madagascar I Love, by Arkady Fiedler
o   Again a random find (free for Kindle on Amazon). An account by a European explorer to Madagascar in the early 20th century. Amusingly racist, and funny to think how today’s sex tourism industry in Madagascar may have its origins in the custom of providing a girl to every European visitor as a show of hospitality. Interesting to put things into some historical context if you are visiting Madagascar.

What I’ll be reading next:

·         The End of Poverty: Economic Possibilities for Our Time, by Jeffrey Sachs
o   This is Sachs’ seminal work, laying out his side of the aid argument, which is in favor of giving people as much aid as possible in an effort to break the cycle of poverty.

·         The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good, by William Easterly
o   Easterly’s seminal work, in which he (essentially) opposes Sachs by arguing that we must use the free market to encourage development among the poor, as aid will not be useful until people demand it of their own volition.     

·         Pathologies of Power: Health, Human Rights, and the New War on the Poor, by Paul Farmer
o   A look at human rights abuses in the context of public health, with examples from countries such as Haiti, Peru and Russia. Farmer is a passionate physician who is the incredibly inspiring founder of Partners in Health. See also Mountains Beyond Mountains by Tracy Kidder.

·         The Poor and Their Money, by Stuart Rutherford
o   A look at why microfinance does or does not work, by examining how the poor save and budget, which is not at all using the same strategies as the rest of us.

·         Not for Sale, by David Batstone
o   A call to arms against human trafficking

Saturday, August 18, 2012

Being schizophrenic is no fun anywhere, but…

Normally I try not to write so often because I’m afraid you all will stop reading, but I got inspired this morning and wanted to share with you. I’m hoping you’ll decide this is interesting rather than filing me as spam.

Today I went on an exploratory visit to some tiny villages near Ambovombe, looking for sites where my NGO can start doing screenings. Our first stop was Mahavelo, which is about a mile from Ambovombe. What I wasn’t told before going there is that it’s not actually a village in the traditional sense, but a treatment center for the insane.  The story as it was told to me was that in 1992 a Malagasy pastor from the Lutheran Church came here and built the church, around which, as word got out, a town slowly built up composed of “crazy people” and their families.

In fact, however, these people aren’t really “crazy” but possessed by devils, anywhere from one to hundreds, who speak through them, often in tongues. Sometimes the devils bring translators with them, so you will hear the devil speak first and then the translation in Malagasy. Treatment lasts from three months – if there is only one devil inside – to much longer if you have to expel hundreds of them (and their translators). The treatment consists of an intense period of prayer, starting at 4am on Monday and continuing all day every day throughout the week. On Saturday afternoons at 2:30, they all get dressed up in white outfits, burn traditional medicines, and make gestures as though they are slapping the spirits (although apparently they don’t make physical contact) and yell at them to “get out in the name of Jesus Christ.”
The woman pictured here was a “new arrival,” who had just come in today and apparently was likely to run away. As you can see, they have bound her hands and ankles, and I found her lying in the dirt talking to herself, which was, of course, proof that she really was possessed by devils.  To be fair, she was the only one I saw tied up. Most everyone else was working – pounding corn and such – or lying around on mats.

According to several relatively well-educated people here locally, this is all 100% true, both the possession by devils and the efficacy of the treatment. Apparently there are psychiatrists here in Ambovombe, but I was told that only people who “don’t go to church” see the psychiatrists, and those who go to church just go to get their demons exorcised in Mahavelo.

So it looks like there is a niche to be filled by a psychiatric NGO if anyone is inspired, and yet another reason to be thankful for what we have, because as bad as it sometimes is in America, it could be worse.

Thursday, August 16, 2012

Should we be force feeding African children?

I haven’t been very inspired to write for the past month or so, as there has been a lot of drama and negativity amongst the volunteers here that I don’t really want to go into. I had a couple of really nice visits to some national parks, saw dancing lemurs and the world’s smallest chameleon, and now I’m in Ambovombe, an incredibly poor town in the far south of Madagascar.  I had to get here by way of Fort Dauphin, which I expected to be relatively large given that it’s got the only airport in the region, but instead I found a ghost town with what looked like long-abandoned buildings. Given the general deterioration of the situation here in Madagascar, partly because that’s the way it always is and partly because of the “transitional government” (the DJ president who gained power via coup d’etat 3 years ago), there has also been increasing violence in the region. Just last week a band of thieves attacked and murdered people outside of Ambovombe in order to steal their zebu (cows), and it’s not safe to walk outside the main streets during the day or anywhere after dark, which unfortunately starts at 6pm.

But even more striking is the poverty I’ve found in Ambovombe. The region is dry and windswept, the landscape covered in cactus. The town itself is the capital of the region, with about 40,000 people living in it, although it mainly comprises one long, dusty street with some smaller streets off to the side. The big problem here, which has been a problem for decades, is that there is no water. They have dug some wells but they have to go incredibly deep to find water and they keep drying up. They cart in water from these wells via zebu-drawn cart, and people have to buy it, and it’s expensive. As a result of this there has been widespread famine, and various well-known NGOs (you can guess who they are) have been here at various times or continuously through the last several decades trying to help. As one long-term volunteer put it to me, “I think the best answer for the food and water problems here is for everyone to just move somewhere else.”

One large NGO is handing out PlumpyNut, a nut-based protein and vitamin concoction that is designed for severely malnourished children, and various other groups are giving out rice, cassava and other staple foods. Unfortunately what has happened is that anything given to moms for their malnourished kids – including food and hygiene products like soap – is instead sold on the street to buy cassava for the fathers, with only leftovers going to the kids. Despite being educated that malnutrition leads to disease and death in children, the mothers feel compelled, for reasons I don’t entirely understand, to put the fathers first, even if it means their children suffer. Various explanations have been offered to me by locals, for example that people here are short-sighted and unable to see beyond the right now that their child is currently alive, or that elders are held in esteem while children are considered little more than a nuisance, or even that husbands beat their wives if they are not fed first, but I am having trouble wrapping my head around the fact that the maternal instinct does not outweigh all of those cultural factors. And in truth, though I have come here to try to figure out how the NGO I’m working with can contribute to the fight against malnutrition, it is difficult for me to see how I can convince mothers to care about their own children’s welfare if they don’t do so already.

The solution I’ve arrived at is something akin to “directly observed therapy” like we use for TB patients, wherein we would give the kids PlumpyNut but they would have to eat it in front of us rather than take it home where it could be sold instead. Maybe a few better-nourished kids would be enough eventually to break the cycle and show people it doesn’t have to be this way. However, this solution is extremely labor intensive, and moreover it starkly emphasizes the fact that we are forcing something on these people that they do not want. Even if the thing we are forcing is nutrition for children, it starts to walk a line where you begin to question who has the right to tell other people what to do, and why I, as a white person, think I have the right to tell an African mother how to raise her children.

I just finished reading The Bottom Billion, by Paul Collier, a book you should read if you haven’t already. Madagascar is solidly among those bottom billion, which are a group of about 60 countries that, while you may think of them as part of the “developing world,” in reality are not developing at all, but for various reasons are just stagnant. The author tells a story about how the former president of Madagascar, unhappy at having lost an election, decided to blockade a port that was the main source of growth and jobs for his country, in hopes of blackmailing his way back into the presidency. After 8 months and the loss of more than 250,000 jobs, he finally gave up, but by then the foreign companies who had been using the port had been scared off. Collier quotes one company’s manager as saying “If it’s like that, then count us out. We’ll stick to Asia.”

This president’s short-sightedness and selfishness are pretty typical of what I’m seeing here on a day to day basis. These people seem determined to work against their own best interests no matter how hard anyone tries to show them another way is possible. At some point you start to wonder if it would be better to go to a country where they are interested in learning, collaborating and bettering themselves, and to come back to Madagascar when they’ve developed enough to want that, too. One of the major arguments made in The Bottom Billion is that aid to these countries is most effective when timed with movements within a country, such as just after a major conflict, when the people are looking to make changes and improvements. But of course, it’s not so easy to turn your back on a country with such obvious need while you are waiting for them to revolt.

So what’s the answer? Do we force feed the kids and hope that eventually they see the positive effects of good nutrition and want to continue it on their own? Do we throw in the towel and go somewhere where our efforts are appreciated and welcomed in hopes that with cooperation from local people we can make a bigger difference? Do we keep on walking the middle ground, making ourselves feel better by handing out PlumpyNut to malnourished children and ignoring the fact that it’s not actually reaching the children at all? I don’t feel right about the last option, although this is what the major NGOs are doing and it certainly avoids any moral dilemmas about forcing our views onto unwilling people. Of the first two, I don’t know that there is a “right” answer, but I look forward to hearing your comments and opinions.

Adventure map for 2009...