June 18, 2011
The Weirdness of Walking to Raise Money
By TED GUP
IT’S a peculiar institution, this walking to raise money.
Not long ago, I stood on a corner near my home and watched as some of the 42,000 men, women and children participating in Boston’s Walk for Hunger strode by. Their 20-mile round-trip trek was a success, raising $3.6 million for food banks. It was as if, by burning calories, they were feeding the hungry.
Still, the logic that united the walkers, the donors and the hungry mystified me. After years of witnessing such events I still wonder why we must be a nation in motion to secure aid for the needy.
Why are benefactors moved by the sight of urban hordes headed for the suburbs and back? Why do such exertions trigger the charitable impulse?
What I saw that morning in Boston was a resource diverted from its true purpose. Imagine those 210,000 man-hours (42,000 times a five-hour walk) put into direct service to benefit the poor. Think of the houses that might be built, roofs repaired, gardens planted and harvested, public spaces improved, and meals delivered to shut-ins. (And add in the efforts of the 2,000 volunteers that day and the contributions of 50,000 donors.) Now multiply that by the millions of man-hours that are represented by such events in cities across the nation, from Los Angeles to Louisville, Ky., from Austin, Tex., to Grand Rapids, Mich.
In the charitable ritual that has evolved, two sides expend energy, but only the sponsors’ efforts directly aid the poor. The others’ is pure sweat equity that goes nowhere but down the necks of the participants. Consider, too, the public resources expended: the rescue squads and medics along the way, the police sealing off urban arteries, the snarling of traffic. We tie our cities in knots. Enduring such inconvenience is what each of us gives to the cause.
I do not question the sincerity of the participants, but in these mass mobilizations I see many lost opportunity costs. I recognize the value of exercise and companionship, but question why society values these schemes.
The easy explanation, of course, is that there would be no giving — or not nearly so much — without the walks. Fund-raisers recognize that the nobility of giving is often stimulated by activities that conjoin the selfless with self-interest. For giving, we often offer value received. Raffles and auctions and naming rights are among the inducements used to win support. But that’s not what’s going on here.
Those who oversee such fund-raising spectacles argue that there is more to these events than meets the eyes — mine included. These walks and runs are incubators for future volunteers and donors. They constitute a public proclamation that others matter. They make the invisible visible. More to the point, it is easier to get relatives, friends and colleagues to open their pocketbooks than it is to win over the largess of strangers.
That is the genius of such events. Where abstract appeals on behalf of the faceless needy may fall on deaf ears, appeals from family and neighbors do not. Ultimately, it is not the mass of walkers that moves us to give, but the knowledge that a familiar face — a nephew or friend — is among them. It personalizes the issue, quite literally turning the abstract into the concrete, converting perspiration into philanthropy. There is an exquisite — albeit attenuated — logic to it all.
In the end, getting others to give is as much art as science, and if traversing great distances is what it takes to discover that charity begins at home, then so be it.
These events have become so deeply rooted in our cities and culture that their eccentricities and irrationalities escape our notice, lost in the blur of matching T-shirts, sponsors’ logos and banners. Through my puzzlement, I too applaud and cheer them on.
Ted Gup, the chairman of the journalism department at Emerson College, is the author, most recently, of “A Secret Gift: How One Man’s Kindness — and a Trove of Letters — Revealed the Hidden History of the Great Depression.”
June 22, 2011
The Breast Milk Cure
By NICHOLAS D. KRISTOF
DOGON DOUTCHI, Niger
What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn’t require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes?
Impossible, you say? Actually, this miracle cure already exists. It’s breast milk.
When we think of global poverty, we sometimes assume that the challenges are so vast that any solutions must be extraordinarily complex and expensive. Well, some are. But almost nothing would do as much to fight starvation around the world as the ultimate low-tech solution: exclusive breast-feeding for the first six months of life. That’s the strong recommendation of the World Health Organization.
The paradox is that while this seems so cheap and obvious — virtually instinctive — it’s also rare. Here in Niger, only 9 percent of babies get nothing but breast milk for the first six months of life, according to a 2007 national nutrition survey. At least that’s up from just 1 percent in 1998.
(In the United States, about 13 percent of babies are exclusively breast-fed for six months, according to the federal Centers for Disease Control and Prevention. Then again, most of the rest get formula, which is pretty safe in America.)
Next door to Niger in Burkina Faso, fewer than 7 percent of children get breast milk exclusively for six months. In Senegal it’s 14 percent; in Mauritania, 3 percent.
These are some of the countries we’re passing through on my annual win-a-trip journey, this year with a medical student from Atlanta, Saumya Dave, and a teacher from Newark, Noreen Connolly. It’s heartbreaking to see severely malnourished children and to meet mother after mother who has buried children when such a simple life-saving solution is not applied.
The biggest problem is that many mothers believe that breast milk isn’t enough, and that, on a hot day, a child needs water as well.
On a rural road near the remote town of Dogon Doutchi, in southern Niger, we ran into a family of Tuareg nomads traveling north.
“On a hot day, babies need water,” Gayshita Abdullah, the mother, told me. She said she tries to get water from a well, but if there is no well nearby she gets it from a mud puddle.
In fact, most nutritionists are adamant that babies are best off with nothing but breast milk for the first six months of life (they used to recommend four months, but now say six months). And water in poor countries is often contaminated and dangerous for a baby.
Even when the mother is herself malnourished, her body will normally provide enough milk for a baby, nutritionists say.
A 2008 report in The Lancet, the British medical journal, found that a baby that is partially breast-fed is 2.8 times as likely to die as a baby that is exclusively breast-fed for at least five months. A child that is not breast-fed at all is 14.4 times as likely to die.
Over all, The Lancet said, 1.4 million child deaths could be averted each year if babies were breast-fed properly. That’s one child dying unnecessarily every 22 seconds.
“As far as nutritional interventions that have been studied, we have crushing evidence of breast-feeding’s efficacy in reducing child mortality,” said Shawn Baker, a nutrition specialist with Helen Keller International, an aid organization that works on these issues.
“It’s the oldest nutritional intervention known to our species, and it’s available to everybody,” Baker added. “But for a development community too focused on technological fixes, it hasn’t gained the traction it should.”
The challenges with breast-feeding in poor countries are not the kinds that Western women face, and many women in the developing world continue nursing their babies for two years. The biggest problem is giving water or animal milk to babies, especially on hot days. Another is that mothers often doubt the value of colostrum, the first milk after childbirth (which is thick and yellowish and doesn’t look much like milk), and delay nursing for a day or two.
One mother near the town of Dosso, Fati Halidou, who has lost four of her seven children, told me that after childbirth, it is best to give a baby sugar water or Koranic water. This is water made by writing a verse of the Koran on a board and then washing it off; the inky water is thought to protect the child.
It’s not clear why a human instinct to nurse went awry. Does it have something to do with the sexualization of breasts? Or with infant formula manufacturers, who irresponsibly peddled their products in the past but are more restrained now? Or is it just that moms worry that their babies need water on hot days? Nobody really knows.
But what is clear is that there’s a marvelous low-tech solution to infant malnutrition all around us.
I invite you to visit my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.
August 22, 2011
The Rugged Altruists
By DAVID BROOKS
Many Americans go to the developing world to serve others. A smaller percentage actually end up being useful. Those that do have often climbed a moral ladder. They start out with certain virtues but then develop more tenacious ones.
The first virtue they possess is courage, the willingness to go off to a strange place. For example, Blair Miller was a student at the University of Virginia who decided she wanted to teach abroad. She Googled “teach abroad” and found a woman who had been teaching English in a remote town in South Korea and was looking for a replacement.
Miller soon found herself on a plane and eventually at a small airport in southern South Korea. There was no one there to greet her. Eventually, the airport closed and no one came to pick her up. A monk was the only other person around and eventually he, too, left and Miller was alone.
Finally, a van with two men rolled in and scooped her up. After a few months of struggle, she had a fantastic year at a Korean fishing village, the only Westerner for miles and miles. Now she travels around Kenya, Pakistan and India for the Acumen Fund, a sort of venture capital fund that invests in socially productive enterprises, like affordable housing and ambulance services.
The second virtue they develop is deference, the willingness to listen and learn from the moral and intellectual storehouses of the people you are trying to help.
Rye Barcott was a student at the University of North Carolina who spent a summer sharing a 10-by-10 shack in Kibera, the largest slum in Nairobi, Kenya. One night he awoke with diarrhea and stumbled to the public outhouse. He slid onto the cement floor and vomited as his bare body hit puddles of human waste.
He left his soiled pants outside the hut, but when he went to find them later they were gone. He was directed to another hut where a stick-thin girl, with missing clumps of hair, had the pants, scrubbed and folded, in her lap. Barcott said softly, “I’m grateful,” and asked her why she had cleaned them. “Because I can,” she replied. A week later, she died of AIDS and her body was taken in a wheelbarrow to a communal grave.
Over the next several years, Barcott served as an officer in the Marines in places like Iraq and created an inspiring organization called Carolina for Kibera, which offers health services and serves as a sort of boys and girls club for children in the slum.
The greatest and most essential virtue is thanklessness, the ability to keep serving even when there are no evident rewards — no fame, no admiration, no gratitude.
Stephen Letchford is a doctor working in Kijabe, Kenya. One night, years ago, when he was working at a hospital in Zambia, a man stole a colleague’s computer. Letchford drove the police down the single road leading from town. The police found the man carrying the computer and, in the course of the arrest, shot him in the abdomen.
They put the man in the back of the car and rushed him back to the hospital to save his life. Letchford pressed his wounds to stem the bleeding, using tattered garbage bags as surgical gloves. He had scraped his hands gardening that day and was now covered by the man’s blood.
They saved the thief’s life and discovered he was infected with H.I.V. For several days, Letchford and his family were not sure whether he had been infected by the man who robbed them. Their faith was tested. (They later learned that he was not infected.) When the man recovered, he showed no remorse, no gratitude; he just folded in on himself, cold and uncommunicative.
This final virtue is what makes service in the developing world not just an adventure, a spiritual experience or a cinematic moment. It represents a noncontingent commitment to a specific place and purpose.
As you talk to people involved in the foreign aid business — on the giving and the receiving ends — you are struck by how much disillusionment there is.
Very few nongovernmental organizations or multilateral efforts do good, many Kenyans say. They come and go, spending largely on themselves, creating dependency not growth. The government-to-government aid workers spend time at summit meetings negotiating protocols with each other.
But in odd places, away from the fashionableness, one does find people willing to embrace the perspectives and do the jobs the locals define — in businesses, where Westerners are providing advice about boring things like accounting; in hospitals where doctors, among many aggravations, try to listen to the symptoms the patients describe.
Susan Albright, a nurse working with disabled children in Kijabe, says, “Everything I’ve ever learned I put to use here.” Her husband, Leland Albright, a prominent neurosurgeon, says simply, “This is where God wants us to be.”
August 23, 2009
The Women’s Crusade
By NICHOLAS D. KRISTOF and SHERYL WuDUNN
IN THE 19TH CENTURY, the paramount moral challenge was slavery. In the 20th century, it was totalitarianism. In this century, it is the brutality inflicted on so many women and girls around the globe: sex trafficking, acid attacks, bride burnings and mass rape.
Yet if the injustices that women in poor countries suffer are of paramount importance, in an economic and geopolitical sense the opportunity they represent is even greater. “Women hold up half the sky,” in the words of a Chinese saying, yet that’s mostly an aspiration: in a large slice of the world, girls are uneducated and women marginalized, and it’s not an accident that those same countries are disproportionately mired in poverty and riven by fundamentalism and chaos. There’s a growing recognition among everyone from the World Bank to the U.S. military’s Joint Chiefs of Staff to aid organizations like CARE that focusing on women and girls is the most effective way to fight global poverty and extremism. That’s why foreign aid is increasingly directed to women. The world is awakening to a powerful truth: Women and girls aren’t the problem; they’re the solution.
September 28, 2011
Just Look at What You Did!
By NICHOLAS D. KRISTOF
In a Mother’s Day column in the spring, I suggested that readers commemorate the day not only with flowers but also with a donation to lift up women around the world. Readers showered one group that I mentioned, www.MothersDayMovement.org, with more than $135,000 that was forwarded to a slum empowerment group in Kenya.
So while in Kenya recently, I dropped by to see what was being done with your money. In the grim alleys of the Kibera slum in the capital of Nairobi, I found a dazzling girls’ school being built with some of those donations — and, yes, I found a love story.
The saga begins with a young man named Kennedy Odede who grew up in the slum. He never received a formal education and lived homeless on the streets after the age of 10, but he was exceptionally bright and taught himself to read.
When he was about 15, a visiting American gave him a book about Nelson Mandela — a biography that captivated Kennedy. Another American visitor, charmed by hearing of the impact of the first book, gave him a biography of the Rev. Dr. Martin Luther King Jr. “That book changed my life,” Kennedy recalls.
Dazzled by Mandela and King, Kennedy resolved to fight for social justice. Already active in Kibera, he bought a soccer ball and announced the formation of a youth soccer club that would wrestle with social issues.
Kennedy had become outraged at the abuse of women, partly because his 16-year-old sister had been raped and become pregnant. So his soccer club began to hold street theater performances to denounce sexual violence.
Jessica Posner, a Wesleyan University student interested in theater, heard about the performances and decided to spend a junior year abroad helping the group. She arrived in Nairobi — and then insisted on living inside the Kibera slum itself.
“I thought she was crazy,” Kennedy remembers. He told her that there was no indoor toilet or running water, and plenty of rats. She is white, and Kennedy told her that no white people lived anywhere nearby. But Jessica got her way, sharing a room with four other people — and a romance blossomed.
Kennedy told Jessica of his dream to get an education, and Jessica nudged the Wesleyan admissions office into offering him a full scholarship — even though he had never gone to formal school before.
So Kennedy flew to Connecticut to begin college as a freshman at the age of 23, and, after her graduation, Jessica flew out to Nairobi to help expand his program, called Shining Hope for Communities (ShiningHopeforCommunities.org). They won grants from Newman’s Own Foundation, Echoing Green and DoSomething.org, and they used the money and Jessica’s savings to start the Kibera School for Girls.
Jessica, now 25, showed me around — chattering with local people in the Swahili and Luo languages. It’s staggering what she and Kennedy have created. The Kibera School for Girls now has 64 students in pre-kindergarten through second grade, adding one grade a year. Almost 500 children competed for the 19 slots in the current pre-kindergarten.
The school looks like a good American school, and classes are taught in English. Even though English is a second or third language for these children, 82 percent perform at American grade level — and these kids are ravenous to learn.
“Some of the first and second graders are reading at seventh-grade level,” Jessica said proudly.
Still, obstacles are enormous. This broke my heart: At least 20 percent of the girls have been raped, the teachers say. Rapes have left two of the kindergarten girls with fistulas, internal injuries causing them to leak wastes.
The school has helped prosecute an alleged rapist of a 4-year-old kindergartner who required surgical repairs and is working to end the impunity on sexual violence in the community. It also provides a dormitory for half-a-dozen girls who are at risk of sexual violence in their own homes.
With the money from Times readers, Shining Hope is now building a much larger school that is expected to accommodate 500 pupils. It has also bolstered services, including free family planning, for women at a clinic it runs. It trains women entrepreneurs and has just installed a new water tower that is expected to become the slum’s largest source of clean water. It operates a public library and computer center where slum-dwellers can earn money by performing Internet piece work.
Shining Hope also oversees a network of public toilets, one of which produces biogas used to cook meals for children at the school.
All this may be just a beginning. Kennedy says his dream is to expand Shining Hope across East Africa.
So that’s what your money has wrought. You should be proud. And one more thing to make the story perfect: In June, after Kennedy graduates, he and Jessica plan to marry.
November 2, 2011
The Birth Control Solution
By NICHOLAS D. KRISTOF
What if there were a solution to many of the global problems that confront us, from climate change to poverty to civil wars? There is, but it is starved of resources. It’s called family planning, and it has been a victim of America’s religious wars.
Partly for that reason, the world’s population just raced past the seven billion mark this week, at least according to the fuzzy calculations of United Nations demographers. It took humans hundreds of thousands of years, until the year 1804, to reach the first billion. It took another 123 years to reach two billion, in 1927. Since then, we’ve been passing these milestones like billboards along a highway. The latest billion took just a dozen years.
In 1999, the United Nations’ best projection was that the world wouldn’t pass seven billion until 2013, but we reached it two years early. Likewise, in 1999, the U.N. estimated that the world population in 2050 would be 8.9 billion, but now it projects 9.3 billion.
What’s the impact of overpopulation? One is that youth bulges in rapidly growing countries like Afghanistan and Yemen makes them more prone to conflict and terrorism. Booming populations also contribute to global poverty and make it impossible to protect virgin forests or fend off climate change. Some studies have suggested that a simple way to reduce carbon emissions in the year 2100 is to curb population growth today.
Moreover, we’ve seen that family planning works. Women in India average 2.6 children, down from 6 in 1950. As recently as 1965, Mexican women averaged more than seven children, but that has now dropped to 2.2.
But some countries have escaped this demographic revolution. Women in Afghanistan, Chad, Congo, Somalia, East Timor and Uganda all have six or more children each, the U.N. says. In rural Africa, I’ve come across women who have never heard of birth control. According to estimates from the Guttmacher Institute, a respected research group, 215 million women want to avoid getting pregnant but have no access to contraception.
What’s needed isn’t just birth-control pills or IUDs. It’s also girls’ education and women’s rights — starting with an end to child marriages — for educated women mostly have fewer children.
“In times past, the biggest barrier to reducing birth rates has been a lack of access to contraceptives,” the Population Institute notes in a new report. “Today, the biggest barrier is gender inequality.”
The seven billion population milestone is also a reminder that we need more research for better contraceptives. One breakthrough is an inexpensive vaginal ring that releases hormones, lasts a year and should not require a doctor. Developed by the Population Council, it has completed Phase 3 trials and seems highly effective. It could even contain medication to reduce the risk of an infection with the AIDS virus.
Traditionally, support for birth control was bipartisan. The Roman Catholic hierarchy was opposed, but Republican presidents like Richard Nixon and George H.W. Bush provided strong support. Then family planning became tarnished by overzealous and coercive programs in China and India, and contraception became entangled in America’s abortion wars. Many well-meaning religious conservatives turned against it, and funding lagged. The result was, paradoxically, more abortions. When contraception is unavailable, the likely consequence is not less sex, but more pregnancy.
Contraception already prevents 112 million abortions a year, by U.N. estimates. The United Nations Population Fund is a bête noire for conservatives, but its promotion of contraception means that it may have reduced abortions more than any organization in the world.
Republicans are seeking to cut more money from global family planning — which, in poor countries, would mean more abortions and more women dying in childbirth. Conservatives have also sought to slash Title X Family Planning programs within the United States. The Guttmacher Institute estimates that in a year these domestic programs avert 973,000 unintended pregnancies, of which 406,000 would end in abortions.
Guttmacher calculates that these family-planning centers in the United States actually save taxpayers roughly $3.4 billion annually that would otherwise be spent on pregnancies and babies.
Finally, a ray of hope: A group of evangelical Christians, led by Richard Cizik of The New Evangelical Partnership for the Common Good, is drafting a broad statement of support for family planning. It emphasizes that family planning reduces abortion and lives lost in childbirth.
“Family planning is morally laudable in Christian terms because of its contribution to family well-being, women’s health, and the prevention of abortion,” the draft says.
Amen! Contraceptives no more cause sex than umbrellas cause rain.
So as we greet the seven-billionth human, let’s try to delay the arrival of the eight billionth. We should all be able to agree on voluntary family planning as a cost-effective strategy to reduce poverty, conflict and environmental damage. If you think family planning is expensive, you haven’t priced babies.
I invite you to visit my blog, On the Ground. Please also join me on Facebook and Google+, watch my YouTube videos and follow me on Twitter.
Hashoo Foundation seeks to empower Pakistani women
Murtaza Ali Shah
Friday, October 14, 2011
LONDON: Women in the UK have been urged in a landmark campaign to bond with needy Pakistani women to help empower them and increase their social and economic prospects.
Philanthropist and Chair of Hashoo Foundation, Sarah Hashwani made this appeal at the launch of the Hashoo Foundation's UK Chapter launching here at a gala dinner on Wednesday night.
Sarah Hashwani announced the launch of the campaign “500 for 500”, which will focus on fundraising to help empower women living in the remote regions of Northern Pakistan.
Former UN ambassador to Pakistan Sir Mark Lyall Grant, Pakistan's High Commissioner to the UK Wajid Shamsul Hasan and Sadruddin Hashwani, Patron in Chief, were present on the occasion, with a host of special guests and dignitaries in attendance. Sarah Hashwani said: “We started work on this initiative a few weeks back and I have been amazed, delighted and touched by the level of support that the UK women have already given to the idea. We have women from all walks of life coming forward to lend their support and use their networks to engage more women.
The simplest proposition can change the lives of so many in Pakistan.”
The 500 for 500 campaign aims at inviting and engaging 500 women from the UK to join hands with 500 women in the Northern Areas of Pakistan, through the foundationís award-winning Plan Bee project, which provides women in the Northern region of Pakistan with the opportunity to become beekeepers.
It is based on a system of social barter, designed to promote social change and enhance women ability to work independently and in their spare time.
Sarah Hashwani told The News that the focus will remain to increase household incomes so that the standard of living of families could improve and they could get better access to education and health.
“We want to expand and there are so many Pakistanis here in the UK who wants to invest in Pakistan, but want a transparent organisation to contribute with comfort. We are sure we will work with fairness and will be able to utilise the money of donors in the right way.”
Sarah said she was very happy with the response and many leading professional Pakistani women have come forward to announce their help. “Our supporters will arrange dinners at their houses to raise funds and to create connections with the Pakistani women for their betterment,” she said.
Sir Grant appreciated the remarkable commitment of Hashwani family to help the poor people of Pakistan and the efforts made the foundation to increase the self-reliance of some of the most vulnerable sections of the Pakistani society.
He said the Hashoo Foundation had in a short time come from being a family-based charity to emerge as a leading global development organisation.
Sir Grant said he was impressed by the resilience and resourcefulness of Pakistani people and their eagerness to aspire and pursue a better way of life for themselves. He spoke of his familyís historic links with Pakistan and the remarkable qualities of Pakistan that he remembered.
He said there were many challenges that needed to be met head-on, but they should not “hide the underlying qualities of the people of Pakistan”.
Sadruddin Hashwani informed the audience that his foundation's vision is to help create an ethical and inclusive society in which people live with dignity and have power over their own lives.
He said those who have been gifted with wealth and resources should never forget those who are in need.
“One day, we all have to go back,” Hashwani said, emphasising the need for generous giving.
A number of Pakistani women have come forward to become volunteer first set of ambassadors, which include: Adeeba Malik, a business women; model and TV presenter Gulzaeb Beg; the UK’s youngest Muslim female Councillor, Rabia Bhatti; fashion designer Raishma Islam; Dr Shaheena Janjuha-Jivraj, a businesswoman, broadcaster and presenter Yasmeen Khan and make-up artist Zaynab Mirza.
International Group - The Institute of Rural Education and Development
During a three year work assignment in Chitral, Pakistan, Aly Nanji saw
it was absolutely apparent that a change was put in place to better the
lives of children and adults. IREAD's best solution to the problems of
poverty, ignorance and hopelessness was to start with the younger
children and give them the best possible education.
"Visiting the villages we found that people were leading a very poor
lifestyle, said Aly Nanji. "They were badly situated in the sense that
there were no schools and there was no hope for the children."
The Institute of Rural Education and Development was formed in 2009 by
Aly Nanji and Dr. Noorali Jaffer to advance education in the developing
world by establishing and operating Early Childhood Education Centres in
the remote regions of the Chitral District in Pakistan.
"The impact to me is that I had tears in my eyes because these people
are so thankful for what you're doing," said Dr Nooralli Jaffer. "That
basically sealed the deal that I was coming back and I was going to help
IREAD has worked on numerous projects and all with the same goals in
mind - long term sustainability, advancement in education and a safe and
healthy place for children to grow and learn. Aside from building Early
Childhood Centres and training teachers, IREAD has also sponsored 64
students to begin schooling at the High School level.
IREAD wants to give young boys and girls hope and support to finish
their High School education and pursue careers and a better life.
With future goals of expanding across the world, IREAD wishes to bring
hope, stability and peace in the much needed areas of the third world.
December 8, 2011, 9:30 pm
Keeping the Water Flowing in Rural Villages
By TINA ROSENBERG
Fixes looks at solutions to social problems and why they work.
health, Third World and Developing Countries, Water
Keeping projects in business for the long term has been a constant theme of the Fixes column, and if sustainability has a poster child, it would be a water pump. Travel anywhere in Africa or South Asia or Central America, and you will find a landscape dotted with the rusting skeletons of dead water pumps or wells..
In most developing countries, these water points are installed with great fanfare by the government or a charitable group. They greatly improve the lives of villagers. Having a water point in or near the village means that women don’t have to spend 6,8, even 12 hours a day on perilous journeys to fetch water from rivers or lakes. The pumps allow girls to go to school instead of staying home to help their mothers fetch water or take care of siblings. They allow villagers to drink reasonably clean water instead of risking their health with every sip.
Then something breaks on the pump — a huge catastrophe like an underground pipe bursting, or a small one, like the loss of a bolt or a washer. And it never works again.
Early death is shockingly widespread for water pumps. Perhaps the biggest study of this ever was carried out in 21 African countries by an organization called Sustainable Water Services at Scale. It found that 36 percent of pumps were not working. “This level of failure represents a waste of between $1.2 billion and $1.5 billion in investments in 20 years,” said the organization.
In Tanzania, mapping of water points showed that nationally, less than half the existing rural water points were working. Of water points that were less than two years old, a quarter had already stopped functioning.
Why, when communities benefit so obviously from water, do so many water points fall out of use? The short answer is that keeping the pumps running usually falls to the community or local government. But it requires specialized skills, spare parts, tools and funds. None of these are found in rural villages.
One group taking a hard look at how to solve the problem is the British-based charity WaterAid. When the organization analyzed why water points failed in Tanzania, it found something interesting: the most sustainable were those maintained by private contractors. This is not a ready-made solution; it won’t work everywhere — really poor areas won’t be able to pay. And in some regions, problems like price gouging were associated with private operators. But WaterAid felt it might be able to solve these problems. So in the north of India, it came up with an ingenious way to do just that.
Uttar Pradesh is the most populous state in India — it is also one of the poorest and most drought-prone. The government has been aggressively installing new water pumps, but they quickly fall into disuse. In the Mahoba district, south of the state capital of Lucknow, there are about 12,500 community water pumps, said. K.J. Rajeev, WaterAid’s general manager for the northern region of India. “But 40 percent of them are usually down, especially in summer,” he said. And when they break, they stay broken — three-quarters of the repairs take at least a month, and many are never repaired at all.
Shanti Devi and Ram Sakhi fixing a handpump in the Mahoba district of Uttar Pradesh, India.WaterAid/Marco BettiShanti Devi and Ram Sakhi fixing a handpump in the Mahoba district of Uttar Pradesh, India. CLICK TO ENLARGE
Now things are different in Mahoba. In May, Lisa Millman, WaterAid America’s director of development and communications, was visiting a town called Charkhari. She was sitting in a small storefront office, a shop lined with shelves of hand pump parts, when a cellphone rang. The call was from the village of Kotedar, where the main hand pump had broken. A master mechanic took the call and asked some questions. This was apparently going to be a big job — five mechanics piled onto two motorbikes, along with the 10-year-old son of one of the men. They reached the village 20 minutes later. As a throng of villagers watched, they took out huge wrenches. They disassembled the pump and began pulling up heavy segments of pipe. At the tenth segment they found a hole and patched it. Two and a half hours after they arrived, the pump was reassembled and working. They got on their bikes and rode off into the sunset.
Millman, who had followed in a car, had asked the 10-year-old if he wanted to be a mechanic like his dad. “He was smirking and laughing,” she said. “But after he watched his dad repair the pump, he was in awe.”
WaterAid and its local partners have set up four workshops, called Community Participation Centers, in the Mahoba district, and the project is now expanding into the neighboring state of Bihar. A call to the workshop reaches a master mechanic. He or she can choose the appropriate mechanics in the group, depending on location and skills, to send to address the problem. Each is is equipped with a cellphone, tool kit and a bike, moped or motorbike. Including mechanics-in-training and several who work part time, the centers have 27 female mechanics.
Many of the women were landless agricultural laborers before they learned hand pump repair, and many were members of the Dalit, or Untouchable, caste — the most downtrodden in Indian society. In a very traditional region, where women cover their faces and do not speak in public, it was at first hard to find women who wanted the job. Even some who completed the training didn’t want to go out to villages and work in public, said Rajeev. Now, however, wherever they go, village men accept them and women embrace them. Seeing a mechanic in yellow hardhat and sari has opened up the spectrum of possibilities for village women.
In 14 months of work, the center mechanics have repaired more than 1,100 pumps in Mahoba. Ninety-three percent of the repairs were made within 24 hours of the phone call, and only 3 percent took more than two days. A simple repair costs a village 100 rupees — roughly $2.00 — with more complex repairs costing up to $6. Water quality testing costs $1.20. The mechanics guarantee all work.
Rajeev said that the four Mahoba workshops cost WaterAid about $40,000 to set up — to train mechanics, buy parts and tools, provide bikes and cellphones and visit village councils to promote the new service. But now WaterAid is tapering off financial support to the workshops, which are all operating sustainably and on the verge of meeting their profitability goals. “We will be providing only technical assistance and hand-holding,” he said. To keep the workshops running, the mechanic keeps 70 to 90 percent of the repair fee and deposits the rest in the workshop’s account.
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This isn’t the first time WaterAid tried to train mechanics in the area. In 2004, its local partner recruited men and women and trained them to do preventive maintenance and minor repairs in their own villages. It didn’t last. The trainees learned only the most basic repairs and often had to leave work incomplete. They also earned very little money. So WaterAid then decided it needed to create a real business, using high standards of training, aggressive outreach to village governments and attractive practices like guaranteed work.
Why couldn’t the market take care of this problem? There are hand pump mechanics in Mahoba, after all. But they tend to live in major market cities. Rajeev said they demanded very high fees to go out to remote villages — often too high for villages to pay. There are also information disconnects – they do no outreach to villages, so some village councils don’t know about these mechanics or how to call them.
The market also can’t finance major repairs — most villagers are too poor. The center program can work because the government has a fund that village councils can use to pay for hand pump maintenance. The fund can take 45 days to pay — too long for most traditional mechanics. Center mechanics, however, don’t mind. (Very minor repairs can usually be paid on the spot.) And now four villages have signed maintenance contracts with center workshops, paying directly from the government’s fund.
What’s happening in Mahoba is promising. But the key to this process is that the Indian government pays the bills. In the places where this problem is most serious, government is AWOL. On Wednesday I’ll look at why it has been so difficult to keep water points running, mistakes that water groups have made and what poor villages might do to keep the water flowing.
A doctor treats a patient in pain in Kerala, India.Last year in Mexico, just a couple of days into my vacation, I fractured my kneecap. In the emergency room, through pain so severe I found myself yelling at all helpful parties around me, particularly my wife, the doctors noted that they did not have painkillers to send home with me. “WHAT!?” I screamed. “No oxycodone, hydrocodone, nothing?” They explained that Mexico’s drug laws had grown so strict due to the actions of the narcotraficantes that pain meds were tough to come by (and only provided to patients who had been admitted to the hospital).
Two days later at the airport, the gate agent for American Airlines nearly refused to let me fly because she could see how much pain I was in and thought I might force the plane to make an emergency landing. After much haranguing I was finally allowed to board and made it back home for surgery and painkillers. But this incident compelled me to look at the state of pain management in developing countries.
It is clear that we live in a world where inequities of healthcare are paramount: there are millions dying of AIDS in Sub-Saharan Africa for want of drug therapy, while expensive surgeries for cancer, heart disease, or even to repair an injury like mine is out of reach for the world’s poor.
But what of the inexpensive palliative measures for those experiencing pain? I don’t have to dig very deep in my memory to pull up countless images of people I’ve witnessed in excruciating, seemingly never-ending agony. In Cambodia I came across a man who had lost half of his arm clearing mines, and hours later at a health clinic, he still hadn’t received so much as a Tylenol.
The good news is that public health workers around the world have identified palliative care as a priority: The Kenya Hospices and Palliative Care Association advocates for inclusion of palliative care in medical curricula and key government health strategies. Public health professionals in Vietnam have focused on expanding pain treatment services, and their efforts have resulted in more reasonable pain medication prescription regulations and new academic training courses on palliative care.
A nurse works with a cancer patient in Kampala, Uganda.Just across the border from my home in Rwanda, Hospice Africa Uganda has collaborated closely with the Ugandan Ministry of Health to increase institutional support for palliative care, especially for AIDS patients.
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One group that stands out on the cutting edge of pain management is Global Access to Pain Relief (GAPRI), an international initiative of the global cancer community. GAPRI has put the issue of untreated pain at the forefront of the global cancer agenda for the first time, working to improve market access to morphine while empowering governments to loosen restrictions on pain relief treatment.
Nonetheless, we still have a long way to go to respond to chronic and situational pain around the world. Some countries have legitimate reasons for implementing strong laws to deter illegal drugs, but distinct inequities remain in the distribution of pain relief globally. Indeed, only six percent of all palliative care services are located in Asia and Africa – the regions where the need is undoubtedly greatest.
The international community – led by groups like GAPRI – is beginning to pay heed to the staggering numbers of people unnecessarily suffering each day, but institutional support for such initiatives is critical. HIV treatment programs funded by the United States should provide pain relief for people living and dying with the virus. In fact, the United States President’s Plan for Aid Relief (PEPFAR) released its first guidance brief on the importance of HIV/AIDS pain management and palliative care in 2006, but it ought to be dedicating far more resources to the issue.
The World Health Organization should treat the lack of palliative care as the global health emergency it is, and create and fund an agenda and strategic plan for increasing access to pain relief.
On the ground, donors and aid workers need to step up and tackle different kinds of health challenges. Effective health care is not simply about supporting the diseases that are waiting for a new drug or vaccine, but also about fixing the broken health systems that keep solutions we already have out of the hands of patients who desperately need them. Alleviating pain – in my relatively lucky case as well as millions of others– means reducing suffering and increasing productivity to help people be more happy, and of course more healthy. That’s what health care is all about. It’s high time we got on with it.
Josh Ruxin is the founder and director of Rwanda Works and the Access Project. A Columbia University expert on development, Dr. Ruxin has extensive experience operating at the intersection of business, international development, and global health. He lives in Kigali, Rwanda, with his wife and three children.
By NICHOLAS D. KRISTOF
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If you want to understand some of the best new ideas to chip away at global poverty, an excellent place to start is the Nasoni family hut here in the southern African nation of Malawi.
Alfred Nasoni and his wife, Biti Rose, have had seven children in this village of Masumba. Two died without ever seeing a doctor. Alfred and Biti Rose pulled their eldest son out of school in the fourth grade because, they said, they couldn’t afford $5 in school costs for a term. And they farmed only part of their 2.5 acre plot because they lacked money for seeds.
Yet poverty is sometimes romanticized, and it’s more complicated than that. Alfred, 45, told me that even as his children were starving, he spent an average of $2 a week on local moonshine and 50 cents on cigarettes. He added that he also spent $2 or more a week buying sex from local girls — even though AIDS is widespread.
All this hints at an uncomfortable truth: The suffering associated with poverty is sometimes caused not only by low incomes but also by self-destructive pathologies. In central Kenya, a recently published government study found that men, on average, spent more of their salaries on alcohol than on food.
It’s a vicious circle: despair leads people to self-medicate in ways that compound the despair.
Yet there are escape hatches. In 2005, Biti Rose joined a village savings group founded by CARE, the international aid group. These “village savings and loans” are among the hottest ideas in development work. They now serve some six million people in 58 countries.
After recent financial crises, plenty of Americans love to hate banks, but many of the world’s poor don’t have that luxury: more than 2.5 billion people worldwide don’t have a bank account, according to a landmark World Bank report, “Measuring Financial Inclusion.”
The poor typically receive a pile of cash once or twice a year, at the end of a harvest, and then have no good way to save it. That increases the risk that some of it will be squandered.
In some African countries, cellphones are emerging as the new banking system. But here, and in much of the world, the solution is savings groups like Biti Rose’s. She and 19 other members met weekly and each deposited the equivalent of about 10 cents. The money was then lent out to members, and CARE coached them on how to start small businesses.
With a loan of $2, Biti Rose started making and selling a local version of doughnuts, which she initially sold for 2 cents each. “People really liked my doughnuts,” she noted, and soon she was making several dollars a day in profit. Inspired by her example, Alfred began growing vegetables and selling them; he turned out to be a shrewd businessman as well.
Seeing an upward trajectory in the family fortunes, Alfred cut out the girlfriends and curbed his drinking, he says.
Biti Rose and Alfred then had the resources to buy seed and fertilizer for all their own land and to lease an additional two acres as well. These days, they hire up to 10 farm laborers to work for them. In the old days, they harvested less than one bag of corn a year; this year, their harvest filled seven ox carts.
All savers aren’t that successful, of course, but there’s no doubt that the nudge to save money and start businesses can be transformative and self-sustaining. CARE moved on in 2009 to take its model to more needy areas in Malawi, but the savings groups around this village multiplied anyway. Other farmers envied Biti Rose and Alfred replacing their leaky grass roof with a tin one, and they decided to start their own savings groups. The idea has even spread, without CARE’s help, across the border to villages in Mozambique.
Yet I think there’s something going on here beyond microsavings and entrepreneurship. Esther Duflo, an economist at the Massachusetts Institute of Technology and co-author of an exceptionally good book called “Poor Economics,” argues that outside interventions sometimes work partly when they give poor people hope. That’s precisely what I’ve seen in many countries: Assistance succeeds when it gives people a feeling that a better outcome is possible, and those hopes become self-fulfilling as people work more industriously and invest more wisely.
For Alfred and Biti Rose, their hopes are now focused on their younger children (the oldest has married). Biti Rose never went to school at all, but she is planning to send her younger children to university.
She is also planning future purchases, including the first television in the area. But don’t think Biti Rose is going to kick back. She sees the TV as an investment.
“I’m a businesswoman,” she said firmly. “I can’t give anything away. If there’s a soccer match or something, anybody who comes in my house to watch will have to pay a fee.”
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The farm fields here are cemeteries of cornstalks: a severe drought has left them brown, withered and dead. Normally, a failed crop like that signifies starvation.
Then television cameras arrive and transmit images of famished children into American and European living rooms. Emergency food shipments are rushed in at huge expense.
Yet there is a better way, and it’s unfolding here in rural Malawi, in southern Africa. Instead of shipping food after the fact, the United States aid agency, U.S.A.I.D., has been working with local farmers to promote new crops and methods so that farmers don’t have to worry about starving in the first place.
Jonas Kabudula is a local farmer whose corn crop completely failed, and he said that normally he and his family would now be starving. But, with the help of a U.S.A.I.D. program, he and other farmers also planted chilies, a nontraditional crop that doesn’t need much rain.
“Other crops wither, and the chilies survive,” Kabudula told me. What’s more, each bag of chilies is worth about five bags of corn, so he and other villagers have been able to sell the chilies and buy all the food they need.
“If it weren’t for the chilies,” said another farmer, Staford Phereni, “we would have no food.”
President Obama has made agriculture a focus of his foreign aid programs with mixed results. On the plus side, these initiatives are smart, cost-effective and potentially transformative. On the negative side, they’re boring. At a time when there’s a vigorous political debate in America about foreign aid, outreach to African farmers doesn’t wow Congress or the American people.
But if it’s boring, it’s also succeeding. I’m on my annual win-a-trip journey with a university student — this year, it’s Jordan Schermerhorn of Rice University — and we have seen fields here being irrigated for the first time, powered by foot pedal treadle pumps (resembling elliptical machines from an American gym).
Some of the farmers are trading up from foot power. Evelyn Kadzamira, a barefoot entrepreneur, showed off a $110 gas pump that she purchased with help from her village savings and loan association. She waters her crops with it and plans to soon start renting it out to others as well.
U.S.A.I.D. can work with only a tiny minority of farmers. But agricultural innovations can go viral, and that’s how Kadzamira got started.
“We saw others irrigate last year and were successful, while we didn’t irrigate and went hungry,” she said. “So, this year, we decided to irrigate.”
The backdrop is that for half a century, agriculture has been one of Africa’s failures. Agricultural yields in Africa are only one-third of the global average, and they have risen much more slowly than in the rest of the world. As a result, Africa’s share of global agricultural trade has fallen from 8 percent in 1960 to around 3 percent today, according to the International Food Policy Research Institute.
Only 3.5 percent of African crop land is irrigated, compared to 39 percent in South Asia, according to the United Nations. Asia applies almost 20 times as much fertilizer as Africa. And plant scientists have developed few crop varieties tailored for Africa.
The upshot is that about 47 percent of children under 5 years old in Malawi are stunted from malnutrition.
Yet now there are signs that African agriculture is poised to surge, despite warnings from climate scientists of weather changes linked to rising carbon emissions. The improved prospects reflect growing efforts to place agriculture at the center of efforts to fight poverty.
Malawi itself has also made progress by defying global experts and subsidizing fertilizer. This went against international advice — African governments have been pressured to cut subsidies of all kinds — but more fertilizer use led to huge increases in harvests, and Malawi has become a net corn exporter.
Another challenge for farmers has been poor storage: Up to 40 percent of the corn crop is lost after harvest because of rodents, insects and moisture. So CARE, the international aid group, is showing farmers how to construct mini-silos — made of mud, and resting on stilts — that reduce spoilage to about 5 percent.
In Kasungu, in northern Malawi, a woman named Viknesi Chimbonga showed me two of these new mud silos that she has built. These allow her to store her corn for months and sell it in the “hungry season” just before the next harvest, when prices are five times higher. Chimbonga never went to school at all, but she is planning to use the profits to send her son to university. He would be the first student from her village to go.
So, sure, there’s no less glamorous kind of foreign aid than chilies, irrigation pumps and mud silos. But if this kind of assistance can help end famine and emergency aid, and if it can send kids to college, then let’s celebrate boring aid!
In the poorest places, the lack of proper clothing costs lives. Now a simple and efficient program in India is attacking the problem with the urgency it deserves.
One of the most glaring oversights in the field of development is the lack of attention to clothing. Countless organizations work on food, energy, education, health care, economic opportunity — but beyond disaster relief efforts, you hear little about the need for clothes. In India, this makes no sense. Despite the explosion of growth in recent decades, hundreds of millions of Indians still live in conditions of extreme material deprivation. Somewhere between 40 percent and 80 percent of the population subsist on 50 or 60 cents a day, according to government estimates.
For very poor people, clothing is shelter. “In earthquakes, the shake kills people; in a tsunami, the water kills people; but in winter, the cold does not kill people. It’s the lack of proper clothing,” says Gupta. “Why don’t we consider lack of clothing a disaster?”
An awkward truth for bleeding hearts like myself is that there has never been much rigorous evidence that outside aid can sustainably lift people out of poverty.
Sure, evidence is overwhelming that aid can overcome disease, boost literacy and save lives. But raising incomes is trickier — and the evidence in that arena has been squishier.
Now that’s changing. A vast randomized trial — the gold standard of evidence — involving 21,000 people in six countries suggests that a particular aid package called the graduation program (because it aims to graduate people from poverty) gives very poor families a significant boost that continues after the program ends. Indeed, it’s an investment. In India, the economic return was a remarkable 433 percent.
The heart of this aid package? A cow. Or a few goats. Even bees.
Why would a cow have such an impact? This gets interesting: There’s some indication that one mechanism is hope. Whether in America or India, families that are stressed and impoverished — trapped in cycles of poverty — can feel a hopelessness that becomes self-fulfilling. Give people reason to hope that they can achieve a better life, and that, too, can be self-fulfilling.
Bleeding hearts, rejoice! One of the lessons of modern research is so simple and human: the power of hope to ease poverty.
In the graduation program, recipients of livestock were inspired to work more hours, even in areas unrelated to the livestock. They took more odd jobs. Their savings rose. Their mental health improved.
“Poverty is not just poverty of money or income,” noted Sir Fazle Abed, founder of a Bangladeshi aid group called BRAC that developed the graduation program. “We also see a poverty of self-esteem, hope, opportunity and freedom. People trapped in a cycle of destitution often don’t realize their lives can be changed for the better through their own activities. Once they understand that, it’s like a light gets turned on.”
Esther Duflo, an economist at the Massachusetts Institute of Technology and a co-author of the study, believes that’s right. “The mental health part is absolutely critical,” she said. “Poverty causes stress and depression and lack of hope, and stress and depression and lack of hope, in turn, cause poverty.”
Could hopelessness and stress create a “poverty trap” — abroad or here in the U.S. — in which people surrender to a kind of whirlpool of despair? Some economists and psychologists are finding evidence to support that theory, and experiments are underway to see if raising spirits can lift economic outcomes.
One study found that Ethiopians randomly assigned to watch an hourlong inspirational video ended up saving more and spending more on their children’s education, compared with participants randomly assigned to watch an hour of comedy television. The forward-leaning behaviors persisted in a six-month follow-up.
Researchers are now studying whether exposure to religion might have a similar effect, improving economic outcomes. If so, Marx had the wrong drug in mind: religion would not be an opiate of the masses but an amphetamine.
The graduation program is a bit similar to the model of the well-known group Heifer International, which I’ve written about before and provides “gifts of hope” such as heifers, goats and chickens to impoverished families. “There was a lot of excitement — with just a hint of smugness! — at Heifer at the published results,” said Pierre Ferrari, the president of Heifer. But the graduation model includes a couple of other elements.
The graduation program starts with a cow or other animals, as well as training on how to raise them. It includes months of food or cash support, partly to reduce the need to eat or sell the animal in a financial crisis. There’s a savings account (microlending has disappointed in randomized trials, but microsaving works very well), health education and regular coaching to reinforce skills and build confidence.
The study, which was just published in the journal Science, found that the graduation model was enormously successful in India, Ethiopia, Ghana and Pakistan, and somewhat less effective in Peru and in Honduras (where some animals died). A follow-up found the effects still strong three years after the donation of the animals.
Dean Karlan, a Yale economist who is co-author of the study, said that aid groups focused on very similar approaches include Trickle Up, the Boma Project, Village Enterprise and Fonkoze. Professor Karlan’s students in a seminar on philanthropy were given a pool of money from a foundation and the challenge to donate it where it would do the most good; they spent the term reviewing the evidence and, in the end, voted to donate it to Trickle Up.
So bleeding hearts, rejoice!
Much of the news about global poverty is depressing, but this is fabulous: a large-scale experiment showing, with rigorous evidence, what works to lift people out of the most extreme poverty. And it’s exhilarating that one of the lessons may be so simple and human: the power of hope.
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