Posted: Sun Apr 29, 2007 6:41 am Post subject: AFRICA
Crisis in Africa
Twenty-eight stories represent the many faces of HIV-AIDS
Stephen Hunt
Calgary Herald
Sunday, April 29, 2007
CREDIT: Brent Stirton, Getty Images
A grandmother stands with her grandchildren, whose parents died of AIDS, in rural Kenya.
FACTS AND FIGURES
10: Number of days for HIV to spread to the brain and other major organs
28 Million: Number of AIDS infected Africans
37 million: Number of AIDS-infected people around world
SPOTLIGHT
Stephanie Nolen reads from 28, Tuesday at the Glenbow Museum Theatre, 7:30 p.m. Tickets $5, from Pages on Kensington, or Wordfest, 294-7462.
Stephanie Nolen arrived in the village of Malala, Zambia one day and spied 70-something Regine Mamba and 13 small children.
"I really did think, the first time I walked up to her, that it was a pre-school," says journalist Nolen, over the phone from Toronto.
It wasn't a preschool. Rather, it was a portrait of Zambian family life in the middle of the AIDS pandemic.
"It just never occurred to me that one old, tired lady could be responsible for this many children," Nolen says. "There were just so many. Her kids died. One after another, her kids died, and she just kept taking the (grand)kids until suddenly were 13 of them. By Zambian standards, she was ancient!
"She's got all these kids, and beyond thinking, how am I going to feed and clothe them, what's going to happen to them when I go?"
That's one of the stories Nolen tells in 28, Stories of AIDS in Africa (Knopf, 408 pages, $34.95). The title arose out of Nolen's attempt to tell the story of a pandemic whose numbers read more like statistics from a horror movie than actual statistics.
"28 million people infected. What does that even mean? It's a number you can't get your head around . . . I can't give you 28 million reasons, but I can give you 28, one for each of those million people."
The book is a kind of continental survey of the impact of the AIDS pandemic on Africa, in stories that are frequently both tragically sad and just as often hugely inspiring. There's Winstone Zulu, a Zambian poet who becomes a leading AIDS spokesperson around the world. There's Siphiwe Hlophe, from Swaziland, who, after losing a scholarship to study in England because she has tested HIV positive, eventually becomes a government spokesperson. There's Lydia Mungherera, a Ugandan-born, AIDS-infected South African physician who survives having her T-cell count drop to one.
One word that comes up when speaking with Nolen about the African AIDS pandemic -- besides 'pandemic'-- is 'treatable'. Thanks to the emergence of retroviral cocktails, the virus is no longer the automatic death sentence it once was in North America and Europe. However, a combination of a bad lag in making affordable retrovirals available, coupled with crippling staff shortages, has conspired to accelerate the pandemic in Africa while it's being brought under control in the First World.
All of which is what makes what is going on in Africa so frustrating, particularly for HIV positive Africans.
"Really often, what people say, especially in places where very few people have treatment, out of genuine curiosity is, 'Why doesn't your country help us?' They know it's a treatable illness. They know if they lived in Canada they wouldn't be dying, and they think like, 'Wow, if this happened in your country and we could have helped you, we would have.' "
The country that stands out in 28 as possessing the most enlightened attitude towards AIDS is Uganda, where Mungherera received access to the potent retroviral cocktail that saved her life, while in other countries throughout southern Africa, governments refused for a long time to even acknowledge the existence of the virus.
"There's a school of thought that Uganda got it right better, righter, earlier, because they didn't have international interference," Nolen says. "They got sick first, and they had to respond on their own, and fashioned a kind of African response which was, in communities people taking care of each other -- partly because there was nobody else to do it -- and also, a philosophy they called Zero Grazing."
Nolen describes it as keeping your circle of sexual partners to an close, uninfected few. It stand apart from the international aid agencies' official policies of abstinence and condoms.
Since Nolen arrived in Johannesburg in 2003 as correspondent for a Canadian newspaper, the international attention paid to the AIDS pandemic has risen dramatically. Between Angelina Jolie and Madonna adopting African children, Bono and Simon Cowell travelling there (American Idol Gives Back has raised $60 million US and counting in one week for at-need children in Africa and America), and the whole Hollywood media machinery turning its lens towards Africa, it's starting to feel something a little like momentum building to help fight the pandemic.
"When I moved there, nobody had a freaking clue what was happening, more or less," she says. "Now there's a Gap T-shirt. The Gap makes a T-shirt for AIDS in Africa, so it must be real. But hey -- if that's what it takes to get people to notice."
To tell the stories she tells in 28, Nolen had to place herself at considerable risk. Is there a line she has that she won't cross to cover a story, or is the trick simply to pretend there's no line?
"The only way you're going to understand these things, the only way you're going to tell these stories, is if you go," she says. "A couple years ago, I drove a motorbike through the Eastern Congo to write about the civil war. Which again, in hindsight, was not the smartest thing to do. There's no roads! Congo is the size of all of Europe and it's got less than 500 kilometres of paved road."
After it was over, she remembers thinking, " 'Well, that wasn't the brightest idea I ever had.' But it's usually fine."
All of which has conspired to create a conflicted inner life that's one part Africa, one part Bloor Street, and nowhere these days is she really in a place where she is completely at home. Nolen's doing this interview fresh from Africa. She's been back in Toronto for less than 24 hours, following a 39-hour flight from her base in Johannesburg, South Africa, where she lives with her husband and son in a house surrounded by four-metre-high electric walls.
"Canada's home, and I pine for Canada when I'm away," she says. "(But) to be honest, it's hard. We were walking down Bloor Street in Toronto yesterday and I was listening to the conversations people were having and -- I don't want to sound at all sanctimonious -- but I'm aware that a lot of the people that I care about in my other home don't have the privilege of worrying about who's going to pick up the fuel for the barbeque on the first nice day of summer and it's hard to go between those two worlds. I don't forget what's home in Johannesburg just because I'm here.
"I guess I have to keep a couple channels in my head and switch back and forth between them."
The problem is that the African channel keeps taking her back to places like that scene with the Zambian granny and her 13 grandchildren.
"Her whole village was just made up of grannies and kids," Nolen says. "There was nobody around my age. Nobody.
"That's the other thing that makes it like sci-fi. It's like they've come in, and they've taken all the 30-year-olds. They're gone."
The recent conviction of former Zambian president Frederick Chiluba by a London High Court on charges of embezzlement of state funds is the latest in a series of tentative steps aimed at holding former African leaders accountable for their actions in office.
Corrupt and authoritarian African dictators and presidents, who once plundered the continent with impunity, are now having to answer to criminal charges ranging from genocide and corruption to graft.
With the increasing number of democratically elected governments, and a growing obsession with good governance as a prerequisite for direct foreign investment, as well as for trade and economic co-operation with the West, the era of untouchable African dictators and consequence-free autocratic rule is fading fast.
Chiluba, with his reputation as an expensive, designer-label dresser, was found guilty of stashing more than $46 million of public money in a U.K. bank account during his term in office from 1991 to 2001.
Although his official salary during this period did not exceed $100,000 per year, in recent months, Zambian officials have seized several of Chiluba's properties and vehicles worth millions of dollars. Meanwhile, more than 75 per cent of Zambians live on less than $1 a day.
The attorney general's decision to take Chiluba to court bears testimony to Africa's resolve to rid the continent of corrupt practices and make those leaders who have already left office pay for their misdeeds.
Several governments have lifted the impunity, granted by their constitutions, which kept erring former leaders beyond the law's reach for decades.
In Senegal, the National Assembly's adoption, in February 2007, of a law to allow Senegalese courts to put the exiled former dictator of Chad, Hissene Habre, on trial, signifies the first attempt by an African state to deliver justice to victims for atrocities committed by a former leader elsewhere on the continent.
In September 2005, the former Chadian dictator was indicted in Belgium for crimes against humanity, torture and war crimes that had taken place during his presidency from 1982 to 1990.
Human rights organizations accused him of orchestrating the killing of 40,000 members of opposition groups and facilitating the torture of more than 200,000 dissidents from other ethnic groups.
Although he had been under nominal house arrest in Dakar since fleeing Chad in 1990, following a request by the African Union, a decision was reached to try him on charges of human rights violations.
Meanwhile, in South Africa, former deputy president and African National Congress (ANC) deputy president Jacob Zuma's chances of being convicted on corruption charges increased during March 2007.
This followed a court order allowing the national director of public prosecutions to expand an investigation into financial irregularities in dealings between Zuma, the French arms company Thint, and a number of British banks, with regard to the multibillion-pound South African arms deal.
Zuma stands accused of accepting at least 1.2 million rands (#85,000) in bribes from his close friend and personal financial adviser, convicted fraudster Shabir Shaik, and of accepting a bribe from Thint.
The case was struck off the roll in September 2006, when the national prosecuting authority was not ready to proceed.
However, a court has given permission for the corruption charge to be reinstated.
These actions, among many taking place across Africa, have been hailed as the beginning of a new era of political accountability for autocratic and corrupt leaders who no longer enjoy their predecessors' job security.
Movements such as the African Peer Review Mechanism (APRM) and the New Partnership for Africa's Development (NEPAD), are regarded as efforts by African governments to emphasize their commitment to good governance, political transparency and accountability.
Although the APRM and NEPAD are not without shortcomings, they constitute a definite shift in the mindsets of African governments that this kind of change is long overdue.
Not all is smooth sailing.
In Zimbabwe, President Robert Mugabe, once applauded for his efforts in putting an end to South African apartheid and steering Zimbabwe through a difficult transitional period post-independence in the 1980s, is regarded as a liability to peace and justice on the continent.
Under his 27-year rule, his people's well-being has disintegrated to unprecedented proportions, which is as much an abuse of human rights as the systematic torture and stifling of civil liberties across the country.
With the exception of Zambia, Zimbabwe's neighbours have done little to intervene. South Africa, the pivotal state on the sub-continent, has been criticized for its policy of quiet diplomacy with regard to Zimbabwe.
Despite the apparent failure of African leaders to clamp down on Mugabe's reign of terror, developments elsewhere warrant cautious optimism.
The trend towards greater democratization and improved political accountability appears to be on track, despite the occasional setback.
With the necessary political will, and the legal machinery to prosecute in place, African leaders seem focused on turning a new chapter on impunity.
Hany Besada is a senior researcher, working on fragile states, at the Centre for International Governance Innovation in Waterloo, Ont.
Will Robert Mugabe's outrages never stop? For months he has been jailing and brutalizing opposition leaders and trampling the rule of law in order to guarantee himself another rigged victory in next year's presidential elections.
If Zimbabwe is to brake its headlong descent into tyranny, famine and some of the world's lowest life-expectancy figures, the leaders of neighboring African countries will have to bring strong political and economic pressure on Mr. Mugabe, and they will have to move quickly. So far they have done the opposite. In the midst of Mr. Mugabe's reign of terror, his fellow African leaders appallingly selected the continent's prime example of economic free fall as the chair of the United Nations' Commission on Sustainable Development.
The leader with the most potential leverage is Thabo Mbeki, the president of South Africa, which is the region's political powerhouse, as well as the supplier of 40 percent of Zimbabwe's electricity and one of its largest investors. A group of southern African nations have asked Mr. Mbeki to mediate between Mr. Mugabe and his opponents. So far, Mr. Mbeki hasn't done much more than write a few letters.
If his mediation is to succeed, substantive negotiations will have to start quickly and be concluded well in advance of next year's election. And, to assure that the opposition can freely campaign, Mr. Mbeki must insist that Zimbabwe repeal its legal restrictions on free assembly and that Mr. Mugabe stop terrorizing opposition leaders.
If the human tragedy of Zimbabwe cannot move Mr. Mbeki, he might at least consider his own country's narrow self-interest. Potential investors in South Africa can only be put off by the growing tide of misery and upheaval just over the border.
When the author of 28, Stories of AIDS in Africa, spoke recently to a capacity crowd at Calgary's Glenbow Museum, she had advice for volunteers keen to visit Africa.
"You need to stay home," Nolen says.
"Some of these places face 65 per cent unemployment. Volunteerism is great for the people who come, but it's not so great for the people you come for."
Nolen believes letters objecting to things like unfair trade practices work better than a stream of do-gooders heading overseas.
"Charity is rewarding, social justice isn't. Writing 10 letters isn't fun."
One brave soul at the back of the room objected to the travel ban. Fresh from a voluntary medical trip to Africa, she says telling her stories raises awareness in Canada . . . reason enough to go.
Nolen softens slightly -- medical personnel are the one exception to her wrath against volunteers.
"But how much did it cost to send you? How many qualified Africans could be hired for the same amount. They'd have done as much as you did," Nolen says.
n n n
It isn't easy being kind these days.
When Oprah Winfrey opened her $40-million South African boarding school in January 2007, reaction was swift. Why establish a luxurious, elitist institution to serve so few girls -- 125 now with a goal of 450 students?
And why separate girls from their communities when community is one of the greatest African strengths?
Winfrey's response was quoted by the Boston Globe:
"I understand that many in the (South African) school system feel that I'm going overboard, and that's fine. This is what I wanted to do."
Oprah is not alone in both personal generosity and her insistence on doing it her way.
The Bill and Melinda Gates Foundation has committed $35 billion to African development. Warren Buffett added $31 billion. First, it was vaccinations, now agricultural development -- what Gates hopes will start a "virtuous cycle" of productivity to address African hunger and poverty.
"There's no doubt there are parts of Africa where this will be successful," Bill Gates told the Seattle Times.
Others aren't so sure.
William Easterly, a professor of economics at New York University and author of The White Man's Burden (Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good) writes of "the tragedy in which the West spent $2.3 trillion on foreign aid over the last five decades and still had not managed to get 12-cent medicines to children to prevent half of all malaria deaths."
Easterly decries "the legend of development" pursued by those he calls "planners."
"Don't expect a Big Plan to reform foreign aid," he writes. "The only Big Plan is to discontinue the Big Plans. The only Big Answer is that there is no Big Answer."
Easterly applauds the "searchers" who "experiment and come up with smaller, but more useful, initiatives that outsiders can do to help the poor."
They employ, "ruthless testing to see if they really work," they are patient with gradual, piecemeal reform, and they recognize that the best "searchers" are often the poor themselves.
At best, aid should be a short-term stopgap to meet the most desperate needs of the poor, says Easterly, but only until the real answer arrives: "homegrown, market-based development."
The idea, Easterly says, is "not to abandon aid to the poor, but to make sure it reaches them."
The concern is well-founded.
Not only are "social entrepreneurs" like Oprah criticized for following agendas outside the context of African values, but government-to-government aid fails, too.
The recent Canadian Senate report on the Canadian International Development Agency (CIDA) is entitled Overcoming 40 Years of Failure: A New Road for Sub-Saharan Africa.
The reports cites $12.4 billion spent by CIDA in the area since 1968 . . . with little to show for it.
Robert Calderisi, an author and former World Bank official, dares to question African responsibility for African problems.
In The Trouble with Africa: Why Foreign Aid Isn't Working, Calderisi writes: "Over a period of 40 years, Africa has failed to develop. Even worse, its political and intellectual leaders still blame the continent's problems on factors as varied as an unjust international economic system, the slave trade, colonialism, the Cold War, crushing debt burdens and even basic geography. On close examination, each of these explanations grows shaky and throws the spotlight back on Africa itself."
Chillingly, he quotes a conversation between travel writer Paul Theroux and a political science teacher from Malawi who said, "The tyrants love aid. Aid helps them stay in power and contributes to underdevelopment."
"What if all the donors just went away," Theroux asked him.
"That might work," was the reply.
In January 2006, newly elected Liberian President Ellen Johnson-Sirleaf brought fresh hope to the west African country.
The Harvard-trained economist believes Liberians have the ability to make it on their own. At a 2007 World Economic Forum panel discussion, she affirmed her country's need to "finance our own development from our natural resources."
"Sometimes you have to have short-term support through aid, but the aid should have a very clear focus leading toward enabling us to move to the trade nexus where we can move away from a dependency on aid over time," Johnson-Sirleaf says.
Next Sunday, May 27: Intelligent Aid Part 2: Making a difference on the ground
Africa's Storied Colleges, Jammed and Crumbling
By LYDIA POLGREEN
DAKAR, Senegal, May 19 — Thiany Dior usually rises before dawn, tiptoeing carefully among thin foam mats laid out on the floor as she leaves the cramped dormitory room she shares with half a dozen other women. It was built for two.
In the vast auditorium at the law school at Cheikh Anta Diop University, she secures a seat two rows from the front, two hours before class. If she sat too far back, she would not hear the professor's lecture over the two tinny speakers, and would be more likely to join the 70 percent who fail their first- or second-year exams at the university.
Those who arrive later perch on cinderblocks in the aisles, or strain to hear from the gallery above. By the time class starts, 2,000 young bodies crowd the room in a muffled din of shuffling paper, throat clearing and jostling. Outside, dozens of students, early arrivals for the next class, mill about noisily.
"I cannot say really we are all learning, but we are trying," said Ms. Dior. "We are too many students."
Africa's best universities, the grand institutions that educated a revolutionary generation of nation builders and statesmen, doctors and engineers, writers and intellectuals, are collapsing. It is partly a self-inflicted crisis of mismanagement and neglect, but it is also a result of international development policies that for decades have favored basic education over higher learning even as a population explosion propels more young people than ever toward the already strained institutions.
The decrepitude is forcing the best and brightest from countries across Africa to seek their education and fortunes abroad and depriving dozens of nations of the homegrown expertise that could lift millions out of poverty.
The Commission for Africa, a British government research organization, said in a 2005 report that African universities were in a "state of crisis" and were failing to produce the professionals desperately needed to develop the poorest continent. Far from being a tool of social mobility, the repository of a nation's hopes for the future, Africa's universities have instead become warehouses for a generation of young people for whom society has little use and who can expect to be just as poor as their uneducated parents.
"Without universities there is no hope of progress, but they have been allowed to crumble," said Penda Mbow, a historian and labor activist at Cheikh Anta Diop who has struggled to improve conditions for students and professors. "We are throwing away a whole generation."
As a result, universities across Africa have become hotbeds of discontent, occupying a dangerous place at the intersection of politics and crime. In Ivory Coast, student union leaders played a large role in stirring up xenophobia that led to civil war. In Nigeria, elite schools have been overrun by violent criminal gangs. Those gangs have hired themselves out to politicians, contributing to the deterioration of the electoral process there.
In Senegal, the university has been racked repeatedly by sometimes violent strikes by students seeking improvements in their living conditions and increases in the tiny stipends for living expenses. Students have refused to attend classes and set up burning barricades on a central avenue that runs past the university.
In the early days, postcolonial Africa had few institutions as venerable and fully developed as its universities. The University of Ibadan in southwest Nigeria, the intellectual home of the Nobel Prize-winning writer Wole Soyinka, was regarded in 1960 as one of the best universities in the British Commonwealth. Makerere University in Uganda was considered the Harvard of Africa, and it trained a whole generation of postcolonial leaders, including Julius Nyerere of Tanzania.
And in Senegal, Cheikh Anta Diop, then known as the University of Dakar, drew students from across francophone Africa and transformed them into doctors, engineers and lawyers whose credentials were considered equal to those of their French counterparts.
The experience of students like Ms. Dior could not be further from that of men like Ousmane Camara, a former president of Senegal's highest court, who attended the same law school in the late 1950s. A cracked, yellowing photograph from 1957 shows the entire law school student body in a single frame, fewer than 100 students.
"We lived in spacious rooms, with more than enough for each to have its own," Mr. Camara said. "We had a minibus that drove us to and from class."
The young men in the photo went on to do great things: Mr. Camara's classmate Abdou Diouf became Senegal's second president. Others became top government officials and businessmen, shaping the nation's fortunes after it won independence from France in 1960.
Today, nearly 60,000 students are crammed on a campus with just 5,000 dormitory beds. Renting a room in Dakar is so expensive that students pack themselves into tiny rooms by the half dozen.
Firmin Manga, a third-year English student from the southern region of Casamance, was lucky enough to be assigned a cramped, airless single room. But six of his friends were not so fortunate, so he invited them to share. In a space barely wide enough for two twin beds, the young men have squeezed four foam mattresses, which serve as beds, desks, dining tables and couches. Their clothes were neatly packed into a single closet, a dozen pairs of shoes carefully balanced on a ledge above the doorway.
"We have to live like this," Mr. Manga said, perched on his bed late one night.
"Two will sleep here," he said, placing his palm on a ratty scrap of foam. "Two over there, and two over there. Then one more mattress is underneath my bed."
Once the last mattress is laid out there is no floor space left. Mr. Manga works on his thesis, a treatise comparing the grammar of his native Dioula language with English, early in the morning, before any else wakes up.
"That is my quiet time alone," he said.
The graffiti-scarred dormitories, crisscrossed by clotheslines, look more like housing projects for the poor than rooms for the country's brightest youths. A $12 million renovation of the library modernized what had been a musty, crowded outpost on campus into a modern building with Internet access. But technology does not help with its most basic problem: it still only has 1,700 chairs. Students study in stairwells and sprawled in corners.
In a chemistry lab in the science department, students take turns carrying out basic experiments with broken beakers and pipettes.
Equally frustrated are the professors, many of whom could pursue careers abroad but choose to remain in Senegal. Alphonse Tiné, a professor of chemistry, said he struggled to balance his research with the demands of teaching thousands of students.
"If I went abroad maybe I would have more salary, better equipment, fewer students," Mr. Tiné said. "I studied on a government scholarship abroad, so I felt I owed my country to stay. But it is very hard."
Mr. Tiné, 58, plans to stay in Senegal for the rest of his career. But many educated Africans will not. The International Organization for Migration estimates that Africa has lost 20,000 educated professionals every year since 1990. Those who can afford it send their children abroad for college. Some of those who cannot push their sons and even their daughters to migrate, often illegally.
The disarray of Africa's universities did not happen by chance. In the 1960s, universities were seen as the incubator of the vanguard that would drive development in the young nations of newly liberated Africa, and postcolonial governments spent lavishly on campuses, research facilities, scholarships and salaries for academics.
But corruption and mismanagement led to the economic collapses that swept much of Africa in the 1970s, and universities were among the first institutions to suffer. As idealistic postcolonial governments gave way to more cynical and authoritarian ones, universities, with their academic freedoms, democratic tendencies and elitist airs, became a nuisance.
When the World Bank and International Monetary Fund came to bail out African governments with their economic reforms — a bitter cocktail that included currency devaluation, opening of markets and privatization — higher education was usually low on the list of priorities. Fighting poverty required basic skills and literacy, not doctoral students. In the mid-1980s nearly a fifth of World Bank's education spending worldwide went to higher education. A decade later, it had dwindled to just 7 percent.
Meanwhile, welcome money flooded into primary and secondary education. But it set up a time bomb: as more young people got a basic education, more wanted to go to college. In 1984, just half of Senegal's children went to primary school, but 20 years later more than 90 percent do.
And more of those children have gone on to high school: Africa has the world's highest growth rate of high school attendance. Abdou Salam Sall, rector of the Cheikh Anta Diop, said 9,000 students earned a baccalaureate in Senegal in 2000, entitling them to university admission. By 2006 there were more than twice that. The university cannot handle the influx. Its budget is $32 million, less than $600 per student. That money must also maintain a 430-acre campus, pay salaries and finance research.
Even those lucky enough to graduate will have difficulty finding a job in their struggling economies. As few as one third of African university graduates find work, according to the Association of African Universities.
Governments and donors in some countries are starting to spend more on higher education. The World Bank chipped in for Cheikh Anta Diop's library renovation, and a coalition of foundations called the Partnership for Higher Education in Africa has pledged $200 million to help African universities over the next five years.
Fatou Kiné Camara, a law professor and the daughter of Mr. Camara, the former judge, said she felt the frustration of her students as she struggled to teach a class of thousands. When the students cannot hear her over the loudspeaker, they hurl vulgar insults, a taboo in a society that prides itself on decorum and respect for elders.
"They are angry, and I cannot blame them," she said. "The country has nothing to offer them, and their education is worthless. It doesn't prepare them for anything."
Attempts to reduce the student population by admitting fewer students are seen as political suicide — student unions play a big role in elections, and the country's leaders are fearful of widespread discontent among the educated youth. Senegal has created new universities in provincial capitals like Saint Louis and Ziguinchor, but few students want to attend them because they are new and untested, and the government has not forced the issue.
"They fear us because we are the young, and the future belongs to us," said Babacar Sohkna, a student union leader. "But where is our future? We are just waiting here for poverty."
'Small is beautiful' new motto for aid
Local projects help people help themselves
Sheila Rowe
For the Calgary Herald
Sunday, May 27, 2007
Calgarian Sheila Rowe travelled to Kenya recently to observe the work of several non-profit organizations.
In Africa, they sweep the dirt.
It tidies the debris around the simple mud huts that are home to many rural Kenyans.
Rachel Kavali's yard is impeccable; a few goats are tethered nearby. The 64-year-old is a modern African cliche: the grandmother left to raise nine grandchildren after the death of their parents through HIV-AIDS.
Rachel has little and expects little more. This is life.
The debate concerning aid to Africa is heating up. Despite an estimated $2.3 trillion that the West has spent on all foreign aid during the last five decades, Robert Calderisi, a former World Bank official and author of The Trouble With Africa, calls the continent "the only
region of the world that has grown steadily poorer since 1970."
"The drawbacks of government-to-government aid are now obvious," Calderisi says, "but private individuals and charities continue to make an important contribution to the development of Africa."
The question becomes, What does intelligent aid look like?
Helping Rachel may not solve the problems of Africa, but failing to help her isn't a moral option.
"Small is beautiful" could be called the new motto of effective aid.
"We don't have a messianic complex," Ralph Bromley states simply. "We just crawl into a corner somewhere, plant a stake in the ground and start doing good. That's what brings about change."
On this hot March morning, Bromley, president and founder of Kelowna-based Hope for the Nations, and his wife Donna visit the Kenyan backwater of Mukwa to meet with Bishop Mary Naliaka, a widow with five children.
Under the shade of a tree, Mary explains the needs of her little community.
Hope For the Nations has established a school here in co-operation with Kansas-based Love Mercy. Water supply is still a problem; simple gutters on the school would gather precious rain into storage tanks. Discussion turns to a large community garden and a new home for Mary's family and a growing number of community orphans.
"We're most successful when we find an existing, indigenous project or operation and come along to see how we can help," says Bromley.
The organization operates in 22 countries worldwide.
Wherever it goes, Donna says, it looks for national partners of "proven character and the same vision and values.
"The need doesn't constitute the call," Donna says. "The need is always there."
Indigenous initiative, shared values and solid partnerships are keys to resurrecting African hope. So, too, are agriculture and small business.
"Africa's main industry, agriculture, has been dragged down by mismanagement of every kind," writes Calderisi.
"Following independence in many countries, agriculture was considered an archaic way of earning a living, an inheritance of colonialism, rather than a real expression of Africa's wealth. By 1990, indifference to agriculture had cut Africa's already small share of world trade in half."
"What I love about Africa is the potential here in agriculture," Ryan Schumacher says.
Under the auspices of Love Mercy, the 28-year-old oversees the Rutuba Bio Organic Fertilizer Co. in the heart of a slum in Kitale.
Ten Kenyans are employed here to sort, sift and bag organic matter for domestic and export use.
"We take town trash, farm trash, plant and animal waste; we ferment it, formulate it, and analyze it into the perfect balance of organic fertilizer," Schumacher explains. "We create a healing agent for the soil."
Schumacher also oversees well drilling and community gardens, and explores the potential of unconventional crops like hemp.
"Traditional aid always has to give more and it's never enough. Sustainability and empowerment release people to create their own wealth. We're not giving a handout."
Diane Bennett, founder of Servant's Heart, based in New York, is similarly committed to combating aid dependency in the Upper Nile region of southern Sudan.
"We don't do anything for them that they can do for themselves," explains Bennett.
"Most organizations say, 'What can we do for them?' They don't look at what they can do for themselves."
She talks about the town of Daga Post in southern Sudan where 400 orphans languished.
Bennett asked the women why they weren't fulfilling their traditional societal obligation to care for these children.
"There was not enough food for their own children," she relates.
When Servant's Heart offered modest food assistance, the problem virtually disappeared. The five remaining orphans were sent to a Kenyan orphanage and are expected to return home when they're finished school.
Bennett decries foreign aid that hauls in supplies from overseas while depriving local merchants an opportunity to do business.
"It's critical to source locally whenever possible."
"One would think that helping poor countries would be as easy as fishing in an aquarium," writes Calderisi.
"In fact, helping other nations successfully can be like looking for pearls in a murky sea.
"The simplest way to explain Africa's problems is that it has never known good government. No other continent has experienced such prolonged dictatorships," he flatly states.
Calderisi adds that one of the few options left is to be more demanding, even intrusive, with governments, and to impose more, not fewer, conditions.
Among many other factors, he cites "honest elections, strong parliaments and an energetic free press as a means of promoting economic reform and an equitable sharing of the benefits of growth."
Bromley is philosophical about what can be realistically tackled.
"Mercy is helping the person who fell down the cliff. Justice is asking, 'Why did he fall down the cliff? Fix the road!' We're primarily in the mercy and development phase. We haven't got to justice, yet."
As Schumacher walks Rachel's dusty land, he spots an area where he could drill a well for her.
It's a small start that will make all the difference to one struggling African grandmother.
RE: Advice to do-gooders: don't go to Africa; Author warns of wasted aid efforts, May 20. Several Calgary-based non-governmental organizations that work in Africa contacted the Herald after an article by Sheila Rowe, inspired by a recent visit by author Stephanie Nolen.
Val Grossman argues much can be achieved with the right approach.
- - -
Traditional thinking and aid to the developing world is based on what we in the West think is needed. As a result of this thinking and action and billions spent, there is little to show for it. The reason for this outcome is simple. It is because it was our idea of what was needed and not theirs. It was our problem and not theirs.
People in the developing world know what their issues are and they also know how to resolve them in culturally appropriate and sustainable ways. Given the opportunity to identify pressing issues, strategies and actions, those of the culture can decide and implement sustainable positive change. Our job is to be there in a supportive role.
Unlike traditional western thinking and aid, this model is grounded in what I call outside-insider thinking. This means we put aside our thinking about how things should be done in order to really listen and hear what we are being told.
This helps us think more like those of the culture and lets us ask questions to help clarify, plan for and implement action, which we would not be able to do if we held on to what we thought needed to be done.
The outcome of this thinking and acting is strong relationships where people trust us to know and understand them as best as possible, as they deal with life's issues in their culture. We partner with people and we do nothing unless they ask.
We sit with people to discuss their issues and problem-solve with them to find the best way they can address any issue they bring forward. It totally amazes me every day when I think of how much we are able to do with so little in the way of funding. The following is occurring right now in Tanzania.
We support a weekly health education radio program. Local doctors provide 40 minutes of instruction followed by a 20-minute call-in. Doctors donate their time. Monies go to buy radio time. As of this January, between seven to nine million people tune in weekly.
This program was asked for by the people from the hospital we are connected with. They run it, provide programming, and are pleased with the results. The goal is to reach all of Tanzania.
We run Safe Motherhood Mobile Clinics. After discussion with community leaders and traditional healers, we worked together to begin the first clinic two years ago. It runs once a week in the village where more than 200 women and children are seen for education, health care and vaccinations. The third clinic -- to serve 100,000 -- will open as soon as we have funding.
HIV testing is now provided in the clinics for mothers and children who are indicative. This was also requested by the people. The government provides antiretrovirals but does not provide for testing. Once testing is done, antiretrovirals and counselling are provided.
Pap testing for STDs and cancer is asked for. We are looking at this seriously and beginning this program.
Water purification is being requested. In response, we are working with CAWST and SIDO, the Small Industry Development Organization, to provide education and training to build and maintain biosand water filters.
This program will be a small industry development local initiative in action. For those who cannot afford them, filters will be provided as possible with funding gathered from the sale of the filters to others who can. Filters are inexpensive, purify water to 97 to 99 per cent purity and last 50 years. Our role is to bring the training program to those who want it, so they can begin production and train others.
Education in the school consists of several elements. It includes funding for government exams (students at all levels must drop out if they cannot pay for government exams), and for supplies and clothing. In one school of 2,054 students, 500 are orphans. The program includes funding for medical students who would not be allowed to remain in school for lack of funding.
Adopt a Doc provides doctors and nurses in specific areas as requested by the Tanzanian medical staff, to partner with them and to teach in the medical school as requested. Westerners learn about issues faced and work with staff. They continue their professional and personal relationship over the Internet, providing support and assistance to each other.
These programs are the result of meeting and listening to people who know what their issues are. After discussion, sifting, thought and planning they also know the best way to address their issues sustainably in their culture.
Valerie Grossman PhD is the founder of Health Span Canada, director of HealthSpan International, and associate faculty at Royal Roads University. drval@telus.net
June 14, 2007
Op-Ed Columnist
Africa’s World War
By NICHOLAS D. KRISTOF
THE RWANDA-BURUNDI BORDER
Speciose Kabagwira lost another baby last week. It was the end of her 12th pregnancy, and the infant was stillborn on delivery.
It was her fifth stillbirth or miscarriage. And of her seven children born alive, four have died.
At one level, what killed her children and cost her those pregnancies was a combination of poverty and pathetic health care. But hovering in the background is another of Africa’s great killers: civil conflict and instability.
Earlier this year, I held a “win-a-trip contest” to choose a student and a teacher to take with me on a reporting trip to Africa. Now I’m taking the winners to the Great Lakes region here in Central Africa partly because it underscores the vast human cost when we in the West allow conflicts to fester in forgotten parts of the world.
On our two-week trip, the winners — Leana Wen, a medical student from Washington University, and Will Okun, a high school teacher in Chicago — will travel with me through Rwanda, Burundi and the Democratic Republic of Congo. (Will and Leana are blogging and video blogging at www.nytimes.com/twofortheroad.)
Since the Rwandan genocide began in 1994, at least five million people have died in the Great Lakes region in what is sometimes called Africa’s first world war. In the Congo, those deaths are still piling up.
Leana, Will and I visited the Catholic church yesterday in Nyamata, in Southern Rwanda, where hundreds and hundreds of terrified Tutsis were butchered in 1994 after they took shelter there.
Most numbing are the bloodstains on one section in the back of the church. That is where the attackers gathered babies and bashed them against the wall. Below the church is a crypt with endless rows of skulls and other bones of the victims — a monument to the shameful refusal of Western powers to get involved in African genocides.
The Rwandan bloodbath was over quickly, and Rwanda is now peaceful and booming, but the turmoil is still enveloping families like Ms. Kabagwira’s. We found her in an encampment of 2,000 Rwandans, all of whom who had fled tribal violence to Tanzania — but who were driven back last year by rampaging Tanzanians.
Now Ms. Kabagwira is living in a makeshift hut, in an area where water is inadequate, soil is poor and the nearest hospital is a one-hour bus ride away. She says she might have been able to save her baby last week if she had gone to the hospital earlier, but she couldn’t pay the $1.20 bus fare.
So how do we help people like Ms. Kabagwira? Some excellent answers are found in the best book on international affairs so far this year: Paul Collier’s “The Bottom Billion: Why the Poorest Countries are Failing and What Can Be Done About It.”
Mr. Collier, a former research director of the World Bank, notes that when the G-8 countries talk about helping Africa, they overwhelmingly focus just on foreign aid. Sure, aid has a role to play, but it’s pointless to build clinics when rebel groups are running around burning towns and shooting doctors.
One essential kind of help that the West can provide — but one that is rarely talked about — is Western military assistance in squashing rebellions, genocides and civil wars, or in protecting good governments from insurrections. The average civil war costs $64 billion, yet could often be suppressed in its early stages for very modest sums. The British military intervention in Sierra Leone easily ended a savage war and was enthusiastically welcomed by local people — and, as a financial investment, achieved benefits worth 30 times the cost.
Josh Ruxin, a Columbia University public health expert living in Rwanda, notes that a modest Western force could have stopped the genocide in 1994 — or, afterward, rooted out Hutu extremists who fled to Congo and dragged that country into a civil war that has cost millions of lives.
“Had an international force come in and rounded them up, that would have been the biggest life-saving measure in modern history,” he said.
So it’s time for the G-8 countries to conceive of foreign aid more broadly — not just to build hospitals and schools, but also to work with the African Union to provide security in areas that have been ravaged by rebellion and war. A starting point would be a serious effort to confront genocide in Darfur — and at least an international force to prop up Chad and Central African Republic, rather than allow Africa to tumble into its second world war.
Today we visited Jomba, a town that was attacked by rebel soldiers about a month ago. A local priest was killed during the attacks, and the villagers left and recently returned.
We talked to a teacher at the religious school. There were children running around outside the school, and as usual, once they saw the "muzungus" (white people), especially muzungus with lots of camera equipment, they came flocking over. "How do you feel about the future?" I asked him, leaving the question deliberately vague. "Il n'y a pas d'espoir," he responded (there is no hope). "I do not have hope for these children. We don't even know when is the next time we will be attacked. We do not know if we will be living tomorrow. How can we think about the future?"
It was striking that many villagers we've spoken to have said that life was better before. A 21-year-old father of three told us that he thought his grandfather's life is better than his life now. A principal of a school told us that he liked life better under the despotic rule of Mobutu than now, "At least there was security then, and people were not always worrying about being raped and killed."
Aya Shneerson, the World Food Program provincial director who accompanied us to Jomba, related another story that illustrated to her just how bad the situation in the Congo was getting.
When she was visiting a village with a foreign dignitary, an elderly woman came up to them and begged. "Please colonize us," she said. Both Aya and her visitor were aghast that someone could think that the colonial days were better, especially since the Belgians had such an atrocious history in the Congo. Yet, this is how bad things had become.
How is it possible that the situation has gotten so bad that people wish for the past, and not for idyllic good times, but for pasts dominated by corrupt leaders who exploit the local population, and neglect heir people while amassing treasure troves of billions? Right now, the people's needs are not just neglected—their everyday life is threatened. Recall Maslow's hierarchy. A person needs to have the most basic needs fulfilled, like food and shelter, before they can think about other needs. In this case, a basic level of security needs to be in place before people can even start thinking about health and education. Without the security, daily existence is tenuous. Il n'y a pas d'espoir. There is no hope.
June 21, 2007
Op-Ed Columnist
A Student, a Teacher and a Glimpse of War
By NICHOLAS D. KRISTOF
MALEHE, Congo
I'm taking a student, Leana Wen, and a teacher, Will Okun, along with me on this trip to Africa. Here in this thatch-roofed village in the hills of eastern Congo, we had a glimpse of war, and Leana suddenly found herself called to perform.
Villagers took what looked like a bundle of rags out of one thatch-roof hut and laid it on the ground. Only it wasn't a bunch of rags; it was a woman dying of starvation.
The woman, Yohanita Nyiahabimama, 41, weighed perhaps 60 pounds. She was conscious and stared at us with bright eyes, whispering answers to a few questions. When she was moved, she screamed in pain, for her buttocks were covered with ulcerating bedsores.
Leana, who had just graduated from medical school at Washington University, quickly examined Yohanita.
"If we don't get her to a hospital very soon, she will die," Leana said bluntly. "We have to get her to a hospital."
There was nothing special about Yohanita except that she was in front of us. In villages throughout the region, people just like her are dying by the thousands — of a deadly mixture of war and poverty.
Instead of spending a few hundred dollars trying to save Yohanita, who might die anyway, we could spend that money buying vaccines or mosquito nets to save a far larger number of children in other villages.
And yet — how can you walk away from a human being who will surely die if you do so?
So we spoke to Simona Pari of the Norwegian Refugee Council, which has built a school in the village and helped people here survive as conflict has raged around them. Simona immediately agreed to use her vehicle to transport Yohanita to a hospital.
The village found a teenage girl who could go with Yohanita and help look after her, and the family agreed that it would be best to have her taken not to the local public hospital but to the fine hospital in Goma run by Heal Africa, an outstanding aid group with strong American connections ( www.healafrica.org).
Now, nearly four days later, Yohanita is on the road to recovery, lying on a clean bed in the Heal Africa Hospital. Leana saved one of her first patients.
What almost killed Yohanita was starvation in a narrow sense, but more broadly she is one more victim of the warfare that has already claimed four million lives in Congo since 1998. Even 21st-century wars like Congo's — the most lethal conflict since World War II — kill the old-fashioned way, by starving people or exposing them to disease.
That's what makes wars in the developing world so deadly, for they kill not only with guns and machetes but also in much greater numbers with diarrhea, malaria, AIDS and malnutrition.
The people here in Malehe were driven out of their village by rampaging soldiers in December. Yohanita's family returned to their home a few months later, but their crops and livestock had been taken. Then Yohanita had a miscarriage and the family spent all its money saving her — which meant that they ran out of food.
"We used to have plenty to eat, but now we have nothing," Yohanita's mother, Anastasie, told us. "We've had nothing to eat but bananas since the beginning of May." (To see video of our visit and read blogs by Leana and Will, go to nytimes.com/twofortheroad.)
I'm under no delusion that our intervention makes a difference to Congo (though it did make quite a difference to Yohanita). The way to help Congo isn't to take individual starving people to the hospital but to work to end the war — yet instead the war is heating up again here, in part because Congo is off the world's radar.
One measure of the international indifference is the shortage of aid groups here: Neighboring Rwanda, which is booming economically, is full of aid workers. But this area of eastern Congo is far needier and yet is home to hardly any aid groups. World Vision is one of the very few American groups active here in the North Kivu area.
Just imagine that four million Americans or Europeans had been killed in a war, and that white families were starving to death as a result of that war. The victims in isolated villages here in Congo, like Yohanita, may be black and poor and anonymous, but that should make this war in Congo no less an international priority.
Blogs catch on in Africa, despite limited technology
Internet use jumps sixfold since 2000
SHASHANK BENGAL)
McCLATCHY NEWSPAPERS NAIROBI, KENYA
In Nigeria, bloggers documented chaotic scenes at polling places in April's presidential elections, which international observers said were marred by widespread fraud.
In Ethiopia, they outpaced the international media with detailed, often dramatic coverage of the recent trial of 100 opposition supporters and journalists.
In Kenya, they debate news, politics, music and local gossip with equal gusto.
Africa's bloggers are coming of age, thanks to fast-expanding Internet access and a growing awareness of the power of the medium, creating a public space in countries where traditional media still face repression.
Until recently, the African blogosphere had a foreign tilt, with the vast majority of web-sites manned by Africans living overseas or by missionaries, Peace Corps volunteers and other foreigners passing through the continent.
"There's still a strong expatriate influence. But, over time, we're seeing more people in these countries working with blogs," said Ethan Zuckerman, a fellow at the Berkman Center for Internet and Society at Harvard Law School and an expert on technology in the developing world.
Internet access is expanding faster across Africa than anywhere else in the world, albeit from a very low base. There are 334 million web users on the continent now, a sixfold increase from 2000, according to Internerworldstats.com, a web-site that tracks worldwide Internet usage.
Still, that represents only 3.6 per cent of Africa's population — by contrast, 70 per cent of Americans have web access — so blog-ging mostly comes from the urban, college-educated middle class. As a result, many sites focus on current events, with writers voicing frustration at the corruption and bad government plaguing African nations.
The centre of the trend is Kenya, which enjoys one of the continent's most open societies. Although the government periodically cracks down on news media, voters have dealt blows to incumbents in the past two nationwide elections — defeating longtime president DanielArap Moi's handpicked successor in 2002 and rejecting current President Mwai Kibaki's draft constitution in 2005.
"The powers that be have lost the last two elections. Subconsciously, this makes people think that we all count, that my voice counts," said Daudi Were, a 28-year-old who blogs as Mental Acrobatics and who co-founded the Kenyan Blogs Webring.
Established in 2004 with 10 member sites, the group now includes more than 430 blogs about Kenya. Were describes it as a democratic space, with roughly half the blogs written from in Kenya and half written by women.
When Kenya Airways Flight 507 crashed mysteriously in a jungle in southern Cameroon last month, killing all 114 people aboard, some of the most thoughtful reactions came in Kenyan blogs.
"I don't know if I'd want to fly Kenya Airways again," wrote Kenyanentrepreneutcom, a blog about business.
On his site, Were countered that Kenya Airways' safety record was good.
The plane involved in the incident today was a brand-new Boeing 737-800" that had been in service for only six months, he wrote.
June 25, 2007, 11:39 am
Where Are the Doctors?
By Leana Wen
Dr. Dan Rudasingwa
“Can you take me back to the U.S. with you?”
My friend Dr. Dan Rudasingwa is a general practitioner (GP) at King Faisal Hospital in Kigali, Rwanda. His family returned to Rwanda after 30 years of exile in Uganda to help rebuild the country. Now he wants to leave Rwanda.
Dr. Rudasingwa loves his country. He also cares about his own future. He wants to pursue specialty training in neurosurgery, which is not available in Rwanda. Everyday, he sees patients who need brain surgery, heart surgery, chemotherapy, or other specialized treatments to survive. There is no doctor who can provide these treatments. The best he can do is to watch the patients die. The only person he was able to “save” recently was a high-level official who was airlifted to South Africa after a head injury.
The problems with health care access in Africa are often attributed to lack of resources, but a more insidious and perhaps more difficult problem is the dearth of doctors.
Africa is facing a severe crisis of doctor shortage, on a scale almost unimaginable in the U.S. and Western Europe. Rwanda, a country with 10 million people, has about 500 doctors — a ratio of one doctor per 20,000 people. This is less than 10 percent of the World Health Organization recommendation. The vast majority of the country will not see a physician in their lifetimes. The Congo and Burundi have similarly poor ratios. Suburban U.S. hospitals could have more than 200 doctors on staff, while in Burundi, 165 doctors serve 8 million people.
The shortage of specialists is particularly acute. The only cardiologist in Rwanda is a Kenyan with a two-year contract in Rwanda. There are just 10 specialists for the 5 million people in the North Kivu province of the Congo. Even at the HEAL Africa hospital in Goma, which always has at least five visiting specialists, waits for gynecological and orthopedic surgeries be 60 days.
Where are the doctors? Blame is often — and rightly — attributed to the global brain drain. One-third of practicing doctors in the US trained in non-U.S. medical schools. Lower-income countries supply between 40 to 75 percent of these foreign-trained doctors. While one can hardly fault an individual like Dr. Rudasingwa for wanting to seek new opportunities, the developed world has an obligation to ensure that we are not poaching doctors from areas where they are most desperately needed. To meet American workforce needs, we should be opening more medical schools instead of taking individuals that other governments trained and need.
In Central Africa, the pipeline for doctors hits a kink even before the brain drain occurs. Countries are not producing nearly enough doctors. Rwanda only has one medical school. All graduates become general practitioners, but few have the option of going through specialty training. The few lucky graduates are able to obtain training in just four specialties in Rwanda — to study other fields like neurosurgery or cardiology, they have to vie for fellowship spots in Kenya or South Africa.
What can we do to help resolve the crisis of doctor shortage? I believe the solution lies in both ensuring adequate pipeline from the front end and preventing the brain drain from the bottom end.
To increase production of doctors, we should assist developing countries with building capacity for training both generalists and specialists. GPs are easier to train, and one way to help is to assist medical schools with their curriculum. I was astounded that no textbooks are used in the medical schools of the three countries we visited. Following a standardized curriculum could make medical education easier to expand to more students.
We can increase specialty training by developing short modular training courses. There are many Western doctors who go abroad for health care work. While the medical care delivered by visiting doctors will assist patients, what will help patients more is training local doctors. An intensive 3-month training session might not be enough to teach complex brain surgery, but would be enough for a doctor to be comfortable performing c-sections or managing diabetes. Capacity building for health care has much longer-lasting and wider-ranging effects than delivering direct care.
To prevent brain drain to developed countries, we should strive to retain qualified and trained doctors to serve their own country. As an immigrant, I certainly understand the desire to pursue a better future, especially if one’s own country is mired in poverty and conflict and offers little prospect for advancement. Restricting immigration is not the best policy. Rather, incentives should be created to retain doctors, such as better pay, more autonomy, and more resources to better assist patients.
There is also a recent trend of an internal brain drain from the public sector to private NGOs. In Rwanda, well over half of the national health spending is from international NGOs, many of which have recruited physicians away from working in public hospitals by offering higher salaries and better benefits. A more responsible policy for NGOs is to tie their work to existing public infrastructure. Dr. Paul Farmer’s clinic in Rwinkwavu, Rwanda, is a good example of private funding to assist a public hospital. All of the doctors in the Partners in Health hospital work for the public sector, yet also receive competitive benefits.
Finally, not everyone needs to see a doctor. We can work to train ancillary staff and community health workers. Just because their abilities are limited doesn’t meant that we should not provide formal training and fair pay, and hold them accountable for their responsibilities.
I believe that most physicians enter medicine for the right reasons, and have a strong sense of social responsibility to provide for their country. Dr. Rudasingwa said that there is no question he would stay in Rwanda if he can get trained as a neurosurgeon and has the equipment to help his patients. We should do what we can to help him stay in his country, and do our best to alleviate the overall doctor shortage crisis in the developing world.
June 28, 2007
Op-Ed Columnist
Our Gas Guzzlers, Their Lives
By NICHOLAS D. KRISTOF
BUJUMBURA, Burundi
If we need any more proof that life is unfair, it is that subsistence villagers here in Africa will pay with their lives for our refusal to curb greenhouse gas emissions.
When we think of climate change, we tend to focus on Alaskan villages or New Orleans hurricanes. But the people who will suffer the worst will be those living in countries like this, even though they don't contribute at all to global warming.
My win-a-trip journey with a student and a teacher has taken us to Burundi, which the World Bank's latest report shows to be the poorest country in the world. People in Burundi have an annual average income of $100, nearly one child in five dies before the age of five, and life expectancy is 45.
Against that grim backdrop, changing weather patterns in recent years have already caused crop failures — and when the crops fail here, people starve. In short, our greenhouse gases are killing people here.
"If the harvest fails in the West, then you have stocks and can get by," said Gerard Rusuku, an agriculture scientist here who has been studying the impact of global warming in Africa. "Here, we're much more vulnerable. If climate change causes a crop failure here, there's famine."
Guillaume Foliot of the World Food Program notes that farmers here overwhelmingly agree that the weather has already become more erratic, leading to lost crops. And any visitor can see that something is amiss: Africa's "great lakes" are shrinking.
Burundi is on Lake Tanganyika, which is still a vast expanse of water. But the shoreline has retreated 50 feet in the last four years, and ships can no longer reach the port.
"Even the hippos are unhappy," said Alexander Mbarubukeye, a fisherman on the lake, referring to the hippos that occasionally waddled into town before the lake retreated.
The biggest of Africa's great lakes, Lake Victoria, was dropping by a vertical half-inch a day for much of last year. And far to the north, once enormous Lake Chad has nearly vanished. The reasons for the dipping lake levels seem to include climate change.
Greenhouse gases actually have the greatest impact at high latitudes — the Arctic and Antarctica. But the impact there isn't all bad (Canada will gain a northwest passage), and the countries there are rich enough to absorb the shocks.
In contrast, the Intergovernmental Panel on Climate Change warned this year that the consequences for Africa will be particularly harsh because of the region's poverty and vulnerability. It foresees water shortages and crop failures in much of Africa.
"Projected reductions in yield in some countries could be as much as 50 percent by 2020, and crop net revenues could fall as much as 90 percent," the panel warned. It also cautioned that warming temperatures could lead malaria to spread to highland areas. Another concern is that scarcities of food and water will trigger wars. More than five million lives have already been lost since 1994 in wars in Rwanda, Burundi and Congo, and one factor was competition for scarce resources.
"It seems to me rather like pouring petrol onto a burning fire," Jock Stirrup, the chief of the British defense staff, told a meeting in London this month. He noted that climate change could cause weak states to collapse.
Yoweri Museveni, Uganda's president, describes climate change as "the latest form of aggression" by rich countries against Africa. He has a point. Charles Ehrhart, a Care staff member in Kenya who works full time on climate-change issues, says that the negative impact of the West's carbon emissions will overwhelm the positive effects of aid.
"It's at the least disastrous and quite possibly catastrophic," Mr. Ehrhart said of the climate effects on Africa. "Life was difficult, but with climate change it turns deadly."
"That's what hits the alarm bells for an organization like Care," he added. "How can we ever achieve our mission in this situation?"
All this makes it utterly reckless that we fail to institute a carbon tax or at least a cap-and-trade system for emissions. The cost of our environmental irresponsibility will be measured in thousands of children dying of hunger, malaria and war.
By NICHOLAS D. KRISTOF
Published: July 2, 2007
RUTSHURU, Congo
Win a Trip: Leana's Reflections
Quiz time: So what do hundreds of millions of ordinary schoolchildren around the world possess that American kids almost never get?
Answer: Worms.
My win-a-trip journey to Africa, with a teacher and a student, has taken us to regions where most people are "poly-parasitized." So while in Congo, I picked up doses of deworming medicine for myself and those travel partners who wanted it. (It's over-the-counter here. In the U.S. the simplest approach is to ask a vet for medication to deworm a St. Bernard.)
AIDS is the disease in the global spotlight, capturing celebrity attention and billions of dollars in treatment programs — and that's terrific, because it still kills almost three million people a year. But it's also time to recalibrate our efforts and devote more money to other ailments.
Some 40 million people have H.I.V. or AIDS, and 600 million have hookworms. Here in Congo, one study found that 82 percent of children have worms, and partly as a consequence 70 percent are anemic.
It often costs hundreds of dollars a year to treat a person with AIDS, continuing for as long as the person lives. But it costs 3 cents per year per person for medicine to prevent elephantiasis, which is caused by worm-like creatures and is on my personal top-three list of diseases never to develop.
Elephantiasis causes one's legs to become grotesquely swollen, looking like an elephant's, hence its name. And a man's scrotum balloons so monstrously that in extreme cases the victim needs a wheelbarrow to support it as he walks.
Not knowing the local word for the disease, we had some trouble at first; it was awkward inquiring about men with oversized genitalia. But once we conveyed our meaning, villagers quickly pointed us to many sufferers.
Justine Nyinobajambere, 30, can barely walk, because both feet are leathery, pus-oozing stumps with flies feasting on them. She has already lost two of her four children, perhaps in part because her deformity makes it difficult to get food and water for them. All that suffering could have been prevented for 3 cents a year.
In addition, the disease is spread by mosquito bites, so the bed nets and mild DDT spraying that protect against malaria also help prevent elephantiasis.
I'm not criticizing the AIDS effort at all. Indeed, there should be an even bigger push for AIDS prevention measures such as condoms, education, male circumcision and drugs to block transmission in childbirth. All those steps are incredibly cost effective and should be expanded.
But Western support for health in poor countries right now has to be broadened to include more attention to malaria and especially to what are called the neglected tropical diseases.
The Global Network for Neglected Tropical Diseases estimates that more easily preventable and treatable ailments, including worms, elephantiasis and trachoma, kill 500,000 people annually. Indeed, ordinary worms kill 130,000 people a year, through anemia and intestinal obstruction.
More generally, these diseases prevent children from achieving their intellectual or physical potential.
"Why are millions of kids getting enough to eat but are still malnourished?" asks Josh Ruxin, who runs the program in Rwanda against neglected tropical diseases. "Because they have worms."
These ailments together can be prevented or treated for just 50 cents per person per year.
"This is a chunk of global health that we can fix for almost nothing," says Michael Kempner, chairman of the board of the Sabin Institute, which hosts the global network. (The network is an outgrowth of Bill Clinton's work on international health.)
The benefits are also economic. One study found that chronic hookworm infections in childhood reduced future earnings by 40 percent. And a landmark study in Kenya found that deworming reduced school absenteeism by one-quarter.
Indeed, the cheapest way to increase school attendance in poor countries isn't to build more schools, but to deworm children. Yet almost no government aid goes to deworming.
"The average American spends $50 a year to deworm their dog," notes Peter Hotez, president of the Sabin Institute. "In Africa, you can deworm a child for 50 cents."
This win-a-trip journey is an excuse to examine issues that are so basic that they usually get ignored. And so as we look at the international agenda, in addition to energy, war and nuclear proliferation, it's time to add something that affects more people more intimately than almost anything else in the world.
African leaders argued fiercely on Monday over whether to rapidly create a single state stretching from the Cape to Cairo, with one small group threatening to break away and forge ahead with the project.
Delegates said the atmosphere in an African Union (AU) summit was charged as a group of states led by Libya's Muammar Gaddafi and Senegal's Abdoulaye Wade argued with a more gradualist majority led by South Africa's Thabo Mbeki.
"I think everybody is a little bit tense, because they know how serious this is," Senegalese Foreign Minister Cheikh Tidiane Gadio said.
"It is getting heated between Gaddafi and the southern Africans," said one delegate, who did not want to be identified.
While almost all the 53 member nations agree with the goal of African integration and eventual unity, most of the summit leaders want this to be a gradual process.
Gadio held out the prospect that a small group of states committed to creating a United States of Africa could push forward without the others and sign up to federation, ironically splitting the AU over the idea of unity.
"If Senegal wants to build this union with two, three, four more countries, there is not a country in this room that has enough power to tell Senegal you cannot do it," he said.
"Some of us think that Africa's unity has become a matter of survival . . . my president is here with his pen ready to sign," Gadio told reporters.
"Some will start and the others will follow. . . . Now, who is ready to start?
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