Bill Easterly’s blog, Aid Watch, is taking some criticism in the development blogosphere right now. I normally try to avoid discussions like this because, honestly, my opinions change every 35 seconds about what the right way to blog about development is. (Or, for that matter, to do development) We all have different ways of writing, and different motivations for our blogging. But I’m an occasional contributor to Aid Watch, and some people have questioned why.  I feel like I should get into this one, at least a little bit.

For those of you who don’t obsessively follow (like I do) the RSS feed of every existing development blog, Transitionland, The Big Push, and Siena Anstis have all recently called out Aid Watch for not contributing to discussion about international development in a useful way. They’ve called it a pointless echo chamber and an unproductive and mean-spirited use of time. Prof. Easterly has responded by linking to their critiques, and defending the use of satire.

I see both sides. I think that Prof. Easterly is too quick to blame aid agencies and NGOs for problems that are systemic. He blames individual actors for doing things that are incentivized by the development industry. I would like him to write and think more about fixing the system than attacking the individual organizations. And I agree that his tone can be snarky to a degree that stops being funny and makes you tune the post out.

On the other hand, the system needs someone who will speak truth to power (or, in this case, development money.) And I know from my own experience that the blunter and snarkier you are when writing about development, the more people listen. How many times have I written about the damage done by poorly considered in-kind donations? But I never got any attention until I wrote a post called “Nobody wants your old shoes.” Then all of a sudden, I was getting quoted in the NY Times.

Prof. Easterly is nasty because being nasty makes people listen. People listen because he’s willing to say things no one else will, and he says them loud and mean. Sometimes he crosses the line. But sometimes he says exactly what needs to be said.

I think that your view on the Aid Watch blog depends on where you’re standing. If you are working in development, actually doing the hard jobs and fighting to make an impact, then Aid Watch feels like one more attack on your efforts. If you are in DC, though, or Geneva or London, exposed on a daily basis to the ugly business end of development funding, then Aid Watch is like watching Dorothy unmask the Wizard of Oz. Sometimes, behind the rhetoric, there is nothing but an empty space. We need somebody to point that out.

I’m in Dushanbe now, it’s true. And I’m fighting to support a project I care about. But my last job was Washington, on the donor side, in one of the deepest and most obscure nooks of the development bureaucracy. The memory hasn’t faded just yet.

My take on Aid Watch varies from day to day. Sometimes it offends me, sometimes the thinking seems shallow, sometimes I want to stand up and cheer. But I wouldn’t call it useless.

(This is a reprint of a post I wrote for my Global Health Basics blog, which it turns out I have neither the time nor the technical prowess to maintain.)

In social media, they talk about eating your own dog food. In global health, I think the equivalent would be drinking our own Oral Rehydration Solution (ORS). We need to do a lot of that. It’s important to think about what we ask of people because it gives us a much clearer sense of why we get ignored. Here’s the starter list for how to drink your own ORS:

1. Drink an entire glass of ORS from a packet every time you get the runs, not the tastier homemade kind. Don’t take Imodium.

2. Boil and cool all your water before drinking it.

3. Never spend a single cent on a treatment or cure that hasn’t been proven to work. No vitamin C for a hangover, no Preparation H, no Neosporin on your cuts.

4. No antibiotics when they aren’t strictly necessary. That means nothing for your bronchitis or your child’s ear infection.

5. Use a condom every single time you have sex, even with your spouse, even if your spouse doesn’t want to.

6. Take your child to the doctor immediately if she is showing any of the IMCI warning signs, but don’t take her if she is less sick than that.

7. Breastfeed exclusively until six months, and continue breastfeeding until at least age 2. If you have to work, then express milk by hand into a jar and store it in a cool place. But never feed your child with a bottle. Use a cup and spoon.

8. Choose your food on the basis of what is cheapest and most nutritious, without regard for flavor or cultural tradition.

9. Don’t see the doctor you are most comfortable with; instead, see the doctor that your government recommends.

10. When caring for your sick child, don’t follow the advice of your mother or mother-in-law. Instead, follow advice from a government doctor you may only have met once.

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(No antibiotics for her! photo credit: rabble)

One question I get asked very often by readers of this blog is how I got funding for my first overseas internship. It was an unpaid position with a multilateral organization in Tashkent, Uzbekistan, and it pretty much launched my global health career. It led to the job that led to my next job and so on and so forth until here I am now with enough experience that I believe myself capable of blogging about it.

My answer generally depresses people: I didn’t get funding. I estimated how much it would cost me every month to live in Tashkent. I figured out how long I wanted to stay – six months. Then I got a job, saved up my money, deferred my student loans, and got on the plane to Tashkent.

There is funding for overseas internships, but most of it seems to be for graduate students. I actually ended staying at my internship for a full year, funding the extra six months with a US government fellowship that no longer seems to exist.

But I got to Tashkent on my own, and I don’t think I could have gotten that fellowship if I wasn’t already there.

I was lucky, I know. I had student loans that could be deferred, and I was able to find work that let me save money. But I don’t have a trust fund and my parents haven’t helped me financially since I was 18. (Yes, Mom, I know you would have. But it didn’t feel right.) (What, no one else’s mom reads their blog?)

I can happily recommend the place I worked to earn the money to go to Tashkent. I was a faculty member at NYLF, the national youth leadership forum. They teach specialized week-long programs to high school students on topics like medicine and international affairs. I had a ball teaching high school kids, and learned a surprising amount from the site visits. Plus, you stay in the program hotel with the kids so I had no living expenses to contend with. NYLF is pretty much always hiring faculty instructors, since that much time with teenagers will burn you out fast.

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photo credit: penguincakes

The other day, the WHO asked aid groups in Haiti not to leave for at least 60 days. I found that kind of confusing, to be honest, because no aid agency is going to leave Haiti on purpose. Their humanitarian mission will make them want to stay – these groups do after all, want to help people. So will their competitiveness. Getting to open an office in a new country is exciting, and expands an NGO’s global reach.

NGOs will leave Haiti when they no longer have the funding to stay. They will do their best to stay – intense public fundraising appeals, unsolicited proposals to government donors, staff drawdowns and salary cuts, but eventually there will be no money to remain in Haiti. Then, and only then, they’ll leave. (Except MSF. MSF leaves when the “emergency phase is over.” But as far as I know, only MSF does that.)

That means there is no point in appealing to the NGOs to stay. The WHO is aiming its pleas in the wrong direction. It’s not, in the end, the NGOs’ choice. We need to donate the money to keep them there, and push our governments to do the same. Whether or not the NGOs stay in Haiti is up to us.

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Photo credit: Zedworks

Chosen because – that’s how you leave, right? On a jet plane?

I have mentioned two or three or thirty times that I am not the only person in the development world who obsesses about how we could do our work better. Everyone has ideas; it’s a very common topic of conversation among people who work in this field. Most of us have the same ideas. So why don’t we ever get to act on them? There are a few reasons I can think of:

Donors don’t always know what they are doing. Government donors are usually democratic nations, which means in practice that foreign aid programs are often defined by legislatures with no real background in international development. So you end up with earmarks for pet ideas, rules forbidding useful practices like harm reduction, and an overall lack of direction. Private donors tend to go for exciting quick impact ideas like mobile health clinics and cash-for-work projects. Overall, complicated, unsexy ideas like health system strengthening may go unsupported.

Donors are politically motivated. I have seen health projects where the donor chose the pilot areas because of mysterious HQ calculus about the possibility of terrorism or political instability. Or take a look at how funding goes to Gaza and the West Bank. Donors have reasons for supporting international development funding that go way beyond supporting international development, and it can be hard to take that money and make it useful. Many (maybe most) organizations tend to try anyway.

Lack of time. There is a steady supply of new research on what works in international development. There is no steady supply of time in which to read that research and figure out how to apply it in practice. Some places have a technical team at headquarters to keep up with new research and recommend how to use it. That’s not as common you would think, though, because that kind of work counts as an overhead expense. High overheads make it hard to get grants and donations.

Host country capacities. A good development program works with the host country government to build its skill set, so that impact will continue once the program is over. Sometimes that means obeying host country regulations that contradict best practices, or spending a year convincing a government to change its rules. For example, some countries in sub-Saharan Africa were achingly slow to adopt community therapeutic feeding (plumpy’nut and other RUTFs) even when the data showed it was much more effective than older ways of treating malnutrition. It’s miserable being stuck in a project that could be doing far more than it is allowed to, but I think the alternative – setting up an aid system that is parallel to the government – or worse yet, contradictory – is worse in the long term.

Funding and evaluation cycles. It’s very hard to design a program that will have a long term impact and also start showing results in two years. It’s not impossible; I’ve worked for several projects that managed it. But it’s hard. It limits your options severely. And inexperienced or unskilled NGOs may just aim for quick results and worry about the long term later.

This is not an exhaustive list. It’s just off the top of my head. What am I missing?

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Photo Credit: Iowa Politics.com

Chosen because Senator Brownback once tied up hundred of hours of manpower from an HIV/AIDS program because he didn’t understand the difference between harm reduction and risk reduction.

There is a woman who works for a friend of mine. I’ll call her Gulia since half the women in this country go by Gulia, so it’s safely anonymous. Every winter, all winter long, Gulia wears the same pair of battered brown ankle boots. They are too small for her, and they have no insulation. We know this because Gulia complains about her boots every day, all winter long. Her feet get cold, and her toes hurt.

My friend is a good person and a caring employer. She pays Gulia well enough that she could buy herself a pair of boots, but Gulia never does. She also gives Gulia boots.

She has given Gulia knee-high black boots to go with a dress. She has given her insulated fuzzy boots to fight the cold. She has given her cheery yellow rain boots to splash through the puddles that cover the roads here. Gulia does not wear these boots. When my friend asks about these boots, Gulia thanks her warmly for her generosity and insists that she wears the boots all the time, just not to work. We are quite sure that Gulia is lying about this.

Now, Gulia likes me. She is supporting her parents on her salary, and she likes that I am doing the same for my parents. She is ethnically Uzbek, and I speak Uzbek, so we can chat in her mother tongue. We get along. My friend asked me to try and find out what exactly was going on with the boots.

So, the other day I asked. And Gulia actually told me what was going on with the boots.

The answer? She’s short, and she’s a mom. Because she’s a mom, when she has cash she can spare, she doesn’t spend it on boots for herself. She spends it on her kids. Because she’s short, she only wears shoes with heels. And since my friend has been trying to give her practical, durable boots, she’s been buying flats. The ankle boots may hurt, but they have heels. Gulia can’t face life without the extra two inches. She’d rather have pinched toes and cold feet.

My friend’s gift boots are sitting at home in Gulia’s closet, waiting for Gulia to get so old she can’t wear heels any more, except for the fuzzy pair, which her mother now wears in cold weather.

The moral? There are several, I think. 1) Gulia wants other things, like school supplies for her kids, more than she wants new boots, so maybe we should stop giving her boots. 2) People want what they want, whether or not it makes sense to me. 3) And donated shoes need to actually meet people’s needs, as people themselves see them.

(This story is mostly true. I have changed some elements to make it totally anonymous.)

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(photo credit: KayVee.Inc)
Chosen because I suspect those are Gulia’s dream boots.

Hello to everyone coming in from metafilter. For the record, I don’t consider myself to be an iconoclast. I am fairly certain that my ideas are 1) very ordinary and 2) shared by most people who work in international development. I’m just the person who’s willing to take the time to blog about it. And while I know I am critical, I do believe that international development can – and does – work. If I didn’t believe that, I wouldn’t be working in this field.

I know this blog isn’t all that searchable (I am working to fix that) so here are some links that might help you get a sense of what I am about:

Positive deviance, and why I like it

Why we should care about global health

Oral rehydration solution

The list of things I believe in

Learning from failure

Monitoring and evaluation

I am working a lot right now, so I don’t update that often. I have been blogging for a long time, though, so the archives run deep. (if you do go into the archives, you’ll notice I occasionally contradict myself. That’s because I’m still learning.) The best way to keep up with this blog is the RSS feed.

If you want fresh content, these are some international development blogs that say everything more eloquently than I do, use data more effectively, or both:

Tales from the Hood (currently blogging from Haiti)

Good Intentions Are Not Enough

Owen Barder’s Blog

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photo credit: Jason-Morrison