THAILAND: Rising rice prices fuel fears of food shortages and starvation. I think just about everyone is worried about rising food costs, all over the world.
Lesson: We’re all connected.
Month: April 2008
How not to help a malaria infected girl in Mali when you live in Connecticut
Uganda’s Scarlett Lion: How not to help a malaria infected girl in Mali when you live in Connecticut. Go, read the post. It’s a nice little capsule on the challenges of person-to-person charity.
Lesson: The obvious solution is rarely the right one.
Obama talks about congressional delegations
Obama: No Need For Foreign Policy Help. Why yes, Senator Obama, that does sound like every congressional delegation I have ever helped organize. I always really appreciated the interest being shown by the senators or congresspeople in question, but a visit like that is in no way equivalent to serious time in country.
Lesson: Showing up from HQ and spending three days on site visits does not mean you understand your field programs.
The Art of the Layoff
Guy Kawasaki on the art of the layoff. Layoffs are a part of life when you work for a donor-funded project. Funding typically tapers up and then tapers back down and staffing shifts accordingly. It hurts to work the end of a project, and watch all your colleagues leave. It’s lonely, and especially lonely if you’re the boss doing the layoffs.
Guy Kawasaki offers some great advice here on how to do layoffs well. He’s though this through in excellent detail, and I recommend the article to anyone who has to do staff cuts. Point #6, share the pain, is especially impressive to me. I had a boss refuse his annual raise because staff were being laid off, and it really made a difference to how people felt.
I do agree with his sole commenter, though. If it is a not-for-cause layoff, let people have a day or two more at work to say goodbye to their colleagues. I was fired once and the hardest part for the colleagues I left behind was having no idea what happened to me or why I was let go. One of them found my home number (this was back before cellphones) and tracked me down, just for closure. An NGO is unlikely to have much proprietary data to be stolen, and some staff members may want to do some handover.
Not talking about abortion
Outcry Over Search Word Ban on Health Site. Johns Hopkins recently made it impossible to search for the word “abortion” on their health information site, and then reversed the decision. Although I certainly agree that people need to be able to find information about abortion on a health website, I also feel bad for Johns Hopkins. They really can lose their USG funding for this.
The USG controls what you can say about abortion and family planning if you take their money. Agree or disagree with it, but that’s the way it is. The government’s policies put Hopkins in a terrible position. They have to choose what is “right” over what gets them money. That sounds like an easy decision. But it isn’t as if they were spending their government grants on strippers and hot air balloon rides. Their government funding goes towards vital research that benefits at least as many people as the information on abortion would. I wouldn’t want to have to make that decision.
Lesson: Diversify your donor base.
Gone Kurtz on the Burma border
A piece on foreign mercenaries in Burma. I don’t even know what to say about this, except – read it, it’s important. Everyone who thinks they are doing good in a foreign country should read it.
Excerpts:
He is caught up in the fact that he was taken to the top echelons of the local KNLA unit. But, all foreign visitors are received by the highest ranking people. This is normal. He was allegedly awarded a political position. Once again, these are handed out like candy. He believes he was asked to be the US representative. The rebels are nice people and it is against their culture to disagree with anyone. If you asked, “Can I represent you in American?” they would definitely say “yes.” This would either be because they desperately need representation or because they don’t want to refuse a friend. But again, this great “honor” is bestowed on everyone.
and
One aid worker, who requested that he remain anonymous, said: “Oh man, that Bleming guy is a real piece of work. He’s walking around, giving out his business cards which he autographs for you, talking loudly in all the wrong places about going to Burma, blah blah. The Karen have issued all sorts of statements saying this guy is his own work, denying almost everything he says, etc. The KNLA and KNU have worked for years at cultivating a good public relations, this guy goes and sets that back decades. America just took ex KNLA combatants off the Homeland Security terrorist risk list for refugee resettlement, and this guy goes and makes them look like a bunch of well armed terrorists again.”
It is easy to point a finger at Thomas Bleming, or any of the foreigners showing up on the border to fight, and label them thrill seekers or, at the very least, slightly disturbed. But in the modern world of confused sides, things are never that simple.
Sympathetic article about Bleming in a Wyoming newspaper here.
Black Flag Cafe discussion of Bleming, including the great term “professional war tourist.”
Lesson: Question what you think you know, and then question it some more.
Physician training has very little impact
Jishnu Das writes about research on physician training in low-resource countries. His disheartening conclusion is that the training has very little impact on improving quality of care.
The research was as follows:
Our approach has been to try and decompose the quality of medical advice into two components—what doctors know and what doctors do. What doctors know—measured by testing doctors—represents the maximum care that a doctor could provide. What doctors do—measured by watching doctors—represents the care they actually provide to real patients. We call the first “competence” and the second “practice quality”.
And the depressing conclusion:
In Tanzania we find that two additional years of school and three additional years of medical school buys an increase of only 1 point in the percentage of essential tasks completed. Results are similar for other countries.
Training doctors has been a standard way to improve the quality of health care for years. It’s a major shock to discover this minimal impact. I wonder if the quality of training make a difference? Perhaps competency based training would make a difference.
While this is depressing research, it’s not necessarily telling us things we didn’t already know. If you want to change a physician’s behavior, you don’t just give her training. You change the system she is part of. Good projects health projects recognize that, and so do American HMOs.
Lesson: Don’t try to change individuals, try to change the system they are part of.