Month: January 2010

Three bad ideas for helping Haiti

By Alanna Shaikh | | 27 Comments |

plane over Haiti

In the rush to engage on Haiti, a lot of well-meaning groups are jumping in to help. Some are brand new, and some have never worked on a disaster like this before. Most of these groups are going to be useless. Some will actually do harm to themselves or others. A tiny minority will have a positive impact. I wish those odds were better, but they’re not.

I’ve seen three bad ideas for helping in Haiti floating around recently. I don’t want to single anyone out for criticism – after all, everyone is trying to do good here. But in this case, the culture of nice may be letting bad programs hurt people. I need to say something.

Bad idea #1 – 50,000 Shoes The idea is to donate 50,000 shoes in 50 days for Haiti. They are asking for a $5 donation for each pair of shoes. The problem with this idea is that it’s based on an assumption – that lots and lots of shoes are what Haitians need right now. What if they need clothes? Or food? Or water purifiers? Should they sell their new shoes and use the money to buy those things? Has anyone done an assessment to find out if shoes are needed? To decide what kind of shoes are needed?

The shoes could end up wasted and useless, absorbing people’s donations without providing any benefit. They could clog supply lines that also bring in desperately needed medicines. They could keep the local shoe suppliers from rebounding after the earthquake, and if badly chosen for the Haitian climate they can give people disgusting fungus.

This is almost a good idea. The time-delimited fundraising with easy to remember numbers will drive people to donate, and they’ve got celebrity endorsements that are raising their profile.

How it could be a good idea – call it $500,000 in 50 days instead of 50,000 shoes. That would double their fundraising goal (since they are trying to provide $250,000 of shoes) but I think they could pull it off, considering their level of media attention. Then they could make a high profile donation, including a ceremony with one of those oversize checks on poster board to Partners in Health.

Bad idea #2 – Flight to Crisis Volunteer doctors and nurses are banding together to charter a flight to Haiti and help with medical care. It’s brave, it’s scrappy, and it shows amazing initiative. It’s also a horrible idea. The people don’t seem to have any plan from bringing in their own supplies and haven’t set up a place to stay in Haiti. They don’t have a hospital to work out of or any background in responding to this kind of disaster. This is exactly the kind of misguided effort I was afraid we’d see, because Haiti is close enough to the US to make it possible. For more information on why this is such a bad idea, read this account of another group of health care providers that chartered a plane.

[Edited to add: please see comments below for a response from Flight to Crisis. They are better organized than their Idealist.org page makes them look.]

How it could be a good idea – in about three months, when rebuilding gets serious and Haitians have time to think, this group could choose a Haitian hospital to partner with. They could fundraise to help it rebuild, and donate supplies and equipment. They could visit the hospital quarterly to train the providers there as needed, and make sure that the equipment is in good shape and well maintained.

Bad Idea #3 – The Global Volunteer Network Haiti Project This project, which volunteers pay to support, is seeking people to volunteer for the following projects: working with children, teaching, health/medical efforts, building and construction, counseling, and business development. They say that volunteer trips can run from one week long to six months. This list seems designed to please volunteers, not meet the needs of people in Haiti. You already know that I am not a supporter of trips where you pay to volunteer.

This, however, is even worse than usual. This isn’t just useless feel-goodery for rich people. This will hurt people in Haiti. Traumatized children should not be making emotional attachments to volunteers who will be gone in six months. Volunteer labor for building and construction will keep Haitians from getting paid jobs to do the work themselves. And no outsider volunteer has any business providing counseling; counseling needs a background in local culture and context that a visitor won’t have.

How it could be a good idea – It’s almost impossible to rescue this one, but short-term volunteers could offer brief, targeted English or French classes to Haitians who needed them. They could cover technical topics that local teachers might not be able to offer. Not in a week. There really isn’t anything useful you can do in a week. But two months might work. It really wouldn’t qualify as disaster response – or rebuilding – but it would at least be useful.

For more information on how to help in Haiti, take a look at my Aid Watch post.

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Photo credit: simminch

Me, in other locations

By Alanna Shaikh | | 0 Comments |

I’m writing less often for Blood & Milk because I am writing in other places now. Some recent stuff that might interest you:

The Lancet is Off-Base About Aid Agencies – at UN Dispatch

Nobody Wants Your Old Shoes – How Not to Help Haiti – at Aid Watch

Teaching Americans What Haiti Needs – The New York Times (I didn’t write that one, I’m just quoted)

Should We Be Vacationing in Haiti Right Now? – at UN Dispatch

Haiti – Some Thoughts and Some Links

By Alanna Shaikh | | 10 Comments |

Rescuers in Haiti

Right now, the immediate emergency stage is already over, barring severe earthquake aftershocks. Tales From the Hood has some great posts up on Haiti and disaster relief. One excellent point:

The first phase of an emergency response is carried out by ordinary citizens in their own neighborhoods. Now, a day after the earthquake, the most nimble international aid agencies are just getting “feet dry” on Hispanola…All of those agencies will make dramatic statements about their life-saving relief work. But remember: At this moment people are being dug out and pulled alive from the rubble by their neighbors, husbands, mothers, and cousins…

I have a post at UN Dispatch on the health impact of an earthquake. Here’s the fast version – after the initial injuries are over, you need clean water, good toilets, and decent housing as fast as possible to prevent typhoid, dengue, and malaria.

Tales From the Hood, Aid Watch, and Good Intentions are Not Enough all have suggestions for who to give to for Haiti. My own suggestion is this – the single most important thing you can do when choosing where to donate is to pick an organization with a history in Haiti. That will make all the different in the speed and quality of their work.

I gave my own Haiti donations to two groups: Partners in Health (PiH), and Architecture for Humanity. PiH, founded by Paul Farmer, has an excellent reputation and a long history in Haiti. It’s also big enough to absorb as many donations as it gets. Architecture for Humanity has longstanding ties to Haiti, and strong relationships in country. They will be focused on the rebuilding effort, which is very important. Experience with the Tsunami showed that it’s easy to waste funds on building new structures that are culturally and environmentally wrong. I trust Architecture for Humanity to help make sure that Haiti builds back better.

Edited to add one more thing – Haiti doesn’t need donated goods right now. It’s difficult and expensive to ship donated stuff, and most donations will not be appropriate for Haiti. Now is the time to give cash.

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Photo credit: American Red Cross

Arguing against innovation

By Alanna Shaikh | | 8 Comments |

Well, I didn’t win the CSIS Smart Global Health Essay Contest, possibly because I argued against innovation in a contest that was explicitly looking for new ideas. I liked my essay, though, so I am sharing it here. CSIS was asking how the US government should spend their money on global health, and specifically looking for new and exciting ideas.


An Argument Against Innovation

Now is not the time for programming innovation. Instead, we should focus the next fifteen years on expanding the programs that work. Innovation is aimed at system-changing efforts that will lead to huge success or major failure; that’s not what we need right now. US government resources are not limitless, and we have a deep body of research in what works in global health. We have highly effective programs that are begging for funding; that is where our money should go. The government is well suited for the role of supporting boring but effective health interventions.

Global health research is full of solid, evidence evidence-based interventions that have been proven to improve health. These include increasing access to contraception, increasing vaccination coverage, home visits by nurses or community health workers, and strengthening primary health care and training health care providers in Integrated Management of Childhood Illness (IMCI). These are many effective pilot projects – proven to work – that have not been broadly implemented. Three examples:

Incorporate IMCI into physician and nurse education in every developing country. IMCI prevents stunting, promotes breastfeeding, and gets mothers to support child development by talking to their children more. It provides inexpensive, effective care for children. We know how train health care works in the strategy, and we know how to include it in medical education. The only thing stopping global adoption is money.

Meet the unmet demand for contraception. Studies have shown that giving couples access to contraception reduces child mortality rates, maternal mortality rates, and deaths from unsafe abortion. Letting women control their fertility also helps to promote gender equality and improve a family’s income. And contraception can be provided by trained health workers; a physician is not needed.

Put more resources into tropical diseases. Onchocerciasis control is a demonstrated success story, but 18 million people are still infected with the nematode that causes it. The African Programme for Onchocerciasis Control seeks to control the illness through universal treatment by 2010, but it will require financial support to keep providing the necessary drugs.

If we want to innovate, we should innovate with our funding models. The United States should start a fund that is devoted to supporting pilot projects that want to expand their reach. That would be an effective counterpoint to the many funding programs that provide “venture capital” for innovative efforts. Governments, NGOs, or UN agencies could apply for funding to scale up pilot programs with a certain number of years of experience, and a certain level of proven effectiveness.

Individuals and foundations love to fund innovative ideas; exciting new programs are easily marketed to foundations and philanthropic individuals. The Gates Foundation, for example, has a clear focus on innovation. In contrast, there is an important role for the US government in supporting the interventions that have been proven to succeed.

The American government doesn’t need to sell its ideas to fickle donors or get intensive publicity for the work it does. Instead, it can commit to the slow and steady underpinnings of global health. It’s good for global health efforts to have reliable donors supporting programs that work, and it’s good for American taxpayers to know that their money is going to projects that will definitely have an impact in improving global health.

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photo credit: LaniElberts

What Poor People Have

By Alanna Shaikh | | 3 Comments |

view of Indian slum home

These photos were published a couple of months ago, but I just ran into them today. A Norwegian photojournalist spent six weeks living in the slums of Nairobi, Caracas, and Jakarta. He took panoramic photographs of the homes that he saw there.

I found them extremely moving, in an unexpected way. This is not the usual set of poverty pity tragic pictures. That element is there – what do you say about the family in Jakarta living in a house you can’t stand up in? But what struck me was just how homey many of these slum dwellings are. No matter how small or desperate the structure was, people were doing their best to make it a home. The pictures feature decorations, family photos – efforts to make the spaces personal and welcoming.

It was a strong reminder of just how similar we humans are at our core. It was also a strong reminder that no matter how poor a person might be, you can never say they have nothing.

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Photo credit: Jonas Bendiksen