Month: March 2010

Why you can’t understand global health

By Alanna Shaikh | | 3 Comments |

This is another reprint from my sadly abandoned Global Health Basics blog.

If you are reading this blog post, you can’t really understand the most important dynamic in global health: poverty and ill-health. They go together in a powerful vicious cycle. When you are poor you lack access to medical care and are you exposed to environmental factors that put you at a hugely increased risk of getting sick.

If you can read this, that’s not you. By definition, you speak English and you have access to the internet. You earn more than a dollar a day. You can’t understand.

It’s all well and good for people to opine and analyze global health issues. We can obsess about behavior change, system strengthening, and maximizing the value of dollars spent on health. But when you are poor, your life is a zero-sum game. Everything you do has a trade-off somewhere. There is no give in the system. It’s a level of decision management that is impossible to fully understand from the outside.

Among other things, that’s why bad treatments are destructive, even when they aren’t physically harmful. They cost money that is needed elsewhere, and take time that poor people need to spend doing things that support their basic survival. There is nothing unimportant that they can give up. Everything opportunity cost is brutal.

I can’t actually understand what it’s like to live that. Neither can you.* It is very important to remember that when we design programs. That’s the real reason that consulting with your communities is best practice. It’s not a new trend, a way to appease the donor or local government, or a belief in social justice. It’s because nobody except the poor knows what their lives are like. There is a role for outside experts to see opportunities and combinations, using their larger base of outside-the-system knowledge. But they don’t know what it’s like to live in poverty. Nobody does, except poor people.

*Unless you started your life that poor and accumulated wealth now. My dad did that; it’s not impossible. It is, however, rare.

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(photo credit: cooperniall)

Is Bill Easterly useless?

By Alanna Shaikh | | 7 Comments |

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.

Drinking Our Own ORS

By Alanna Shaikh | | 12 Comments |

(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)

Finding Funding

By Alanna Shaikh | | 9 Comments |

coins

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