Haiti – Some Thoughts and Some Links

By Alanna Shaikh | 14 January, 20106 December, 2011 | 31 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 | 11 January, 201024 July, 2013 | 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 | 5 January, 20106 December, 2011 | 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

Sixteen Ways to Tell a Health Project is Doomed

By Alanna Shaikh | 29 December, 20091 December, 2011 | 6 Comments |

weird scary stencil of a scary guy

1. It focuses on AIDS, TB, or malaria but is not coordinating or harmonized with global fund activities in country.
2. The staff are all clinicians, with no public health people.
3. The staff are all public health people, with no clinicians.
4. There is no plan to involve local or national health authorities in the project.
5. The project director is a clinician with no management experience.
6. It is planning on developing its own training content instead of adapting existing curricula to the current situation.
7. It depends on practicing physicians to serve as trainers, but has no plan to teach them the skills they will need to become trainers.
8. There are no women on staff.
9. It ignores the role of nurses in health care.
10. The underlying conceptual model doesn’t make any sense or staff have trouble explaining it in a way that makes sense.
11. The only monitoring indicator is how many people were trained.
12. Training success is identified by pre and post tests of participant knowledge instead of testing their skills and whether they are actually using new skills in practice.

Special guest additions:
13. Local partners/beneficiaries cheerfully insist that another expat program manager is the ONLY WAY to make the next phase sustainable… (from Tales from the Hood)
14. It’s a two-year contract and the only local staff are secretaries and drivers. (from Texas in Africa)
15. You visit the public health office and they want to know why you’re taking away their public health volunteers. (from Good Intentions Are Not Enough)
16. The per diem for your capacity building event is less than that for the World Bank project just down the road. (from Ian Thorpe)

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Photo Credit: REDRUM AYS
Chosen because searching for “doom” on flickr gets scary quickly, and my initials are AYS

December 25th, 2009

By Alanna Shaikh | 26 December, 200928 November, 2012 | 9 Comments |

Star in the sky

The Christmas story is one of the defining stories of American culture. The fact that I’m Muslim didn’t keep this story from shaping me. On Christmas, I think about the story and what it means for my own life.

Sometimes I think the story is about being just good enough. The innkeeper didn’t throw out an important customer to give Mary and Joseph a room – he wasn’t a hero. But he didn’t send them back outside, either. Instead, he offered them something small. A warm place to sleep. The best he could do without trying too hard, and that was all it took. Jesus was born out of the cold, somewhere safe and friendly. Somewhere good enough.

But the story could be about the animals, whose friendly presence makes the barn a warm and loving place instead of cold and frightening. About the way that ordinary beings, be they people or livestock, can offer extraordinary help to others when they get the chance to do so.

Maybe the story is about the wise men, and the shepherds. The ones with the perception to recognize a miracle when it occurred. How many of us actually recognize the important things right when they happen?

Mary and Joseph might be the heart of the story – poor, struggling parents just trying to do their best for their child.

I’m not really sure who the most important character in the Christmas story is (beyond the obvious), and I’m not sure there is just one. All great stories have multiple meanings.

I wonder, though, which character I am. I suspect I’m the innkeeper, just trudging along at good enough. Or the parents, since I’m a mother. Or both; I can be more than one character. But most importantly, who do I want to be?

–Merry Christmas to all who celebrate it–

Speaking of Cars…

By Alanna Shaikh | 30 October, 20091 December, 2011 | 7 Comments |

car in mud

Speaking of cars, some things I have observed about cars and driving. They may or may not generalize:

1. When your project owns the cars, your drivers will be happy, enthusiastic types who show real commitment to your work. When you hire contract drivers who own the cars, you get cranky hard-cases who begrudge every extra mile they drive. Of course, contract drivers are also a much better financial choice.

2. The polite thing to do is to sit in front next to the driver, unless you’re in a high threat environment. In that case, sit in back so you can both dive to safety if there’s gunfire.

3. If you’re sitting in a parked car on a hot day, the best way to keep cool is to open your door and roll up the window, to divert any breeze you get into the car.

4. How to get into an ancient Landcruiser while wearing a skirt: Stand next to the car, facing forward. Put your left foot up onto the running board, and hold the grab handle with your left hand. Step up and pivot into the car, leading with your left hip. Slide into the seat. If you need to get out at some point, you are on your own. I haven’t mastered that yet.

5. Earplugs are a nice solution to the open window = noise, closed window = stifling hot dilemma. I like the kind you squish with your fingers. Obviously, this is a bad choice if you are the driver. In that case, roll up your own window and make your passengers open theirs.

6. You can back a 4×4 surprisingly far into an open drainage ditch without breaking an axle.

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Photo Credit: tjflex2
Chosen because I really hope I never have to do that with a car.