Wednesdays are for jargon

I’m bringing back a feature from years ago. Every Wednesday I’ll unpack some development jargon for you.

HIV jargon

PEPFAR – President’s Emergency Plan For AIDS Relief, an anti-AIDS program started by George W. Bush.

Key Populations (KPs) – people who are at a higher risk for getting AIDS. PEPFAR considers these populations to be people who inject drugs, gay men and other men who have sex with men (MSM), transgender persons and sex workers. USAID reference on key populations | US State Department reference | e-learning courses on key populations

Most At Risk Populations (MARPs) – the UN term for key populations.

Concentrated Epidemic – UNAIDS has a very good definition of this one, “HIV prevalence is high enough in one or more sub-populations, such as men who have sex with men, injecting drug users, or sex workers and their clients to maintain the epidemic in that sub-population, but the virus is not circulating in the general population.” UNAIDS explanation of epidemic scenarios

 

The Questions I Ask

Americans are weirdly private people. Nearly every other culture I’ve experienced involved sharing more personal information with strangers than your average American wants to provide. It used to feel really uncomfortable. (Okay, it stills tends to feel uncomfortable.)

But I have a technique now – I lean in. I counter intrusive-feeling personal questions with nosy questions of my own. It serves as both self-defense and a chance to learn about other cultures. I stop, obviously, if my conversational partner seems uncomfortable being questioned. Most of the time people seem thrilled to answer, though. I’ve heard an awful lot of interesting stories.

Here’s what I ask:

1) Do you have children? Why or why not? Do you wish you had more boys/girls? How old were you when your first child was born? Were your children born at home or in a health facility? Was the doctor friendly? Are your kids in school? What school?

2) Who lives in your house? Just you and your spouse and children, or other relatives? Whose house is it? Do you own the house or rent it? How long have you lived there? Who does the cooking and cleaning?

3) Are you married? (Why not?) How old were you when you got married? Who chose your spouse – you or someone else? Where was your wedding? How many people attended? Were you happy on your wedding day or just nervous? Did you have food at your wedding? What kind?

4) What is the biggest health problem in this city/village? In this country? Are doctors kind and friendly here? Where would you go in a health emergency? Is health care expensive?

5) What job do you do? Do you like it? What job would you do if you could have any job? What job did you expect to have when you were a child? What careers do you want for your children?

Bonus questions just for taxi drivers:

1) Do you rent or own this car? How does the rental arrangement work? How did you buy it – did you take a loan or save up money, or get a gift from a friend or relative? How many hours a day do you drive? How did you become a taxi driver? Is this safe work? Do you carry a weapon? Do all your friends and relatives ask you to drive them around? What is the most interesting customer you’ve ever had?

(Photo credit: me)

Blog Posts I Will Apparently Never Write

1. Jargon is generally accused of being 1) a sign of fuzzy thinking and 2) a tool for oppression and exclusion. Sometimes even by me. It has struck me lately, though, that jargon is also a sign of people who care so much about a particular topic that they want to get their vocabulary exactly and precisely correct. Focusing obsessively about whether people more likely to be infected with HIV are best called most at risk populations, key populations, or risk groups is another form of genuinely caring about accuracy in the work you do. Is it a useful form of caring? Beats me.

2. For reasons that are probably obvious, I’ve been thinking a lot about bureaucracy lately. I continue to believe that structures and process are what differentiate a functioning organization from a cult of personality. That being said, where’s the line between the structures that help and the structures that suffocate? Probably there are papers written about this. I see Google Scholar in my future. (This happens to me approximately a hundred times a day – I have a thought and realize someone else must have thought it better. It’s a miracle I every get anything done with all the web searches I do.)

3. I was at a trilingual meeting the other day that was attempting to interface with an international conference call. The interpreter was somewhat overwhelmed by the challenge. Some problems really can be solved by nifty new tech. On a related note, I used the translate function on chrome to spend quite a while (successfully) tracking down a corruption scandal on a local web forum.

(photo credit: me)

Five fast facts about Bishkek

 

I moved to Bishkek, Kyrgyzstan a little more than two months ago. It’s always hard to start a new posting in the winter, but I have been coming here on and off since 2001. I am very pleased to have a good long stay.

Some notes:

1) It’s been snowing since December. It blows away and then snows more. It’s very pretty and very cold. My Kyrgyz colleagues tell me this is a mild winter.

2) North is downhill in Bishkek. For those of us raised on the Mercator projection, that’s confusing.

3) There is an opera or ballet performance pretty much every weekend.

4) The country’s official English language name is the Kyrgyz Republic, which leads to much confusion over whether it’s properly abbreviated as KG or KR.

5) The Kyrgyz republic is famed in song and story (or at least sector assessments) for having one of the most vibrant NGO communities in the former USSR

(photo credit: me)

China’s labor migration

Last week, the Washington Post ran a great article about economic growth in China, and its impact on one young couple who migrated from their rural village. It starts out telling us that:

More than 61 million children — about one-fifth of the kids in China — live in villages without their parents. Most are the offspring of peasants who have flocked to cities in one of the largest migrations in human history. For three decades, the migrants’ cheap labor has fueled China’s rise as an economic juggernaut. But the city workers are so squeezed by high costs and long hours that many send their children to live with elderly relatives in the countryside.

The article goes on to tell the story of one particular couple, Wu Hongwei and Wang Yuan. They take their daughter home to his parents’ house to live, and when she reaches age two they realize they’ve become strangers to her. The article ends with Wang and Wu making a plan to bring the baby back to the city with them. It’s a moving, personal story about the costs and benefits of labor migration.

It’s also a story about people getting wealthy enough to develop new kinds of problems. I have known a lot of very poor people who would sacrifice their relationship with their kids in a heartbeat if it meant making sure their children were safe, healthy, and well-fed. You can always get to know your child later, when she’s a living grownup thanks to her good childhood. They are in real pain, but Wang and Wu have a safe place for their daughter, which is more than many people have. It’s a sign of China’s growing prosperity.

You can see a little bit of that in a quote from Wu’s mother, who is raising the girl. She pretty clearly doesn’t see what everyone is all worked up about: “The countryside has been good for Beibei…The food here is clean. The air is not polluted like in the city.”

It’s a rotten world where your mom has to raise your baby. I totally agree. It’s just not the most rotten world. Honestly, I wish it were.

[health person side note: I also noticed that one reason they cite for taking their baby girl back to the village is the high cost of baby formula, which she started needing at nine months. You can breastfeed a baby past nine months and avoid paying for formula. If she’d just gotten the baby to one year, she could have gone right to table foods and cow’s milk. They’d never have needed the costly formula.]

 

The Easy Answers

Sometimes people ask me what they should know about international development. Sometimes they’re new professionals in this field, or people who want to be educated donors. Sometimes they’re health care professionals interested in international work. And sometimes they’re my mom. (Hi Mom!)

It’s a hard question to answer. This work is not easily summed up, and there isn’t a lot of advice that is one-size-fits-all. I usually end up stuttering and mumbling and then saying something trite like “It’s hard but it’s worth it,” or “There’s so much good we can do!” These are true statements, but it’s not exactly useful advice. You’d really think an international development blogger could do better. It’s embarrassing.

It turns out I have exactly one useful thing I can tell everybody: be very suspicious of the easy stories. That’s my very best guide to understanding international development. (Probably understanding everything, for that matter.) People aren’t characters, our problems don’t resolve easily, and it’s hard to understand us. Easy stories aren’t true.

It doesn’t matter if the easy story is about how an outsider can solves problems quickly, new tech immediately fixing things, or how nothing can ever change because we’re all too flawed. It’s not true. The difference between truth and fiction is that in fiction there’s usually a narrator to tell you what’s going on. Outside of fiction, we spend our whole lives in the muddle.

If someone tells you the answer is simple and obvious, they’re deluded or they’re lying. Don’t trust them.

(photo credit mac_filko)

Humanitarian Response, Complexity, and UHC: My High Hopes for 2014

 

These aren’t predictions, exactly, or New Year’s wishes. More like positive signs I am hoping will occur. Clues that we’re getting our act together as an international system.[1] The good omens I would like to see.

1. Better response to complex humanitarian emergencies. Every single year, complex humanitarian emergencies get worse. Refugee and displaced persons crises tend to be cumulative, not sporadic. Kenya’s Dadaab refugee camps were established twenty years ago. The oldest Palestinian refugee camp was established in 1948. On top of displaced persons, natural disasters are increasing in frequency because of climate change – massive storms and extended droughts are the new normal. We may also see increases in conflict as a result of climate change. The old ways of providing relief in emergencies aren’t going to be able to hold up when the emergencies keep coming faster and harder. We need to do better[2]. I hope that next year we’ll start to figure out what better looks like, and start to make it happen.

2. Complexity: Complexity theory as it applies to international development first hit my personal radar a couple of years ago, when I started seeing people talk about cynefin on Twitter. (possibly this Linda Raftree post). Then I started twitter-following Dave Snowden.  This year Ben Ramalingan, one of my favorite aid thinkers, wrote a whole book on it[3]. I really hope that next year we’ll see complexity theory go from fascinating topic of conversation to actual tool used in designing aid efforts.

3. Universal Health Coverage: We’ve heard a lot about UHC in 2013. Nearly every major development player, from Oxfam to the World Bank was talking about it.[4] We’ve all agreed that universal health coverage is a good thing. That’s the easy part. Actually making UHC happen will be the hard part, and I am hoping to see some movement on that in 2014. Next year let us know whether we’re looking at a catchy phrase that gets talked about (remember health for all[5]?) or a catchy phrase that translates into action (ie the Millennium Development Goals).

 (photocredit: futureatlas.com)


[1] If we were naming baby princess 2014 and I was the good fairy invited to the party, these are the gifts I would give her.

[2] And there are a lot of really interesting tools we could use for better emergency relief – crowdsourcing information, drones for relief deliveries, faster, better emergency communication tools.

[3] Which I haven’t read yet because I am inexcusably lazy and also was distracted reading everything ever written about health in Kyrgyzstan in order to obsessively prepare for my new job. Here is one brief example if you would like your heart thoroughly broken.

[4] Even my own employer, USAID. And please remember, as always, this blog is my personal opinion and not that of USAID or the US Government.

[5] Feel free to argue that I am wrong about the minimal impact of Health for All. I would be entirely delighted to be wrong about this.