Blood and Milk

1.       Does the success of cash transfers mean that poverty is a result of the capitalist system and instead of working for international development projects I should be an activist trying to change the global economy?

2.       Are we going to look back at 2011 as the year that climate change became obvious in US weather?

3.       Why is it so hard for people to understand breastfeeding? (I just had a woman at a convenience store tell me that she didn’t breastfeed because her milk didn’t come in because she didn’t drink much milk when she was pregnant. I was genuinely at a loss for words.)

4.       Behavior change efforts work best when we remove obstacles and help people do what they already want to do. Is it possible to frame all change programs that way? Or are we stuck always trying to change what people want to do?

5.       I agree with GiveWell’s conclusion that philanthropic money is better spent overseas than in the US (thus my career choice) but wow, the US is awfully bad off in some places.

6.       Premature babies are often born early because of difficult circumstances in the life of the mother: chaotic or abusive home life, poor nutrition, poor access to medical care. Then we sent these fragile babies home to the same situation that made them this way. It’s a vicious cycle.

So, on Monday I had a baby. (He’s healthy, I’m healthy, and he’s the most perfect and adorable baby in the whole world, for the record. And no, that’s not him in the picture; the internet and kids makes me nervous.) We’re home from the hospital now, and returning to ordinary life, which is as you’d guess a lot of work. And lots of well meaning people want to help me. So they offer to hold the sleeping baby so I can get something done.

But holding the sleepy baby is not helpful. Holding a baby while they sleep is the single best part of having a newborn. They’re all sweet and snuggly in your arms, and they look like angels. Holding the unconscious baby = not work.

If you want to help me, offer to make me a sandwich or clean my bathroom or scan my tax documents so I can pay the IRS. Or hold the baby when he’s crying and won’t nurse or sleep or settle down. That’s the help I actually need right now.

I think too many aid projects just want to hold the baby. (In the case of orphanage tourism, quite literally.) They see what they think is a need – a need that’s easy to fill! And they rush to do it. They don’t stop to ask – what do you need?

This is true both of big institutional donor programs that are eager to apply the sexy solution of the day to every situation – microfinance, health savings accounts, results based financing – and small individual donors who create tiny barely-functional NGOs to provide broiler chickens or used clothes to the needy.

The answer is to pause first, and actually find out what people need. It sounds easy, but it’s not. Just asking people generally isn’t enough. I feel like a total jerk complaining about the nice people who want to help me by holding my son, and I am a deeply privileged resident of the wealthy world.

If I was a Bangalore slum-dweller or a Congolese villager, who would I feel comfortable talking to about my needs? Would I talk to a researcher from the capital about what I need and what I don’t? Or would I just be afraid that if I criticized any aid, they’d send it all somewhere else to people who were grateful?

Bad aid isn’t solely the result of laziness or indifference – doing research on people’s true needs is surprisingly difficult. So is designing programs that meet those needs. But taking the time to do it makes all the difference.

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(Photo credit: Sinosplice)

Chosen because it’s a guy holding a baby

Some disjointed thoughts that won’t quite grow into blog posts. In no particular order or relationship to each other.

1.       I spent my lunch time in our office kitchen, eating some kind of meat soup, potatoes, and carrots. I listened to my colleagues chat in Russian about minor domestic topics. I finished my meal with black tea and sour Russian bread. I’ve spent the last decade of lunches like this. I will spend 2011 the same way.

2.       People need narrative to make sense of their lives. If you don’t have a story, your life is just a series of disconnected events. If you help someone find the right story, their life will change. Religious people know this, even if that is not how they see things.

3.       I worry about inequality, all the time. I worry that income inequality, in particular, is going to destroy everything good that human beings have managed to build. But I am a health professional, so I focus on inequalities in health and access to health care. It’s what I can do. It is not enough, but it is something.

4.       My brother and his wife are visiting from the US for the holidays. I have lost the knack of relating to non-expatriate Americans and I keep forgetting to give them information. They want to know stuff all the time. What’s for dinner? Who will be at the party we’re going to tonight? Expats just assume that either no one knows or it doesn’t matter that much. You don’t really have to tell them anything except the time of the next scheduled event. I am pretty sure my brother and his wife are the normal ones in this situation.

5.       I worry about water all the time. We are clearly using up and destroying all of our clean water. What happens next?

6.       Some Excel tricks: If you’re dealing with a big spreadsheet full of text, like a workplan or a logframe, it’s always easier to review column by column than line by line. I wish I had learned this years ago. Also, you can spellcheck an excel spreadsheet. And if it has any text in it, you should.

7.       Is everything getting worse now that it has been before, or is it just that we have more information about all the bad stuff? Aside from climate change, which is clearly getting worse.

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photo credit: stagewhisper

I spent quite a while working on a Christmas post, and finally decided I’m not going to write anything better than last year’s. Last year’s post:

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 are 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–

These are not the books that teach you about development. These are the books that crack your head open so you can start (or continue) to learn.

1.       Anything by Graham Greene. Doesn’t have to be The Quiet American or Our Man in Havana, honest. The Comedians or The Heart of the Matter will do fine. But his take on the world will help guide your own perspective in a way that’s useful. The Portable Graham Greene, while not actually portable, is a nice start.

2.       Biggest Elvis, by P.F. Kluge. The important thing to remember about this book is that it’s not just the narrator who is unreliable, it’s the author. But read it and if you’re paying attention, you’ll see yourself. It’s a warning and a gift of insight to everyone who thinks they know how to help.

3.       Anything by Nahguib Mahfouz. I actually find his writing a little dry in English – Mahfouz’s true genius as an author is the way he uses the Arabic language. But he also writes deeply felt, emotionally resonant stories about the lives of poor people, set in one of the world’s biggest, oldest, poorest cities. Children of the Alley is a good example, and it’s faster than reading the whole Cairo trilogy.

4.       Prague, by Arthur Phillips. Okay, the Amazon reviews really hate this book. But I think it’s a dark and brilliant reflection on expatriate life and it has changed the way I see my place in the world. (Not necessarily for the better.)

5.       Orientalism, by Edward Said. Surprise! Nonfiction! I’d say about 50% of development programs that go horribly wrong do so because of orientalism on the part of the foreigners involved. Even programs outside the Middle East. Said is writing about the Arab World, but the larger issue is about how we perceive the other, and that’s a universal problem. This book is considered one of the most important of the 20^th century, and I totally agree.

Note: these are affiliate links. If you’re going to buy a book, I may as well get a miniscule percentage of its value.

(photo credit: Lin Pernille)

International development is infamous for its constant, jargony, changes in vocabulary. It’s not the third world, it’s the developing world. It’s not the bottom billion, it’s an ascending market. They’re not people living with AIDS (PLWA), they are people living with HIV (PLHIV). It seems ridiculous, because it kind of is, and we all get tired.

But I do believe in the power of words to shape the way we think. It’s easy to laugh at each new acronym update, but vocabulary does affect how we frame things. So there are a few words and phrases I never use, because I think they lead us in the wrong directions:

1) Beneficiaries – I never use this word unless I am contractually obligated to do so. I know that it serves a useful purpose as a standard term for the people a project serves, but I don’t like it. It implies that people are sitting around passively waiting for a savior to help them. No project works if they don’t have partners to make it work. Even handing out lollipops to children requires children who’ll take candy from strangers and parents who’ll permit it and get the children to the lollipop distribution site.

Your partners might be a community, a local government, or a community organization. But those people are not passively benefitting. They are helping make the project happen.

2) Individuals – This word is just a synonym for “people.” But it’s a cold, formal word that helps you forget that the individuals involved are actual human being people.

3) The Poor – Pretending that poor people are a homogenous collective is poor thinking, and dehumanizing. People fall in and out of poverty for a whole range of reasons, and they cope with poverty in different ways. Fighting poverty requires that we recognize that, and terms like “the poor” are a barrier. (That bring said, two great books – The Poor and Their Money, and Portfolios of the Poor – use the phrase.)

4) Africa – Okay, there are appropriate ways to use this proper noun. Like in a discussion of continental geography. Then there are all the other ways: lumping all the nations on the continent together, as though Senegal and Somalia are exactly the same; using “Africa” in the name of your tiny MONGO that works in one village in Uganda; getting confused and lumping China, Russia, and Africa together as though they are equivalent political units. Let’s stop.

Photo credit: thinkretail

As you might guess, I didn’t originally write this post for this blog. But no one else wants it, so I’ll publish the poor orphaned post myself.

The term public-private partnerships don’t get explained much. They partnerships a lot of attention, but it’s such common vocabulary that no one ever stops to explain it. That’s okay, though, because it’s a useless term.

A public-private partnership is any collaboration between public bodies – like a government, the UN, or an NGO – and a business entity. That’s all. Public organization working with a private one. A pharmaceutical company donating drugs to UNICEF or a developing country government. A consulting firm offering free services to the Global Fund. A local government providing start-up capital to a business that may serve a public good.

Personally, I think this piece of jargon has pretty much outlived its usefulness. It doesn’t describe an unusual situation, help corporations understand their role, or serve as an accurate or specific term. We should retire it.

Ten years ago, when private sector business rarely got involved in development, we needed special vocabulary to encourage them. “Public-private partnership” sounds reassuring. “You’re not in this alone, frightened little corporation! You’re in a partnership. The UN will help you, we promise!” The special term helped to normalize business participating in international development efforts.

Now, though, it’s pretty much become the norm. Businesses get involved in international development and global health all the time. They don’t need supportive language to help them understand that they belong. They have decided it’s in their interest to support global health, and that’s pretty much enough to motivate a profit-making entity.

Because it’s the norm, we also don’t need special exclusive language that sets apart business-funded development work from work funded by government or private donors. Those are not the traditional donors any more; people expect that there will be corporate involvement in global health, for example. So we don’t need to single out public-private partnerships as a special case. They’re just one of the many ways that we fund international development work.

It’s also a term that is so general it’s useless. For all that it was supposed to helpfully describe a special kind of health or development effort, instead it’s meaningless. I mean, what if the US government hires an international development company like Casals Associates to implement a development effort? Why isn’t that a public-private partnership?  If Oxfam buys plane tickets for its employees, why is that not a public-private partnership?

The horse has left the barn. The bird has flown the coop, and you can never get those square foam pieces to fit back into the box once you’ve opened it. The corporation has entered the hen house, and it’s pretty much okay with the hens. Public-private partnerships vary, to a huge degree. It’s not useful to try to lump them all together, any more than it is to assume all official development assistance is the same. This new world of business participation in global health needs a new vocabulary to describe it.