Me in Other Places

dollar bills and vicodin

I’ve done a lot of writing lately, and I wanted to highlight a few pieces I’m especially proud of.

I guest-posted on the Results for Development Institute blog, about how we can encourage drug companies to develop medicines for the poor, not just the rich. Most of my writing for the last few months has been technical documents and reporting for my day job, and short, snappy blog pieces. It was nice to sink my teeth into something a little longer and more thoughtful, and it made me envy all the CGD folks who get to think for a living.

Over at UN Dispatch, I offered unsolicited advice to the soon-to-be-established South African aid agency.

Finally, in my weekly post at End the Neglect, I talked about corruption and transparency in global health.


(photo credit: bryan_chan)

UN Week Notes: Wednesday

I spent the morning at CGI and meeting with several different people to talk about the MDG summit and what they expected to come out of it.

No one wanted to go on the record, but the general consensus is that the meetings seem like a repeat. There is very little that’s new coming out this week. And while we don’t expect huge new research discoveries or anything, a new perspective or two wouldn’t be too much to ask for. The always brilliant Janet Ginsburg did give me one key piece of advice for interpreting the hype around the MDG Summit: look for what they’re not talking about. So I’ve been keeping my eyes open for that. One thing she pointed out is that the only water mentioned in the MDGs is drinking water, which ignores the other major use of water: irrigation.

After lunch I headed over to the Mashable Digital Media Lounge. I watched the live broadcast of Ban Ki Moon’s big announcement about the new global strategy for women and children’s health. He has commitments of 40 billion dollars from governments and private donors to back up the strategy.

I find myself very tired of linking women and children together in health approaches, but an additional 40 billion dollars is all to the good. I am a little suspicious. Often these kinds of commitments are just rehashes of money that would have been provided anyway (see Obama Global Health Initiative, Gates Foundation vaccine funding). Oxfam shares my skepticism about the money for the strategy, by the way, and also estimates that we really need more like 80 billion. I also heard from someone in the know that the team charged with overseeing the global strategy for women and children’s health is scrambling to figure out how to measure all of the things they have promised to do.

Also interesting: inclusion of Paul Kagame in the Every Woman, Every Child speaker’s roster.

The other big highlight of the day was the Millennium Promise Reception, a fancy shindig at the plaza hotel to “celebrate the leadership of Ban Ki-Moon, the MDG advocates and Champions, and innovators who are guiding breakthroughs for the Goals around the world.” (If you’re thinking that sentence makes no sense, I agree.) It was a little disconcerting to go to a lavish event at a luxury hotel to talk about extreme poverty.

But the purpose of the event was to get pledges from people to support the MDGs. And I guess you need rich people in their comfort zone if you want them to do that. It was a big deal event – Bob Geldorf spoke, and quoted Goethe. They started collecting MDG pledges at the reception. There are eighty so far, and some of them are big.

I don’t really have thoughts about the reception yet. I ran into several ex-colleagues and waited in the rain for 20 minutes for a bus to get back to my hotel, but that’s not really relevant.

Disclosure: I attended UN Week as an Oxfam VOICE, which funded my trip as part of an effort to increase awareness of the MDGs.


photo credit: Mr Azed

It was the only picture I could find of Bob Geldorf on flickr that was cc licensed

UN Week Notes: Tuesday

I’ll be doing one of these entries each day, with a few notes on the most interesting things I attended and any thoughts I had to share. I’ll have some more reflective and detailed posts coming, but I wanted to share the basics of this experience as fast as possible.

So, Tuesday.

In the morning, I went to the Clinton Global Initiative. It’s intensely controlled – tons of security, including secret service. Bloggers and regular media are combined in a subterranean press room which is packed full. I saw a nasty squabble break out over front row seats in the press room. There is an interesting contrast between part-time analytic bloggers like me and the full timers who do this for a living. If you want to attend any sessions at CGI, you have to be escorted by event staff. I spent my time watching the live feeds in the press room since I hadn’t had the chance to register to attend anything. On Wednesday, I’ve got some registrations.

The most interesting things I saw were Hilary Clinton’s speech launching the Global Clean Cookstove Alliance and a panel with Ellen Sirleaf Johnson, Queen Rania of Jordan, and Muhtar Kent of Coca-Cola talking about empowering women and girls.

Initial thoughts on Hilary Clinton: We’ve been trying to get people to use better cookstoves for 50 years. Why would it work now? But impressive framing of cookstoves as a global health issue. It needs a context if anyone is going to care, and global health is the sexy issue right now. I’ll have a post on cookstoves at Aid Watch soon.

Initial thoughts about the Women and Girls Panel: Muhtar Kent from Coca-Cola was up there like he belonged. He had serious ideas and plans about empowering women and girls, including an announcement that he is challenging Coca-Cola to empower 5 million more women by 2020. What does it mean that corporations are engaging in global health like this? How is it going to change the landscape? I should be writing on that for UN Dispatch.

In the afternoon, I was at the Mashable Digital Media Lounge. My favorite event was the panel on malaria. It focused mainly on Nothing but Nets, and included Mikkel Vestergaard Frandsen CEO of Vestergaard Frandsen group, Bishop Thomas Bickerton of the United Methodist Church, and Elizabeth Gore, Executive Director of Global Partnerships for the UN Foundation.

They made a persuasive case for the important of continuing the fight against malaria, arguing that we’re making real progress and we just need to stick with it. That ties to my own mantra of keeping on with what we already know how to do, so it’s not surprising I liked it.

They also discussed the importance of good storytelling and of small donations, which I liked less. While it’s true that ten dollar bills have been the lifeblood of Nothing But Nets, keeping up the stream of stories and pictures to motivate those small donations is misery for the field team who are actually attempting to run a project. A nice government or foundation grant that just asks for a report every month and some proof that you’re hitting your goals is far, far easier. Otherwise you spend valuable program time generating the stories that trigger small donations, and it takes away from the work you’re really trying to do. That is an eternal dilemma of this work, but the enthusiasm of this high level panel really brought it home to me.

Finally, in response to the one guy who was convinced that DDT is the magic bullet against malaria and environmentalists have been depriving us of it. NO NO NO NO NO. While DDT is environmentally vicious, that’s not why we stopped using it in the developing world. We stopped using it because mosquitoes get resistant to it really fast and it was losing effectiveness and making the mosquitoes stronger.

Disclosure: I attended UN Week as an Oxfam VOICE, which funded my trip as part of an effort to increase awareness of the MDGs.


Photo credit: Mashable

I wasn’t actually there for this, but it’s from the Digital Media Lounge, so bear with me.

Sakeena Yacoobi and Healthy Mothers

I have been watching the Ashoka Healthy Mother Competition with interest. Maternal Health is one of my passions; I studied it in graduate school and it has been part of my work for the last ten years. The ideas submitted to the competition have ranged from half-considered flashes of thought to fully imagined comprehensive maternal health programs. I am an advisor to one of them – AYZH, a social venture that works to provide clean, green birth kits to women in India.

It will not surprise you, then that I would love to attend the 2010 Maternal Health Change Summit in India. This post is my entry in the contest to attend the summit. I’m not going to talk about AYZH here, because it doesn’t seem quite fair to write about something so close to my heart in this context.

Instead, I will write about Sakeena Yacoobi. Founder of the Afghan Institute of Learning (AIL), she is one of the true heroes of this world. An Afghan-American, she returned to Afghanistan to serve women in her country of birth. The Afghan Institute of Learning offers services from basic education to human rights leadership training for 350,000 women and children in Afghanistan. They supported underground schools during the Taliban regime.

They also offer health care and health education. AIL is the provider of medical care for thousands of Afghan women. They use a family health approach, focusing on education and preventative care as well as medical services. When you are dealing with maternal health, it’s the gold standard. Women need knowledge in order to have a health pregnancy, not just skilled care when giving birth.

One of the most interesting things about maternal health is the range of interventions we have to improve it. We need both innovations like better incubators for premature infants and well-known essentials like educating mothers, supporting maternal nutrition, and skilled personnel to accompany births.

AIL offers those essentials, to women who have no other options. Maternal mortality rates in Afghanistan are staggering. 18 mothers out of every thousand die as a result of motherhood; the second highest rate in the world. The three clinics of the Afghan Institute of Learning are helping to bring that number down, and they deserve our support to do it.

Check out other solutions for improving maternal health or to participate in the global call to solutions, please visit Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health.

Me, in other places

What if we renamed Chagas to “blood sucking assassin bug disease?” I sexify NTDs over at End the Neglect.*

Just to demonstrate that I have range, I also have a post up at UN Dispatch, looking at the possible outcomes of the events in Kyrgyzstan.The scenarios range from almost good to very, very bad.

*Clever description stolen from Kathleen McDonald

Why you can’t understand global health

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.


(photo credit: cooperniall)