rants

Say No to Old Clothes

By Alanna Shaikh | | 72 Comments |

used clothing stall

Some of you may have heard of a new campaign called One Million Shirts. They want to collect 1,000,000 used and new t-shirts and send them to Africa to help people with no clothes. They are also collecting money for the shipping costs. They’ve got some NGO partners, and they are starting to think about how best to distribute the t-shirts.

When I first heard of it, I thought it was an another well intentioned mess. The project is taking criticism for obvious reasons (if they’re not obvious, I’ll come back to them at the end of this post). The consistently brilliant Texas in Africa blog vouched for the good intentions of the founder, Jason Sadler, despite the terrible weakness of the idea. I decided I was going to stay out of the argument. Other, smarter people were saying everything I would have.

Then I saw the video. Now I don’t think it’s a well intentioned, poorly planned charity effort. Now I think it’s a marketing ploy from someone who is totally uninterested in helping others. When you actually want your project to have an impact, you listen to criticism. You put your ego aside and learn from what people have to say. You don’t cling to your original idea with wounded fury and attack the people questioning you.

I watched the video seven times, and transcribed it for you. My notes are in red:

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Hey internet trolls, angry people on twitter, whatever you want to call yourselves.

Angry people on Twitter seems accurate. I don’t know about trolls. Trolls make trouble for the fun of it. Not everyone who disagrees with something is a troll.

You all have a problem with me? That’s fine. I’m very easy to get ahold of. 904 312 2712. Call me.

I am not calling. I am writing this blog post, because I think public discussion is important. And you put your idea out into the world. It seems unreasonable to then demand that all conversation about the idea take place in private. Also, I live in Tajikistan, where I do international development work. Calling you by phone would cost me a fortune, and my internet is too slow for a decent Skype call.

Be a man.

This is sexist. I for one cannot be a man, without major surgery and life changes, because I am female. Are you assuming that everyone who disagrees with you is male? Or that everyone in the world is male? Or, wait – I get where you’re going with this. You think the people who disagree with you are cowardly, and you want them to be straightforward and courageous. Fair enough. But associating bravery and candor exclusively with men is sexist. And yes, your sexism is relevant here. I don’t trust you to do a good job working with women and children if you think they 1) don’t exist or 2) are incapable of courage.

Don’t sit behind Twitter. 140 characters. You don’t even have the time to email me, and you’re going to talk to me on Twitter.

Twitter is a pretty common forum for public discourse. This comment seems roughly equivalent to comparing that someone is hiding behind email or a telephone. I do agree that 140 characters doesn’t lead to useful, detailed discussion. That’s why people are writing blog posts.

I don’t care. I don’t drink hatorade. I really don’t. I don’t care at all. My dog doesn’t care. I don’t care. I don’t care at all.

That is not exactly the response of someone who is interested in learning from criticism. This isn’t personal. Nobody has any problem with you. This is about fear that this project you have founded will hurt the people in Africa that it intends to help. You getting mad does not change that.

If you have a problem with 1 million shirts, you probably really don’t like the fact that I get paid to wear t-shirts for a living. So, go to iwearyourshirt.com if you really want me to ruin your day.

Either this is a massive logical fallacy or a blatant plug for your business. I will assume the best and address it as a logical fallacy. Nobody is opposed to this project because they hate t-shirts or people who wear them. We are worried that sending a big pile of used clothes to African countries will hurt the local textile industry and people who sell retail clothes.

Otherwise I’m going to keep trying to give kids and families who don’t have shirts in Africa clothing to wear. Because you guys all seem to think that everyone in Africa has clothing.

Not everyone in Africa has clothing you would approve of, or want to wear. But yes, I am willing to state that just about everyone in Africa has clothing. Certainly in the countries that you are planning to target: Kenya, Uganda, DRC, Ghana, Liberia, Mozambique, Nigeria, Ethiopia, Sudan, Swaziland, and South Africa. For one thing, Kenya and South Africa are among the strongest economies on the continent.

So apparently you know better than I do. I’ve only been talking to charities who go there often.

Most of the people arguing with you are experienced aid workers and international development professionals with long histories of working with Africa. I am not. I have backstopped Africa programs from DC, and I have a degree in global health, but that’s all I’ve got. J from Tales from the Hood is a different story. So is Texas in Africa. I can pretty much guarantee they have as much or more experience with Africa than the charities you’ve been talking to.

So just want to let you guys know 904 312 2712. I’m happy to talk to anyone who wants to talk like a man maybe step up and actually speak to somebody, not just sit behind a computer. I don’t do that. I step up and get things done. So have a great day, I wish you all the best.

I’m still a woman. Still interested in public discourse, not closed doors wrangling. And I still live in Tajikistan. You have a good day too.

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For more information on why donations of used clothing can hurt Africans, see the following resources:

1)      The T-shirt Travels – a documentary on used t-shirts in Africa

2)      Dead White People’s Clothes

3)      Oxfam Report on secondhand clothing in Africa

Photo credit: Kim_TD

Why you can’t understand global health

By Alanna Shaikh | | 10 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)

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)

Why don’t we do better?

By Alanna Shaikh | | 5 Comments |

Sam Brownback

I have mentioned two or three or thirty times that I am not the only person in the development world who obsesses about how we could do our work better. Everyone has ideas; it’s a very common topic of conversation among people who work in this field. Most of us have the same ideas. So why don’t we ever get to act on them? There are a few reasons I can think of:

Donors don’t always know what they are doing. Government donors are usually democratic nations, which means in practice that foreign aid programs are often defined by legislatures with no real background in international development. So you end up with earmarks for pet ideas, rules forbidding useful practices like harm reduction, and an overall lack of direction. Private donors tend to go for exciting quick impact ideas like mobile health clinics and cash-for-work projects. Overall, complicated, unsexy ideas like health system strengthening may go unsupported.

Donors are politically motivated. I have seen health projects where the donor chose the pilot areas because of mysterious HQ calculus about the possibility of terrorism or political instability. Or take a look at how funding goes to Gaza and the West Bank. Donors have reasons for supporting international development funding that go way beyond supporting international development, and it can be hard to take that money and make it useful. Many (maybe most) organizations tend to try anyway.

Lack of time. There is a steady supply of new research on what works in international development. There is no steady supply of time in which to read that research and figure out how to apply it in practice. Some places have a technical team at headquarters to keep up with new research and recommend how to use it. That’s not as common you would think, though, because that kind of work counts as an overhead expense. High overheads make it hard to get grants and donations.

Host country capacities. A good development program works with the host country government to build its skill set, so that impact will continue once the program is over. Sometimes that means obeying host country regulations that contradict best practices, or spending a year convincing a government to change its rules. For example, some countries in Sub-Saharan Africa were achingly slow to adopt community therapeutic feeding (plumpy’nut and other RUTFs) even when the data showed it was much more effective than older ways of treating malnutrition. It’s miserable being stuck in a project that could be doing far more than it is allowed to, but I think the alternative – setting up an aid system that is parallel to the government – or worse yet, contradictory – is worse in the long term.

Funding and evaluation cycles. It’s very hard to design a program that will have a long term impact and also start showing results in two years. It’s not impossible; I’ve worked for several projects that managed it. But it’s hard. It limits your options severely. And inexperienced or unskilled NGOs may just aim for quick results and worry about the long term later.

This is not an exhaustive list. It’s just off the top of my head. What am I missing?

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Photo Credit: Iowa Politics.com

Chosen because Senator Brownback once tied up hundred of hours of manpower from an HIV/AIDS program because he didn’t understand the difference between harm reduction and risk reduction.

Arguing against innovation

By Alanna Shaikh | | 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

Dear Enough Project, refugee kids are people

By Alanna Shaikh | | 55 Comments |

(photo from Enough blog)

Updated on July 13 – Enough has issued an apology for this poorly handled distribution, and committed to doing better in the future. You can see their apology here. I was impressed; it was like a case study in how to take criticism with grace.

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The Enough project works in advocacy against genocide, particularly on Darfur. All well and good. I don’t know much about the intricacies of Darfur, or the intricacies of advocacy. I know some people think Enough is too heavy on the celebrities, and others think they do good work. That’s not what this post is about.

This post is about the idiotic, dehumanizing, tacky stunt they pulled in a refugee camp in Eastern Chad. They brought a limited number of New York Knicks jerseys on a visit to the camp, and made the kids fight for them. You don’t believe me? I will quote the blog:

“(We) separated the children into groups based on which blocks in the camp they lived. Then we began to hand the jerseys out as evenly as possible. The scramble began, and within minutes the jerseys were devoured. Though we informed them that we had no more to give, the children still scrambled up to us to peer into the empty bag to ensure a jersey had not escaped our notice.”

Okay, not fight – scramble. And note the dehumanizing language – devoured – like the kids are starving animals. This makes me mad. Refugee children are human beings with human dignity who should be treated as such. Enough just came and taught the kids that there isn’t enough for everyone and the good stuff goes to the strong and fast.

Now you ask – what would I have wanted them to do? Well, first of all, I would posit that there is no reason to bring New York Knicks jerseys to a refugee camp except to feel good about yourself. If you are determined to bring the jerseys I still have three suggestions:

  • Bring enough jerseys for all the kids (a lesson many of us learned in kindergarten)
  • Give the jerseys to schools to use as prizes or rewards for high-performing students
  • Use a transparent lottery system to select parents to be given jerseys for their kids

All of these would take more time and effort than just carrying basketball jerseys to a refugee camp and throwing them at kids. It’s worth it.

At this point, I would like Enough to make sure this doesn’t happen again. I’d like them to develop guidelines on appropriate donations and methods of donations for visitors to camps. They should refuse to visit camps with any group or individual who does not follow those guidelines. And they should publish those guidelines on their blog for public review and comment.

PS – If you don’t want my advice on how to handle a distribution to refugee children, may I recommend the Sphere standards?

I’d appreciate it if anyone who reads this post would go over to the Enough post, tell them what you think of this dumb stunt, and leave a link to this post.

Last note: Before you post a comment telling me that Enough means well and we shouldn’t criticize them, read this post.

Fund People, Not Concepts

By Alanna Shaikh | | 13 Comments |

Leader on sand dune
(photo credit: Hamed Saber)

Have you ever seen a really great project run by a terrible leader? I never have. I’ve seen competent development work done by bad leaders, but not great work. I’ve never seen it in a company, either. No amount of quality systems can make up for a lack of good leadership at the top.

But we give our grants and contracts to development work based on the structure of the project, as though the logframe and the staff chart are all that matter. This is a problem. It’s not the shape of the staff chart that matters, it’s the names you find in the chart.

We should give money to people who can do good things with it. I once worked with a Ministry of Health official who ran one small department of the Ministry of Health. He was committed to his work, and to his country, and he was flat-out brilliant. He was my go-to advisor for everything my project did, not just the stuff that involved his center. He had ideas – great ideas – about how to improve health in a whole range of different ways.

He should have been running a project. Some donor should have been bankrolling him to improve his department and then the health of the people in his country. With appropriate safeguards, of course. Reporting on how the money was used and what impact it had and so on. But he could have done amazing things with the right support.

The project I work for now, which I won’t name because nothing I write here is their opinion etc. etc. blah blah blah, does really good work. I am proud to be part of it. But our chief of party is the smartest human being on earth. She leaves Marilyn Vos Savant in the dust. She could be doing anything, and she’d do it well. Someone should give her the development equivalent of a MacArthur genius grant (note to self – find way to nominate boss for MacArthur grant) to use her big brain to attack development problems any way she wants to.

Instead of supporting people who can get things done, we support structures. Some of that is an effort to support fragile states and build democratic institutions, and we should keep it up. Some of the support for structures, however, is just intellectual laziness, and a desire to do things how they have always been done. That needs to change. I know this sounds like a recipe for corruption, but anything is a recipe for corruption if you do it badly. We can still ask for financial accountability, and for proof of results.

Innovation comes from individual people with ideas and passion. We should find and support those people to bring change in their countries and communities.