Another look at international development from someone who's been there
February 4, 2010 9:47 PM Subscribe
Blood and Milk is the blog of international development worker and writer Alanna Shaikh, who consults on global health development and writes for publications such as the UN Dispatch. Her views, based both on her work in the field and her study & understanding of sociology, international relations, and other such subjects, tend to be contrary to most other opinions on international development: voluntourism isn't helpful, development work is mired in a culture of nice, don't bother starting an NGO (or, if you will anyway, here's how to succeed), global health doesn't need innovation, and microfinance is a disappointment. Also, here's how to tell if your health project is doomed, and Haiti doesn't need your shoes (some people vehemently disagree). Educated well-researched iconoclast, or pessimistic Mary Contrary?
One of the things that seems to be missing in most NGO's is any sort of project management. This is really the cure for a lack of focus and an inability to make good on objectives. Being well intentioned is great it is just not the same as being effective.
posted by empty vessel at 10:18 PM on February 4, 2010
posted by empty vessel at 10:18 PM on February 4, 2010
She's an educated, well-researched iconoclast, pretty conclusively. She's one of the most thoughtful and perspicacious development-oriented bloggers around.
posted by clockzero at 10:32 PM on February 4, 2010
posted by clockzero at 10:32 PM on February 4, 2010
OK, we get the ironic street theater, oddman, but I think you're missing the point by pressing it. Volunteerism shouldn't be about satisfying the volunteer, but about unmet needs.
One of the looming things we face in Haiti now is assistance fatigue. The problems are, here, so all-encompassing that one hardly knows where to start and it's tempting to think that almost anything helps, or that good intentions always bring good results. It's necessary to have some contrarianism to those warm'n'fuzzy shibboleths. In the long run, which is what effort should now begin to focus on, we want stuff that works more than stuff that makes us feel good.
I wouldn't dismiss shoes so quickly, as a lot of survivors will have lost many or most of their possessions -- but then there are also local sources of shoes, shoes made available by the death of their owners, and so on. We do know from experience and axiomatic economics that introducing something into an environment that isn't needed can create grey markets and unintentional effects. Still, the main objection comes down to people starving and dying from lack of clean water, and you're filling a plane with ... shoes?
Right now the aid juggernaut is trying to change course from handing out tents to urging people to build temporary shelter using lumber and tarps. Surprisingly, they prefer the tents. But this is about accommodating people for the long term before any sort of reconstruction on a mass scale can begin. Macro, not micro. It really seems as if most of the help is more on a micro level. We need more of this type of thinking if we're going to begin to make a dent in the problem.
posted by dhartung at 10:51 PM on February 4, 2010 [1 favorite]
One of the looming things we face in Haiti now is assistance fatigue. The problems are, here, so all-encompassing that one hardly knows where to start and it's tempting to think that almost anything helps, or that good intentions always bring good results. It's necessary to have some contrarianism to those warm'n'fuzzy shibboleths. In the long run, which is what effort should now begin to focus on, we want stuff that works more than stuff that makes us feel good.
I wouldn't dismiss shoes so quickly, as a lot of survivors will have lost many or most of their possessions -- but then there are also local sources of shoes, shoes made available by the death of their owners, and so on. We do know from experience and axiomatic economics that introducing something into an environment that isn't needed can create grey markets and unintentional effects. Still, the main objection comes down to people starving and dying from lack of clean water, and you're filling a plane with ... shoes?
Right now the aid juggernaut is trying to change course from handing out tents to urging people to build temporary shelter using lumber and tarps. Surprisingly, they prefer the tents. But this is about accommodating people for the long term before any sort of reconstruction on a mass scale can begin. Macro, not micro. It really seems as if most of the help is more on a micro level. We need more of this type of thinking if we're going to begin to make a dent in the problem.
posted by dhartung at 10:51 PM on February 4, 2010 [1 favorite]
Cool post. I'm building a CV pretty similar to Alanna's myself, currently (working in the NGO sector, I too have worked in 4 of the world's most dangerous places - including Haiti). I'm working way too damn long and hard to write as much as she does, and I'm not nearly as highly educated, but I have to say that in large parts, based on my experiences, I have to agree with her. Even when I don't like to admit it.
Working in international development and relief is hard enough without the pessimism though. As fascinated as I am by all of the aid-doesn't-work-yes-it-does debate on the Ted videos and in books like Dead Aid, et. al., I had to at some point forbid myself from watching / reading them anymore. The fact of the matter is that, at my core, I have seen first hand the positive impacts of aid work in the 3rd world and disaster situations. Imperfectly executed, in need of better strategic management and better donor accountability. Sure. But still - positive change.
People like Alanna discourage me, because, while they paint a realistic picture, they don't always paint the complete picture. Rather - they very often focus solely on the negative. Development and aid, on a broad scale, work - the data proves it. It might not be as rapid and radical as we'd all like, but what do you expect? There are no magic pills.
But that isn't what people want to read - it doesn't make headlines. And, I suppose, people like Alanna have to, in a sense, write what people will read, even if its sometimes under the guise of "things they don't want to hear."
And yet still...I pretty much have to agree with her.
posted by allkindsoftime at 12:16 AM on February 5, 2010 [4 favorites]
Working in international development and relief is hard enough without the pessimism though. As fascinated as I am by all of the aid-doesn't-work-yes-it-does debate on the Ted videos and in books like Dead Aid, et. al., I had to at some point forbid myself from watching / reading them anymore. The fact of the matter is that, at my core, I have seen first hand the positive impacts of aid work in the 3rd world and disaster situations. Imperfectly executed, in need of better strategic management and better donor accountability. Sure. But still - positive change.
People like Alanna discourage me, because, while they paint a realistic picture, they don't always paint the complete picture. Rather - they very often focus solely on the negative. Development and aid, on a broad scale, work - the data proves it. It might not be as rapid and radical as we'd all like, but what do you expect? There are no magic pills.
But that isn't what people want to read - it doesn't make headlines. And, I suppose, people like Alanna have to, in a sense, write what people will read, even if its sometimes under the guise of "things they don't want to hear."
And yet still...I pretty much have to agree with her.
posted by allkindsoftime at 12:16 AM on February 5, 2010 [4 favorites]
I've been reading her blog (and many others in this area) for some time and she has some important, blunt points. In this field we talk a lot about 'here's the theory', but then we must always contend with reality. We all know what we would like to happen in any given situation, but development involves a lot of compromise and embracing the unknown. I work in the capacity building side of things, so a lot of what we do is putting things out there and skilling people, and we get some amazing unintended outcomes.
allkindsoftime - I agree with you that it's important to stay positive and celebrate success too. The Gates Foundation did a very good presentation recently on being "impatient optimists" and how US aid is working in global health.
posted by wingless_angel at 1:55 AM on February 5, 2010
allkindsoftime - I agree with you that it's important to stay positive and celebrate success too. The Gates Foundation did a very good presentation recently on being "impatient optimists" and how US aid is working in global health.
posted by wingless_angel at 1:55 AM on February 5, 2010
oddman: It's easy to nitpick and poke holes in other people's plans, very easy. It's much harder to actually make a positive contribution to the world.
It's very easy to use textual substitution to portray sarcasm, very easy. It's much harder to actually make a legitimate contribution to the thread.
posted by 0xdeadc0de at 3:25 AM on February 5, 2010
It's very easy to use textual substitution to portray sarcasm, very easy. It's much harder to actually make a legitimate contribution to the thread.
posted by 0xdeadc0de at 3:25 AM on February 5, 2010
How are her views contrary to most other informed opinions on international development? That's a pretty unsupported assertion you're making.
posted by ahughey at 5:02 AM on February 5, 2010
posted by ahughey at 5:02 AM on February 5, 2010
0xdeadcode, careful you don't hoist yourself on your own petard. Oh, too late.
I understand what she is doing, but I'm not sure that publicly shaming the people who want to help is a positive step. Does, it encourage people to work more effectively? Perhaps. But, people can be as contrary as she is, and her efforts might just encourage them to entrench further.
Furthermore, I am uncomfortable with taking such a harsh tone with people like medical volunteers. Scolding the very people who want to help. Is probably just as likely to discourage them as it is to change their behavior. Will this raise awareness about the pitfalls of medical volunteering? Likely so. But that will only help in the next emergency. In this emergency it would be much more helpful to get on the phone and help them to get the things that she says the need. Did she do this? I don't know. I hope so. But she was too busy being a pedant and a scold to let us know.
At very least she could, while she berates the benighted souls, actually let them know how to do a better job or who to contact in order to get help.
posted by oddman at 5:24 AM on February 5, 2010 [1 favorite]
I understand what she is doing, but I'm not sure that publicly shaming the people who want to help is a positive step. Does, it encourage people to work more effectively? Perhaps. But, people can be as contrary as she is, and her efforts might just encourage them to entrench further.
Furthermore, I am uncomfortable with taking such a harsh tone with people like medical volunteers. Scolding the very people who want to help. Is probably just as likely to discourage them as it is to change their behavior. Will this raise awareness about the pitfalls of medical volunteering? Likely so. But that will only help in the next emergency. In this emergency it would be much more helpful to get on the phone and help them to get the things that she says the need. Did she do this? I don't know. I hope so. But she was too busy being a pedant and a scold to let us know.
At very least she could, while she berates the benighted souls, actually let them know how to do a better job or who to contact in order to get help.
posted by oddman at 5:24 AM on February 5, 2010 [1 favorite]
I'm not sure that publicly shaming the people who want to help is a positive step.
That's not what she's doing. She's just saying that their motivations are great, but their path is misguided and potentially deeply unhelpful.
Personally, as someone who has done development work and studied it in graduate school, I agree with much of what she says (and with what Allkindsoftime says above) particularly on "voluntourism" and on her comments on Haiti. It might be uncomfortable to read, but she's right -- good motivations don't substitute for good plans and good logistics, ever.
And in terms of discouraging some of the people who are trying to help, you say that like it's a bad thing. Some kinds of "help" are worse than doing nothing. Imagine that I had charted ten planes and filled them with used clothes the day after the earthquake. With the airport barely functioning, my unneeded planes of used clothes would have blocked planes carrying trained rescue teams, for example. More to the point, doctors and surgeons can only operate (in both senses of that word) with extensive logistical support. Without clean instruments, nurses, antibiotics, and all the other pieces of medical infrastructure, never mind a place to sleep, water, and food, a doctor alone isn't of much use. Haiti doesn't need lone-gun medical teams -- it needs teams that can fit into the rebuilding of its medical infrastructure.
She's saying much the same as I did in the AskMe about how to go and help -- if you aren't genuinely needed there today, delay a bit, wait until Haitians have begun rebuilding, and then partner with a local organization or institution for the long term. It's correct advice, and it's kind of frustrating how no one wants to hear it. The tendency so many of us have towards feel-good actions rather than effective ones is very natural, but not very helpful in the end.
posted by Forktine at 6:12 AM on February 5, 2010 [3 favorites]
That's not what she's doing. She's just saying that their motivations are great, but their path is misguided and potentially deeply unhelpful.
Personally, as someone who has done development work and studied it in graduate school, I agree with much of what she says (and with what Allkindsoftime says above) particularly on "voluntourism" and on her comments on Haiti. It might be uncomfortable to read, but she's right -- good motivations don't substitute for good plans and good logistics, ever.
And in terms of discouraging some of the people who are trying to help, you say that like it's a bad thing. Some kinds of "help" are worse than doing nothing. Imagine that I had charted ten planes and filled them with used clothes the day after the earthquake. With the airport barely functioning, my unneeded planes of used clothes would have blocked planes carrying trained rescue teams, for example. More to the point, doctors and surgeons can only operate (in both senses of that word) with extensive logistical support. Without clean instruments, nurses, antibiotics, and all the other pieces of medical infrastructure, never mind a place to sleep, water, and food, a doctor alone isn't of much use. Haiti doesn't need lone-gun medical teams -- it needs teams that can fit into the rebuilding of its medical infrastructure.
She's saying much the same as I did in the AskMe about how to go and help -- if you aren't genuinely needed there today, delay a bit, wait until Haitians have begun rebuilding, and then partner with a local organization or institution for the long term. It's correct advice, and it's kind of frustrating how no one wants to hear it. The tendency so many of us have towards feel-good actions rather than effective ones is very natural, but not very helpful in the end.
posted by Forktine at 6:12 AM on February 5, 2010 [3 favorites]
One of the things that seems to be missing in most NGO's is any sort of project management...
That's paragraph is a pretty big generalisation. I hope you have an incredibly broad amount of NGO experience to back that up, because it doesn't tally with my NGO experiences at all.
NGOs are just like regular O's: some are shit, some a great, most are in between. They do different things for different reasons, in different ways, and accomplish a varying degree of goals. I would be reluctant to characterise an NGO in any particular way except to say they are generally on the broke-ish/underfunded side of things, can't pay as much as similar jobs in the private sector, know the public sector quite well, and work pretty hard. I've seen some project management that puts my private sector experience to shame, and vice versa.
posted by smoke at 6:18 AM on February 5, 2010 [2 favorites]
That's paragraph is a pretty big generalisation. I hope you have an incredibly broad amount of NGO experience to back that up, because it doesn't tally with my NGO experiences at all.
NGOs are just like regular O's: some are shit, some a great, most are in between. They do different things for different reasons, in different ways, and accomplish a varying degree of goals. I would be reluctant to characterise an NGO in any particular way except to say they are generally on the broke-ish/underfunded side of things, can't pay as much as similar jobs in the private sector, know the public sector quite well, and work pretty hard. I've seen some project management that puts my private sector experience to shame, and vice versa.
posted by smoke at 6:18 AM on February 5, 2010 [2 favorites]
She posted a Welcome Metafilter message that addresses a few of the posters here.
posted by Adam_S at 6:49 AM on February 5, 2010 [3 favorites]
posted by Adam_S at 6:49 AM on February 5, 2010 [3 favorites]
It's much harder to actually make a positive contribution to the world.
I think if you take a look at her resume, you'll see that she is indeed putting her proverbial money where her mouth is. Walking the walk and all that.
posted by grapefruitmoon at 7:17 AM on February 5, 2010
I think if you take a look at her resume, you'll see that she is indeed putting her proverbial money where her mouth is. Walking the walk and all that.
posted by grapefruitmoon at 7:17 AM on February 5, 2010
Public health grad student with Global Health background here. Oddman, I believe you're putting too much emphasis on the marketing aspect of international development and health programs. While I understand the possible negative impact of Shaikh's articles on charitable giving or volunteering, I believe that the negative impact of misapplied resources far outweighs their benefit. Dee Xtrovert underscored this difficult truth in an AskMe thread a couple weeks back:
So for most TB infections, the patient needs to take a rifampicin and isoniazid cocktail every day for 6-24 months. If that doesn't happen, the bacterium mutates and becomes resistant to treatment-- bad news for the patient, especially if they contracted a resistant strain to begin with and had to take second- or third-line drugs. If they run out of drugs, they die, usually passing the disease onto someone else before they do-- and we're talking about 1.6 dead people a year here. That's 180-720 doses of medication that need to be delivered EVERY DAY, long after the patient no longer feels ill. We're talking daily patient contact for at least the first two months, and probably the entire course if you really want to be effective. Most governments can't even provide this kind of service.
How do you even begin to construct a system to deliver that sort of treatment? You do it by finding a sustainable source of funding, interfacing with the systems already operating in the region, and training local community health workers to deliver most of the care-- pretty much everything Shaikh pointed out in her article. You don't need tons of American doctors and nurses volunteering for a couple weeks through their hospitals; you need a sustained commitment. Otherwise, resistance rises, your patients infect others with their resistant strains before they die, and the next group of plucky global health do-gooders has to clean up a mess that is infinitely more intractable than it was when you started.
So there's some pretty empirical proof for you: quality insurance mechanisms and watchdog groups need to be harsh. Otherwise, well-meaning programs end up getting in the way, wasting vast amounts of resources, and ruining health outcomes. If it comes at the expense of discouraging a few donated dollars or turning away a couple bright-eyed idealists, then I think that's an acceptable loss.
posted by The White Hat at 7:25 AM on February 5, 2010 [5 favorites]
It's actually "Haiti." And people do know whether unskilled volunteers are a hiindrance or not. I do, because while these sorts of situations all have unique aspects, they fundamentally are the same. We had such people show up in Sarajevo, during the war. They were - to a person - a great drag on life there for those of us without the ability to leave.Please read the rest of her comment. Then read this speech by Ivan Illych:
If you have any sense of responsibility at all, stay with your riots here at home. Work for the coming elections: You will know what you are doing, why you are doing it, and how to communicate with those to whom you speak. And you will know when you fail. If you insist on working with the poor, if this is your vocation, then at least work among the poor who can tell you to go to hell. It is incredibly unfair for you to impose yourselves on a village where you are so linguistically deaf and dumb that you don't even understand what you are doing, or what people think of you. And it is profoundly damaging to yourselves when you define something that you want to do as "good," a "sacrifice" and "help."And now that you've got some anecdotal/philosophical grounding in the subject, let me throw some science your way: I want to talk for a bit about multiple drug-resistant tuberculosis, or MDRTB.
So for most TB infections, the patient needs to take a rifampicin and isoniazid cocktail every day for 6-24 months. If that doesn't happen, the bacterium mutates and becomes resistant to treatment-- bad news for the patient, especially if they contracted a resistant strain to begin with and had to take second- or third-line drugs. If they run out of drugs, they die, usually passing the disease onto someone else before they do-- and we're talking about 1.6 dead people a year here. That's 180-720 doses of medication that need to be delivered EVERY DAY, long after the patient no longer feels ill. We're talking daily patient contact for at least the first two months, and probably the entire course if you really want to be effective. Most governments can't even provide this kind of service.
How do you even begin to construct a system to deliver that sort of treatment? You do it by finding a sustainable source of funding, interfacing with the systems already operating in the region, and training local community health workers to deliver most of the care-- pretty much everything Shaikh pointed out in her article. You don't need tons of American doctors and nurses volunteering for a couple weeks through their hospitals; you need a sustained commitment. Otherwise, resistance rises, your patients infect others with their resistant strains before they die, and the next group of plucky global health do-gooders has to clean up a mess that is infinitely more intractable than it was when you started.
So there's some pretty empirical proof for you: quality insurance mechanisms and watchdog groups need to be harsh. Otherwise, well-meaning programs end up getting in the way, wasting vast amounts of resources, and ruining health outcomes. If it comes at the expense of discouraging a few donated dollars or turning away a couple bright-eyed idealists, then I think that's an acceptable loss.
posted by The White Hat at 7:25 AM on February 5, 2010 [5 favorites]
Okay, so she's pointing out bad ideas to help Haiti, but its not just complaints. After each callout, she's got a suggestion for how the idea could work better, and possibly be more helpful. That, to me, is a good kind of criticism.
posted by sandraregina at 7:26 AM on February 5, 2010
posted by sandraregina at 7:26 AM on February 5, 2010
@smoke - I have experience in a broad range of organizations, both private and NGO's. My experience show that most organizations struggle with managing projects well. The NGO's i have worked with definitely see the need to manage projects, they may not have the skills in house to do it well. Most local chapters of the Project Management Institute will publish volunteer opportunities to their membership. This is a great way for NGO's to engage a profession project manager it they do not have one on staff.
posted by empty vessel at 7:27 AM on February 5, 2010
posted by empty vessel at 7:27 AM on February 5, 2010
Very cool.
posted by anotherpanacea at 8:00 AM on February 5, 2010
posted by anotherpanacea at 8:00 AM on February 5, 2010
My only recommendation would be to follow the following pattern acknowledgement - criticism - acknowledgement. This approach is based in opening someone up to what you have to say, saying what you want them to hear and then leaving them with a positive association after reading what she has to say.
It is great that she is willing to share her experience with us. I really wish was more positive in her approach. I do find what she has to say as extremely valuable, and will be adding her to my list of blogs I read on a regular basis.
posted by empty vessel at 11:22 AM on February 5, 2010
It is great that she is willing to share her experience with us. I really wish was more positive in her approach. I do find what she has to say as extremely valuable, and will be adding her to my list of blogs I read on a regular basis.
posted by empty vessel at 11:22 AM on February 5, 2010
The NGO's i have worked with definitely see the need to manage projects, they may not have the skills in house to do it well.
I agree with smoke that this is also a problem in many for-profits as well. NGOs have a special problem, which is the fact that many donors don't want to pay for project management, which falls under the umbrella of the dreaded "administrative costs." And money for training in project management is even harder to find.
posted by lunasol at 12:44 AM on February 6, 2010 [2 favorites]
I agree with smoke that this is also a problem in many for-profits as well. NGOs have a special problem, which is the fact that many donors don't want to pay for project management, which falls under the umbrella of the dreaded "administrative costs." And money for training in project management is even harder to find.
posted by lunasol at 12:44 AM on February 6, 2010 [2 favorites]
I clicked on the "microfinance is a disappointment" link which was pretty thin and references a blog post on GiveWell which was full of useless speculation.
posted by euphorb at 11:48 AM on February 7, 2010
posted by euphorb at 11:48 AM on February 7, 2010
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How could one respond?
The problem with this idea is that it’s based on an assumption – that lots of technical and language education is Haitians need right now. What if they need learn about farming? Or waste disposal? Or first-aid? Should they use their new English skills to take classes in those things? Has anyone done an assessment to find out if French is needed? To decide what languages are needed? Their new communication skills could end up wasted and useless, absorbing people’s focus without providing any benefit.
It’s brave, it’s scrappy, and it shows amazing initiative. It’s also a horrible idea. The people don’t seem to have any plan from bringing in their own teaching supplies and haven’t set up a place to stay in Haiti. They don’t have a school to work out of or any background in responding to this kind of educational disaster. This is exactly the kind of misguided effort I was afraid we’d see, because Haiti is close enough to the US to make it possible.
Wow, Alanna's education plan sure sounds misguided doesn't it?
It's easy to nitpick and poke holes in other people's plans, very easy. It's much harder to actually make a positive contribution to the world.
posted by oddman at 10:13 PM on February 4, 2010