An explanation for the subtitle of this blog.
And! An exploration of the twisted mathematics of aid work.
Yes. You read that right. I’m gonna talk about math. Sort of.
Written on February 2nd, 2009 in a car between somewhere between Chicago and Los Angeles.
OK, first of all. I LEAVE IN 25 DAYS WOOOOAAAAAH!!!!!!!!!!
Believe me, I know that any sort of apologia is an awkward way to introduce this blog to you, but it’s all I’ve got for now. I mean, I could tell you about the packing process (if I had started it yet) or what I’ve been doing with myself since I received my invitation to do rural health work in Senegal (filling out paperwork and traveling from Chicago to LA – woo!). But. Um. I don’t feel like it. So at the risk of alienating my friends and family and ensuring that no one will ever read this, here I go.
So I want to think about what it means to do public health work in a rural village in Africa. Weird, because I haven’t even been there yet. And weird, because my ideas are probably going to change a lot when this whole adventure starts. But for now, this is where my head is.
OH. And just to be clear, a lot of what I’m saying isn’t going to apply to what I’ll be doing during my time in the Peace Corps at all. I’m not a doctor, I’ll be doing a very different type of work, and the resources situation will be different. This is just some stuff I think about. The point I want to bring with me to my work in Senegal is about scale and perspective.
The fight for access to essential medicines continues, and in the mean time people are dying of entirely preventable diseases. One more time, for emphasis: AIDS and malaria and tuberculosis aren’t killing these men, women, and children. Lack of proper treatment is. Of course, even if people in developing countries had access to all the drugs you and I can get our hands on, malnourished patients usually don’t do very well. Trust me, this paragraph could go on forever. The lack of access to proper medication is just one very small part of it all. I’m not even remotely qualified to be writing about all this, but I wanted to give you a sense of how fricking huge the problem of public health in developing countries can be. At the very least, you should know that it’s way bigger than what I’ll be able to see and comprehend while in Senegal.
Sick people in developing countries ought to have the same chances of getting well as I do. I really can’t see this as a controversial statement. It’s just not up for debate, guys. All the resources they need to get well should be given to them. The best possible treatment should be administered. (I’m ignoring the problem of shoddy health care in the United States and other wealthy countries. I know, I know. But still.) But the doctors aren’t there. The technology isn’t there. Selling drugs to poor people isn’t a moneymaking prospect for drug companies, so they don’t even try to develop cures for the diseases that are killing people in impoverished countries. With access to resources so chokingly restricted and demand for medical care so shockingly high, how do you even think about health care in places like this?
Since I’m not heading to Africa with cartons of peanut butter and antiretroviral drugs, what exactly am I doing? The whole thing looks even funnier when I don’t manage to forget that I studied the liberal arts in college. I’m not sure I can even feed myself with philosophy, let alone help anyone else out.
Luckily for all of us, Peace Corps Volunteers do get quite a bit of training before being unleashed upon our villages (the possessive pronoun is used widely in this style by PCVs, by the way, and it totally weirds me out – but more on that later). I’ll be able to give advice to mothers about how to prevent malnutrition in their babies as they are weaned. I’ll be able to organize the community around an AIDS awareness event, or give workshops on how to chemically treat the malaria nets in which we’ll all be sleeping. I will probably not be able to keep myself from getting worms in my gut, or the occasional rash, or bouts of diarrhea – and whether or not that makes me feel like a hypocrite, we’ll see. (And yes, I will tell you all about those things. I know why you’re really reading this, after all. Gross stuff is fun.)
But what does this work amount to? I’ll be in one village in one district in one country in the whole damn world. There are thousands of Peace Corps volunteers out there, and bajillions of people doing aid work of some sort. Nevertheless, how can I avoid feeling that my individual contribution is not meaningful? Is there any perspective from which I can look at my work and not see absurdity and futility?
Maybe not, honestly. After all, I’m pretty sure there are a lot of ways to be an ineffective Peace Corps volunteer. At the very least, I am absolutely sure that there are more ways to be bad at this job than there are of being good at it. But even if I manage to pull it off, what am I accomplishing?
The way I think about it, it’s all about perspective and scale. I hope I can illustrate this in a way that makes sense.
I spent some time in post-Katrina New Orleans, gutting out destroyed homes in the lower Ninth Ward. It was by no means a given that this area would be inhabited ever again, though we knew we were gutting the houses of people who honestly meant to return to them one day. And even after we gutted these houses, got rid of the mold, and brought back the residents, who could say when the next Hurricane Katrina would hit? What would happen then?
On a day particularly full of frustration, when I felt that my compatriots and I could never do enough to bring life back to this dead place, it occurred to me that all I could do was the job in front of me. Sink your shovel into the muck, lift the shovel to the wheelbarrow, dump. Repeat. It wasn’t a lot, but you would do that enough and then throw some bleach around and you had a clean room. And in the meantime, the other people on your crew would be doing the same thing in other rooms. After a few days, the house that had been full of mud and debris and rot up to your hips was… better. It was on its way to being a home again. Of course, New Orleans was still a mess, but we had this place now. That place had been the job in front of me, and I had done it. One family could come back and try again, and in the twisted mathematics of aid work, one is infinitely better than nothing.
More on that twisted mathematics, because I think it was the piece I was missing for a while when I thought about this stuff, and I’m closer to understanding it now. It’s a problem of scale, sort of like in New Orleans – you can only do so much, so what do you do? The answer in New Orleans was something about treating every destroyed house as the whole problem, the only destroyed house. Pour everything into making it better. The big dirty secret about the world, as I see it, is that so often the things we think are impossible – aren’t. The resources will be there. It can totally happen. Trust me, gutting the second house is easier than gutting the first house, even though getting out of your cot once you were done with the first one seemed impossible. And maybe if you solve that first health problem well enough, you’ll figure out a way to do an even better job next time. Maybe someone will want to give you lots of money to do that second job. I know, maybe maybe maybe. But it’s better than just saying no, I’m done, this is impossible, I won’t go any further. So much better.
Scale is just weird in aid work. The only choice you’re making is to stand up and get to work or not. You say either that you will do the job in front of you, or you turn it down. The flooded room you’re standing in is both the only and every flooded room in New Orleans, and the sick villager in the bed you stand beside is both the only and every sick man, woman, and child in every developing country. It’s not that you make the choice to help people once. I think it’s something more like making the same decision over and over again with each new person.
Am I making sense? It almost doesn’t matter. I think I’ve begun to make sense to myself, anyway.