Who's to say?

“The basic purpose of development is to enlarge people’s choices. In principle, these choices can be infinite and can change over time. People often value achievements that do not show up at all, or not immediately, in income or growth figures: greater access to knowledge, better nutrition and health services, more secure livelihoods, security against crime and physical violence, satisfying leisure hours, political and cultural freedoms and sense of participation in community activities. The objective of development is to create an enabling environment for people to enjoy long, healthy and creative lives.” -United Nations Development Program (2003)

We’ve nearly completed the solders and circuits portion of our technical training. For the remainder of the 10 days we are here at MS-TCDC our afternoon sessions will focus on the reality of working in the developing world: how will we interact with the staff? What will we actually do in the hospital? What can we hope to accomplish? Today we discussed the causes and symptoms of poverty. We focused on the Human Development Index, a scoring system that combines life expectancy, adult literacy, school enrollment, and GDP. Norway scores highest of 177 scored countries; Sierra Leone comes in last. The U.S. comes in at #8, Tanzania at #162. We were asked to discuss which indicators we thought truly identify a poor nation, which indicators we thought were missing, and what we believed causes poverty in the developing world.

As you can imagine, the debate was heated and, in the end, inconclusive. Most believed that lack of education is a good indicator of poverty, and certainly one of its causes. Others, however, argued that enrollment in school by no means indicates quality education. They went on to say that lack of education doesn’t always lead to poverty. What about Masai cattle herders who measure wealth in cattle, not shillings? One might even argue that forcing children to go to school and learn in a Western-style classroom (in the case of the Masai, in boarding schools) hurts their families who need them to look over their estate.

One student proposed that perhaps lack of work ethic was to blame for poverty in the developing world. Maybe, he said, some people are just used to living in squalor and don’t feel like changing. He was thoroughly excoriated for this comment. Not long after, though, very similar sentiments, couched in more palatable terminology, were expressed by other students. After years of corrupt government and oppression, they said, how can we expect people to suddenly adopt industrious attitudes? They cited the inability of the people of Ghana to run basic infrastructure (let alone build an economy), and the tendency of some Central and South Americans to prefer to steal rather than work.

All of the prosperity indicators listed above (and several others that weren’t listed, such as women’s education, infrastructure, corruption, and wealth distribution) were met with ambivalence. Yes, X is important, but is it a cause or a symptom of poverty? Does the metric used to quantify it actually measure something significant? Do we have the correct definition of poverty? If we wish to end poverty, where should we start? Should we even try? Emotions ran hot, loud people yelled, timid people shut down, and I had flashbacks to freshman year philosophy. The instructor’s suggestion that we leave the conversation behind was met with enthusiasm, and we set to work fixing ECG’s and pulse oximeters.

I’m currently reading Mountains Beyond Mountains, Tracy Kidder’s account of Dr. Paul Farmer. Founder of Partners In Health, Farmer is a Duke- and Harvard-educated medical doctor who has dedicated his life to providing modern medical help to the impoverished people of Haiti (#153 on the Human Development Index). As I listened to the debate get more and more heated, I wondered how Dr. Farmer would respond to these questions and ideas. Here are some excerpts from the book:

“And don’t think they don’t know [that they’re poor]” [Farmer] said. “There’s a WL line – the ‘They’re poor but they’re happy' line. They do have nice smiles and good senses of humor, but that’s entirely different.” [By WL Farmer means White Liberals.] "I Love WL’s, love ‘em to death. They’re on our side. But WL’s think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.”

“[Political correctness] is a very well-crafted tool to distract us. A very self-centered activity. Clean up your vocabulary so you can show everybody you have the social capital of having been in circles where these things are talked about on a regular basis. [Some academic types would ask] ‘Why do you call your patients poor people? They don’t call themselves poor people.’ [We would reply] Okay, how about soon-dead people?”

“The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don’t want you to look like them. They want you to dress in a suit and go get them some food and water.”

“[There is Haitian proverb: God gives but doesn’t share.] This means that God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid upon us.”

[Tracy Kidder says] “Some people would ask ‘How can you expect others to replicate what you’re doing here?’ What would be your answer to that?” [Farmer] turned back, and, smiling sweetly, said, “F#$% you.”

So what do I think? I’m still processing. I will say this, however: before coming to Tanzania, I heard a great deal more about the needs of the developing world from WL’s than from the people who actually live there. I don’t think it’s my job to decide what Tanzania needs. However, I know of a hospital in Kibosho that has asked for someone to come and fix a few broken instruments so that they can help the sick and injured get back to living their lives as free as possible of pain and disease. I’m glad to help.