Why We Come Here

I've been visiting the hospital quite a bit lately. I'm not a doctor, and I certainly don't know what to tell a sick person about the recovery process. My work is entirely preventative, and my favorite phrase these days is "Je ne suis pas un docteur," I'm not a doctor. But I want to get in some face time with the people, and recognition as being involved in the health care process in some fashion.

Some of the health care professionals are very interested in talking with me. Some lose interest when they learn that I'm not a doctor, but many are happy to have any help that comes their way. Understandably. They work in the only hospital in the entire region, which is home to about 250,000 people. There are only 8 doctors, a handful of nurses, and some sagefemmes, who work with maternal health. Any help is certainly appreciated.

I especially saw this when I toured the operating rooms. Two OR's, neither of them particularly well stocked. Baba Sise (See-Say), who is responsible for sterilizing all materials, showed me around. Before beginning, he insisted that I wear a clean, white shirt over my own sweat-soaked button down, and that I change into a pair of tiny plastic clogs. In a city built on sand, the operating rooms are protected from the sand by a long hallway and a strong door (never mind that one of the rooms in the operating suite has a broken door held fast but ajar with a chain).

Baba and the doctors who came through remarked that they don't have much, but that they do what they can with the materials available. I have a hunch that they were hoping that I, the American health agent, would be in a position to donate medical supplies and improve their hospital. Doctors Without Borders donated an incinerator, new and powerful. But no one knows how to use it, so it sits unused behind the hospital. Which got me to thinking, what do these gifts really do? We can give them, but should we? If an organization offers materials that can't be used, what have we actually accomplished? (One would hope that this is an isolated case, but I have seen an incinerator that was never assembled in Kaedi because the donors never sent a technician)

Sustainability is, I think, the primary concern. The hope of the Peace Corps is that a volunteer will, over the course of two years, teach enough basic information and know the community well enough to make small differences that will add up to a big difference over time. Other programs will donate a single, large gift (a waste management system, for instance) and then move on to the next town in need. But will educational programs just stop without a dedicated staff to provide lessons, or will the people in the community take up the banner and continue the program? Will the gift be useful when the donor organization is gone, or will incinerators sit unused, or if used, break down without qualified maintenance staff available?

To me, the answer seems to be to combine the best parts of the Peace Corps with the best parts of donor organizations. Putting a big-ticket item into a town, and sending in a technician for a longer stay to train the staff in use, maintenance, and repair, seems reasonable to me. Longer-term integration would also allow the organization to see what more they could do, what more is needed, how their gifts could fit into the town.

As for the long-term, a town like Nema, a regional capital with a significant population, will ideally use and recognize the value of the gifts given by larger organization. When an incinerator no longer functions, the town can make the investment in its own health care system, or when garbage trucks break down for the last time, the town can invest in its own infrastructure. But that assumes that the town can afford such big-ticket items, and that the system is free of corruption, which would siphon off any funds. Making that assumption of internal accountability, I have grave concerns regarding the ability of a country struggling with poverty and development and competition in the global economy to make such an investment in its own infrastructure.

As the plight of Africa has come to the fore of American consciousness in the past few years-thanks in part to the efforts of so many high-profile people in business, politics, and entertainment-an argument that I've often heard against making donations to developing countries is that it creates a dependency cycle, that a gift doesn't provide the same sense of ownership as internal development does. That we need to be careful in forgiving debts, and in giving more money, because any gifts may be squandered.

I don't pretend to be an expert on the subject. I am not familiar with the complex inner workings or interplay of the economies of the various African countries, and how they interact with the US, the EU, China, Russia. I know that there is a difference between a gift of ten billion dollars and a trash collection system. I know that money given for a trash collection system can be embezzled. But I do know that a hospital needs an incinerator. I've seen too many used vaccine bottles and hypodermic needles on the ground, in the street. I know that a town needs a good water filtration system. Half of Nema leaves town for four months out of the year because the water table drops and the taps no longer work. I know that a town needs a good sanitation system. When the streets are filled with trash, diseases flourish.

And I also know that it is difficult for a poor country with an infrastructure from the mid-20th century and a population that has tripled since then, but an economy that hasn't, is not in a position to make the necessary investments in such basic needs.

That's not to say that I don't see the importance of local involvement and financial support for the programs that the people want to see. Such involvement encourages pride in the work being done. I have seen wonderful work done in education and in material support that has come from the local level. I am only suggesting that, given the depth of need in so many different areas of operation, significant support would be more beneficial than detrimental, if handled properly.

Standing in the hospital in Nema, it is difficult to give much weight to any argument against giving a better hospital to a town that needs it. Talking with people stricken with malaria, seeing women holding sick, malnourished, or premature babies, I can't argue against supplying the hospital with everything that it needs. Walking through town, stepping over scraps of rusty metal and around piles of goat and donkey shit, see how America as a nation could keep people from getting sick and having to go to the hospital. And carrying home buckets of water to put into my small, personal water filter, I remember that it is not a half of a population that leaves their homes in search of water, but tens of thousands of people.

We need to enter any development program with caution, certainly. But we can never, ever, forget that the goal of development, the reason we try to help, is because the less we do, the more people die.