Wednesday, December 27, 2006

Creating a Cripple or Saving a Continent?

Some years ago, a couple of people came into my store. As usual, I tried to strike up a conversation with the one not busily examining merchandise. Turns out both of them worked for an organization that was involved in HIV/AIDS prevention and containment in Africa.

As I had spent four years in Africa myself during the 1980s, I was interested in what they were doing. As I had buried (quite literally—I ran a small Quaker cemetery for a few months between stints in Africa) way too many AIDS victims, I was also quite attuned to the disease and even to the then-new anti-retrovirals that were just coming into use.

As they were leaving, I said something to the two women that bothered me almost as soon as I had said it, something I am only now coming to understand.

My thoughts were not clearly formed, but they came from my own personal experience in Africa. My words seemed callous to my ear even as I said them—though I knew there was something important in there, somewhere. Only today, this evening, did I suddenly understand just what it was I had been trying to express.

What I said was something like this: “We’re worrying too much about AIDS in Africa. Few people, where I lived, made it past their 40s even before this new disease. AIDS isn’t increasing deaths as drastically as we may think; many of its victims would have died young anyway.”

As I said, I was horrified with myself.

This evening, someone on the BBC show “The World” was talking about healthcare in places where HIV/AIDS is a problem. She said that concentration on AIDS had an unfortunate side-effect, the increase in problems (and deaths) from other sources.

Suddenly, I realized why I had said what I did, that day years ago. Without even consciously realizing it, I was badly paraphrasing the policy philosophy of the best of the aid organizations in the developing world: the entire community needs to be considered as part of any development project, even one with an ostensible focus on one disease.

Even one with ostensible focus on certain individuals. Save the Children, for example, doesn’t simply pay for individual children’s needs, but works to improve their entire community.

The same needs doing with any development project, even one so critical as the stopping of a pandemic. It’s not the same as addressing a problem in the United States or in any of the other countries with strong infrastructures, economies, and health-care systems. What we are doing with AIDS in Africa is like putting a patch on an old inner tube. That patch may stop the major leak, but (with that spot now stronger) other parts of the rubber will break down, new leaks will appear. The tube will be no better than it was before.

Malaria, for example, a huge killer in Africa, should have been wiped out years ago. Wars, corruption, and other problems kept that from happening. Even were it under control in one country, problems in the next would end up undoing the progress.

That radio program said that, right now, more is being spent on healthcare in developing countries than ever before. But it isolates too frequently, focusing on specific problems in specific places.

Some of this is needed. We can’t ignore the crisis situations. But by merely meeting them, we are not improving the situation. Africa, in particular, continues to stumble, no how much is done through well-meaning aid efforts like Live Aid in the 1980s. The HIV/AIDS efforts of today may have no greater effect in improving the lives of Africans as a whole.

This is what I was trying to get at, those years ago. The problems in Africa are so severe that no project, especially from the outside, focusing on just one issue—no matter how vital it seems—was not going to do much towards solving Africa’s problems.

Why not?

Part of the reason is that we in the West tend to “send in” specialists in particular problems. Each has a focus: HIV/AIDS, education, malaria, prenatal care, small-enterprise development, reforestation. Each of these, though important, can’t answer the problems of the developing world alone. Yet each jockeys for a larger part of the aid pie.

There are plenty of organizations—Save the Children, Catholic Relief Services, The Mennonite Central Committee, among them—that do try to work with communities as a whole. Many others, as if overwhelmed by the sheer number of problems, just close their eyes and focus on a single piece.

And that has dangers. At the end of World War I, my grandfather was wounded by shrapnel in both feet. The doctors thought they would lose the one, so concentrated on it, and were quite happy when they realized they had saved it. But gangrene had set into the other. Nine amputations later, and my grandfather had no leg below his upper thigh. He could easily have died—others did, when what seemed a lesser wound was overlooked.

Or not simply a lesser wound. In Catch-22, Yossarian tries to take care of a gaping leg wound on Kid Snowden as they fly back from a bombing run. He does so, but Snowden keeps complaining of the cold. Yossarian finally tried to warm him up but, in moving him, sees that his stomach has been torn open, his intestines sliding out. Yossarian, too, had been trying to treat the wrong wound.

I hope that the situation we are in now is not as serious as Snowden’s. There was no way he could survive. But we do need to be treating the whole patient, and not just a part. If we don’t, at the best we will end up with a permanent cripple.

And a crippled continent is not something we can afford.

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