Commentary, Experiences, Learning, Platform

The Danger Of Playing Doctors

Back in March 2014 I caught malaria.

My host organization took me to a clinic for a test but it was closed so we went straight to the pharmacy and bought malaria treatment. From my previous 9 months experience in Africa I had found that most people self-diagnose malaria. I allowed myself to be self-diagnosed too.

I thought, “Well they certainly know more about malaria than me”.

The symptoms were pretty much like a flu, feeling unwell, vomiting, diarrhoea, but nothing too extreme. It lasted a week.

But now I know it wasn’t malaria. It was the acute infection, seroconversion or primary HIV infection phase which usually appears between the 2nd-4th weeks after the person has been infected with HIV.

One of the MDGs is about combating HIV/AIDS, malaria and other diseases. Some of the WHO recommended strategies for this MDG include diagnostics and treatment with quality-assured antimalarial medicines, tracking every malaria case in a surveillance system.

If people can get malaria treatment in the pharmacy without a test that confirms you actually have malaria, some real cases of malaria aren’t being reported properly. Treatment efficacy can also be reduced as a result of drug resistance.

After my experience of an erroneous malaria self-diagnosis finding out that I could get malaria treatment from the pharmacy just by saying, ‘hey, I am not feeling well, they think I have malaria,’ a few question comes to my mind:

  • Why did I follow self-diagnosis and self-treatment in Africa knowing the high prevalence of these diseases if I would never do it even with just the flu back home?
  • Is self-treating with anti-malarials as prevalent as taking, for example, an ibuprofen for a headache?
  • What are the regulations to sell medicines without medical prescription in Africa?
  • Are the drugs sold without prescription actually quality drugs?
  • Do they sell malaria medicine so easily because people can’t afford the cost of transport to a health facility or the tests once they’re there?*
  • Do they practice free malaria tests?
  • Are there any program focused in training pharmacist to advise about the importance of testing?

Until I was diagnosed with HIV I didn’t know about the acute infection. I think it should be an important concept when giving information about HIV as people in general could realize two things:

  1. Feeling unwell doesn’t always mean you have malaria.
  2. Infections have phases and symptoms, and so has HIV/AIDS. From a prevention phase with sexual education, used of condoms and pre-exposure prophylaxis (PrEP), to the different stages of the HIV infection.

Stages of HIV infection

stages-of-hiv-1LINKS: Post Exposure ProphylaxisAcute infection

stages-of-hiv-2

LINKS: Window periodELISAWestern Blot

stages-of-hiv-3LINKS: CD4Viral loadOpportunistic infections

After my time in Africa, and not because I thought I had contracted any disease, just as I always do after long periods abroad, I went for a general check-up.

Although I was feeling great and active, It didn’t surprise me to find that I had a deficiency in iron and vitamin B12, but then my doctor called me in to hear the other result:

“You have tested positive for HIV”

I still remember the scary feeling when I understood the meaning of my 274 CD4. Without specific antiretroviral treatment, people will progress from HIV to AIDS in a span of 8-12 years, but mine in 6 months were almost as little as 200.

18 days after I was diagnosed HIV positive, with CD4 of 274 and a viral load of 94.200 copies, I started my antiretroviral treatment. I take 3 tablets each morning at the same time (Prestiza Norvir, Kivexa). After 2 months under treatment my CD4 were 542 and my viral load 516 copies. In the doctor appointment after 4 months under treatment, my CD4 continued to increase, to 581, and I have undetectable levels of virus (<20 copies). My HIV specialist is aware of my plans to continue my aid career and has given me advice and recommendations and has approved for me to move back to Africa.

In 2015 HIV is a chronic disease for all who can access care and treatment. Going back to Africa will open a window to all of us interested in the real similarities and differences between being HIV positive in a developed country and in a developing one.

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* I went to the doctor/hospital on another occasion and whilst I mentioned that I had had unprotected sex, HIV was never mentioned nor a test recommended by the doctor. The costs of consultation, blood tests, surgery, anaesthesia, etc… would not have been affordable with my local salary. Luckily, medical travel insurance took care of it.
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Commentary

Do They Know What Patronising Means?

All I want for Christmas this year is…another version of Band Aid, another version of the same old stigmatizing ode of guilt and patronizing pity of Sub-Saharan Africa.

You probably saw it somewhere in your facebook/twitter-feed or maybe the radio has already started to annoy you with this christmas’s most pathetic carol: Bob Geldorf and his fresh team to save the world (Can “One Direction” members even find Sierra Leone on a map?) have recorded “Do they know it’s Christmas time at all” for a fourth time.

And as if the first few versions didn’t do harm enough by setting the whole African continent equal to an Ethiopian famine or the Darfur crisis, this year’s crew decided to apparently use this logo for the release of the 30 year anniversary remake.

Yes, Band Aid is really all about Ebola this time – similarly to Africa being all about Ebola, or Ebola all about in Africa. They even adopted the lyrics from dramatizing hunger to dramatizing ‘E30la’ including some weird lines about Geldorf, Bono and co going out to touch Africans this Christmas (even though they warn you later that to be touch is to be scared)…

The haunting image of Bono coming over to fondle me would make me forget about Christmas too.

For a great deconstruction of the new lyrics I recommend this piece by the Guardian’s Stuart Jeffries who seems to be equally as confused as myself.

At least Band Aid improved a bit on their geography over the years and sing only about West Africa this time – even though the guy writing the lyrics must have forgotten to tell the bloke making the logo. On top of that, Nigerians, Malians or Burkinese must be pretty surprised that Bob Geldorf and his gang just expressed their condolences for their lack of joy and fun during this festive season.

Other West Africans who prefer the mosque over church might actually really not care about Christmas this year, but I’d say that’s more a general thing and Ebola cannot be blamed for that.

Today I also had to find out that Bobby G is expanding his patronizing humanitarian crusade to other countries and turns it into a franchise. He has flown into Germany and recruited some (formerly) great musicians for a German version of this 2014 ode to joy. I had realized that Max Herre turned into a douche, but wouldn’t have expected it from Campino.

I guess it’s time to delete my “Toten Hosen” and “Freundeskreis” albums from my iPod. Campino stated: “It’s less about art, but about the gesture.” I say it’s mostly about you not thinking about the impact of your action.

A final fun fact for the German readership: Even the rapper Haftbefehl is jeopardizing his street cred to be part of this fabulous project (for the non-Germans, the last time I checked he did this kinda stuff)

Somehow I thought the world had moved ahead – but I guess it’s time to promote the “Africa For Norway” campaign again. Watching their great video will make you grasp why Bandaid is just ridiculous. However, 2 million+ views on youtube apparently have not been enough.

Ignorance prevails.

I have always found these charity songs fairly annoying but being in Tanzania for this Band Aid season, I actually got furious. I blame people like Geldorf, Bono and their friends for the fact that friends around here have lost their jobs and many Tanzanians will actually have some more problems than usual around this year’s Christmas time. However, they are not sick of Ebola or die of hunger under the burning African sun, but they lost their income as tour guides, porters or hotel staff because of stupid Westerners cancelling up to 80% of their trips to East Africa.

Apparently, they are afraid to catch Ebola thousands of miles away from its source. Yet, now that I think about it – maybe they also fear Bob Geldof’s smeary hands touching them during their Christmas safari.

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Commentary

Newsflash: Non-Profits Are Not Impartial

This piece was originally written for my column about transparency and the media on Beacon Reader

The notion of editorial impartiality can be a very seductive failing.

The rise of data-driven explainer sites like Vox and FiveThirtyEight has heralded a resurgence of this ‘view from nowhere’, an insistence on editorial ‘impartiality’ that, at best, leads to imbalanced reporting and, at worst, is used to obscure the actual editorial line from the public. Either way, it is a widely derided practice within journalism for a number of reasons. For the purpose of this piece I will focus on one of the core problems — as a public communicator, is it ever ethical to obscure your subjectivity?

“If in doing the serious work of journalism–digging, reporting, verification, mastering a beat–you develop a view, expressing that view does not diminish your authority. It may even add to it.” Jay Rosen

The ethical issue, in journalism, centres around deciding what exactly a media organisation is supposed to be doing. On the face of it ‘informing the public’ would be a clear, understandable, boilerplate answer. But does that mean informing the public about everybody’s views, regardless of context, or indicating which way the wind is blowing on various issues?

To do the latter is to be accused of subjectivity, a dreaded insult for reporters. But what is actually more useful for the public?

Objectivity is something to strive for in the news business. To abandon it completely is to abandon your purpose of informing the public. On the other hand, to replace editorial understanding, nuance and instinct with ‘pure’ objectivity is another abandonment — of the truth.

Here’s the secret: nobody is objective. To suggest that your editorial line is totally impartial is fundamentally a lie. Every individual has prejudices and opinions informed by their specific life. You cannot truly step outside of yourself and deliver totally impartial reflections on anything. You can try and fail, that is all.

Unless you own the fact that you are aiming for and missing true objectivity, you are misrepresenting your organisation and the content it produces to the public.

There’s nothing ethical about that.

Changes in non-profit communication

A long-standing interest of mine is the interactions between non-profits, media organisations and government bodies (particularly on the issue of transparency). Usually, my criticism is that these different sectors do not share enough when they could often benefit from closer collaboration. In the case of the view from nowhere, however, crossover simply exacerbates the problem.

A number of excellent articles in the international development blogosphere in the last few months have reflected a changing mood. Essentially, this is a sector that has relied on over-simplification and shocking imagery for the last few decades, an approach often derided as ‘poverty porn’. For many years, lots of people people have been very critical of this approach.

This current wave of backlash is extremely welcome and makes a number of crucial points, which include:

The author of that last piece, Dan Lombardi, makes a lot of points that I agree with but I was slightly troubled by his focus on communication that does not focus “solely on the positive or the negative”. In telling the story honestly, Lombardi suggests, you end up with more balanced content that is better able to deal with the inherent complexity of much of the work done in the development sector.

Undoubtedly, this complexity is there — from competing viewpoints to widespread ignorance of the subject matter (see: Ebola) to deep divisions within the industry on how best to achieve success, or even what success might look like. This is all tough stuff for outsiders, which is 99% of the potential audience. For me, his take on honest story telling does not take in another vital component — the storytellers themselves.

Non-profits aren’t impartial either

Development agencies communicate largely to raise either funds or awareness. They are not making content to inform the public. Non-profits have agendas just like everybody else.

The stated aim of most non-profits is to alleviate poverty in some form or another. It is not to make the public more knowledgeable (although that could align with their aim). In fact, their strategy could well be to make the public shocked enough to give money very quickly — hence poverty porn — or to tell the public that their relatively meagre support will make a huge difference — hence Live8 or Kony2012. Those aims are often better achieved by misinforming the public, by dumbing down the message to the point of dis-ingeniousness.

I don’t think that the Make Poverty History team actually thought that they would end poverty by getting people to buy wristbands. They just wanted maximum coverage and support and figured that’d be a fast way to get it.

Now, don’t get me wrong, I don’t think any of the development bloggers are actively endorsing the view from nowhere. Embracing complexity and rejecting the classically paternalistic approach of development communication should be applauded. But there is a danger that this could lead to communication that seeks to hide the agenda of the NGOs and agencies creating it — all in the name of letting their beneficiaries take centre stage. This is the ethical dilemma that has faced journalism for many years.

For me, the stakes are much higher in the world of development: ultimately, development agencies seek to serve the poorest, most vulnerable people on earth. They have no way of combating the agendas of development organisations. If those organisations do not take ownership of their agendas and seek to communicate that, alongside their more nuanced telling of the stories of their work, they will have misrepresented their beneficiaries.

There’s nothing ethical about that, either.

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Commentary, Projects

The Elusive Art Of Sustainable Development (Part 2)

Written by Hannah Todd

HART distributes emergency aid to its partners as the need arises. When it does so HART has the ability and agility to do so rapidly with targeted relief. Even if the size of donation is much smaller than larger NGOs, feedback from our partners has reinforced the importance of this facility. For example, in South Sudan one of our partners told us: “You gave little but in time. Others gave more but it came too late.”

HART responded to the refugee crisis in South Sudan with emergency aid to its partners in Bahr-El-Ghazal, Wau. Funds were also given for the purchase of seeds and tools for cultivation, anticipating that food shortages would be exacerbated by the rainy season. The type of aid HART supplied here had one eye on the future as well as dealing with the immediate problems the community was experiencing. The delivery of appropriate relief in South Sudan is but one example of how need can be combined with the necessity for sustainability.

Traditionally the time gap between emergency aid being withdrawn and developmental aid being injected into a society by major donors has been too large.

The two forms of aid have been too rigidly divided: aid distribution should not just coincide with the outbreak of conflict or natural disasters (frequently exacerbated by conflict). Rather, if aid is to be preventative as well as palliative then it should be given in times of peace and stability as well as conflict and hardship. In other words emergency aid should be combined with developmental aid. It is during crises of leadership (that cause or are caused by humanitarian disasters) that the seeds of development should be sown.

HART makes a special effort to ask its partners to identify their priorities for aid, thereby giving them the dignity of choice and respecting their knowledge of the problems confronting their people. For example, in Jos, Nigeria, HART visited a Peace Initiative Project earlier this year that seeks to heal relations between Muslims and Christians in the region through teaching entrepreneurial skills. The project has since sent HART detailed accounts of their most urgent needs which range from desktop computers to basic carpentry equipment. HART regularly visits its target communities to highlight these needs, to gather first-hand evidence of human rights violations (for example, in South Kordofan), and to ensure that it is fulfilling its remit in the most responsible and appropriate way possible.

International implications

Part of HART’s strength is its small size which helps keep it focused on the individuals it works with. Of course, larger NGOs and donor governments cannot hope to replicate this level of extremely personal and flexible care because with increased size comes increased responsibility. But what they can do is to adopt some of the approaches HART uses to build these relationships and apply them at a high political level. It is precisely because at this level bilateral and multilateral aid make up the vast proportion of international aid that it is vital that the art of sustainability is mastered.

Many critics have argued that bilateral and multilateral aid given in the form of concessional loans and grants is unsustainable and should be reduced, if not cut off altogether. The problems they cite straddle the social (government corruption and patronage) and economic (trade barriers between neighbouring countries) and all ultimately come down to the exacerbation of aid dependency. This is precisely where the values behind locally-led aid and development initiatives become vital.

It is possible for the ‘partner model’ of aid and development exemplified by HART to be scaled up to a macroeconomic level.

For example, applied at an international level the observation that aid should be invested locally and for a finite amount of time could solve the growing convergence between concessional loans and grants in the realm of international aid. Not differentiating between these two mechanisms of aid distribution – assuming that a loan will eventually turn into a grant – instils a lack of initiative in recipient governments. There is no incentive for them to nurture a fledgling situation of prosperousness so that they can escape the reliance on in-flows of aid to which they have become accustomed.

HART’s Projects Coordinator, David Thomas, says that one of the joys of being involved in HART is to see people’s enthusiasm to rebuild their communities before they have to worry about their ‘track record’ to impress larger aid agencies. It is this spark that larger aid organisations as well as governments need to capitalise on to make aid go further and last longer. The enthusiasm and trust that HART nurtures in its relationship with its partners is the vital aspect of sustainable development that continues to elude major donors and hamper their drive towards eliminating aid dependency.

Sustainability is about scaling up successful models of development. If international governments do not begin to realise this and learn from the models provided by smaller organisations such as HART then we will find that “sustainability” – currently an ever-evolving buzzword within the world of development – is still being discussed as the major hurdle to development in another fifteen years.

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Commentary, Projects

The Elusive Art Of Sustainable Development (Part 1)

Written by Hannah Todd

With the deadline for the Millennium Development Goals (MDGs) looming and criticism of aid unabating, governments have begun to increase cooperation between departments towards the creation of a successor to the MDGs – the ‘Sustainable Development Goals’ (SDGs), due to be launched next year. Specifically this forges a triangle between economics, development and political strategy that has been lacking from aid and development to date.

Although bilateral aid (passing directly between governments) and multilateral aid (between countries via aid agencies and/or multilateral institutions) dwarfs the charitable and emergency aid of smaller NGOs like Humanitarian Aid Relief Trust (HART) it is important that we do not disregard the work of such agencies. It is precisely because smaller organisations have less margin for waste that they are forced to maximise their own efficiency. They thereby gain a better grasp of sustainability and their morals and mechanisms of working should arguably be made more central to the politics of bilateral and multilateral aid distribution.

Organisations such as HART not only help the communities they work with but also strive to engage with the principles and responsibilities surrounding aid and development. The most illuminating lesson I have learnt through working with HART this summer has been that aid is not cold hard cash. Instead, it is a decision. Most importantly, it is a decision that affects the course of a communities’ history. If delivered in the right way, for the right length of time, and in the most appropriate form aid has the potential to lay the foundations for an affluent and peaceful society.

Aid distribution: partners

The way aid is delivered dictates its value. HART exists to support its partners on the ground in eight countries around the world. Many international organisations can only go to locations with the permission of a sovereign government. But because HART’s partners are local, it maintains access to these areas even during times of crisis – when others have been forced to withdraw, either through conflict or because permission is withdrawn by the government. HART has no in-country staff and so if violence breaks out it doesn’t have an obligation to pull its staff out. In other words, HART maintains an access point to societies in need when they are most in need.

HART’s partners know how society works in their country and can achieve things that outsiders cannot. They are both the recipients and distributors of the aid HART sends them and this makes them more able to lay a sustainable foundation for the work that they do. The ‘partner model’ restores local agency and makes HART’s aid a form of private investment albeit without the conditions of repayment. HART’s aid provides the capital for project start-ups, local crisis relief and a range of other initiatives that contribute towards the overall improvement of a community’s standard of living.

This model successfully promotes sustainable development. The relationship is temporary and the supply of aid is withdrawn once the partner has built up their own contacts, thereby enabling them to continue along the path they started with HART’s help.

The unique role aid agencies such as HART play in facilitating this starting point is lending their voice and unique access to international governments that partners on the ground lack. This highlights the importance of the second of HART’s twofold remit: advocacy. Frequently partners move onto bigger funders but it was HART who got their work off the ground and HART who can recommend them as a referee in their applications to larger funders. The Evangelical Presbyterian Church (EPC) in Yei, South Sudan, is one such example. Its healthcare clinics and agriculture projects no longer need funding from HART because EPC has grown to the point where it can forge partnerships across the country on its own and teach others, drawing on its now considerable experience.

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Commentary

Why I Want To Pursue A Career In Development Research

I have just finished my undergraduate degree in Politics and Philosophy and am now attempting to pursue a career at the intersection between international development and academia, in a policy or research-based role.

The main issue with this plan, which became apparent in the last few months of my degree, was that I have very little experience or knowledge of this area of work called ‘research’.

I have always been interested in development (particularly in Africa); an interest sparked no doubt by being lucky enough to visit Malawi on a voluntourism project at the age of 16. As I grew older, I realised that working in development was a legitimate career option, which was great as my main career aspiration was – and remains – to help make the world a better place.

I have no direct skills in education or sanitation. Although my degree has furnished me with theoretical knowledge and numerous opinions relating to development, I have far less to offer directly to a poor community in need of ‘development’ than my engineer boyfriend who, despite suggesting “Ljubljana” when pressed to name 20 African countries, has a set of extremely specific and applicable skills.

Initially, the idea I had of working in development was a romanticised aim of working for a charity, providing immediate aid to poor communities in order to directly improve health, sanitation or education. The more I have learnt about and engaged with development, the more I have realised this was not the best way to achieve my goal.

I have studied development through a political lens. For me, tied to the idea of development in the sense of poverty alleviation is the development of the state to become a capable and meaningful provider for citizens. Whilst a number of charities – including many which I have worked for – do very impressive work providing short-term or immediate help to needy communities, the effect of this on the long-term viability of the state can often be disastrous, as the state is effectively absolved of its responsibility to its citizens.

This is especially true in a region like sub-Saharan Africa where the democratic state is weakly consolidated (leaving aside for now the issue of whether Western-style democracy is necessarily the best option for these states). This realisation has led me to modify what I envisage myself doing, when I say “I want to work in international development”.

Beyond this, and given the recent rise and correlative criticism of ‘voluntourism’, I have to ask myself what I, as a relatively unqualified social scientist, can offer to those who need it most.

All this paints a very bleak picture for the aspiring development intern. Which is what drew me to research. Having completed my degree at a research-intensive university, and (despite the procrastination) actually quite enjoying academia, this is an area of development which I could actually apply my skills to, whether that is by pursuing further study (I currently hold an offer for the African Politics MSc at SOAS) with potential to proceed to PhD, or aspiring to work at a think tank or as a policy advisor to an NGO or a foreign government.

Of course, a number of issues remain.

  1. Research is useful, but it is removed from the cause. Much of your time will be spent in isolation from the people you are trying to help, trying to solve problems not related to development (relating to data analysis and publishing conventions instead, for example).
  2. Even if your research is influential, it may take a while to gain traction, or may not gain traction at all.
  3. It may not reflect the results which you expected or wanted.

Like many areas of development, the path is not clear. At this stage in my career, I have decided to throw myself into research and try to find out as much as possible about whether it is right for me. At the moment I am a Research Assistant to a PhD project which is looking at natural resource management in Tanzania.

In September, I begin an internship in Ghana for the Alliance for African Women Initiative, working on their Operation 100 research project which aims to discover the levels of AIDS and sex education of junior high school students in Greater Accra. For this project I will be working at the data collection level.

Over the coming months I hope to contribute further to this blog, discussing in greater detail some of the issues I’ve raised here, and offering an insight into my experience as a development intern in the research side of development.

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