What is something worth?

I had an interesting discussion with our Central African director yesterday. There is a phenomenon that takes places in the market place here, as in other countries, where by the colour of your skin determines the price you will pay. Call it the ‘foreigner’s tax’ or the ‘price of being white’, the foreigner will always pay more than the local, even when the foreigner knows the local price. This drives Benoit crazy, as I realized during our discussion. The fault, however, is not necessarily the merchants, as much as it is the fault of the foreigner. We are too soft, we don’t fight for the ‘right’ price and we are easily swayed by compassion. Or perhaps we should pay more; we have more money than most people we meet and perhaps it is part of our community service, our way of showing compassion. After all, how does one put a value to an avocado, a bolt of fabric or kilogram of fish?

Here is the catch though. What I pay, out of my apparent abundance of cash, will eventually come back to bite me, or at least the programs that we set up as foreigners, with the eventual desire to leave in the hands of the locals. Let me give an example. If a local NGO is established with the help of an American, and the American is the current director of the NGO and all of the funding comes from America, it looks, for all intents and purposes, as an American NGO. And, I suppose, it is in most senses. So when the NGO needs to buy building materials, or seeds or any other number of things, the American pays the foreigner price, which, the American concedes, he can afford. The long term goal of the NGO, however, is for it to become entirely run by Central Africans, including finding local sources of funding or self-funding through various enterprises of the NGO. The NGO though, has been set up for budgetary failure because it failed to assert itself as a local NGO from the start. The community has accepted that the NGO will pay higher than normal wages for labour and will pay more for any goods it needs to purchase. This will affect the NGO’s ability to serve the community as it will have fewer funds available for its activities as they get eaten up in other expenditures. Out of our compassion we have made it more difficult for those we sought to help in the first place.

I am convinced that if we spent more time thinking about the consequences of our actions and less time getting down to the business of doing, we would be able to foresee how some of our decisions can bring about more harm than good. If we do not learn from the mistakes of the past how can we expect anything different in the future?

A Central African’s perspective on how help can hinder

Part One

Médecins San Frontier versus the Nutrition Garden; relief versus development; malnutrition emergency or chronic underdevelopment; short term thinking or long term sustainability; compassion or suffering; helping or hindering. These are the dichotomies of development, these are the questions we struggle with, and the struggle becomes even greater when you see the skin and bones of a malnourished child laid out in front of you. To those of us looking in from the outside, the ‘malnutrition crisis’ that was brought to MSF’s attention this past summer in Southern CAR was indeed a crisis. However, to those daily working with the hungry and malnourished, the increased number of malnourished patients was a surge above normal, but not so unusual as to be termed a crisis. Every time I visit the nutrition centre I am pained by what I see. Children who have no more meat on their bones than the starving children whose pictures we saw during the Ethiopian famine. But there is no famine here. Looking around at the dry season landscape in Gamboula, everything is lush and green, gardens are full of manioc and there is meat in the markets to buy.

The major sources of malnutrition and hunger in the area include chronic underdevelopment, changes in lifestyle among the Fulani who have been displaced and are undergoing drastic livelihood changes, the downfall of the diamond industry (people moved from farming to artisanal diamond mining, leaving them extremely vulnerable to changes in diamond demand with no sure food supply to fall back on) and the breakdown of the family. Given this context, hunger is not the result of a natural disaster, the immediate effect of armed conflict or climate change (droughts or flooding). So given the situation, is relief a viable option?

Nadege, the nutrition garden supervisor, related a story to me about the months that MSF was helping with the nutrition emergency in Gamboula. Last September, after conducting food security surveys around the area, MSF and Action Contre la Faim (ACF) declared a nutrition emergency in southwest CAR and set up emergency feeding centres. One of these centres was established in Gamboula and people were brought from all over the region for treatment here. MSF, a very compassion driven organization, specializes in emergency medical relief, including the treatment of malnourished children. In four days to a week, they can rehabilitate a child swollen with kwashiorkor, one of the most severe forms of malnutrition. The treatment consists of a variety of ‘chemicals’ as they are termed here in Gamboula. Essentially, specially formulated milk formulas, vitamins, protein powders and the like. Things not available in the local market anywhere, but therapeutic foods designed specifically for the quick treatment of malnutrition. The staff of MSF are very good at what they do, but one must ask if their methods are the most appropriate for the Gamboula context.

Unfortunately, the children treated by MSF, while they did recover, went right back to their homes, to the very setting that landed them in the feeding centre in the first place. In the week they were at the hospital, nothing changed in thier families’ ability to feed itself or access nutritious food. In addition, they learned little while staying with MSF to help change the family situation. We are thankful to MSF, however, as they did an excellent job of giving additional training to the nutrition centre staff and as a result the centre has changed some of its practices. With the help of donors, the centre has increased the amount of milk powder available which has, in turn, allowed the staff to feed children a nutritious porridge 4 times a day and a protein rich milk 6 times a day, including a feeding at two in the morning!

I did want to share Nadege’s perspective on one of the results of MSF’s time in Gamboula. She says, during a child’s stay with MSF everything is done for them. There are staff to sweep the floors of all the tents, to wash the laundry, to cook and serve meals to the parents and the children, to do the dishes afterwards and to even wash the children if the parents are too tired. Essentially, as Nadege saw it, there was someone hired to look after all of the patients needs, not too unlike North American hospitals. On top of this, the treatment is free, MSF provides or pays for transport to and from its clinic and provides some rations for the continued treatment at home.

Compare this with the Gamboula Baptist hospital. There is one staff person on duty at any one time. Patients’ families are responsible for sweeping out the rooms and keeping things clean, for doing laundry and dishes, for preparing meals, porridge and milk for the children and are required to take turns going to the nutrition garden to collect food from Nadege to prepare. Nadege remarked that several of the patients that were treated by MSF, on their return home, fell back into severe malnutrition, and once MSF was gone, they came to the Gamboula hospital for treatment. The women complained severely and said that when they were with MSF they did not have to do anything, but at the nutrition centre they had to do all kinds of things. Nadege said she had many women refuse to come to the garden to work or even collect greens to cook for themselves to eat. Nadege asked the women, “when you leave the hospital and go home, will someone be there to do all these things for you?” Their reply, obviously was no, and slowly they realized the importance of the learning that was going on in both the nutrition centre and garden. If nothing changes at home, the same conditions will result in sick children or their eventual death.

So this leads me to ask, when does our ‘helping’ lead to our ‘hindering’ of development? When we give freely from a heart of compassion, for very good and noble reasons, like the risk of the death of a child, are we possibly causing more harm than good in the long run? Is relief given in a non-emergency situation a hindrance to development rather than a leg-up to development? If we always see people as poor and unable to provide for themselves, does this also help create the conditions for poverty? When we make excuses for people’s actions, or believe that because of cultural norms certain practices will never take root, are we not laying hope aside and giving up prematurely?