“Aid: Can It Work?”

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That is the title of this review essay by Nicholas Kristof, which primarily focuses on “The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good,” by William Easterly but mentions several other recent books analyzing foreign aid issues as well. Among some of Kristof’s observations are these:

In rural Indonesia, you see a cultural problem that aid can’t easily address: pregnant women and babies going hungry, even having to eat bark from trees, while their husbands are doing fine. It turns out that the custom is for the men and boys to eat their fill first. In Ethiopia, you greet parents cradling hungry babies and explaining that they have no food because their land is parched and their crops are dying. And two hundred feet away is a lake, but there is no tradition of irrigating land with the lake water, and no bucket; and anyway the men explain that carrying water is women’s work. In both cases you can see why many who know about aid say that changing the status and power of women is of prime importance if aid and development are to be effective. But it is far from clear how this can be done.

Discouraged, you move on to southern Africa. You see the very sensible efforts of aid groups to get people to grow sorghum rather than corn, because it is hardier and more nutritious. But local people aren’t used to eating sorghum. So aid workers introduce sorghum by giving it out as a relief food to the poor:and then sorghum becomes stigmatized as the poor man’s food, and no one wants to have anything to do with it.

You visit an AIDS clinic there, and see the efforts to save babies by using cheap medicines like Nevirapine to block mother-to-child transmission of HIV during pregnancy. Then the clinic gives the women infant formula to take home, so that they don’t infect the babies with HIV during breastfeeding. A hundred yards down the road, you see piles of abandoned formula, where the women have dumped it. Any woman feeding her baby formula, rather than nursing directly, is presumed to have tested positive for HIV, and no woman wants that stigma.

More broadly, however, aid can be effective even if it doesn’t boost economic growth. Last fall when I was traveling through the remote lands of eastern Niger, miles from nowhere, I dropped in on a clinic in the town of Zinder and found a heavily pregnant thirty-seven-year-old woman named Ramatou who was groaning and suffering convulsions; she was losing her eyesight. The doctors were more interested in me than in her, but they said she was about to fall into a coma from eclampsia, a common condition in Africa that kills pregnant women but is essentially unknown in America. (In developed countries it is detected early, as pre-eclampsia, and then treated so that it never develops into full-fledged eclampsia.)

Cockroaches skittered on the floor underneath Ramatou, as the doctors wheeled her into the small operating theater. The surgery was primitive but could not have been more effective: thirty minutes later, the doctor delivered a baby boy, and an hour later the mother was conscious and recovering. That clinic, financed by the UN Population Fund (whose funding the Bush administration has cut because of its support for China’s family planning program) and by Nigeria’s aid program (poor countries are donors, too), had just saved two lives before my eyes. I don’t know whether that aid will boost economic growth in Niger, but no one watching that drama could doubt that financing the clinic was money well spent.


In Ethiopia, I met Catherine Hamlin, an Australian obstetrician who is overdue for a Nobel Peace Prize. She runs a hospital that repairs obstetric fistulas, one of the most awful injuries humans can sustain. Typically, a fistula occurs when a physically immature teenage girl tries to give birth, and the baby gets stuck. After a few days without a doctor around to help, the baby is stillborn, and the girl is left with perforations between her vagina and bladder or rectum. She cannot hold her wastes, which trickle constantly down her legs. She smells. Her husband divorces her, she must build a hut on her own, and sometimes she is barred from using the village well. At the age of about fifteen, her life is ruined. Some two million girls and women suffer from this affliction around the world.

Dr. Hamlin repairs the fistulas, at the cost of about $450 per operation, supplied largely by individual donors and aid groups, and she brings these teenage girls back to life.[4] You visit her hospital, you see the girls with fistulas, and you just want to hand over your wallet to Dr. Hamlin. I don’t know what impact she has on Ethiopia’s economic development, but she seems to me a saint. Easterly is absolutely right that we need to figure out ways of delivering aid more efficiently, and he has written an immensely stimulating book. But no one who sees a girl with a fistula waiting patiently for an operation could doubt that foreign aid is often the very best investment in the world.

Via Frank Pasquale.

NB: A review of the Easterly book by Amartya Sen, which was published in Foreign Affairs, is accessible here.

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