18 February 2010

A Safari (Adventure!)

There’s a scene in Out of Africa where Meryl Streep and Robert Redford are trekking across the Kenyan wilderness, tracking lions, when one of them suddenly bursts out of the bush with a ferocious growl and charges them. Streep instantly lifts her rifle and shoots it dead, then turns to Redford and watches in stunned silence as he comes to her side and gently wipes the blood from her mouth, where she had bit her lip in exhilarating terror.

Our safari was not like that. To start with, we did not carry rifles, nor did we wear khaki (I wore jeans—which are, it turns out, not an ideal clothing choice for safari). But it was an adventure nonetheless.

With my friends Kevin and Jean, I left Dar es Salaam Saturday morning in a spunky Rav4 (the expat car of choice—tougher than a sedan, but not as neocolonial as a Landrover), drove through the outskirts of town and up the Morogoro Road towards Mikumi National Park, a lesser sister to the grand game parks of the north.

Mikumi offered instant gratification: from the highway we saw an assortment of wildlife: elephants and giraffes, baboons and gazelles. We took some photos, went to the lodge, had a hearty dinner of macaroni and cheese, and went to bed, full of food and anticipation of the safari to come.

Early the next morning, freshly showered and optimistic, we set out into the park. With a map that identified points of interest, which helpfully corresponded to numbered markers on the road, we made our way 10 kilometers or so to the “hippo pool,” and saw, as you might have guessed, hippos sleeping in a crater-like pool of water. When we discovered that sleeping hippos don’t do all that much (and also that they smell), we returned to the car and set off down a road that lead 30 kilometers out and before looping back around to the main gate.

The sky was patchy blue and gray, the air was warm. The valley, dotted with acacia trees, swept out for miles, and far out on the horizon, mountains shown like shadows in the haze. With the windows rolled down, we watched with wonder as elephants led their young across the veld, giraffes stretched their necks to the tree tops, gazelles pranced and zebras grazed. Birds as colorful as a kaleidoscope flitted through the air and buffalo covered themselves in mud to fend off the midday heat.

Further along the road began to change. It became jagged and littered with tall, sharp grass, and the plains were swallowed up by high bush that surrounded us on both sides. We stopped seeing animals, and other cars, and the air outside was suddenly thick with horse flies. We stared out the windows, saying little, until Jean finally broke the silence:

—Dudes, this is BORING.

Kevin and I heartily agreed, but before we could find a place to turn around, we lumbered around a bend and were confronted with a steep embankment that led down to a muddy river. (Okay, river might be a bit of an exaggeration; let’s call it a healthy creek.)

Discussion ensued—to cross or not to cross. We decided to cross.

Now, looking back, one might say that there were various Signs that, had we paid attention, might have helped us to avert the fate that I am about to describe. There was the carcass on the side of the road near the hippo pool, the vulture, grim as a hangman, perched on a dead tree that watched us as we drove by, and the ash gray thorn tree that had fallen into the road, blocking our path (which we decied to drive around). Yes, perhaps the less adventurous traveller would have been deterred by these Coincidences—but not us!

We buckled our seatbelts, held our breath and descended into the water and up the steep rocky climb on the other side. Relieved and emboldened by our good decision (we made it!), it took us a second to notice that the “road” on the other side of the river/healthy creek was nothing more than grass and bush. So we turned around and crossed back, but this time, hit the water at too steep an angle, lodging our front tires in the mud.

Kevin stepped into the muddy water and tried to push the car to no avail. I got out, threw a branch across the water, crossed over and offered to push. (Kevin was hugely relieved to benefit from my added strength and resourcefulness.) We got down on our knees, braced against the oven-hot hood, and listened as the engine clicked, whimpered, and died. The battery was dead.

So there we were, three safari adventurers, up to our knees in mud, with a car nose down in a river/healthy creek with nothing but our wits to save us.


Our wits AND cell phones. Now you would think that the park paperwork (receipt, map, permit for the car) would have in-case-of-emergency telephone numbers on them, but you would be wrong. There were no telephone numbers. Our Tanzania guidebook had a generic Mikumi number, which we tried, but there were two challenges: first, reception was spotty and two, when, for a fleeting moment we connected, no one answered.

So we called a hotel instead, and got through to a receptionist who said she would send help. As a backup we also texted a friend in Dar, letting him know where we were and asking him to “do something” if he didn’t hear back in an hour and a half, since by then we wagered we would either be rescued or our phones would be dead. (*Handy survival tip: before heading out into the African wilderness make sure your phone is fully charged, and that you have credit.)

Assured that help was on the way, we had only to sit and wait. So we did the things that everyone does when they're stranded in the middle of a Tanzanian game park. We applied sunscreen and mosquito repellent vigorously. We found spots to go to the bathroom that weren’t too embarrassing. We made peanut butter and jelly sandwiches. We told ourselves it could be much worse. We played games, drank water, and reflected on the meaning of life (ok, that last one not so much). We sunk into various stages of delirium.

After two hours, I asked the question that we had been trying to avoid: So guys, what if no one comes?


Just as we began contemplating our options (walk back through the park and take our chances with all those cuddly animals we'd passed hours earlier, or stay in the car overnight), a white Landrover turned the corner, and out came two park rangers who valiantly resisted the urge to smack us upside the head for getting ourselves stuck in a river/healthy creek on a road that was clearly impassable.

They jump started the engine, dragged the car out of the water and escorted us to the main gate. It was unclear if the escort was for our own good or for theirs.


Based on our safari adventure, I would like to offer my fellow travellers three handy survival tips:

  1. When you encounter a steep embankment with a muddy river at the bottom and a high grassy impassable road on the other side, DO NOT attempt to cross, not even for adventure’s sake.

  2. Try not to take too many photos of your safari breakdown adventure when the park rangers come to rescue you. They find this a tad annoying.

  3. And finally, don’t test Africa. Africa always wins.

08 February 2010

Looking for Explanations

We hit rough weather thirty minutes out from Bujumbura. A jolt and I could suddenly feel the speed at which we were hurtling through the sky—was suddenly aware that there was nothing beneath us but miles of air.

The man sitting next to me, with whom I’d exchanged pleasantries before take off, saw me clutch my seat and gasp. He looked at me, and feeling his gaze I turned, biting my lip.

—Do you believe in God? he asked. His eyes were as still as the ocean floor.

I shot back instantly: Don’t ask me that, please! And then I turned my head towards the window so he wouldn’t see my tears.


I had just left the central African nation of Burundi where I spent a week at a global health conference. The theme was performance-based financing (PBF), a new(ish) idea for improving health in poor countries by, in the case of Burundi, awarding bonuses to health facilities that achieve certain results, such as increasing the number of children they immunize. This is in contrast to the traditional approach of paying for inputs such as equipment and medicine and hoping that better health will automatically follow. It hasn’t always done so. Despite decades of effort and billions of dollars (and some great successes), some health woes persist. Burundi’s maternal mortality rate, for example, continues to hover at about 1,100 per 100,000 live births—one of the highest maternal mortality rates in sub-Saharan Africa.

There are all sorts of ways to explain tragedies like this. PBF says that the reason so many are still sick and dying is that health systems are weak, and health workers underpaid, under-motivated and unaccountable. The answer is incentives: a modest bonus, along with scrutiny of their work, will enable/force health workers to act on the motivation they already have, or inspire motivation if it is lacking.

A small group of young, mostly European men presided over the PBF workshop. They are old friends mostly, who like to talk about their early days in the “trenches” working for Medicins Sans Frontiers in places like Cambodia. There is a lot of camaraderie among them, a lot of shared excitement about their work. None of them would say PBF is full-proof, a silver bullet, but they were confident (almost Certain), that these programs can and will work.

“Evangelists,” is what one observer called them. Just like the man who sat next to me on the plane, they have an answer.


Burundi is emerging from a 12-year, ethnic-based civil war. When Hutu president Cyprien Ntaryamira was killed in 1994 alongside the president of Rwanda when the plane they were travelling in was shot down, violence ensued. More than a half million were killed and many more fled to neighboring countries (including Tanzania, where I live). South Africa mediated peace talks and a power-sharing government was set up in 2001. Most of the rebel groups agreed to a ceasefire, and the country has enjoyed several years of relative calm.

But there is a ripple, just below the surface, of uncertainty, a sort of brace for what might happen. You can feel it in the torn up streets, sudden road blocks, the industrial wasteland feel of parts of the city.

Because it is a post-conflict environment, we had to travel with an armed United Nations security detail on our visit to a rural health clinic. The convoy—a small pick up truck packed with bored Burundian men carrying Kalashnikovs, and us following in a Landrover—felt intrusive, menacing on the simple dirt roads. Especially when we passed a procession of mourners carrying a coffin down a steep jungle hill. They pulled close to the edge of the ravine as we passed, including the somber old man who was leading them. He had a small wooden cross in his hand, raised up to the sky.


There are other wars too. One broke out just before the conference when one of the attendees, a long-time public health expert, decided not to come, citing, in an email sent to all his colleagues, philosophical objections to PBF. Financial incentives, he said, commercialize health care, induce cheating, and create distrust of and among health workers. And dissent is not welcome—the club of proponents are single-minded, arrogant, and rarely willing to admit the limits of their own theories.

There was a flurry of response. Recriminations, a hardening of views and marshalling of evidence. The cc’d list ballooned, and the Burundian Minister of Health even chimed in.

Then came an email with a decidedly different tone. The writer, a Bujumbura-based donor representative, began his note with the usual formalities, but then he summoned a quote from St. Augustine:

“Hope has two beautiful daughters, anger and bravery. The anger at such things and the bravery required for change.”

The author of the email then said that though he did not endorse the charged comments and personal attacks of the PBF dissenter, he admired his bravery, his willingness to speak up, and suggested that such anger could be constructive, if it is channeled toward more useful enterprises.

It was just a small word of calm, a small word of credit to a man who feels besieged, and it reminded me of another quote, this one from Shakespeare’s Richard III:

“O momentary grace of mortal men, which we more hunt for than the grace of God.”


Our wars are low-level—fought amidst the banality of power point presentations, cocktail parties, and networking lunches. But the stakes are high. Our lives might not be in danger, but our reputations are—the way we are viewed by our peers, which affects what conferences we get invited to, what panels we are asked to speak on, what journals we can write for. And through this, our professional success will be judged. And we will judge ourselves too: did what I committed to actually do any good? Did my career matter?

One morning I asked one of the “evangelists”: do you think criticism or doubt ever get drowned out at events like this? He was thoughtful: yes, he said, we should talk more about the limits of PBF, but "look, for years there was no progress, and now something is actually working…and I don't think we should let doubt get in the way of at least trying this. If someone has a better idea of what we should do, fine, but until then, we need to do this, we can’t wait."


I got to the conference hall early one morning. It was quiet out, cool. Some attendees were seated around a table watching a televised church service that was being projected on the wall. A choir was singing:

Hallelujah, Hallelujah, He is risen, He is risen

Some say belief in God is comfort for the suffering, order within the disorder, a port in the pitiless storm. Maybe that is part of what belief is about.

But if that’s all it is about then we are bound to be disappointed. And what I had really wanted to say to the man on the plane was that God, whatever that means, is not responsible for tragedy. Nor does the idea that our lives are guided, that everything is part of a Plan, make me more willing to swallow suffering and grief. Belief like that is bound to be sentimental and fragile.

And new gods like PBF can be fragile too (even war-inspiring). A community tired from years of inadequate solutions to massive problems is in danger of holding on too tightly, moving too quickly, and glossing over details that must be addressed carefully if these programs are going to really succeed.

Everyone knows this. No one needs to be told that caution and careful consideration are needed. Despite the confidence we often project, for most of us, there are moments of serious doubt. But there are moments when we really believe too, when, despite our real differences, a common hope is felt—that even though we may not be able to explain tragedy, there are things we can do to fight it.

That's why most of us got into this business in the first place: Because we want people to live. We want people who are poor not to be poor anymore, or sick. We want life to be more fair than it is.