14 August 2010

The Believers

I’m sitting in the back seat of an old blue and white Russian Lada, looking through the drizzle flecked window at some wet goats standing in mud on the side of the road. The morning is gray and smells of petrol and exhaust and I have a headache from a bad night’s sleep.

The day before I’d showed up at the Addis Ababa Fistula Hospital and asked to speak to its 84-year-old founder, Catherine Hamlin. I didn’t have an appointment, and was ambivalent about whether or not she would see me. I’d been travelling non-stop for three months, living out of a suitcase, eating with strangers. I felt dislocated and lost, weary of ideas, weary of writing.

But the hospital public relations manager, Feven, told me to come back in the morning at 9 o’clock and we could meet.

Now I’m stuck in traffic, and my driver, Fikadu, is creeping along the street like a snail. It’s okay, though. I need the time. Looking out the window—a crumbling church, an open market, masses of Ethiopians darting in and out of traffic—I try to think of questions for Dr. Hamlin. Usually, I have a list prepared for the people I interview. The questions have a logical, linear progression.

But when I think about Dr. Hamlin, my questions feel irrelevant, like abstractions (does aid work?) compared to her concrete reality (yes—these women were sick and now they are healed).

And when I arrive, ten minutes late, my mind, and notebook, are completely blank.


Feven tells me to have a seat while she fetches Catherine. I pick up a brochure, flip through it absently, then set it down and look out the open window. The morning air is cool and smells of eucalyptus. Nurses dressed in white walk along a corridor next to the admissions office, which, like the surgery and recovery ward, is nestled on a hillside among trees and flowers.

Then I see Dr. Hamlin, tall and conspicuous in a long white lab coat, walking slowly with a cane, Feven’s hand in hers.

Catherine Hamlin and her husband came to Ethiopia in 1959, after answering an advertisement in the Lancet Medical Journal, seeking an obstetrician and gynecologist to establish a Midwifery School at the Princess Tsehay Hospital in the Ethiopian capital of Addis Ababa. Fifteen years later, they established the Fistula Hospital, a place where women with horrendous injuries from childbirth*, women who have been abandoned, cast away to the margins, can come and be cared for, and in many cases made well again.

Dr. Hamlin's face is deeply lined and rosy, and as we sit down to talk, she tells me about the hospital, which provides fistula repair surgery to about 2,500 patients each year, and cures over 90 percent of them. They also care for fifty long-term patients, who are not able to be cured, and train local health workers and specialists. All services are provided free of charge.

In the opening pages of her book, The Hospital by the River, Hamlin says that she came to Ethiopia as an answer to the calling of God. Has her faith changed in the fifty years she’s lived in Addis?

—No, she says. There has always been good and evil in the world.

Do you ever get discouraged, I ask? Why did you stay when so many others have left?

—I was excited, she says. I was curing people.


One night in Nairobi, a friend and I had dinner with a young woman just arrived in Kenya to do research for her PhD. It was her first time in Africa, and in between bites of teriyaki chicken, she told us about the angst she was feeling, questioning the purpose and utility of development. Is it arrogant to come to a place you know nothing about and study it? Is it just another form of colonialism?

—Colonialism is underrated, my friend, M, interjected with a grin. The young woman laughed uncomfortably and shifted in her chair.

I frowned at M and asked her: What is the most defining thing about your first few weeks here? What do you feel most acutely?

She said: Guilt.


—Go easy on the newbie, I told M later in the car. I’ve been here a year, and I’m still pretty sure colonialism is NOT under-rated.

—I know, I know, he smiled, hurtling like a rocket through Westlands roundabout. But you can get lost in the debates forever. I wouldn’t be here if I didn’t think my job was important.

M works in conflict resolution and has lived in Kenya for three years. His job is to think about and work with groups most consider beyond the pale, outcasts.

—I choose to be here. I signed a contract. I know my work isn’t perfect. But I have to do the best I can with what I have.


Back in Addis, I’m sipping a macchiato with Owen Barder, head of aidinfo.org, an initiative promoting aid transparency.

He is, as usual, like loose electricity, overflowing with ideas and optimism. Where does this fierce belief in the power of shared information to change things for the better come from?

—I’m a hacker, he says, leaning over the table conspiratorially. I was shaped by the idea that information should be shared.

He tells me about a meeting he attended in Paris, in which donors who give about half of the world’s aid agreed to publish data more quickly, and in a common, open format, so that it is readily accessible, comparable, and easy to find.

Owen’s ambitions are massive. He wants to fundamentally realign incentives in the aid business, to change it from the inside out. How is a meeting in Paris going to do that?

—This is work, he says, undeterred. It’s slow and incremental. Over time, low key technical and technocratic changes will change the system dynamics, and hence the whole trajectory of the aid system.


It is easy, in the development business, to get caught up in words and ideas, to be mesmerized by doubt and uncertainty. But we must move on. People like Owen and Catherine and M believe in the work they are doing, not because they are under any illusions about its limits, but because they get up each morning and do the work. Because they try. Their dreams and hopes are grounded in responsibility.


As our interview draws to a close, I tell Dr. Hamlin: I don't want to leave! Your work is amazing!

She smiles: "They keep coming, though, year after year." The Fistula Hopsital gives women their lives back, but it does not solve the underlying problem of poverty and lack of access to basic health services that brings them there in the first place.

"But we're working on it," Hamlin says. She and her colleagues recently opened four mini-fistula hospitals throughout Ethiopia where prevention education programs are being delivered to communities and traditional birth attendants are being trained. They have plans for much more.

Outside, in the crisp morning air, Feven chides Catherine gently for being up and about so soon after hip surgery a few months ago. Catherine takes her hand: “There’s work to be done.”

*Obstetric fistula is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth. A woman with obstetric fistula will suffer from incontinence and extreme social stigma.

11 August 2010


One afternoon in Juba, I arrived at the headquarters of an international NGO to find that my interview had just left. I walked back to the car, kicking the dirt in frustration, then noticed, across the road, a sprawling neighborhood of mud huts tucked away behind a bamboo fence—a scene right out of rural Africa, in the middle of the capital of South Sudan.

I asked Joseph, my driver, if we could walk through the neighborhood. He was confused: do you want to interview people, he asked?

“No, I don’t want to bother them,” I said. “I just want to see it.”

He grinned, started the engine, and two minutes later we were at a pub down the road to pick up his friend, William, a soldier with the SPLA (Sudan People’s Liberation Army) and part time bar-owner. William’s aunt lived in the neighborhood, and when Joseph asked, William offered to give us a tour.

“It’s called Tomling area,” he said as he led us down a narrow mud path, a labyrinth organized neatly along bamboo fences, around the neighbourhood of thatched-roof huts. We passed school children in navy blue uniforms on their way home from school; a woman in a pink and orange kanga hanging clothes on a line to dry; another woman stirring something in a steaming iron pot.

Tomling did not feel depraved, squalid—the words I used to associate with the word slum. But it was not all cheerful either. A middle aged woman lay in the dirt moaning; a man without a leg limped with a cane, barely able to cross the jagged mud road. Occasional bursts of sour air, the smell of human waste, wafted out of some of the structures we passed.

On our way out, I saw a young man in slacks and a polo shirt walking in front of us, out of Tomling, onto the main tarmac road. He had come from a mud hut, but now he’s walking down the street with everyone else.

I watched him: tall, back erect, book in hand, one foot in front of the other. He was not an image or an abstraction. Each footstep he took I imagined him looking back at me. In my mind he was saying: I am someone. I am someone.


In a recent New York Times op-ed, Slumdog Tourism, Kennedy Odede discusses the phenomenon of tourists paying to visit Kibera, the largest slum in the Kenyan capital of Nairobi. He writes:

"...Many foreigners come to the slums wanting to understand poverty, and they leave with what they believe is a better grasp of our desperately poor conditions. The expectation, among the visitors and tour organizers, is that the experience may lead the tourists to action once they get home.

But it's just as likely that a tour will come to nothing. After all, looking at conditions like those in Kibera is overwhelming, and I imagine many visitors think that merely bearing witness to such poverty is enough.

Nor do visitors really interact with us. Aside from the occasional comment, there is no dialogue estabished, no conversation begun. Slum tourism is a one-way street: They get photos; we lose a piece of our dignity.

Slums will not go away because a few dozen Americans or Europeans spent a morning walking around them."


Maybe tourists paying to walk around slums, to spend thirty minutes snapping photos of another person's life, another person's hardship, is distasteful, irreverent, and unhelpful.

There are many thoughtful people, though, who think that, on the whole, it is a good thing, the same way some thoughtful people think student "mission trips" are a good thing, even if they do little to help the poor in developing countries.

"It has to be done completely differently, but they should absolutely be done," a friend of mine said. "And yes, if even 99 percent of the tourists don't feel like doing anything about global poverty, but 1 percent do, I still think that is a net positive."

Maybe. I'm inclined to agree, but then I wonder: if it was me in there, in the slum, and someone with more power and chances and money came to look at me, in my rags and filth, what would I feel? Humiliated. Powerless. I would feel anger at their pity.

Is there a way to do development tourism right?


And what if you work in the development business? What if visiting slums is part of your job?

I was in Nairobi a week ago, working on a story on a program that sells highly subsidized vouchers to poor women, who can use them at accredited health facilities to safely deliver their babies, among other things. One morning, I visited three such facilities. They were located in a slum called Korogocho, less well-known than Kibera but nearly as large and just as poor.

After an interview, the clinic manager took me on a tour of the facility. This is the reception, he said, the lab, the delivery room. I nodded, jotted down some notes.

Then he turned a door knob to take me into a room where a nurse was counseling a patient being tested for HIV. No, I said, reaching out my hand to stop him. We don’t need to go in there.

The tours are all the same: exhaustive, intrusive, helpful, uncomfortable, and bewildering.


Maybe it’s debatable—whether development professionals like me should be here at all. (I happen to think that we should.) But we are here because, despite the imperfections and inconsistencies of our business, this is the job we have chosen to do. And to do it well—to change the way things are for the better—we have to get as close as we can to reality as it is. Needing to see and understand poverty, even though we are not poor, is a dilemma we have to live with.

(Thanks to M for your fierce sense of getting on with it.)

08 August 2010

Eclipse (Dispatches from Burundi)

Thirty minutes west of downtown Bujumbura, past the flat, empty swamp lands of Gatumba, along a little two-lane road, is the border between Burundi and the Democratic Republic of Congo (DRC).

When I asked the taxi driver to take me there, he asked why I wanted to go.

—I just want to see it, I said.

He faked a smile and shrugged.

Truth was I wanted to see something other than the Bujumbura the New York Times’ travel section describes as “a freewheeling city of palm trees and colonial-era Art Deco buildings,” an unexpected oasis for expats—great restaurants and nightclubs, charming hotels—smack in the middle of war-torn central Africa.

Burundi is at peace now, but flash back to 1996: for the third time in a decade the government is turned upside down: the president has been overthrown in a military-led coup, even as it is still reeling from the murder of its two previous presidents—one in 1993 and another in 1994. The coup prompts the international community to impose economic sanctions. GDP falls by about 8 percent. The Burundian franc plummets. The government institutes fuel rationing, and all over the countryside, civilians are caught up in a brutal and bloody battle.

Since independence in 1962, ethnic and political conflicts have resulted in five wars in Burundi, left tens of thousands massacred and close to two million displaced or fleeing to neighboring countries.

Burundi has enjoyed several years of relative calm since holding its first successful post-war democratic election in 2005, but at the time of my visit, the international press was describing the country as dangerously close to the brink.

The International Crisis Group, for example, warned that tensions could escalate in the run-up to communal, presidential, then legislative elections, which began in May and continue through September. Opposition parties face harassment and intimidation from police and the ruling party’s youth wing is dangerously volatile, the report said.

Looking out the window of the taxi, I wondered: Where is this Burundi? And if I get away from my hotel, away from the familiar restaurants, offices, and cafes, and just drive, what will I see?


There were—technically—two lanes on the road to the border, but my taxi driver drove straight down the middle. There are always streams of bikes and people, loaded down with mattresses, grass, charcoal, but it was more crowded than usual. The further we went, the thicker traffic became.

Then we saw it from the road: what looked like thousands of people were gathered around a huge stage on a grassy field next to Lake Tanganyika, many wearing tee-shirts and baseball caps with the acronym CNDD emblazoned on them in red. (The CNDD—National Council for the Defense of Democracy—is the political party of Burundian President Pierre Nkurunziza.)

We parked and got out. It felt like the fourth of July. There were flags everywhere (not the Burundian national flag, but the CNDD flag)—fluttering outside shops, draped across the hoods of pickup trucks, strung down peoples' backs like capes, on tree branches and the sides of buses. Young men were talking into loudspeakers, cars were decorated with balloons, groups of men and women were running in step together singing. The rhythmic stomp of their feet against the dirt was like a drum beat. It was buoyant, electric.

I took off my sunglasses and tried to look inconspicuous, which was ridiculous and impossible, especially with a band of barefoot kids following me, giggling. People gave me sideways glances and whispered as I edged my way toward the stage and watched as a man in a black cowboy hat talked forcefully into a microphone, his voice rising and falling like waves in a storm. He began to chant, his fist in the air—Shirira! Shirira!— and the crowd started chanting too. Their voices carried like a shockwave through the open air, reverberated like an insistent, pulsating eruption.

I looked at my driver. His face was grave and strained.

We turned to leave, and in the car, I asked him about the slogan they were chanting. What does it mean?

—It’s to make people afraid, he said.

I shook my head: I don’t understand.

He scratched his chin, and looked out the window. “Comme allumer,” he said. “It means to light up. To set on fire.”


I called a Burundian friend back in town and told her breathlessly: We must meet! You won’t believe what I saw!

She was unmoved: Don’t be fooled by all those people, she said. They are poor, they are given tee-shirts and food. Just because they are there does not mean they support the CNDD.

She told me that “meetings” like the one I’d seen were a dime a dozen in Bujumbura—there was nothing special about the rally I’d happened upon. And this specter of violence I'd read so much about? Unlikely, she told me.

"This is the problem: foreigners come here, and they see things and are told things, but they don't know how to interpret it. Most of what you read in the newspapers is wrong."

The art of reporting is more difficult than is generally assumed.

It's twilight and I'm sitting outside my hotel room at Ubuntu, watching a pair of cranes prance across the lawn. The air is filled with the rustle of palm trees, the quiet murmur of conversation and clink of china from nearby tables. Lake Tanganyika is just across the street. Its cool, silvery vastness conveys a tranquility that belies Burundi’s troubled past.

Then I hear it again—the pounding of feet and faint, distant chanting. I turn my head but I can’t quite make out where the sound is coming from.

Beyond the lake, the Congolese mountains, normally a tower of massive gray solidity, are obscured in the clouds, hidden.

(Nkurunziza was re-elected for another five year-term in June, with 91.62 percent of the vote. Observers praised the calm surrounding the election, but the government was heavily criticized for limiting freedom of expression. All six opposition candidates boycotted the vote following complaints of fraud in district elections in May.)

05 August 2010

There's No Blood Thicker Than Ink? (Dispatches from Kenya)

Nairobi is a gritty town. Sure, it’s got the shopping malls, the fancy restaurants—but underneath the veneer, Nairobi is a coarse industrial machine, with money and labor pumping through its veins like crude oil through a pipeline. You feel it on the road—black plumes of exhaust, traffic jam, horns blaring, streams of men and women weaving in and out of traffic, some selling things, others just on their way somewhere. Pass by petrol stations, car lots, and factories—cement, foam, tires. Then by an ocean of slums, waves of brown cardboard and tin, and along their periphery, commerce: blacksmiths, spare parts, sheet metal. There are lorries everywhere. From the back seat of my taxi I watch a man seated atop one, riding there in the back in the early evening haze, his shirt flapping in the wind.


In December 2007, Kenya held presidential and parliamentary elections. Incumbent President Mwai Kibaki was declared the winner, but his opponent, Raila Odinga, contested the result. The election commissioner admitted he didn’t know who won.

People began to say that the election had been stolen and riots broke out. First in the Rift Valley, they spread like a shockwave to the streets of Nairobi, ripping, tearing, blasting apart the sense of solidity that the country (and the world) had of itself. Buildings were set on fire, demonstrators were shot.

—We locked ourselves in our house for two days.

—I lived across from Kibera [a slum]. Even in the house we had to wipe our eyes from the tear gas police were using outside.

—If the international community hadn’t come in, this place would have been gone.

—Sometimes I don’t even like to remember.

Over 1,300 people were killed and hundreds of thousands displaced. Such things are not easily forgotten.

Which is why Wednesday’s referendum, in which a large majority of Kenyans voted in a new constitution, was monitored so closely. No one wanted what happened in 2008 to happen again.

Reports from international news agencies preceding the referendum suggested that Kenya was on the brink of a descent to violence:

“Kenyans will decide on Wednesday whether to adopt significant changes to their constitution, but the vote may produce violence rather than reform.” —Reuters

There are “heightened fears of political violence ahead of 6 Aug constitutional referendum.” — International Crisis Group

“Once again, many Kenyans fear that the prospects for more violence are increasing as their country heads toward another politically divisive turning
point.”—The New York Times’ Jeffrey Gettleman

The reports did not match reality. Most Kenyans felt relatively confident (rightly it turns out) that violence was unlikely. So was this just another example of the press painting African countries as more violent and chaotic than they really are? One more example of cowboy reporters making things sound more dangerous (and exciting?) in the cities where they are based? (Yes, Gettleman, that one’s for you.) Maybe that is part of it.

But maybe the speculation was also borne out of the doubts that appear, like cracks on the surface of an ice-covered pond, when our sense of the inevitability of stability is broken.


The constitution contains many landmark provisions—a Bill of Rights, land reforms, and limits to presidential powers. No one is sure if it will usher in a new era, one less riddled by corruption, one defined more by equality and opportunity than sickening poverty side by side with ostentatious wealth. It is, after all, just a document, just words. And we rarely live up to our words.

But words are not meaningless either. They express what we hope for, what what we think we have it in ourselves at our best to be. Maybe that's why, all around Nairobi, in newspapers, on billboards and banners, on the radio, scattered like flecks of gold on the beach, are words like Renewal. Healing. Unity. They are words about leaving the past behind, about bringing fighting to an end and having peace.

Making them real will require effort—mundane, unglamorous work. (For a good analysis of the challenges ahead, see John Githongo’s Fear and Loathing in Nairobi.)

But at least for now, there is a sense of possibility.

"Things change for the worse so quickly. They change for the better more slowly—but they can." --Bono

(With thanks to Matilda for taking the time to talk.)