Thursday, May 29, 2008

Carl Talk and the Folly of Aid

I had a chance to sit down with my favorite French-Canadian general surgeon yesterday, and just chat. Carl is finishing up his stint at CHC, and his departure is a loss to the people of the CNMI. Last week Carl gave a presentation on his year in Ethiopia, his last post of service before arriving in Saipan.

Carl was there with an international aid organization. He was part of a three member team that consisted of a surgeon, an anesthesiologist, and an OR nurse. The project aimed to identify local people who would spend a year with them, get trained in how to be a surgeon, an anesthesiologist, and an OR nurse, and then head back into their provinces to provide service. The aid organization sent 21 of these teams throughout the country. Ideally, by the end of the year, there would be 21 local teams prepared to provide services to their people.

Carl had planned on spending his life doing humanitarian surgery. But his experience so disillusioned him, that he’s taken a break from pursuing that as a career.

He told me about how much difficulty he had when he was applying to various international agencies. He was offering his life to them, for free, and only one agency could accommodate him.

He told me that throughout Ethiopia, there were many international aid organizations, all in competition with one another, refusing to cooperate or pool their resources. The agencies were more concerned with making their annual reports look good and getting more funding than making sure their work actually made a difference.

He told me that the organization he worked for failed to take the local situation into account. They sent these fancy autoclaves to sterilize instruments – fancy because they had microprocessors with them to control the sterilization process. But the chips were set for sea-level, not for the elevation of Ethiopia, so they were useless. It would have been better to simply send pots and teach the people how to sterilize their instruments by boiling them, because that technology would always be available and repairable.

He told me that they used sutures at the central training hospital that would never be available in the provinces.

A year after his departure, of the 21 teams that were trained, only three were still functioning. That’s better than nothing, but it doesn’t make for a success story, especially considering the talent and dedication that poured in the way of the volunteer surgeons, anesthetists and nurses, who gave a year of their lives for this project.

It again points out the need for development projects to be decided locally, on the ground. For people to become empowered to identify their own problems and create their own solutions and seek the assistance they need. Development projects imposed from the outside are simply folly.

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