The News From Africa
It’s been a long time since I’ve sent out an update, but I have been quite busy in remote places. Most recently, I was working on a UCSF study of an infectious eye disease called trachoma, a volunteer on this project in the Amhara region of Northern Ethiopia. In practice, this has meant getting up every morning at 6 AM, heading by Land Cruiser and foot out to a remote village somewhere, and gathering a hundred test swabs from a hundred randomly-selected villager’s eyelids. Despite the early wake up, I’ve really enjoyed the experience, and feel that I’ve learned a lot about both the village life here, and how global-scale public health operates – this study is the largest of its kind in history, involving over 200,000 people, and will doubtless deeply influence the WHO treatment guidelines.
But now I am back in the capital of Addis Ababa, staying with friends, and I have time to write.
I find that I am at a loss to describe my experiences in Africa. This continent is, really, a whole other world. Just the everyday experience of living here is quite different in many ways, though less so when I’m hanging out with a West Coast couple who have a hot shower and can afford to eat something other than injera, the local staple. But then I go outside, and it’s an African city all right, noisy and run down and muddy. And although the beggars seem kinder in Ethiopia than in more tormented West Africa, and although the children are absolutely beautiful, it is still hard to walk down the street as a white person. It is always hard to walk down the street in Africa. “Faranji!” they yell here, and “you!” as well, and “I am hungry” the children say with that beautiful smile, and probably they are. And it kills you, because these people really are destitute, but there are millions and millions of them — and begging is an industry, just as aid money is an industry.
The truth is that the West has been trying to help Africa for close to fifty years now, and really not very much has changed.
A very short primer on the continental situation: some countries are at war. Everyone else is dirt poor. Most Africans are sustenance farmers, still growing their food or raising their herds in much the same way they have been doing for thousands of years: no tractors, no fertilizers, only the most primitive irrigation systems. This might sound idyllic, but it’s not: without any modern technology, crop output is entirely dependent on the rains. When the rains fail, people starve. Even worse, without proper management policies, fields are turning to deserts and rivers are dying from over-fishing. High population growth exacerbates all these problems — the average number of live births per women in Mali, for example, is 8 point something. Fixing these types of deep societal problems requires education, but most Africans are illiterate. In fact, Ethiopians are the only Africans who had written language in pre-colonial times, and even they are today mostly illiterate, and certainly very poor. Then there is HIV, which is far worse for the way it destroys hope than in its mere physical effects. But of course all of these problems are very difficult to approach without massive government support, and African governments are notoriously corrupt, while the various global organizations dedicated to world health and poverty – the WHO, the World Bank, and the UN in all its myriad manifestations – are at best manifestly ineffective and at worst self-serving.
Africa is one of those complicated things that cannot be understood in a simple way. No matter what Bono, the World Bank, or Oxfam tell us, it’s just not that simple. The economists talk of poverty traps caused by lack of capital. The IMF rails about government financial mismanagement. The NGOs point out that when you’re starving, nothing else matters. Those who study government say that corruption is the killer, while others tell us that HIV is the great problem. Or population growth, or education, or access clean water – everyone has a different story. And all of these stories are probably true, because the truth is that all of these problems are interlinked in very complex ways.
Africa is the most difficult thing I have ever attempted to study. I suspect I could spend a lifetime on these questions. Last week I made a list of the subjects I think I would need to understand in order to untangle the cause and effect of this continent. The list included economics, political science, peace and conflict studies, social work, public health, governance, epidemiology, religion with an emphasis on fundamentalism, and of course the specific histories of the countries involved. It is also hard to overstate how diverse this largest continent is. The “problem”, as if there is only one problem, varies greatly from country to country and region to region. The only thing I am sure of so far is that there is no single solution.
The best description I’ve been able to come up with is to say that the process of development is the process of installing the entire apparatus of modern civilization — except that we can’t simply replicate the Western model, because these people are not Western. A modern Africa will be different from a modern America, and no one yet knows exactly how.
Where to begin?
I don’t know. I do not know whether you should give your money to HIV prevention, or if you should adopt a little black child, or neither. I will not preach about moral responsibility, or the obvious tragedy of the place, or the missionary glow of idealism, or the frustrating and dangerous satisfaction of trying to change things. These are for each person to sort out on their own. Africa is one of those experiences that changes people, and each person finds something different. All I can say is that there is something here, something very real.
