Who are we to talk?
A few months ago I stumbled onto that golden ticket of freelancers: a job that actually pays. For three weeks, I appeared at the bougainvillea-covered gate of an NGO in Haiti and happily dug into the gruelling work of proposal development. The team was great, the people pleasant and the work engaging. But given its nature, we ended up sitting at desks for much of the day. We were busy, yes, and the time was productive by the usual professional measures. But in a country like Haiti, where the informal economy is still so strong, this type of work continues to feel so out of place. Contrast us and our Excel spreadsheets with the majority of people – more likely to be carrying basketfuls of produce to unload at market, selling soft drinks from tired cardboard boxes, or hustling pedestrians into tap-taps for five gourdes a stretch.
The majority of people in developing countries (allow me to state the obvious for the sake of argument) are poor (by which I mean that there are few evenings where they go to bed feeling totally secure about how their basic needs – food, water, shelter – will be met the following day), rural (by this I mean they are dependent on the land – if they are lucky enough to have land - to bring them food and provide for their livestock, and they are further dependent on the weather and environment to sustain both land and livestock) and isolated – either because of lack of education and literacy or lack of electricity or other technological amenities or because of strong cultural norms.
Although I work in development aid, I did not grow up poor; we had plenty of food, we always had a house. Neither did I grow up rural, though I did live in a town of 25,000 right next to Rural and took a lot of healthy ribbing from my farm friends for my ‘city’ ways. Nor was I isolated – either through lack of education or through lack of exposure to the greater world; much to my mother’s chagrin, we always had a TV.
Which begs the question: who are the people who work in development aid?
Most of them are much like me. They grew up with sufficient material and basic goods, they are literate, they are wealthy beyond comparison next to the world's majority. Watching us over the years, perched at our desks, I have begun to wonder: how do we expect this type of person – someone who has never once gone to sleep hungry, who has never once had to guess about the right day to plant her crops to catch or miss the rains, who has (only) once been awakened to a birthing ewe bleating in distress (and in my case, that was one ewe of 20, not my only hope of a future) and who knew next to nothing of cultural or geographic or social isolation – be in charge of designing, implementing and evaluating appropriate programmes for developing countries?
The people allocating money and other resources in poor countries are almost never people who actually know what it is to be critically, and crucially, dependent on the whims of the natural world. They are people who, by and large, have never known viscerally what it feels like to be living on the rawest edge of material security.
We do need cultural ambassadors, and we need people who can understand different government norms and technical experts to implement technical programmes. But what I think we need even more than this is for the people who are designing and implementing the development agenda to have a fundamental understanding of the life conditions of the people the programmes are supposed to be serving – not just through learning some words in the local language, hobnobbing with local vendors or spending a few nights in a village in the mountains.
Intention and goodwill aside, you cannot understand a lifetime of insecurity by spending a few days without running water.
Hitting the nail
The moment that I became a better implementer of public health was one afternoon in Rwanda, listening to a woman with AIDS who was living out her final months and trying to tell us about her life.
The woman was perhaps 40 but looked, at the end-stages of her disease, much older. Most of her family had been killed during the genocide in 1994, during which time she was gang raped. She became pregnant from the rape and also contracted HIV, but it was more than a decade before she discovered this. By that time she had had another child, who was also HIV positive. When we met her in 2009 she was dying, and trying to believe that her youngest child was not, in fact, as ill as he appeared to be.
Rwanda is a country that prioritizes privacy. Emotions are rarely exhibited. But on this day, perhaps because my translating colleague was so kind, this woman’s mumbled words morphed into a stream of confessions and, finally, into tears. It was shocking to see someone in that country cry publicly; and it was terrible to see the manifestation of such pain.
The woman's son heard his mother’s weeping and came in to hold her hand. Then he turned to stare at us, with an expression that was equal parts fury, pleading and pure desperation.
And that was when I got it. The week before I had returned from a hospital visit in the US where the doctors informed us that my own father – after years of failed interventions – had a 50/50 chance of making it through the next operation alive.
Without weighing relative sorrows, the weeping of the woman in front of me was my stepmother’s weeping; and the little boy’s look was exactly like the look I gave the poor intern on call that day.
This was a revelation. It was the first time I had understood so clearly that the problem in front of me was not about HIV or about AIDS or about poor people living in Rwanda, or anywhere else.
It was about what living with a terminal illness and being terrified of losing your home, your job and your ability to care for your children does to a family.
It was about me, and my family, too.
The agenda of development aid should not be set by resource-rich countries according to their western and global North paradigms. Even more than that, it should not be set by people so far removed from the uncertainty of life that has dominated human existence for most of time.
Give me rural, poor and isolated westerners who have overcome the odds and achieved an education and let us make them programme managers in developing countries and you will see, with or without local language lessons and with or without a glossary of NGO acronyms, they will get out from behind their desks and go into the field – not through an obligated sense of cultural kindness but because they are, for once, really speaking the same language as the people they are trying to help.
It is not that educated and well-off people cannot make a difference in development; we are all, no matter what our background, accountable to basic principles of human kindness. Through our experiences we can always choose humility, and we can always invest in becoming more profound and expansive in our views.
But there is something searing about growing up in need. And it is something that I do not believe can be learned through a workshop or even a stint working in a desperate environment.
We who have the power both to choose the development agenda and to hire the leaders who make that agenda happen have an obligation to the people whose lives our influenced by those choices.
I believe we owe it to these people to send experts and managers and implementers of development aid who, because of their own personal history, really understand what it is to live life on the cutting edge of death.
Because from my own experience I know: at our most profound and desperate moments in life, words may simply fail us. When they do, what we want more than anything is to be able to look at the person who is there, supposedly, to help and know that they are fully qualified to say the two words that go further than any culture or language or nation-specific training can go:
‘I understand.’
Emily Cavan Lynch is a public health consultant and freelance writer. Email emilycavan@gmail.com
