The aid circus

On my first day at the XXXX, Richard and I meet with X NGO. They’ll be paying for my internship in Zambia. Harvard has access to good people, but limited funding. X NGO has money to spare, but no resources. It’s a match made in Aid Circus heaven. As I listen to X NGO describe the different projects they have going on throughout Zambia, I begin to really understand the sprawling and unmanageable nature of International Aid’s presence in Africa.

Individually, each project has a wonderful objective and seems completely justifiable on a cost benefit basis. But taken together, you start to get this creepy feeling that the whole world is using Zambia and other African countries like giant laboratories. Not just through the randomized experiments, but through all the examination, implementation, and evaluation that goes into running an aid project. Our study of community health workers requires each one to fill out detailed information on each patient they see and other activities. On one hand, the activities of CHWs are made possible by NGO funding. On the other hand, when you add up all the data requests from all the different aid organizations involved in community health care, you wonder how much time they have left to treat patients.

I get inexplicably furious at Richard when I see a CHW form (that he did not write, by the way, hence the inexplicable nature of my anger) that includes fields for “patient name”, “dob”, and “gender”. Our goal is to analyze how effective CHWs are at diagnosing and treating illnesses, something that in no way requires identifying patient details. Who are we to store this information, I say testily to Richard, coupled with HIV diagnoses and lists of symptoms? Maybe there are no laws protecting medical privacy here, but that doesn’t mean that we shouldn’t give these people the same protection we would expect in our home countries. I start to feel that by trying to help the people of Africa, we’ve depersonalized them. Turned them into rows in excel spreadsheets. Or even just problems to be solved. Either way, for whatever aid has given Africa, it’s also stripped away some of the humanity of its people.

Even Lusaka itself is as vibrant and bustling as it is due to the presence of the aid industry. Hotels, restaurants, shopping centers, and cinemas exist solely to serve the expats who work for the multiple NGOs entrenched in Zambia, and the Zambians who they in turn employ. The direct intervention is only a small piece of aid’s support of the economy—it also comes in the form of thousands of idealistic Westerners like myself hoping to help Zambia, and enjoy a nice cup of tea while we’re at it.

Zambia, and other countries I imagine, is torn between desperately needing the aid and trying to preserve their sovereignty. They push back in subtle ways, by making each NGO jump through multiple hoops to get anything done, to make it sure that the Zambian government is still involved, no matter who pays the bills. On the first day, Richard takes me by to introduce me to the head of XXXX. She shakes my hand reluctantly and requests that my presence be announced through a formal letter to her office. Even though we’ll be working just down the hall, we spend part of the next day running to an internet café to print said letter, since we aren’t allowed to use XXXX's computing resources. The relationship between Zambians and the westerners who want to help them is complicated to say the least.