Delivering healthcare to billions of the world’s poor

A review of Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, by Eric C. Bing and Marc J. Epstein

@@@@ (4 out of 5)

Despite the widespread conviction that the state of the world is deplorable and getting worse by the day, the human race has made measurable, even dramatic progress in some important ways. The collective state of our health is the most telling example. In part because of the eradication of smallpox, the near elimination of polio, and the significant recent progress on HIV/AIDS, humanity in general is living longer and healthier lives. Average life expectancy at birth in India around 1950 was 38 years; today it is 65. In China, it was 41; today it is 77. Over the same period, average life expectancy in the United States has risen from 65 to approximately 80. Numbers can be misleading, but these tell a compelling story.

Building on this amazing success story, major institutions — the United Nations, the U.S. Government, and the Bill and Melinda Gates Foundation, for example — have invested billions of dollars in recent years, targeting specific diseases, promoting the use of vaccines, and building public health infrastructure in developing nations. All these admirable efforts promise to continue the favorable trend in healthcare that has unfolded over the last half-century.

However, there is a hidden dimension in this picture. As Eric Bing and Marc Epstein explain in Pharmacy on a Bicycle, billions of poor people living in rural areas all too frequently fail to gain the benefit of these advances in healthcare. It’s fashionable to look on the world today from the perspective of the cities, but in spite of the massive migration of the last several decades, nearly half (49%) of the world’s population still resides in rural areas. Great numbers of these people live far from transportation hubs, often hours or even days of walking from the nearest road. It’s to these billions of people, nearly all of them desperately poor by American or European standards, that Bing and Epstein turn their attention in their illuminating little book.

Pharmacy on a Bicycle rests on a single, fundamental premise: “Most poor outcomes [in healthcare] are caused not by lack of effective medicines or medical know-how. The ability to prevent and treat many of these diseases inexpensively has been available for a very long time. But getting the right remedies to the right people in the locations where they are needed, in a way they will use them, and at a cost they can afford is continually a challenge. This is not a scientific problem. It’s a business challenge.”

Bing and Epstein argue that humankind has never before been in such a good position to meet this challenge. The costs of many widely-used drugs have fallen dramatically, and scientists have greatly simplified the treatment of many diseases by combining multiple drugs into single capsules or tablets. Extremely cheap diagnostic techniques that provide nearly instant assessments are now available. Through telemedicine, a single well-trained physician can now offer her or his expertise to much larger numbers of patients. The widespread use of clinical checklists and the application of franchising to the healthcare industry have both improved access and lowered costs. And new business models, successfully piloted in many countries, using bicycles, motorcycles, and trained village-level representatives, make it possible for healthcare agencies and for-profit companies to overcome the “last mile problem” that has traditionally limited most of the benefits of the market economy to population centers. “We are now at a tipping point to make lasting global health impacts,” the authors write.

One of the most promising recent developments is the now near-universal access to cell phones; by next year, the number of mobile phones is expected to be greater than the world’s population. “Mobile phones are now being used for patient education and awareness, treatment compliance, health care worker training, data collection, disease and epidemic outbreak tracking, and diagnostic and treatment support.”

Pharmacy on a Bicycle is intended to spark much wider adaptation of these advances by making them more widely known. The book presents a seven-point implementation model called IMPACTS, which encompasses innovation and entrepreneurship, maximizing efficiency and effectiveness, coordinating with partners, accountability, creating demand, task shifting (e.g., empowering nurses to take on some doctors’ responsibilities), and scaling. The book includes an abundance of excellent examples that bring these deadly-sounding prescriptions to life.

Eric Bing is an M.D. who also possesses a Ph.D. in epidemiology and an MBA. He’s the director of global health at the George W. Bush Institute at Southern Methodist University. His co-author, Marc Epstein, is an eminent and much-published professor of management at Rice University in Houston whose previous teaching posts were at the Harvard and Stanford business schools and INSEAD (European Institute of Business Administration).

 

The sorry record of microcredit laid bare by an industry veteran

A review of Confessions of a Microfinance Heretic: How Microlending Lost Its Way and Betrayed the Poor, by Hugh Sinclair

@@@@@ (5 out of 5)

“Some microfinance is extremely beneficial to the poor, but it is not the miracle cure that its publicists would have you believe. Microfinance has been hijacked by profiteers, and we need to reclaim it for the poor. The problem is not with a few rogue operators, alas, but with systemic flaws that permeate the sector.”

Thus does Hugh Sinclair lay out the thesis he pursues in Confessions of a Microfinance Heretic. If you skip over this statement in the opening pages of the book, you could easily conclude that Sinclair can see no good at all in the $70 billion industry that has grown up under the impetus of Muhammad Yunus’ 2006 Nobel Peace Prize. After all, Sinclair writes — at least twice — that he wouldn’t invest a single dollar in microfinance today. Nonetheless, he insists that the “debate is not whether microfinance works, but how the inherent conflicts of interest can be managed.”

The systemic flaws Sinclair perceives are eye-opening:

• A majority of the money loaned to poor people goes not to help them launch or sustain microbusinesses to supplement family income but rather for current consumption, sometimes to buy food during a time when there’s not enough money coming in, sometimes just to buy TV sets.”Estimates for consumption loans range from 50 percent to 90 percent of all microfinance loans,” depending on the study. As Sinclair points out, citing numerous sources, the proportion of entrepreneurs among the poor is no bigger than it is among the rich. It’s naive of us to expect otherwise.
• The interest rates charged for microloans are, far too often, prohibitively high. Muhammad Yunus’ benchmark — 10 to 15 percent above the cost of money — is rarely observed. Though there are indeed many, mostly small, nonprofit MFIs (Microfinance Institutions, generally microloan lenders) that charge no more than 25 or 30 percent, the bigger institutions, and most of the for-profit banks in the industry, typically charge far more. In one notorious case, the effective interest rate runs as high as 195 percent, but there are many other instances in which the rate exceeds 100 percent.
• The amounts of money loaned by MFIs are far too small to permit businesses to grow to a size where they may employ workers outside the family. In fact, to the extent that businesses remain family-run, they frequently employ even the youngest children, sometimes withdrawn from school to work in the business. However, there’s another side to this question, as Sinclair reveals in an exchange with one businesswoman: “[W]e asked her about her future plans for the business, and whether she thought it could be built up further and be a useful business for her children to take over. ‘You misunderstand me. I don’t do this job because I like it or want to grow it into a big business. I do it so my children will never have to do work like this.'”
• In countries where local laws and a lack of government oversight give free rein to the MFIs, competition run wild among them has sometimes led to credit crises. In India’s Andhra Pradesh state, for example, “There were more microloans than poor people.” And in Nicaragua “total lending by MFIs was estimated at $420 million in 2008, in a country of about 5.5 million, not all of whom were poor (and MFIs generally don’t lend to children).” Microloan customers frequently borrowed from several of the country’s 19 MFIs — the nationwide average was four — often to be able to pay back loans to other MFIs. “One particularly ambitious client in Jalapa had managed to rack up $600,000 in micro-loans.” As Sinclair disclosed in a talk he gave in Berkeley a few weeks ago, Nicaragua was only the first of several countries where the microcredit bubble is likely to burst. Stay tuned, he said.
• The profit motive appears to have become the central preoccupation of the microfinance funds, which function like private equity funds, gathering together investment dollars and placing them in selected MFIs. Even some of the biggest and most prestigious of these funds — including the Grameen Foundation (USA), Calvert Foundation, Kiva.org, and BlueOrchard (the world’s largest) — have been tainted by longstanding investments in some of the most egregiously exploitive MFIs, brushing aside mountains of evidence that their investments were helping victimize poor people in Nigeria, Mexico, and other countries.

Despite all this, there is NO documented evidence that microfinance has achieved any reduction at all in the level of poverty. As a 2007 article in the Harvard Business Review stated, “In 1991, for example, Bangladesh ranked 136th on the UN Development Programme’s Human Development Index (a measure of societal well-being); 15 years later it ranked 137th.” And Sinclair writes, “In 2001, Nicaragua was the 106th poorest country in the world . . . Microfinance was almost unheard of in Nicaragua at this point, and there were no large microfinance funds throwing money around. By 2009, when the full Nicaraguan microfinance meltdown occurred, Nicaragua had slipped to 124th place.”

Hugh Sinclair is no cranky, slapdash journalist taking on a controversial subject for the sake of selling books. He is a ten-year veteran of the microfinance industry and has been involved as either an employee or a consultant in dozens of MFIs around the world and in several microfinance funds. He clearly knows whereof he writes, his citation of sources is extensive, and his publisher, Berrett-Koehler, is a highly respected source of books on business and current affairs.

Confessions of a Microfinance Heretic is an important book that should be must reading for anyone involved in international development.

Must reading about global poverty and the contrasting approaches to ending it

A review of Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, by Abhijit Banerjee and Esther Duflo

@@@@@ (5 out of 5)

Public debate about the way to combat global poverty has ricocheted between two extremes. One was summed up in 2005 in The End of Poverty by Jeffrey Sachs, the Columbia economist who spearheaded the UN Millennium Development Goals. The other was laid out by former World Bank economist William Easterly the following year in The White Man’s Burden. Sachs advocates massive government-to-government foreign aid. Easterly deplores foreign aid, convinced that it does more harm than good.

In Poor Economics, Abhijit Banerjee and Esther Duflo seek a path between these two extremes, emphasizing the Randomized Controlled Studies they and their colleagues had conducted to ascertain what works and what doesn’t. (As of 2010, they had completed more than 240 studies in forty countries around the world.)They characterize Easterly’s approach as demand-driven, since he believes that poor people must seek their own solutions — a conservative, free-market attitude. By contrast, Sachs’ approach is supply-driven, reflecting Sachs’ conviction that a government must provide for its people based on consensus thinking about what poor people need — a liberal, top-down attitude. (I find myself bemused that I’m on the right side of this debate.)

Banerjee and Duflo report that their observations and research results support each of these two approaches — and sometimes both — depending on what issue they study. Hunger, health, education, financial services, family planning, business development, policy options: each field offers up a unique picture of success and failure attributed to one or another of the two approaches. In other words, circumstances and details matter, all of which may vary from one country to another. There is no silver bullet, they assert, no panacea to eliminate poverty.

Poor Economics focuses on the overarching question of whether there is such a thing as a “poverty trap.” Sachs contends there is: poor people will be stuck in poverty unless and until they are given the resources to release themselves from the trap. In many circumstances, Banerjee and Duflo find scant evidence to support this assertion. In others, however, they see the need for government intervention in the lives of the poor because otherwise they will perceive no reason to act for themselves.

Rather than identifying a simple, unitary explanation why Sachs’ approach often fails, they emphasize “ideology, ignorance, and inertia — the three I’s — on the part of the expert, the aid worker, or the local policy maker.” These three I’s, they claim, “often explain why policies fail and why aid does not have the effect it should.” Banerjee and Duflo explain further: “The poor often resist the wonderful plans we think up for them because they do not share our faith that those plans work, or work as well as we claim.”

It would be difficult to find two scholars better prepared than Abhijit Banerjee and Esther Duflo to forge a middle course through the opposite poles of thought about global poverty erected by Jeffrey Sachs and William Easterly. Banerjee, an Indian economist who is also the son of two economists, holds an endowed chair in economics at MIT. He co-founded MIT’s Abdul Latif Jameel Poverty Action Lab with Duflo, a French economist and a former MacArthur Fellow (recipient of the “genius” award).

For anyone who seeks deeper understanding of global poverty and the ways and means of fighting it, Poor Economics is must reading. This book is the latest I’ve read in my ongoing effort to study world poverty. For a list of additional books on the topic, go to my reading list.

Understanding the day-to-day reality of global poverty

A review of Portfolios of the Poor: How the World’s Poor Live on $2 a Day, by Daryl Collins, Jonathan Morduch, Stuart Rutherford, Orlanda Ruthven

@@@@ (4 out of 5)

This book makes a major contribution to our understanding of global poverty.

Portfolios of the Poor reports the findings of a series of detailed, year-long studies of the day-to-day financial practices of some 250 families in India, Bangladesh, and South Africa, including both city-dwellers and villagers. The authors conducted monthly, face-to-face interviews with each family, focusing on money management and recording every penny spent, earned, or borrowed in “diaries” that formed the principal source for their observations. In the process, they made discoveries that will surely be surprising to some readers:

• The poor rarely live from hand to mouth. “[N]o matter where we looked, we found that most of the households, even those living on less than one dollar a day per person, rarely consume every penny of income as soon as it is earned. They seek, instead, to ‘manage’ their money by saving when they can and borrowing when they need to.”
• Lack of money is just one of the financial characteristics of poverty. It’s equally important that poor people’s income is both unpredictable and irregular. Crops come in two or three times a year, yielding whatever the weather may permit and the market may bear; between-times a family may have no cash income at all. A son might get a job for a day but not again for a week or a month. Illness or injury may interrupt a family’s income. And so forth.
• Rather than helpless victims of their poverty, the authors found, the poor are remarkably sophisticated about the financial circumstances of their lives. “We came to see that money management is, for the poor, a fundamental and well-understood part of everyday life.”
• Microlending is just one of the financial services needed by the poor to lift themselves out of poverty. “[W]e saw that at almost every turn poor households are frustrated by the poor quality — above all the low reliability — of the instruments that they use to manage their meager incomes. This made us realize that if poor households enjoyed assured access to a handful of better financial tools, their chances of improving their lives would surely be much higher.”
• Most observers regard money-lenders as simply a scourge of the poor, as they are so very often. However, given the dearth of mainstream money-management alternatives, there are many circumstances in which it’s logical for poor people to turn to money-lenders for short-term cash loans. “One of the lessons from the diaries is that interest paid on very short-duration loans is more sensibly understood as a fee than as annualized interest.”

Scholars, activists, and policymakers alike have quarreled over the question of global poverty and what to do about it for more than half a century. More often than not, the disputes they air in official policy debates, in the news media, and in scholarly journals are grounded in statistics developed by the United Nations and the World Bank — figures that usually represent worldwide averages. Therein lies much of the trouble.

The most widely accepted benchmark for world poverty today is $2 a day per person, as determined by the World Bank. However, you have to dig deeply before you can understand what the World Bank and the United Nations actually mean by “$2 a day.” They’re not referring to those two one-dollar bills you may have crumpled up in your pocket or purse. To correct for economic differences from one country to another, they use the concept of Purchasing Power Parity (PPP).

In theory, PPP takes into consideration the sharp differences in how much $2 will buy in any given country as compared to the global norm. But in practice the experts have widely differing views on what method should be used to calculate PPP and, in effect, what is the global norm. As if that isn’t bad enough, the most commonly used techniques to calculate PPP are based on each country’s economy-wide standard of living. In other words, the definition of poverty might depend in part on the price of big-screen TV sets and BMWs or their equivalent. In hopes of correcting that problem, scholars have been writing papers for several years about “poverty-based PPP,” excluding anything but goods and services commonly demanded by people living at subsistence level, but none of the approaches they’ve proposed has yet been officially adopted.

The whole question of PPP, then, is so confusing — and so confused — that the authors of Portfolios of the Poor have rejected the concept. They base all their calculations simply on the prevailing exchange rates between local currencies and the U. S. dollar. To which I say, amen.

The four co-authors of this book are an intriguing bunch. Two are men and two women. (Daryl Collins, the lead author, is female.) All four are products of elite universities: Oxford, Cambridge, Harvard, and the London School of Economics, though only one, Jonathan Morduch, is currently an academic. Morduch teaches development economics at NYU’s Wagner School of Public Policy in New York; he is an expert in microfinance. Daryl Collins, Stuart Rutherford, and Orlanda Ruthven are all development practitioners with practical field experience — Collins with a Boston-based global consultancy, Rutherford with a microfinance institution he founded in Bangladesh, and Ruthven with DFID, the UK equivalent of USAID.

The how-to-guide to “the fortune at the bottom of the pyramid”

A review of Reverse Innovation: Create Far From Home, Win Everywhere, by Vijay Govindarajan and Chris Trimble

@@@ (3 out of 5)

Back in 2004, a respected marketing professor at the University of Michigan named C. K. Prahalad raised eyebrows in the business community with a widely-read book titled The Fortune at the Bottom of the Pyramid. In 25 words or less, he postulated that multinational corporations could grow their markets and their bottom line by reaching out to the billions of poor people who crowd emerging nations across the globe. Much of Prahalad’s book consisted of “case studies” — written by his graduate students — that purported to support his thesis. Unfortunately, practically none of them did.

Here, eight years later, is the book that Prahalad — now, unfortunately, deceased — should have written. Govindarajan, a professor at Dartmouth’s Tuck School of Business, and Trimble, a younger Tuck faculty member, have formulated a concept they call “reverse innovation” that is the key to doing business in those emerging markets that excited Prahalad’s lust. Their book, too, is dominated by case studies, but in this case the examples do a good job of illustrating how multinational companies have successfully developed products that gained a foothold in developing countries — though by no means necessarily at “the bottom of the pyramid.”

“Reverse innovation” — an ethnocentric term — begins with the conventional wisdom that business innovation takes place in rich countries but asserts that transnational corporations wishing to become established in developing markets must cast off traditional thinking and develop products and services within those markets and base them on the needs and wants of people living there. Govindarajan and Trimble advocate reverse innovation as the alternative to exporting rich-country products and services with minor adjustments, a strategy that many companies have found unsuccessful. (The authors call this strategy “glocalization.”)

The case studies in Reverse Innovation span a wide range of needs, desires, and prices. The authors write about an extremely inexpensive electrocardiograph machine developed and marketed in India by GE Healthcare, lightweight enough for use by individual physicians on rounds in villages. They relate the story of the development from scratch of a lentil-based new snack food by PepsiCo in India, and of a new automotive “infotainment” system crafted through an international effort by Harman and eventually purchased by Toyota. Other examples include Procter & Gamble, Logitech, and the nonprofit Partners in Health.

Most of the case studies are great stories, even if they are better illustrations of how multinational corporations can make more money than they are of how poor people in emerging nations can gain access to needed goods and services at affordable prices. However, the bulk of Reverse Innovation is given over to discussion about change management in large corporations: it’s clear that the real challenge these companies face in growing their markets is to get around the massive barriers thrown up by organizations that are too large, too successful, and too set in their ways. The authors write, “Reverse innovation begins not with inventing, but with forgetting . . . You must let go of the dominant logic that has served you well in rich countries . . . Reverse innovation is what we call clean-slate innovation.”

Govindarajan and Trimble make it clear that the only way for a transnational company to bring about reverse innovation is to (1) start with a champion at the top, usually the CEO; (2) appoint a brilliant and politically savvy person to head up an “LGT,” by which the authors do not mean to suggest gender preference but simply to abbreviate “Local Growth Team;” (3) recruit to the team a group of mavericks willing to ignore the conventional rules; and (4) work on site in one of the major emerging markets, far, far from headquarters.

Reverse Innovation is well-organized, well-written, and delivers on its promise. Why, then, have I awarded this book only three @@@ out of 5? Out of pique, perhaps, more than anything else. For one thing, the do’s and don’ts of management in large organizations are  . . . well, for me, the only apt word is boring. And I can’t get past my aggravation that this is yet one more instance of brilliant minds being lashed to the task of making the rich richer.

A brilliant rural development specialist shares his ideas on ending poverty in the world

A review of Out of Poverty: What Works When Traditional Approaches Fail, by Paul Polak

@@@ (3 out of 5)

Paul Polak is an extraordinary man. A Czech Holocaust refugee as a child and a practicing psychiatrist throughout the 1960s and 70s, Dr. Polak turned his attention to the challenge of ending global poverty in 1981. In that year, he founded the International Development Enterprises (IDE), a Colorado-based nonprofit organization distinguished by its successful launch of the treadle pump that enables farmers to irrigate very small plots of land at minimal cost. IDE’s mission more generally is to fashion and develop new tools to help poor farmers and other “dollar-a-day” families in developing countries work their way out of poverty. Now nearing 80, Dr. Polak has relentlessly pursued this mission for the past three decades.

In Out of Poverty, Dr. Polak interweaves the IDE story and the principles that guide it with that of one Nepalese family who moved from poverty into the middle class. The fundamental precepts of Dr. Polak’s work are clearly laid out in the introduction:

“1. The biggest reason most poor people are poor is because they don’t have enough money.

“2. Most of the extremely poor people in the world earn their living now from one-acre farms.

“3. They can earn much more money by finding ways to grow and sell high-value labor-intensive crops such as off-season fruits and vegetables.

“4. To do that, they need access to very cheap small-farm irrigation, good seeds and fertilizer, and markets where they can sell their crops at a profit.”

Much of Out of Poverty deals in detail with the challenges entailed in implementing these principles. Irrigation, including the story of the treadle pump, gets the most attention. Dr. Polak describes himself and the staff of IDE as what might be called catalysts rather than experts: from his perspective, the first step in any venture in rural development must be to talk to the people who will be affected by whatever is done — and listen to them. The IDE approach is resolutely bottoms-up, because “To move out of poverty, poor people have to invest their own time and money. The path out of poverty lies in releasing the energy of Third World entrepreneurs.”

IDE’s work over the years has tightly focused on farmers. As he notes, “most of the poor people in the world live in remote rural areas that will likely continue to be bypassed by successive waves of urban-centered industrial growth.” However, in the concluding chapters of Out of Poverty, Dr. Polak also shares a number of ideas for helping slum-dwellers (“43 percent of the urban populatioin in developing regions”) move out of poverty, too. The book is chock full of great ideas for small-scale entrepreneurs.

Dr. Polak and IDE were pioneers in the bottoms-up development model that is fast emerging as the only approach likely to make a dent in the endemic poverty in so many poor countries.

Regrettably, Out of Poverty is not well written. It is endlessly repetitive, with the same phrases and anecdotes appearing in chapters throughout the book, and it fails to deliver on its promise of sharing many examples of families that have moved into the middle class through IDE’s work, since the only story told in any detail is that of one Nepalese farm family. That’s a great pity, since this is a message that needs to be disseminated far more widely among policymakers around the world. A second edition, reorganized and with additional examples, would be a boon to the development community.

A searing look at poverty in India that reads like a novel

A review of Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity, by Katherine Boo

@@@@@ (5 out of 5)

Only the very best nonfiction attains the depths of understanding and insight to be found in the finest novels. Tracy Kidder, Erik Larson, and a handful of others writing today in the English language often achieve this. Now comes Katherine Boo, who joins them with her first book, Behind the Beautiful Forevers.

This enthralling and deeply disturbing book reads like a novel. Its setting is a small slum called Annawadi housing some 3,000 people, nestled between the new Mumbai International Airport and the five-star hotels clustered nearby. During the three-year period she studied, Boo focuses on the experiences of two families, one a familiy of 11 Muslim immigrants from India’s north who have built a business as garbage-brokers, buying up the trash collected by nearby scavengers, mostly children, then sorting and selling it to recyclers. The other family is affiliated with Shiv Sena, one of the most extreme and violent anti-Muslim political parties in India.

Boo’s purpose in studying life in Annawadi is to understand poverty and the ways people find to transcend it. But to put this book in perspective, Boo reveals early on that “almost no one in this slum was considered poor by official Indian benchmarks. Rather, the Annawadians were among roughly one hundred million Indians freed from poverty since 1991.” As anyone truly familiar with rural India can attest, in most respects conditions are far worse in many of the country’s 800,000 villages than in its urban slums. That’s partly because the oppressive bonds of caste bind more tightly in the countryside, which is notoriously resistant to change, than in the cities, where many of India’s poorest farmworkers flee to seek a better life. Still, that “better life” is elusive because “only six of the slum’s three thousand residents had permanent jobs.”

Women and children take center stage in Behind the Beautiful Forevers, and Boo’s most faithful and reliable sources are children. As she explained in a presentation last evening for the World Affairs Council of San Francisco, children are far less likely than adults to be influenced by the considerations of religion, caste, or politics that so often color adults’ remarks about their neighbors.

Boo is a staff writer for The New Yorker. However, as if that isn’t credential enough, she’s also a Pulitzer-Prize-winning reporter, winner of a National Magazine Award for Feature Writing, and a MacArthur Fellow (a recipient of a “genius” award). Behind the Beautiful Forevers represents three years of work in the slums of Mumbai, carrying her two-decade-long study of poverty and its remedies from the United States to Asia.

What does genius look like?

A review of Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, by Tracy Kidder

@@@@@ (5 out of 5)

Pulitzer- and National Book Award-winning author Tracy Kidder has been writing exceptional nonfiction since the 1970s. In that time, to judge from his books, he has encountered many extraordinary people. Clearly, though, Kidder had never before come across an individual as brilliant, complex, and eccentric as Dr. Paul Farmer, his subject in this book.

Farmer is often publicly described as a secular saint for his selfless work bringing world-class healthcare to the interior of Haiti, the slums of Lima and Boston, the prisons and towns of Siberia, and many other challenging environments around the world. He has been mentioned as a possible candidate for the Nobel Peace Prize, and I wouldn’t be the least bit surprised if he wins it one of these days.

Farmer’s accomplishments defy summarizing. Kidder, true to form, doesn’t even try. Instead, he paints an in-depth portrait of Paul Farmer, the individual, in all his boundless complexity. Farmer is, at one and the same time, a brilliant diagnostician, an unusually caring physician, an innovative public health administrator, a consummate leader who inspires thousands to walk in his footsteps — and, in his personal habits, as eccentric as they come. In short, Mountains Beyond Mountains is a case study in genius. It’s an exceptional portrait of one of today’s most exceptional people.

ISBN-10: 0375506160

ISBN-13: 978-0375506161

ASIN: B000FBJAW8

“Turning oppression into opportunity for women worldwide”

A review of Half the Sky: Turning Oppression into Opportunity for Women Worldwide, by Nicholas D. Kristof and Sheryl WuDunn

@@@@@ (5 out of 5)

“. . . more girls have been killed in the last fifty years, precisely  because they were girls, than men were killed in all the wars of the twentieth century. More girls are killed in this routine ‘gendercide’ in any one decade than people were slaughtered in all the genocides of the twentieth century.”

These shocking facts are the basis on which Kristof and WuDunn build their case for a new global movement to gain equality for women. Half the Sky is not journalism in the mode of The New York Times, which once employed both the authors and still  runs Kristof’s twice-weekly column, but a self-professed and passionate work of advocacy.

Kristof and WuDunn expose the terrifying reality of the sex slave trade, maternal mortality, and female genital cutting, and the tragedy of education denied to girls, not in the abstract but through the eyes of women and girls they have interviewed and in many cases come to know intimately through extensive travels to some of the most godforsaken places on earth. They have long since learned the lesson that stories of individual human beings are far more effective in conveying harsh realities than any table of statistics. The result is a powerful book crammed with unforgettable characters.

But Half the Sky is a hopeful book. The most compelling tales told in its pages are those of the heroic women and girls who have refused to tolerate their lot: the illiterate rural woman who now teaches surgery to credentialed graduate surgeons in Ethiopia, the Illinois woman who moved to Senegal and found an effective way to dramatically reduce female genital cutting, the upper-caste Indian woman who is saving hundreds of girls from sex slavery. These are today’s heroes, the avatars of a new worldwide movement — not a women’s movement, the authors insist, but a universal movement to claim for all of humanity the rights to life and liberty that so many of us take for granted.

“Decades from now,” write Kristof and WuDunn, “people will look back and wonder how societies could have acquiesced in a sex slave trade in the twenty-first century that . . . is bigger than the transatlantic slave trade was in the nineteeth. . . They will be perplexed that we shrugged as a lack of investment in maternal health caused half a million women to perish in childbirth each year.”

For the reader who is sufficiently motivated to take action, Half the Sky includes an extensive list of organizations that are actively engaged in addressing these compelling issues. And it’s tough to read this book from beginning to end without feeling that need.

ISBN-10: 0307267148

ISBN-13: 978-0307267146

ASIN: B002MHOCTO

Hope for Africa

A review of The Boy Who Harnessed the Wind: Creating Currents of Electricity and Hope, by William Kamkwamba and Bryan Mealer

@@@@@ (5 out of 5)

A debate has been raging for years within that rarefied global community that earns its keep from the business of what we Americans call “foreign aid.” (Others, less afflicted by an aversion to international engagement, call the field “overseas development assistance.”)

On one side are the advocates for large-scale bilateral and multilateral aid, insisting that huge grants from the World Bank, the International Monetary Fund, the U.S. Agency for International Development, and their ilk are the only source of real hope for the many desperately poor nations of what is broadly, though incorrectly, called the Global South (Asia, Africa, and Latin America). The advocate-in-chief for this perspective is Professor Jeffrey Sachs of Columbia University, who has argued that massive infusions of aid to the governments of the poorest nations can lift them out of poverty in short order. In 2006, Sachs published his seminal book, The End of Poverty: Economic Possibilities for Our Time, a work that provided the rationale for the Millennium Development Goals.

Arrayed against Sachs and his colleagues are the born-again critics of government-to-government aid, most noticeably William Easterly, a long-time World Bank economist who came in from the cold in recent years to testify to the widespread failure of “foreign aid.” His 2007 book, The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good, set off the debate between the two opposing camps.

The gist of the difference between the two perspectives is simple: One side insists that the problem of poverty is far too big to be addressed through anything other than large-scale action carried out within each poor country on a national scale. The other side contends that top-down, nationwide development programs rarely work and that only solutions crafted at the grassroots and adopted by those who are most affected by them can bring about genuine social change.

Though I’ve read a number of other books taking one side or another in this debate, the work that has cast the most light on the topic is one that paid no attention whatsoever to “foreign aid” or economic development schemes, whether large or small. It’s an extraordinary, first-person tale by a young man from Malawi entitled The Boy Who Harnessed the Wind.

William Kamkwamba, the narrator of this awe-inspiring story, was a seventh-grade dropout who mastered fundamental physics by reading an out-of-date English textbook in a local, three-shelf library near his village and using his knowledge to construct a working windmill out of junkyard parts to generate electricity to irrigate his father’s farm. He was 14 years old.

You can read news reports and even the most perceptive magazine articles about the challenges of development, but you won’t get nearly as close to the essential truth of the challenge as you will from reading The Boy Who Harnessed the Wind. Kamkwamba’s tale is unsparing of himself, his community, and his country. Through his all-seeing eyes, we witness the tragic consequences of the profound official corruption that held sway in Malawi for so many years after it gained its independence from Britain in 1964. We feel the unrelenting hunger he and his family experienced for months on end in the famine of 2001-2002. We see the darkness descend all around us as William is hounded by fearful villagers who can only explain his windmill as magical. But, most of all, we observe the steady evolution of his brilliant young mind as he confronts one setback after another, and prevails over them all.

If there is hope for Africa, as I firmly believe, it lies in the minds and hearts of William Kamkwamba and other young people whose innate genius is unlocked by the spread of education and opportunity for self-expression at the grassroots. There are hundreds, maybe thousands, of William Kamkwambas across Sub-Saharan Africa. And it will be a combination of top-down aid – to build schools, train teachers, and buy textbooks – with the local action of countless NGOs, with both local and international support, that will provide them with the tools and the freedom to solve the problems that have held down their forebears for generations past. I don’t think genuine development – thorough-going social change – will come any other way.

ISBN-10: 0061730327

ISBN-13: 978-0061730320

ASIN: B002PEP4U0