It’s the economy (or, rather, development), stupid!

For the past three weeks, I’ve been traveling the Ugandan countryside, meeting with workers in the most remote rural health posts. Our job (to keep it simple) is to assess whether interventions aimed at improving the recruitment and performance of health care workers in these resource-poor areas are actually taking effect. While the results of the evaluation are yet to be tallied, one thing is for certain: the work we do, though sound in intention and application, is like trying to fill the ocean one bucketful at a time.

Now, I’m not trying to undermine the value of service in public health (lest I render myself obsolete); but during these journeys I’ve come to realize that at the heart of everything we’re striving for, every health target at which we aim, is a rotting core of economic underdevelopment. To say the conditions here are poor, abject, wretched, whathaveyou, would be to vastly understate the case. A quick run down the list of lacks will include anything from basic needs (food, water, shelter) to basic services (sanitation, electricity, transportation)…and let’s not even concern ourselves with luxuries such as clothing, education, or employment. In this context, you soon come to question the impact of narrowly focused health interventions. In other words: What good is a dumb ol’ program on health workers when the very foundation of human subsistence is so precarious?

So, ah-ha! I’ve got it! It’s all about broad-scale development, right? Not so fast... Despite the decades-long infusion of foreign aid in every area of development (which recently passed the half trillion mark), Africa maintains the dubious distinction of housing the most corrupt and ineffectual governments; governments which preside over the biggest slice of the world’s impoverished populations. It has widely been argued in scholarly articles (letmegooglethatforyou) that the very concept and content of foreign aid is what lies at the epicenter of Africa’s reverberating wave of poverty, underdevelopment and economic dependence.

And yet here I am, a product of just such aid, wandering the Ugandan countryside marveling in horror at the raw display of indigence and wondering to myself: What am I really doing here?