Follow the aid

Despite an abundance of aid materials and the good intentions of relief agencies, relief efforts in Thailand following the December 2004 earthquake/tsunami were afflicted by skewed distribution.

Jin Sato, associate professor in the Institute for Advanced Studies on Asia at the University of Tokyo, analyzes the factors that skewed relief good distribution in an article in Development in Practice. He discusses how the political and economic turmoil caused by relief efforts themselves constitute an additional risk for victims.

Sato also notes that while the social ramifications of relief efforts are substantial, yet they are often overlooked for three reasons:

most “disaster management” experts are engineers
social analysis requires time
relief organizations are poorly coordinated which prevents the generation of lessons for the future

His recommendations for more effective responses, based on lessons from the 2004-2005 tsunami relief efforts, are:

the selection of goods and distribution mechanisms are of paramount importance
aid efforts should not only supply goods but should focus on strengthening institutional resources that allow recipient communities to more effectively absorb the goods and distribute them fairly
relief agencies should co-ordinate with each other after the emergency stage to develop ways to reduce pre-existing inequalities or dominance

After reading his article, I decided to contact Professor Sato to learn more about him and his involvement in disaster response work. Here is my email interview with him:

Q: What is your background in terms of academic training?

A: My B.A. from the University of Tokyo was in anthropology, and I have a master’s degree in both international relations and public policy from the Kennedy School at Harvard University. My Ph.D. was in international studies (interdisciplinary) at the University of Tokyo, and my dissertation topic was on natural resource governance and politics in Thailand. I did a post-doc at the Agrarian Studies Program at Yale University under Jim Scott in 1998-1999.

Since my student years, I have been interested in natural resource governance and foreign aid. The article is a spin off from my interest in the latter.

Q: When you worked as a policy advisor to the Ministry of Natural Resources and Environment of Thailand, what were your major responsibilities?

A: I was there to advise on the formulation (and prioritization) of the Environmental Policy 5-year plan, particularly about citizen participation and the role of international assistance (especially that of the Japanese government).

Q: Where were you when the tsunami hit, and what role if any did you play in responding to the tragedy?

A: As you might remember, the Tsunami hit on Dec. 25. I was taking a vacation in Samui Island in Thailand. Since my duty was to advise on environmental policy, I was not sure what to do, but I contacted the JICA office to offer assistance since I could speak the language. They put me on the first assistance survey team to develop livelihood assistance strategy from Japan. But Japanese assistance was too slow, and I don’t think we had any impact at all.

Q: Can you comment on the current situation in Haiti, in terms of how your findings about Thailand might relate to that context?

A: Since I have not been to the field, it is hard to comment. But judging from the news, there was more order and discipline in Thailand where people could wait in lines to receive aid goods. The tsunami hit only the coastal zone and other parts remain intact (unlike the earthquake). This is a huge difference in terms of the availability of assistance and speed of recovery. I suspect that there will be some structural concentration in either damage or assistance due to pre-existing resource inequity.

Image courtesy of Jin Sato.

My challenge to David Brooks

As you may have heard, New York Times columnist David Brooks recently wrote about how Haiti’s culture is mired down by vodou and is anti-progress. And as you might imagine, his comments drew a lot of criticism from cultural anthropologists and others who have spent time in Haiti and with Haitian people.

Brooks apparently adheres to the simplistic and misleading idea of culture as used by political scientist Samuel Huntington (pictured) and former USAID administrator Lawrence Harrison. Neither of these men is an expert on culture as it is understood by the social scientists whose central mission is to study it, understand it, write about it and teach about it: cultural anthropologists.

Brooks and other conservatives no doubt find comfort in the Huntington-Harrison approach to culture. Pro-progress cultures are winners. Funny enough, they are pro-capitalist cultures along the lines of the United States with its strong emphasis on individual economic success, competitive social relationships and multiple car ownership. Anti-progress cultures are losers: they value some degree of social equality and group relationships that might include, heaven help us, labor unions. Low on car ownership among other things.

The H&H model goes against basic principles in cultural anthropology by labeling “others” in ways that are blatantly U.S.-capitalist-ethnocentric. Moreover, adopting the H&H model means that you will never recognize the viability, sustainability and warmth of so many other cultural systems. In fact, you are likely to directly or indirectly participate in the destruction of those cultures through economic, political and cultural imperialism. This is where Huntington and Hirshman lead and where David Brooks has followed.

So here’s my challenge to David Brooks: take an introductory cultural anthropology course now. Open your eyes and your heart to “other” cultures that may look like losers according to H&H but in fact hold the clues to a better future for all of us. If we would only give them a chance. I teach a six-week, distance ed version of my intro class every summer: Anth 002.10 at George Washington University. Mr. Brooks is most welcome to enroll.

Image: Samuel Huntington by Flickr user World Economic Forum via Creative Commons.

There is no pill against poverty

No pill can cure poverty. This is an old truth but one that needs repeating. Again and again. An article in the prestigious American Journal of Public Health (reprints can be ordered at the journal’s website) reminds me of this need. Three co-authors with Ph.D.s, two of whom have nursing experience, have published a “Field Action Report” assessing the affect of the formation of fathers’ clubs on child health in rural Haiti.

The article summary reports the key findings:

“The presence of a fathers’ club in a child’s birth village had a positive effect on vaccination status, growth monitoring and vitamin A supplementation after we controlled for socioeconomic status, time and the quality of the village health agent. Child weights and mortality were not affected by the fathers’ clubs.”

That pretty much says it all, but let’s break it down.

The study is based on detailed and extensive individual and household-level data gathered by the Haitian Health Foundation (HHF). The HHF was established in 1985 and is now operating in 104 villages in southwestern Haiti. The HHF instituted fathers’ clubs in 1994 in response to the discovery that fathers play an important role in child care in this region.

The clubs were meant to enhance child health and welfare. The fathers meet regularly to learn about child and family health from a nurse or village health agent. Education focuses on the 12 key family and community practices identified by the World Health Organization and UNICEF. The model outlines three pathways through which child health should improve.

Focusing on data from 23 villages with fathers’ clubs, the authors used children born before the clubs were established as the control group and children born afterwards as the “intervention group.” While not ideal, this approach is scientifically acceptable.

The presence of fathers’ clubs is associated with children aged one to two years being vaccinated, having their growth measured and taking vitamin A supplements. Here is what the authors say about this finding:

“Actual weights of children and infant mortality — measures that are arguably more important than the more proximal outcomes of growth monitoring, vaccinations and vitamin A supplementation — did not improve with the intervention. Furthermore, child weights remained flat over the years of study. Malnutrition is still a major problem in Haiti and continues to contribute to high morbidity and mortality in the first year of life. Malnutrition appears resistant to HHF efforts and is instead affected by factors well beyond the scope of a public health services program such as the underlying conditions of economic deprivation in rural Haiti and the political upheaval that has endured in Haiti for many years.”

I don’t need to remind you that the article under discussion was written before the earthquakes of January 2010.

So what to do? The authors mention the WHO recommendation to educate parents about feeding supplements for infants through 24 months. But they note, “This recommendation may not be feasible, given the economic constraints …. Further research is needed to develop programs that can be successful within these constraints.”

“Constraints” indeed. The kind of “constraints” that prevent the usual well-meaning educational interventions to work. At all.

How would you feel if you had a malnourished baby and no money, and someone tried to educate you about the importance of providing more food for your baby?

You might, as I was, be surprised to read the upbeat concluding paragraph:

“In conclusion, fathers’ clubs appear to be an effective strategy in child health programs. The success of fathers’ clubs in Haiti may encourage other global efforts to include fathers in a wide range of child health programs that use a community-based participatory approach.”

What? An “effective strategy” if your goals are limited to increasing the rate vaccinations, growth monitoring and vitamin A intake. But for improving children’s health? No success at all.

I’m all for fathers’ clubs. They may work in ways that this study overlooks: social support for parents (notably fathers) through the regular meetings. But they are not going to put food in the mouths of Haitian babies.

Source: Elizabeth Sloand, Nan Marie Astone, and Bette Gebrian. 2010. The Impact of Fathers’ Clubs on Child Health in Rural Haiti. American Journal of Public Health 100(2):201-204.

Image credit: Flickr user shouldbecleaning, licensed by Creative Commons.