The Rights of a Man
(By Thuwein Makamba)
A man wakes up in the morning, facing the daunting task of providing for his family; making sure there is food on the table for his children, and that the roof of his Tukul is not leaking when they go to sleep at night. The main means of income for this gentleman is subsidence farming, cultivating round potatoes (famously called Irish Potatoes here). His wife is making her contribution by buying and selling small items at the local market, with the little one on her back at all times. She has four children despite having been pregnant six times. Their three year old son, who has paralytic polio, is playing at home. His brother is four years old with a bloated stomach indicating some sort of malnutrition. Their sister, who is twelve, is the head of the family whenever her parents venture out to find a living. She cooks, feeds, and baths her siblings without ever complaining. In the evening, she is helping out with alcohol sales of the family business. She is also enrolled in nearby primary school in Standard four, but she is incapable of reading and performing basic math. There are not enough motivated teachers in her school, and her class takes place under the mango tree that makes it difficult to learn especially now that it’s the rainy season.
When malaria strikes, which seems to happen on regular basis, (I came down with malaria twice within my first two months here), the man takes his sick one to a nearby health center. This is usually a woman’s job, but on this occasion his wife is attending a funeral of the death of her newly born nephew who succumbed to neonatal tetanus. The health center, which is one structure with four different rooms, was constructed by an American NGO and has a big sign at the entrance that reads; “A Gift from The American People”. Although its only 10 am, the health center is closed. The man decides to wait, while his 3 year old is getting more lethargic. Around 11 am the health worker in charge shows up. He makes a point to let everybody know that he hasn’t received his salary since election time (March, 2010) and he also has a family to feed. The center was designed to have twelve health staff members, but he is the only one who showed up. As clinician in charge, he completed a nine month training that anointed him to be a competent healthcare provider in this village. He attended to the three year old with disregard to the highly promoted WHO’s IMCI guidelines, despite attending refresher training on IMCI provided by an NGO operating in this area. There is neither a microscope nor a microscopist here. A rapid diagnosis test is used; ParaCheck is the brand of choice—despite ample evidence of false positives from the Paracheck brand. the clinician doesn’t know any better. The three year old is diagnosed with malaria, and the man is compelled to ride his bicycle for three hours to buy his son malaria medications. The free medications at the health center arrived with only three months left on the expiration date. This is the place where they dump their drugs. A man then spends his hard earned 4 dollars and 42 cents to buy a dose of Switzerland imported Coartem. Hoping this time around his son’s malaria will never come back again. Hope is the only thing that he has going for him, he cannot afford to have that taken away.
This man, not knowingly— has been at the center stage of a global debate that has included Bono, Bill & Belinda Gates, Ban Ki Moon, and every other expert in between. He is the star of the blockbuster film called MDGs. This man has been a consistent force behind the recession proof of a billion dollar NGO industry. A lot of ground has been covered in the effort to reduce the burden of extreme poverty experienced by this man. But it is far from being enough and sustainable. The debate has been shifted from the needs of a man, towards how much money can be raised for this man. And the blame has been placed on those rich countries that do not commit enough money to help this man. The truest blame should be placed on those rich countries that implement policies that obstruct a man from improving his income. The very nature of life caters to those who are most adaptive to the conditions on the planet and these persons will prosper. That is why we have antibiotic resistant bacteria. It is a very normal process for poor people to suffer at unequal capacity, and die in unequal amounts compared to their “fittest” counterparts. For folks in the business of reducing the burden of extreme poverty experienced by the man, they need to understand that poverty elimination is rather an unnatural process. We are going against the norm, against the order of nature. However, through innovations, the right incentives, sacrifices, and a little bit of luck—mankind has been able to accomplish many unnatural feats. Reducing the burden of poverty is not impossible, but we have been employing dismal efforts that are unable to match the task at hand.
With the current global efforts, infant mortality rate is to be reduced and free education provided—but the man is not involved in how he can make those remarkable accomplishments sustainable. And that is through revenue generations to help paying the costs of these services. i.e an increased income. The current efforts are heavily directed towards lobbying rich countries to contribute more monetary aid. Instead, this energy should be placed on pressuring them to stop flooding poor countries with subsidized products that effectively destroy the local markets and drive a man further into poverty. OXFAM have reported that eliminating US cotton subsidies would improve the welfare of over one million West African households. But trade issues were barely mentioned in the MDG summit that just ended.
The debate in development assistance for health has been between programmatic vs. health system strengthening approach, but it doesn’t go far enough to speculate on the contribution of a man towards making either of those approaches sustainable. A man is to be given what is perceived to be his needs, and nothing more. The NGOs operating on the ground are obsessed with reporting indicators to the donors to showcase their remarkable performance; they almost forget that numbers are meaningless without the everlasting sustainable impact to this man. The recent obsession with achieving the MDGs (especially 4 and 5) has pushed noble professionals to come up with incredible innovations to reduce maternal and infant mortality rates. From Conditional Cash Transfers, Voucher Schemes, and other demand induced interventions, these ideas are being experimented throughout the poverty arena. The notion that in response to the stimulated demand, the quality of health systems in the tropics will improve and sustain themselves at this high level is a fallacy. But the goal here is wrongly assigned towards achieving MDGs instead of equipping a man with the tools to create wealth for his family.
A man doesn’t need free healthcare, all a man wants is to work and provide for his family—the only thing he wishes to change is his income, which has to match the work he puts into. Unregulated globalization has placed a large barrier towards making this a reality. Today, more income is going to rich countries from the poor ones, and anti-poverty advocates continue to bring a knife into a gun fight. It is time to realize the momentous task ahead and coordinate the efforts accordingly.
I’m meeting up with a man at a local bar; we are watching a football game between Arsenal vs. Liverpool. We have paid 10 cents each to watch this game run on a Chinese imported generator, powered by imported Diesel from who knows where, on an expensive South African DSTV. Sipping his Coca Cola quietly, a devout Christian and an avid Liverpool fan; a man is truly a global citizen but the leaders of the globalized world have tied him with invisible chains that rendered it impossible for him and his family to get out of extreme poverty.