765

Yesterday our good friend (and trained pastor and counselor) gave us a stress test. Basically a survey that asks you a bunch of questions like "Did you change jobs in the past 12 months?" and "Were you mugged by congolese police this year?" (Okay, not that last one, but questions like it.)

So then you add up the points you get for all the questions and see how you score. 150-200 says you've encountered a moderate level of stress, 200-300 would be high stress, and over 300 is Extreme Life Crisis.

We scored 765.

Hmm.

Hmm.

the bride's big day

Our good friend Margaret got married this past weekend. Quite an all-day ceremony -- traditional drummers, dancers, hundreds of people, multiple preachers.

But the true cultural experience came a week ago at the Introduction Ceremony, where the men of the families sit across from each other and, well, barter for a couple of hours:

Groom's Family: "We need a woman from your family. Give us Margaret."

Bride's Family: "I'm sorry, Margaret is not here. You will have to find another woman."

(An hour later, after they'd agreed Margaret was in fact nearby)
Bride's Family: "You can not have Margaret because you are not a good family. You passed me on the road when my mother was sick and did not offer me a ride."

Groom's Family: "Ah, I remember that day and am very sorry, but I was taking a madman to the hospital!"

(This last joke, we didn't get at all. But apparently it was very funny. After that we stopped asking people to translate for us.)

Fortunately, they did settle on the number of cows to exchange. And the wedding did happen this past Saturday.

The pastor preached from Ephesians 5 and exhorted men that they need to love their wives like Christ loves the Church. Now I always thought this meant you had to be willing to give up your life for your wife, but the pastor gave some more practical examples:

• If your wife's cooking is bad, don't complain to her family about it. Instead, you should bring someone in to teach her how to cook.

• If you are getting fat, your wife should be getting fat, too. Feed her well.

Then the service culminated with a hug by the bride and groom. (A little different than Corrie and my 23-second kiss...)

joburg

Just returned from a weekend in Johannesburg, South Africa. Rwandair was launching weekly service to Johannesburg so tickets were 60% off.

They told us the flight would stop in Burundi. They didn’t tell us it would stop for 3 hours of cocktails with the Burundian Minister of Transport.

The flight down was packed full and felt like a spring-break party bus -- everybody was drinking and yucking it up. Turns out it was a spring-break party bus -- when we arrived in Johannesburg they announced “if you are returning to Burundi, please remain in your seat.” Half the people on the plane flew four hours each way just for fun (I’m assuming they didn’t pay for those seats). I suppose if you lived in Burundi you might, too.


What I’d heard about Johannesburg was that it was unsafe, violently racist, and dirty. Not at all what we found.

• Johannesburg is heckof developed. There are freeways with off-ramps and malls and movie theaters and banks and fancy cars. When you are on vacation from New York, camping is great. When you’re on vacation from Kigali, you just want to go to the mall.

• We took a city and township tour. General conditions seem to be a big step up from Kigali’s and the government is building tons of housing and providing portapotties in the meantime. We felt relatively safe. Still, I’m sure we were getting the government-sanctioned tour; a friend tells me the electricity and water in the townships has been turned off because the poor can’t pay. At least in Rwanda there’s no pretense (and no power).

• We saw quite a few young mixed race couples -- a definitive end to the apartheid era?

• Took a tour of Nelson Mandela’s old house in Soweto. Random fact: he was once an amateur boxer.

And it was a great vacation for us.

• Boy did we eat. There’s a Smith & Wollensky in Sandton which serves a $12 fillet mignon which is to die for. We also found sushi and Thai curry and orange juice.

• We saw two Hollywood movies. With popcorn.

• The shower worked, the bed had springs in it, and you can drink the tap water. Wow.

lessons from partners in health #1: don't half-ass

There really isn't much money in the development business. To stay alive, non-profits have to appear efficient (or cost effective, as their grant requests say) to the donors who give them money. In turn, the people who manage donor organizations (like USAID and the World Bank) have to be able to brag about their efficiency to the people who employ them.

This means that non-profits can only get money to do things if they are cheap and reach lots of people. In developmentspeak a cheap thing to do is a "scalable intervention."

I'm a good economist and MBA, so this makes great sense to me. Scale. Leverage. Efficiency. Cost-effective, high-beta, hard-edged, chest-pounding stuff.

Partners in Health taught me that this is dead wrong. The value of the half-assed solution (er I mean, scalable intervention) is zero. Or less.

Let's say instead of spending a year with a hundred farmers showing them modern farming techniques, you decide to hand out fertilizer to a thousand farmers. So they burn their crop or pollute their drinking water or (most likely) just throw the stuff away because they don't know how to use it. Highly efficient, zero value.

Or you want to put 1,000 kids in school instead of 100, so you triple the class sizes and hire cheap, illiterate teachers. And your thousand kids learn nothing.

In public health it's even worse. If you hand out drugs for TB or AIDS but don't make sure your patient can get those drugs every single day, the bacteria or virus will mutate until the drugs have no effect at all -- then that "drug-resistant strain" gets passed on to their neighbors. Not long ago, people assumed that this meant that poor people with TB or HIV were doomed to die. PIH was one of the first groups to figure out that people with serious illnesses didn't have to die if you treated them the same way you treat rich people. Said another way, they didn't have to die as long as you didn't half-ass (= pursue a scalable intervention).

So if you give money to a non-profit, learn from Partners in Health and look beyond the metrics. Give to organizations that do good work, not cheap work.

(Caveat: this is my pragmatic MBA analysis of the Partners in Health method. They don't care one whit about my analysis -- they do it because they believe good health care is a human right and lousy health care is an injustice. Either way, they’re doing good work.)

titanic

They're playing the Titanic elevator-jazz-mix sound track in the lobby of the Intercon this morning.

Ah well, at least no one's called me a muzungu.

seasons

Being close to the equator, there isn’t much weather change in Kigali. But we’re learning to tell the season by the bugs.

For example, there was termite season back in October. We’d see the cloud of termites outside our window and yell “turn out the lights! turn out the lights!” Because if we didn’t get the lights turned out quickly enough thousands would swarm to our balcony and squeeze under the crack below the door, then flop around on our floor and lose their wings and die. Apparently this is how termites mate and migrate.

Then this Spring we seemed to have a fly season. And there was the period where we just couldn’t get rid of the ants in our kitchen. (The ant season started on our arrival and seems to be continuing. Much like mosquito season.)

Sadly, it appears we’ve gotten to cockroach season. Corrie lived in Miami long enough that she considers them “just little roaches.” I guess its all perspective.

pih

This past weekend we went out to the Partners in Health hospital in the Eastern Province of Rwanda, to support them as they celebrated one year of providing life-saving medication.

If you are ever feeling jaded and thinking that no one is doing anything good in the world, that foreign aid is too political, and that the entire international development industry is just flushing money down the toilet, you need to get to know Partners in Health. 'Cause they just plain rock.

In one year they've taken a nearly abandoned site off a dirt road in one of the poorest places in the world and turned it into the best hospital in the country. People come from Tanzania for care. I've decided next time I get sick I'm just going to drive the 2.5 hours out there for treatment. Their fundamental belief is that people shouldn't get inferior medical care just because they're poor. That you shouldn't be satisfied with crappy work just because your patients aren't used to anything better. Imagine that.

Not to mention the fact that they're really fun people. You should see them do the cow dance.

Check out the book Mountains Beyond Mountains for the full story. It'll inspire you.

three times

In Kigali, you'll need to repeat all request three times. Three times won't guarantee you'll get what you ask for, but it always takes three times to get a Yes. It's amazing how consistent this phenomenon is.

This exchange, which I observed this week at the best restaurant in Kigali, is typical:

Request #1: "Can I have #31, but with fish instead of chicken?"
Server: "The problem is we do not have chicken."
Request #2: "May I have it with fish?"
Server: "We can make #31 with mutton."
Request #3: "Can you make #31 with fish, not mutton."
Server: "Yes, with fish. #31."