Sunday, November 28, 2010

Malaria Kidogo

On our way to the doctor, carrying a very sick little Caleb who had a scarily high fever and was heartbreakingly and uncharacteristically listless in my arms, we met a Kenyan friend.  We explained that we were on our way to the doctor to see what was going on with Caleb.  The response: “Oh, pole.  Probably malaria kidogo?”  (Sorry, probably a little malaria?)
The concept of “a little malaria” is just plain bizarre to folks in the US who tend to know the disease only by its exoticism and very real lethality.  In the US, you likely don’t know a soul who’s been sick with malaria, you’ll protect yourselves with prophylaxis when you travel to a malarial zone and you hear repeatedly about the millions of children who die from this disease every year.  What’s kidogo about that??
What you don’t hear is that with timely and proper treatment it’s basically like a bad flu that resolves itself remarkably quickly.  Almost everyone here has gotten malaria several times and some don’t bother to call out sick from work when they have it.  I don’t want to minimize how lethal it can be for those with weak immunity and no access to treatment, but the same holds true for the flu.  (Of course there are rarer forms of malaria, like cerebral malaria, that are a hell of a lot more serious than the flu.)
Luckily, Caleb has parents with means and a UN doctor a stone’s throw from his house.  He received an injection of drugs that morning and was transformed back into a giggling toddler by the afternoon.  It’s still no fun of course to watch your baby in pain, and we’ll do everything we can to avoid his getting malaria in the future.  Even malaria kidogo. 

Tuesday, November 23, 2010

Gift's graduation

We had a very full weekend last weekend starting with attending our neighbor Gift's graduation from Standard 5 (5th grade).  Gift is Caleb's closest friend and biggest fan.  She's like a big sister to him. So, we were thrilled to attend her graduation and Caleb, as usual, was a big hit.  When we walked in with Gift's mom, the school Director who was also acting as an MC said something about how wonderful the day was and how great it was to have people here from "all over the world." I waved to the audience in response. ; )

I imagine the children prepared for this ceremony for weeks and there were events spanning poetry recitations, dance performances, speeches and - yes - a fashion show.  In typical African style, the ceremony was scheduled to start at 10 AM, but by 11:30 had not yet begun.  The guest of honor, a Ministry of Education Official, arrived a few hours late and so the Director had the students repeat several of the performances for him.  We left before the whole thing was over at 2 PM because Caleb was pooped. 

But other than being simply long, it was actually a wonderful day.  The dances were great fun and the poems were sweet and it was nice to be among families celebrating their children.  Here are some pictures:

Caleb and Gift with her classmates

Gift's dance performance

The guest of honor arrives

Gift on the "catwalk"

Tiny graduates

Sunday, November 21, 2010

What do I mean by "research on development projects" anyway?

So I’ve explained that IPA does “research on development projects” to understand what kind of an impact they are making and why that is important to do.  But effectively what all this “research” means is that we hire people to go out into the surrounding villages and survey folks they find on just about anything – spending habits, planting habits, household income, attitudes about sex and gender, how often they/their family has been sick in the last month etc…   IPA then does an intervention (a discount for fertilizer, a savings account, installation of a chlorine dispenser) and then resurveys the households to see what how much has changed  among those who received the intervention compared to those that did not.  To grossly oversimplify. 
But the point is the surveys are often the crux of the research.  Most of IPAs 200 employees are surveyers or “enumerators” and the bulk of daily activities have to do with organizing trips to area villages, tracking down respondents and completing as many surveys as possible.  It’s a herculean task and most projects have thousands of respondents and dozens of enumerators.  With this much data if the project is having an effect, they should capture it. 
I’ve gone out into the field with a number of enumerators and I’m always amazed at the willingness of villagers to sit down – sometimes for up to three hours – and talk to virtual strangers about intimate details of their lives.  If the same surveryer came to a house in the US and asked if they could come in and talk about your savings, income and spending habits for around 2 hours, they’d get door slammed in their face about 90% of the time.  Maybe the odd lonely elderly person would acquiesce to a discussion, but that’s about it.  You simply couldn’t do this kind of research. 
But in Kenya, if you can find someone, they will talk to you.  I think this is largely a result of a culture of hospitality and maybe a bit of deference to a large and well known NGO.  Maybe the small gift (salt or soap) we give them for their time helps.  Maybe a visit from a stranger breaks up the monotony of farm life enough to be worth the time.  Who knows?  But the IPA researchers have the luxury of collecting a remarkably high percentage of respondent data they seek. 
The other thing that makes all this extensive surveying extraordinary is the sheer ability to track down the same people for a post-intervention survey round.  There are no street names (or streets really), few people have phone numbers and people are often known by different names than what they tell you.  So, enumerators often have notes like “Just after the Funyula market.  Down the hill from the church. Ask for the late Moses Okweta’s house” to find a respondent. Again, the generosity of perfect strangers is a huge help.  The enumerators can be fairly sure that if they make it to the right village someone they meet along the way will act as their guide to track down the respondent. 
But the enumerators themselves are also quite incredible.  They often remember the exact location of a shamba and stop along the road at the right place even though there are no obviously discernable landmarks.  And despite having interviewed several dozens of respondents throughout the project, they remember and greet their respondents with inquiries about particular family members.  Again, I can’t imagine this happening in the US.
I keep thinking about the recent US Census.  A total of about 10 questions taking under 10 minutes, which required an extensive publicity campaign to get Americans to buy into the importance of doing so and to reassure them that their privacy and security would be protected. 
So, despite the slow internet connection, unreliable power and byzantine government bureaucracy, it’s definitely also a luxury to do research in this context. 

Monday, November 8, 2010

What on earth we're doing

In case I've been giving you the impression that Colin and I moved the family to Western Kenya to give Caleb superstar status in a small town, I'll set the record straight.  Colin (and soon I) are working at an NGO called Innovations for Poverty Action (IPA).  My elevator speech to someone unfamiliar with international development is that "IPA does research on development projects -- anything from health to education to agriculture -- to see if the programs are actually accomplishing what they set out to do." 

If someone seems interested for more (though this is rare, maybe I need to spice up my elevator speech...), I'll explain that it's run by a bunch of hot shot economists (the kind who win MacArthur Genius grants) who run "randomized control trials," in which randomly selected participants get the interverntion (like a subsidy for fertilizer or a HIV education class) and another group does not. This way, whatever positive outcomes accrue to the treatment group and not to the control group one can attribute to the intervention and not some other external event. Kind of like drug trials. The actual studies are inevitably more complicated than this, but that's the basic idea.

If this sounds too wonky for you, the greater context is that international donors have become increasingly cynical about funding development projects and one of the reasons is because decades of aid have shown such poor results (for a host of complicated reasons).  Add to that the fact that rigorous evaluations are relatively new to the development field and almost no one is doing randomized controls to test which strategies are working best - or even at all. 

So, enter IPA.  Using incredibly rigorous research methodology they isolate what's working well and what's most cost effective and then use the information to sway policy makers and to also scale up successful interventions themselves. 

Their research has also helped to put some theoretical international development debates to rest. 

Here's one example: Thanks in large part to Harvard economist Jeffrey Sachs, inexpensive treated bed nets have been heralded as the most cost effective way of reducing malaria - one of the main causes of infant mortality and also major drain on productivity in Africa.  Lots of enthusiasm was generated for the idea that if a bed net were provided for everyone, we'd see child mortality drop and also a development boon.
But the devil is always in the details.  This enthusiasm led to a glutt of bed nets in some places that were, in one notrious example, used as fodder for wedding dresses instead of their intended purpose.  So, economists came in wagging their fingers talking about market distortions and inefficiencies of free distribution and recommended setting a price for bed nets so that those who needed them most would signal so by paying for them.  And those that paid for them would also be most likely to use them most consistently and thus most effectively. 

But others argued that for a public good such as malaria prevention, where reducing the liklihood of contracting the disedase for one person has spillover effects for their neighbors, the most important thing is to maximize coverage and, just as importantly, that even modest cost sharing would prevent some of the most vulnerable from getting protection.

Both sides make some sense in theory, but IPA did the research.

IPA researchers gave bed nets to pregnant women in Kenya, some for free and some for a range of subsidized prices and looked at what happened.  They found that cost-sharing did not necessarily increase how consistently or well the nets were used nor did in increase use by those most vulnerable to infection, as compared to free distribution.  They did a good old cost-effectiveness analysis and showed empirically that cost-sharing is at best marginally more cost-effective than free distribution, but free distribution leads to many more lives saved. 

So, while the work IPA does is soemtimes hard to explain and not as immediately "feel good-y" as providing health care or education or micro-loans, their work is crucial to ensure that the "do gooder" stuff is actually doing good and that the work doing the most good reaches the most people.

Thursday, November 4, 2010

Where on earth we live

Our house lies on a busy-ish road, teeming with all manner and speed of human and animal traffic. Slow rusty bodas (bicycles fitted with a cushioned seat for paying passengers), motorbikes, minivan matatus busting at the seems with people and packages all compete with a steady stream of foot traffic and meandering herds of cows and goats. It's an interesting kind of chaos, but it's hardly picturesque. 

But it takes only a few minutes walk to enter some of the most astonishingly beautiful landscapes I've ever seen, rolling green hills dotted with small shambas growing a patchwork of crops.  Driving through the countryside literally takes my breath away and inspires all kinds of romantic notions of giving up modern life for what appears (I'm sure falsely) to be idyllic farm life. The land is literally overflowing with the most varied vegetation in all shades of green rooted in a rich copper earth. Looking at the scene, the words "lush" and "fertile" pop into your head, completely out of your control. 

Many places of natural beauty in the US are such due to their sheer dramatic expansiveness - monochromatic vistas of evergreen, large and imposing mountain ranges, and even oceans of corn fields.  But the scene here is an amalgam of all variety of tree, shrub, bush and farm all working in complex and beautiful harmony.  It's wild interspersed with tame, and the human footprint of shamba and storefront seems to coexist peacefully with the ancient and feral land.

Now, I know there might be environmental impacts that my lyrical musings miss, and I don't want to over romanticize what I'm sure is an arduous farming existence.  But I love that I can stare out a window or walk through shamba path and drink in the natural beauty that hasn't been conquered or controlled by and even seems to flourish alongside and as a part of human activity. This is not something I often experienced in the US.