Paul Farmer And Our Misguided Quest for the Killer App

I just returned from Dr. Paul Farmer’s talk at IDEO in Palo Alto. What is perhaps most inspiring about Farmer is his use of humor and stories—particularly the sorts of stories that confirm un-sexy truths about working in the social sector. One of these truths is that the search for the “killer app” (known outside of Silicon Valley as the “magic bullet” or similar one-dimensional cure-all) often misses the broader issues at play in social justice work.

In Farmer’s case, these broader issues are what underlie the dire health outcomes observed in the places like Haiti, Rwanda, and Lesotho, where his organization Partners in Health treat patients. His patients often come to him with non-medical requests: can he help them send their children to school? Find a job? Without addressing these root issues, Farmer says, doing public health work is of little consequence.

Focusing on the broader issues requires engaging people, not machines, to visit with and monitor patients on a regular basis. Notes Farmer: “This isn’t nuclear science, and it’s hard to sum up in a sexy package. Donors often wonder whether paying community health workers is sustainable and cost-effective. They want to see something like a ‘palm doc’—a small machine that poor people can use in place of an actual person. A palm doc is not going to do what humans can.” Take, for example, the case of Joseph Jeune, one of Farmer’s AIDS patients in Haiti:

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Joseph Jeune, age 26, before treatment                              Joseph Jeune, six months later

What’s the lesson here? Automation isn’t everything. Early on at Samasource, I spoke with a potential donor and early Google employee who told me that what we were doing was great, but it didn’t seem very scalable. “You rely on human reviewers,” he said, “to screen applications manually—so there are limitations on what you can do. I’m looking to fund a solution that’s horizontal and highly automated.” It’s refreshing to hear people like Dr. Farmer remind us, in Silicon Valley of all places, that in the rush to automate and scale anything that seems to work in the business of solving poverty, we may forget our most valuable asset: people.

     

 

 

WORLD POOREST COUNTRIES (LATEST RECORD)

1. Congo

Population: 70.9 million
GDP (PPP): $20.6 billion
GDP per capita: $332

Even though it has rich economic resources, the Democratic Republic of Congo has suffered from war and corruption since its independence in 1960.

Congo was one of the second most industrialised countries in Africa. Today, it has the lowest GDP per capita in the world.

Poor infrastructure and business, reflects the ill-effects of what has been termed as Africa's 'world war,' where an estimated 3 million lives were lost.

2. Zimbabwe

Population: 11.6 million
GDP (PPP): $332 million
GDP per capita: $354

Zimbabwe is not one of the poorest nations in the world. However, its economy has suffered from war with the Democratic Republic of Congo and hyperinflation.

Further, a violent land redistribution campaign has scared away most potential foreign investors.

3. Burundi

Population: 9.8 million
GDP (PPP): $3 billion
GDP per capita: $400

Burundi has recently come out of a civil war between the Hutu and Tutsi factions. Thus, its economy faces many challenges.

It also lacks in resources and is largely uneducated (only one in two children attends school). Further, one in every fifteen adults has HIV/Aids.

Even though, recent political stability has proven beneficial, poverty remains extremely prominent.

4. Liberia

Population: 3.7 million
GDP (PPP): $1.4 billion
GDP per capita: $424

Liberia has suffered extensive economic hardships since a 1980 military coup, which was led by Samuel Doe.

But, it has an abundance supply of water, timber and mineral resources. This gives Liberia a chance for salvation, a chance to rebuild its war-ravaged infrastructure.

5. Eritrea

Population: 5.8 millionGDP (PPP): $3.7 billionGDP per capita: $679

Eritrea gained its independence from Ethiopia 17 years ago.

It suffers from problems that arise from its position as a small, underdeveloped country that continues to experience military conflict since its sovereignty.

The country's single party government, run by the People's Front for Democracy and Justice, has total control over the economy through military force and the expansion of government-owned businesses.

6. Niger

Population: 15.9 millionGDP (PPP): $10.1 billionGDP per capita: $719

Niger, which suffers from poor economy, has an arid climate that suffers from drought cycles and desertification.

Further, its economy is consistently undercut by price fluctuations in uranium, the country's primary export.

These facts, in addition to Niger's prolonged history of post-independence military rule, makes the nation as one of the poorest in the world - devastated by disease and corruption.

7. Central African Republic

Population: 4.8 millionGDP (PPP): $3.2 billionGDP per capita: $745

The Central Republic of Africa has undergone three decades of military dictatorships, a decade of unruly civilian government, and an unstable transitional government established by a military coup. All these events have happened since CAR gained independence from France in 1960.

CAR shows great potential for economic growth within timber and diamond industries. But, it is still surrounded by political instability and concerns like corruption, which hamper CAR's progress.

8. Republic of Sierra Leone

Population: 5.2 millionGDP (PPP): $4.3 billionGDP per capita: $759

Victim of a 10-year old war - which ended in 2002 - Sierra suffers from poverty and unemployment. The nation, which has rich minerals and agricultural resources, is recovering from the after effects of war.

The export of diamonds, often referred to as 'blood diamonds,' benefits only a small minority of the country.

But, for much of the general population, peace and prosperity seems unattainable.

9. Togo

Population: 6.2 millionGDP (PPP): $5.3 billionGDP per capita: $826

Togo has been experiencing political unrest since it gained independence from France in 1960.

One of the world's poorest countries, Togo is led by the universally condemned President Faure Gnassingbe, son of the corrupt political leader Gnassingbe Eyadema.

The nation, however, has only recently begun to rebuild its relationship with the international community.

With help from the World Bank and the IMF, Togo aims at improving its economic growth through increased privatisation, government transparency and support from foreign donors.

10. Malawi

Population: 15.4 millionGDP (PPP): $11.3 billionGDP per capita: $884

Extreme poverty, the rampant spread of HIV/AIDS and the widespread corruption are the banes of Malawi.

The country is one of the world's least developed nations and also one of the most densely populated.

11. Madagascar

Population: 21.3 millionGDP (PPP): $19.7 billionGDP per capita: $932

Madagascar had a socialist-oriented government until the 1990s. This was later replaced by a government, which relied heavily on the IMF for economic guidance.

Even though, a burgeoning tourism industry was developed, several political crisis, as well as global recession, hurt the nation's best hope for growth in the past few years.

12. Mozambique

Population: 22 millionGDP (PPP): $18.6 billionGDP per capita: $933

Mozambique became independent in 1975. Since, then it has struggled to bring itself out of extreme poverty.

The nation is working against massive foreign debt with the aid of international organisations. It has also managed to garner some attention from investors and has developed a sizable aluminium industry.

However, Mozambique was hit by economic recession, as the growth and export potential of the aluminium industry was hampered by a sharp drop in the price of the metal.

 13. Ethiopia

Population: 88 millionGDP (PPP): $70.9 billionGDP per capita: $954

One of the largest and poorest of the African nations, Ethiopia relies heavily on agricultural exports (particularly coffee) to sustain GDP.

However, the country is hurt by heavy droughts, poor farming practices and price fluctuations. Ethiopia was also heavily affected by a two-year war with Eritrea.

In 2005, the International Monetary Fund waived off the country's debt, which has led to improved conditions.

14. Guinea

Population: 10.3 millionGDP (PPP): $10.3 billionGDP per capita: $991

Guinea retains significant potential in agricultural and mineral resources, as well as hydroelectric development.

But, the nation suffers from a poor literacy rate of less than 30 per cent. It is also engulfed by political uncertainty. As a result of which, industries are left underdeveloped in this nation.

15. Rwanda

Population: 11,055,976GDP (PPP): $9.9 billionGDP per capita: $1,149

Rwanda is one of the countries on this list that shows signs of hope and improvement.

The genocide in 1994 affected Rwanda's infrastructure and left its people in great depths of poverty.

Efforts to develop this resource rich nation, aided by the international perception of increased stability after nearly 1 million deaths during the genocide, have caused mineral production to replace coffee and tea as Rwanda's main export.

16. Mali

Population: 13.7 millionGDP (PPP): $15 billionGDP per capita: $1,172

Mali has a rich agricultural influence. This nation relies heavily on its tobacco industry, which makes up at least 50 per cent of the nation's total exports.

But, the effort extended by the government to develop Mali into an industrial infrastructure aided by the IMF, the UN, and several other philanthropic organisations, has faced major setbacks.

The nation experiences some significant issues like unpredictable and unreliable availability of utilities, including electricity, water and telecommunications. These problems have deterred many foreign investors, thus hampering the overall development.

17. Uganda

Population: 33.4 millionGDP (PPP): $36.9 billionGDP per capita: $1,195

Its vast natural resources, particularly precious metals and minerals, offer Uganda a great deal of potential.

But, over 80 per cent of its population is employed in agriculture.

The underdevelopment of a mining infrastructure, as well as overall lack of industrialisation, is mainly due to major civil unrest and international conflict with neighbouring countries.

18. Nepal

Population: 28.9 millionGDP (PPP): $31.5 billionGDP per capita: $1,205

Like Burkina Faso, Nepal has also experienced much political instability over the past few decades.

While Nepal has significant potential for development of a hydroelectric power infrastructure, the political instability coupled with the nation's propensity for natural disasters, has left this resource largely untapped.

For now, one-third of the nation's GDP comes from small-time agriculture.

19. Burkina Faso

Population: 16.2 millionGDP (PPP): $17.7 billionGDP per capita: $1,304

The infrastructure of this West African nation has been affected by frequent droughts and several coups since the 1980s.

The country's main export is cotton. However, partly due to these intense droughts and heavy fluctuations in the industry, this has been an unreliable cash crop.

20. Haiti

GDP (PPP): $11.5 billionGDP per capita: $1,338

The poorest nation outside the African continent, Haiti has been plagued by natural disasters, poor health conditions, drought and famine.

Adding to the natural calamity, the country has witnessed some of its worst years under the 30-year rule of physician and brutal dictator Francois 'Papa Doc' Duvalier, who was later succeeded by his son, 'Baby Doc' Jean-Claude.

Under their rule, Haiti experienced a massive brain drain. It is still recovering from the effects.

Once again hit by a natural catastrophe, the recent 7.0 earthquake in Port-au-Prince has not helped matters.

TSUNAMI SURVIVOR STORIES

March 12, 2011

WHAT ARE TSUNAMI SURVIVORS FEELING?

Forty-eight hours have passed since the Japan tsunami swept through Northern Japan. Tens of thousands of people are in emotional and physical turmoil right now in Japan.

Over the last hours, friends and several news show have contact me. In trying to help the world understand what is going on, they have asked me, "Rick, what are people feeling and thinking right now?"

My goal is to help people "feel" what survivors are feeling. It is one thing to see the horrific news clips on television. But I want everyone to at least try to understand what people are feelings at this moment.

When we watch television, we see numbers like "9,500 missing." But we are not sure if we should be thankful or sad. What we don't see are numbers like, "500,000 people have had their family, homes and lives taken away." And we don't get to see how they are feeling.

From my minutes and hours of being in the middle of the tsunami, to the hours and days afterwards in Thailand in 2004, I know what it feels like. There are so many emotions running through your body - your head - your soul. You can't even process all of them. One minute, you feel such sadness and loss. Then it becomes overwhelming, and you just sit and stare. Likely in shock. Then you try to think your way out of it - until it just becomes overwhelming again. And then you start the cycle all over again.

Based upon my minutes, hours and days after the SE Asia tsunami, here are some of the emotions and feelings people are likely experiencing right now in Japan.

SHOCK - mostly, it is beyond belief. Your brain nearly shuts down, and you almost feel that the only thing to do is to just get from one minute to the next.

FEAR OF ANOTHER ANY SECOND NOW - You are scared. Your brain tells you that if this one happened, then other will happen. In Thailand, at least 8 successive "waves" came into shore. On the television, they show the main wave over and over. But in the hardest hit areas, the waves go back and forth, as the water settles. And each time the wave comes back, even though it looks smaller than the last, it still rushes in, and pulls back with it more lives, buildings and hope. In Japan - the complication is even worse. Reports are that this "tsunami" is actually the result of a "aftershock" from an earthquake that happened over the previous two days. Everyone was used to these earthquakes. They had been happening. But this time, it causes such great destruction. And now, making the loss worse, is the feeling that the start of every tremor will simply get longer, stronger, and create yet again another tsunami - this time perhaps even stronger and more devastating.

Sidenote: When you move or travel in Japan, you never forget your first earthquake. For me, it was in 1997. I had arrived to work for a year. My first earthquake happened early in the morning. I was awakened by the shaking. I jumped up, and ran into the room of the family with whom I was staying. The mother spoke no English. All I could do was to look into her eyes to see if I could see fear. She did not look alarmed. And so, I could also calm down. Over time, I could always rely on the faces and the eyes of the Japanese to have an intuitive sense if this was going to be a bad earthquake. Fortunately for me, while in Japan, I never experienced a bad one. However, 48 hours ago, it was different. I talked to a colleague in Japan. He told me that this earthquake started out like normal. But this time, after 15 seconds, everyone looked into each other’s eyes. The earthquake started to get stronger. And longer. And this time, they looked into each other's eyes, and knew this one was going to be really bad.

NIGHT TIME IS THE WORSE - For so many reasons, night time is the most frightening of all. First of all, the power is out all around you. And if you have some sort of power to make light, like oil or laterns or candles, you use them sparingly, not knowing for sure if you will need them for hours or days to come. But what is amazing is "how dark, dark really is." I never knew how dark things could be until you have a devastation that results in power loss. When every street lamp, car light or house light is out - then things are so pitch black that you can't even see in front of you. And your sense of hearing takes over. And what do you hear? Not cars or engines. Because nothing is moving. All you hear is the sound of water nearby. The rushing of waves. And that is the scariest thing of all. Your mind starts to play tricks on you. You wonder if another wave is coming. If it will be larger than the last. You think you are safe. You are on high land. But what if another wave comes even higher. This time, you won't even be able to see it. And all you can hear is the water.

FEAR ABOUT THE DEAD. It is something few ever experience in their life. But when you know that dead people are around you, it really scares you. You know that the water around you contains hundreds or thousands of dead people. In the light, before sunset, you could see the bodies floating in the water. And then waves would come, and take them away. And then more bodies would appear. A part of you becomes numb in seeing the dead bodies. But they are also frightening. Horror movies of your past and religious views make you wonder about those bodies. And worse, if you have people that you have lost, then you are not sure if you should go look at those bodies or stay way. And if you stay away, what kind of respect are you showing. Yet, if you go to the bodies, what can you do?

FEAR ABOUT ELECTRICAL THINGS - After a tsunami hits, the power is out. You look around, and think, nothing is working. But electrical cables and wires are hanging everywhere. Your instinct makes you think that at least one of those wires will be live. Or how can they just shut off one of those wires. Or what happens if one of those wires is touching water, than happens to be connected to a puddle that you are standing in. And so, you nearly feel paralyzed about walking around, for fear that any move you make will electrocute you.

THE GOSSIP that happens is amazing. When all cell phones are knocked out, or jammed, no one knows who to believe. In the 72 hours after the SE Asia tsunami, people were walking around the destruction near the beach. And suddenly, everyone would just start to run. Everyone would run inland. And then you were faced with the dilemma. You had heard that no more tsunamis were coming. Yet, surely, someone had heard something. If you ran, then you ran in illogical fear. If you stayed, then you might not be seeing what someone else was seeing. At least 3-4 times when this happened, you would ask, "Who said something was coming…" And often, the answer was "The Police." Yet no one knew which police. Perhaps it was a one policeman who said, "We have to be careful" - and that message was transferred multiple times until it was repeated as "Run!" Or perhaps it was some well meaning policeman trying to keep order on the beach, and so he simply thought it was a better method to say, "Another tsunami might be coming."

I would imagine the same thing is happening in Japan. But they have so much more to deal with. They have had tens of aftershocks. They have hear explosions. And now, they have rumors and realities of nuclear power plants melting down. The fear of the next destruction must be so high.

YOU WONDER IF ANYONE KNOWS. For the 24-78 hours, you wonder if the rest of the worlds know. When you are cut off from television and cell phones and electricity, you just wonder. You know that some help is starting to come around. But you get this feeling inside of you that, "If people really knew the level of devastation, they would be coming in with food and helicopters and ambulances." But when you look around, the rest of the world does not seem urgent. So perhaps, they don't really know. But then again, your perspective of what is urgent is so skewed that it is impossible to even trust your own reality.

FOOD AND DRINK. You really aren't hungry. At least in your mind. But your stomach begins to grumble. And because you can't think about the big things, you begin to wonder about food. And water. Every bottle of water - every packet of food becomes an instant treasure. And you know that without power, everything will begin to spoil quickly.

In Phuket, about 12 hours after the last of the big waves, we sent scavenger crews out to raid minibars on the hotel beaches. We sent them for water and softdrinks. They returned with little water, softdrinks and alcohol. And even then, you are having this odd moral dilemma in your own brain If you take things from a washed out hotel room, are you stealing? Do the rules of stealing change when you are just trying to find food and drink? Are you only making things worse?

THE SMELL - Within 24 hours, something bad begins to happen. Decay starts to set in. And the sell comes. It comes from decaying plantlife that has washed ashore. It comes from fishes from the sea that were swept in with the wave, but not taken away on the return to the sea. It comes from rotting food. And animals. And people. In Phuket, the smell started in pretty quickly, because the temperatures were in the 80+ degree F. range. As you would walk by piles of debris, a strong smell would come from beneath. And you walked on quickly, fearing what might really be under that pile of rubble. The other thing you could also smell - and see - were oil and gasoline slicks. Whether it was from cars or heating oil or tankers - there seemed to be a sheet of oil on the water and ground around you. Which then made your mind wonder, "Will that all start on fire?"

THE BUGS follow the decay. In Thailand, as well as in Japan, they spray much and often for mosquitoes. Once the small puddles of water pooled, the bugs followed. And then you became very concerned of the diseases you might get from those bugs.

CRYING BABIES - I can remember that so many children were crying. They would cry non-stop. If the parents were in shock, then children are just confused. And they are disrupted. There is no way they can make sense of what is going on. They want their normalcy. They want a family member they may not be able to have. They want sleep. And yet, they are denied it. Instead, they look around and see adults crying. And they are confused. And so they just cry and cry and cry.

FITS OF CRYING FOR ADULTS. Most of the time, you are just trying to think of the next moment. But for individuals who have lost things - all they can grasp is how much in life they have just lost. Likely, theh are missing at least one family member. And gone is their home, their possessions, Their home. Their car. Realization begins to set in. You have lost everything. Memories. Homes. Livelihood. People. Neighbors. And your emotions are all over the place. You go from being thankful to be alive to the realization of what you have lost. And you cry for both. You cry to yourself. You cry on the arms of shoulders of people around you. You just cry.

SADNESS FOR THE YOUNG AND THE OLD - There is a gnawing feeling that you don't want to accept. You look around, and realize that there are not many young and many old. And you instinctively know that it is because they are gone. They didn't make it.

AND YOU WONDER IF YOU COULD HAVE DONE MORE - after awhile, while sitting in shock, you begin to wonder what else you could have done whom else you could have saved. Could you have screamed louder? Grabbed more people? Run faster?

SURVIVOR LISTS become an obsession. You become desperate to know about the people you are missing. You just hope - pray - that they are somewhere else. And then the rumors begin about the survivor lists. You hear about locations where people are gathering you here there are long lists of names and you know - just know - that the people you are missing are on those lists. You say you will go find those lists. But then you sit down again, feeling paralyzed to do so.

COMMERCE BECOMES CONFUSING - If a store has survived, then it is a prized place because it might have food and water. And so families and employees go there to guard the supplies. But then people start to show up - needing and wanting food. Yet, for most, items like money and credit cards are gone. And so, for shop keepers - they are torn between if they should offer food or really only sell it.

HOW DO YOU HELP?

Well - those are only a few of the emotions that people feel in the hours after a tsunami. I have not visited them in so many years - seven to be exact. But they are all still there. They are real memories. And seeing the paces and destruction of the people on the coast North shores of Japan, I see in their eyes that they are feeling it too.

For Japan, the culture of organization and preparation adds to the complexity. In a culture where everything is so prepared and organized and calm, I am sure things are even more overwhelming than ever.

What can you do? Just understand. If you meet someone who has gone through the tsunami, have patience. When they are ready to talk, they will talk. If you are a survivor, and are ready to share your story, share it here for others to read.