Photo courtesy of Sally L
he stood outside the clinic with her arms crossed. Dust was settling from where he had run across town. “He’s wrecked our fucking ambulance,” she said. She was right. The man had thrown a rock the size of a brick through the back window of the ambulance. It had smashed the satellite phone & hit some of the equipment. I stood next to her scratching my head. I’d only been here a week, but this wasn’t the first time I’d asked myself, “Does this community really want a clinic?” Be them missionaries, mercenaries or misfits, whatever drives humanitarians is a big mystery to most of us. And even if we understood why, most of us wouldn’t do it. But for those of us who do, there has always been a reasonable assumption, at least from the outset, that the benefits of aid work outweigh the harms. This was the assumption that I had made, on making the decision to volunteer in a clinic servicing a community which was in desperate poverty. The timing could not have been more perfect. It was June, 2005. Millions were attending Live 8 concerts, flaunting their white wrist bands & trendy, altruistic hairdos. The G8 leaders were about to meet in the UK to discuss whether to increase aid to the third world. And the International Monetary Fund (IMF), contrary to its official stance, published two research papers with this unsettling conclusion: there is little evidence supporting the assumption that aid boosts growth. According to the United States Agency for International Development, western countries have spent more than one trillion
Aid: or does it? S
dollars in grants and loans to 70 countries since the early 1950s to help reduce poverty. So how is it that foreign aid has been unable to pull the world’s poorest nations up by the bootlaces & out of poverty? The first reason is corruption. Take the instance of when Australia donated aid to Papua New Guinea - of great benefit to PNG’s leaders as they licked the honey pot clean. A Senior Fellow at the Centre for Global Development in Washington, D.C. says aid is least effective in countries such as Somalia and Haiti, where governments are especially weak, and in politically unstable countries, like Iraq and Afghanistan. The second is this: the amount of foreign aid in many poor countries is very large compared to the miniscule size of their economies. The sheer size of the inflow lifts the value of the local currency, thereby making imports cheaper and exports more expensive, reducing output in other sectors of the economy. The third is quite an overused piece of rhetoric used here in Australia, often espoused to prevent funds being diverted to Indigenous Australians. It is that aid flow becomes an alternative source of funds that reduces the need for communities & governments to become self-reliant. Less effort is put into nourishing domestic sources of growth, creating a good environment for business, & spending money where it will do most to reduce poverty. As Michael Radew of The World Policy Institute in New York says, “It encourages all the wrong economic policies that made those countries poor in the first place.”
But the IMF economists who wrote the offending report are the first to criticise their findings. One criticism is their method – their comparison of broad growth figures across different countries is flawed, and the findings could be overrepresented rather than real effects. Secondly, the research studied aid pre-1990 rather than recent aid, since influenced by massive reforms. For example, in the past five years, most African countries grew at a faster rate in per capita terms than Australia. Nevertheless, the report highlights the importance in the actual execution of providing aid. The authors of the report admit that the findings, which relate more to the past than the present, do not imply that aid cannot be beneficial in the future. “Overall, we see our papers as urging care, prudence and perhaps a little more creativity and experimentation when aid is delivered.” Aid is not a cure-all solution for the developing world’s problems but it has undisputedly been effective in reducing suffering and poverty. It has been vital in improving the health of people in poorer countries, contributing to better education and advancing human rights. While economic growth and international trade are critical to the long term reduction of poverty, continuing assistance is an essential part of the solution. And the future relies on greater efforts to crack down on corruption, to open markets and reduce subsidised competition to exports, ensuring that in this new age of aid, help will go to where it will do most good.
by Sally L
W Lending a Hand: the Aid Issue ISSUE 2
September 2006 1 Aid: or does it? by Sally L 1-2 Lessons from a frozen Capital by Tonya Littlejohn 2-3 Interview with Dr Mark Moore by Andrew Perry 3 AMSA Conference by Gail Cross 4 Upcoming Events & Opportunities 4 Links & Resources by Jacqui McDonnell
hen it comes to thinking about international assistance, buzz words such as ‘collaboration’, ‘sustainability’ and ‘empowerment’ spring to mind almost reflexively. Yet despite the good intent, many programs fall short of achieving positive and sustainable outcomes. Political agendas, competing interests and social factors
serve as impediments to the delivery of aid. When such obstacles are stemmed and overcome however, aid has the potential to bring enormous change and improvement to the lives of those in greatest need. Five years ago, I spent a year living and working in Ulaanbataar, Mongolia, a beautiful, desolate country sandwiched between Russia and China. With up to eight months of winter conditions and temperatures that regularly drop to minus forty degrees, life for many Mongolians is a constant struggle against the elements to meet basic needs. Mongolians eat what the land produces, so mutton is plentiful, but vegetables are scarce. Life expectancy and health status of the population are poor. It is a country undergoing huge socio-economic transition where traditional
Inside a Mongolian yurt
continued on page 24
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Lessons from a frozen Capital
3continued from page 1
Herders in Mongolia
nomadic herding practices coexist with an increasingly youthful population. The outcome of these major structural changes is that services do not always reach the most vulnerable groups. In my brief time there, I was involved in work aimed at adolescent development and well-being. Up to 55% of Mongolia’s
build meaningful partnerships between marginalised populations and the Government. In this spirit, the creation of a national level young people’s forum gave the country’s silent majority the opportunity to articulate their own concerns to policymakers and institutions. It has since become a powerful medium for representation, giving users the confidence to speak out and decision-makers the choice to listen. From such experiences in Mongolia and elsewhere, I have observed the benefits that aid and technical assistance can accrue to the most vulnerable populations. Certainly, the delivery of aid is a complex and difficult undertaking. Nevertheless, in places where the Government cannot, appropriately targeted aid continues to provide services and programs to those who face the greatest burden of poverty and ill health.
by Tonya Littlejohn
Interview with: Dr Mark Moore A:
r Moore is a Plastics and Craniofacial Surgeon in Adelaide, South Australia. His medical school days were spent at the University of Otago, New Zealand, following which he came to Adelaide to undertake his fellowship, having earlier completed his training in Plastic and Reconstructive Surgery. He has a longstanding involvement in developing world healthcare through his involvement with the Overseas Specialist Surgical Association of Australia (OSSAA) Dr Moore, how did you first get Q:medicine? involved in developing world A few years ago I met a doctor from A: the NT, Dr John Hargreaves, who had set up the organization that was to be-
come OSSAA, which coordinated surgical trips to locations in East Timor and Indonesia that were extremely disadvantaged. He convinced me to go along on one of these visits for a fortnight to East Timor in 2000 immediately post-independence. After going on that first trip I haven’t looked back. often do you go overseas and Q:WeHow what do you do? travel four to six times a year. A: Next week I am going to East Timor which will be the nineteenth time I
have made that trip. What is done on these trips varies according to the skill set of the surgeons on that particular expedition. My area is Plastics and Craniofacial surgery so the main conditions that I deal with are cleft lips and palates, and burns. I also come across a variety of other conditions such as other congenital abnormalities of the head and neck as well as tumours involving these regions.
population are under the age of 24, many of which live remotely or outside traditional care structures such as family or community. It was in the midst of this complex and dynamic situation that I discovered that despite my desire to contribute to broader social and political change, ultimately it was the small scale, targeted programs that proved most effective at addressing the immediate needs of Mongolian people. For instance, delivering life skills training to abandoned teenage girls and outreach services to women in isolation fostered independence and had a sustained and tangible impact. Sustainable assistance also involves giving a voice to the disempowered. In many communities, the most vulnerable populations often do not have a say in the decisions that affect them the most. It is vital to create avenues for collaboration and
Looking at the OSSAA mission Q: statement it says that one of your aims is to provide local training in services.
Moving towards local sustainability and independence is one of the ultimate goals of our organization. When I first moved to Adelaide the hospital I worked at had an arrangement with the Malaysian government whereby we trained many of their Plastics trainees. At that time Malaysia had no home grown surgeons in that area, so we helped them develop that capacity. They are now at the point where many of these surgeons are conducting their own outreach services to places in Malaysia that are less advantaged like Sarawak. I consider that a real success story. Similarly whenever we operate in any of these sites we try to get some of the local staff, both doctor and nursing, involved so that their skills are built up. We still have a long way to go but are slowly getting there. The signs though are so promising that AusAid is starting to look at our operation as a potential model to replicate elsewhere in the region.
Do you think that doctors in the Q: developed world have an obligation to assist those in the developing world? I think every doctor, and indeed A: every person, if they choose to can contribute to the health of those in
the developing world. This contribution can be made in countless ways, many of which don’t involve actually travelling to these sites to practice medicine because that is not always going to work for an individual person. It could be through fundraising, assistance with running organizations like OSSAA or by covering the clinical responsibilities of your colleagues who do go overseas. Something that I am against however is a phenomenon that I call “medico-eco tourism” where doctors, often the more junior ones, head to third world countries on one-off visits and undertake operations without adequate follow-up and in some cases the necessary
expertise. One of OSSAA’s principles is to try and send the same surgeons back to the same sites so that some degree of continuity of care exists, along with the opportunity to build an ongoing relationship with the site which provides a whole range of attendant benefits in terms of training and ease of providing services. I also think the medical schools should play their part in this area as well, such as through bilateral exchanges with medical schools in developing countries. Organisations such as your IHN are a good way of starting and increasing this involvement. there a patient or experience that Q:IfIsstands out for you? I had to choose one it is probA: ably the case of a young married woman who was severely burned to the
face and chest while in her late teens. The burns were such that she couldn’t close her eyes and had difficulty putting food continued on page 34
Article photos courtesy of Dr Mark Moore
Article photo courtesy of Tonya Littlejohn
Lending a Hand: the Aid Issue
Lessons from a frozen Capital
in her severely scarred mouth. We have done a number of staged operations for her which have made an enormous change to her quality of life. Her ability to deal with these circumstances and get on with life has amazed and inspired me – since we first met she has gone on to have two young children with her husband who has also been extremely supportive. You give up the opportunity to earn Q: a large amount of money when you go on these trips and stay in some fairly
primitive conditions. Why do you do it? I don’t think anyone does this sort of work for purely altruistic reasons. It is not in human nature to do that. There are rewards for everyone which varies ac-
cording to the person. For me it is the opportunity to share experiences like the one I mentioned before of the burns patient. The other gratifying aspect is the true appreciation your patients give you for your time and skills. I have patients here in Australia who will grumble if they have to wait 30 minutes in my waiting room, whereas in East Timor some of my patients with significant deformities will have been waiting 6 weeks for a scheduled operation which we will have to cancel at the last minute and post-pone to our next trip which will be months away. And yet they still thank you for even considering them. advice for young starry eyed Q:Any junior medicos who want to go
out and heal the world? [Laughs] Go in with your eyes wide open – for some doctors, travelling to these places isn’t going to work out. For those of you who do get involved, the rewards are enormous – it makes you a better doctor and a better person.
by Andrew Perry
Article photos courtesy of Dr Mark Moore
3continued from page 2
Interview with: Dr Mark Moore
AMSA Developing World Conference 2006
Crescent and Oxfam Australia shared their success stories of emergency relief, empowerment of local communities, microfinance initiatives and many other excellent projects. Between sessions, delegates mingled with NGOs at their respective booths, browsed through posters detailing what international health groups had achieved or simply lounged over the delicious lunches to discuss the equally plentiful food for thought. Day three was geared at answering the perennial question, “How I can do something NOW?” We learned about student volunteering opportunities, electives advice, an internship at the UN, strategic planning for international health groups and how to get involved with indigenous and refugee communities locally. This was all topped off with a panel discussion with a junior doctor, a nurse and a retired colonel who answered questions and provided advice on career planning. This conference was a landmark event
ar. Injustice. Poverty. Natural disasters. In an age where turning on the evening news can lead to instant despair, it’s hard to find the inspiration to believe that things can change for the better. For me, AMSA’s second Developing World Conference did exactly that and more. Over three days almost three hundred students, medicos and gurus of international public health and development gathered on the lush grounds of UWA, Perth, for “Talking Truths: Global Perspectives on Health”. The conference was much more than a dry Not only is another world possible, information session on statistics of death, disease she is on her way. On a quiet day, I and devastation. Keynote speaker Prof Dev Bhasa can hear her breathing. urged us to think about - Arundhati Roy the concept of “truth” – is it state sponsored knowledge we subscribe to or do we truly underfor AMSA’s International Health Network, stand the needs of the people we are trying a collaboration of all the university interto help? Then there was the fantastic, cernational health groups. The IHN chair ebral debate on Neoliberal economics and presented their achievements including a its impact on health. Prof Komesaroff ’s comprehensive website: www.ihealthnet. discussion on how aid can disempower net, Vector magazine, and much more. The rather than foster existing capacity within smooth running and quality of the conferdeveloping communities made me realise ence is a credit to its organisers, students how ignorant and naïve I still was. Other from UWA who did a great job with the speakers discussed the crucial topics of academic programme as well as cultured fair trade laws, the powerhouses’ abysmal entertainment and lavish food throughout. foreign aid commitment, war and its toll Amongst all I heard and learnt at DWC, on health, doctor poaching and more. it was the sweet, sad, and often hilarious But it was not all doom and gloom. anecdotes from people on the field that I Representatives from NGOs such as Opcherish. I am so grateful to have experiportunity International, Red Cross/Red enced the camaraderie of all present with
their infectious enthusiasm and dedication. I am certainly looking forward to more learning and a reunion of these ideals at Developing World Conference 2007, to be held in Adelaide. Until then, I’ll put my best foot forward and have faith that that better world is one step closer.
by Gail Cross Article photos courtesy of Sneha Parghi
Delegates gather in the main lecture theatre
Students gather on the grassy common of UWA
Varga, Ruth, Fred Alok and Sneha
Lending a Hand: the Aid Issue
Formation of the new IHN committee
Lending a Hand: the Aid Issue
Upcoming events and Opportunities Photo competition...
Are you a budding photographer?
of Vanessa Fitzger
Do you have photos you’d like exhibited?
you have been to an elective / selective / volunteered or worked in a Community in Need (overseas or remote Australia) and have photographs of these experiences, enter them into IGNITE’s “Communities in Need” photographic exhibition.
Check out the gallery: www.mccullochgallery.com.au
To be held on one night only on the 15th of October in McCulloch Gallery, 8 Rankins Lane (just off Little Bourke St, Melbourne CBD) you stand a chance to win best photo on the night. If you happen to be in Melbourne on the night, come along to see some great photos, meet like minded people and enjoy the fine food, a few drinks and groovy music.
Digital photos and entry forms can be sent to: ignite.photos@gmail. com.
We want your photos! Movies...
Links and Resources
he Constant Gardener Based on the novel by John Le Carre Not the sort of movie that will leave you feeling all warm and fuzzy on the inside but instead gives you food for thought on large scale pharmaceutical testing. Available from the new release section of your local Blockbuster http://www. blockbuster.com.au/The_Constant_ Gardener.htm
Great suspense! oooo
Entering a photo is free of cost. Entry to the exhibition is by gold coin donation. Love to see your photos and love to see you there! Gail Brenda Cross IGNITE Monash University email@example.com
by Jacqui McDonnell
ace Against Time By Stephen Lewis I was inspired to buy this book after listening to Stephen Lewis’s keynote speech at the 6th annual UCSF Women’s Global Health Imperative day. This speech and others are available at
I have found Stephen Lewis to be an emotive speaker, but this does not seem to translate well to the written word especially when he is off on one of his many tangents. That said, this book is a great insight on the workings of the UN and the Millennium Development Goals. Keynote Speech: moved me to tears!
Book: lots of UN backstabbing.
he Australian Development Gateway For information about humanitarian aid work, go no further than the Australian Aid Resource & Training Guide at http://www.developmentgateway. com.au/jahia/Jahia/pid/171
This booklet will point you in the right direction for anything from aid and international health courses available in Australia to international contacts for work in aid-related fields. I cannot recommend this booklet enough! ooooo
orld Vision Poverty Reports Does aid work? You decide. http://www. worldvision. com.au/aboutus/ povertyreports/files/ DoesAidWork_2006_ hi.pdf
DOES AID WORK?
n Inconvenient Truth If you have an innate sense of hate for the fence sitting mumblings of many politicians, and purposefully avoid any contact with their facades, this documentary by Al Gore will change your mind forever. I am in absolute awe of the impassioned way Al Gore was able to simplify the connection between global warming, drought, malnutrition and disease in developing nations. I guarantee that every muscle car fanatic will leave the cinema wanting to buy an alternative fuel hatchback. Out 14th September through Greater Union, but if your study schedule has you under house arrest, check out the website and start making a difference today. http://www.climatecrisis.net/ If you only have time for one movie this year, this is it! ooooo
To enter the competition, download the entry form from www. ignitehealth.org.au, under photographic exhibition.
DOES AID WORK?
What is AID? Aid comes in many forms – from small grass roots projects by non-government organisations through to huge infrastructure or government reform programs by the World Bank. One of the main goals of aid and development organisations is to reduce poverty. This can mean increasing the monetary incomes of people or it can mean helping to ensure that people have access to the basic physical and social needs for their survival and development. An ultimate aim of aid is to make itself redundant – for people to be able to support themselves or their own community. This paper looks at how effective aid has been in reducing the many forms of poverty and improving communities’ self reliance.
Does AID WORK? In discussions about international development, the question of whether overseas aid is effective in reducing poverty is never far from people’s thoughts. This is not surprising given that after over fifty years of aid there are still frequent and terrible stories in the media about people suffering from hunger and treatable diseases, and non-government aid agencies like World Vision are still writing asking people to help children who are suffering in the developing world. This paper takes a look at the evidence on aid and finds that, while it is not perfect, aid has had remarkable successes and has helped to make the world a much better place. The paper concludes with some suggestions to maximise the effectiveness of Australia’s aid program.
Next Issue: The Cost of War
overty, lack of infrastructure, widespread corruption and civil unrest are both cause and consequences of war. But how is our global community addressing the problems? And what can we do, now? We speak to MSF Head of Communications about the current crisis in DR Congo and more next issue...
Editor Design & Layout Kathryn Loon Vanessa Fitzgerald firstname.lastname@example.org email@example.com
“Empowering medical students in creating sustainable health improvements in developing communities”
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© Antonin Kratochvil / VII
Médecins Sans Frontières (MSF) Australia presents
DEMOCRATIC REPUBLIC OF CONGO:
FORGOTTEN WAR “Offers a glimpse of hope through the people’s resilience and the hand of humanitarian assistance. We’re compelled to bear witness...”
“Will send you back out into the world with a changed perspective. A rare and powerful insight into ongoing human disaster.”
New York Downtown Express
A unique photo exhibition from VII photo agency, New York, now on its Australian tour 2006-2007 · Brisbane 12 July-6 August · Townsville 15-27 August · Melbourne 26 September-15 October
· Canberra 23 October-5 November · Adelaide 11-28 November · Hobart 7-18 December
· Sydney 6-28 January · Perth 9-25 February · Shepparton 8-18 March
For more information go to www.msf.org.au
Entry is free