A healthy dose of small good things

A hand-out or a hand-up? The arguments about the benefit of aid in developing countries are well worn, and even though it’s not a crease-free, perfect panacea, Irish Aid in Africa focuses on sustainability

WHEN REUBEN Muteti steps up to the microphone in the grounds of the Mater Hospital in Nairobi, it has to be adjusted downwards. Dressed in jeans and a green T-shirt, he says he is 13 but he looks no more than 10.

Reuben is nervous, but in telling his story he personifies simplicity and innocence. His speech isn’t about hardship and poverty, but he has known both all his life. He was born HIV positive, and is an orphan. His home is a corrugated iron shack in Mukuru, one of the massive slums in Nairobi, Kenya’s capital city.

Instead, Reuben’s story is about a bus journey he took out of Nairobi with his aunt to visit his grandmother in the countryside. Somewhere along the way he realised that he had lost the bag containing his antiretroviral drugs. He describes the overpowering sense of panic, of how he and his aunt desperately searched for it, to no avail.

“Do you know your medication?” his aunt asked, eventually.

“Yes, I know,” Reuben replied.

They went to the nearest hospital, a long way from home, and when Reuben told the doctors the complicated names and dosages of all the drugs he was on – Stavudine, Lamivudine and Efavirenz – they were able to give him the medication he needed.

“The doctors said to me: ‘Well done. Good boy’,” he says.

The story is not just an illustration of how important it is for kids such as Reuben to take their medication every day; it is a vivid depiction of the sense of panic that overtakes a child when they have lost something or made a mistake and think they have done something terribly wrong.

Reuben’s story affects everyone in the room who hears it. It also strikes a chord with Tánaiste and Minister for Foreign Affairs Eamon Gilmore, who is in the audience. He hugs the boy. Later, he says it reminds him of something that happened to him during his childhood in Caltra, Co Galway, where his widowed mother brought her family up in modest circumstances. “I remember, as a boy, going to sell eggs and losing the 10-shilling note on the way home,” he says. He is unable to say any more. Reuben’s story is important because it doesn’t highlight the differences between our world and his. Instead, it evokes powerful human qualities of decency and compassion that we share.

In recent years, there has been a rising level of debate and literature that questions the efficacy and ethics of western aid. A good deal of it suggests that aid programmes hinder, not help, have a tendency to corrupt, rather than liberate, and hamper development and growth in African countries.

In her book Dead Aid, Zambian writer Dambisa Moyo makes a compelling argument that aid can have few discernible long-term benefits and can undermine sustainable development. Describing a vicious cycle of aid, she says it helps foster corruption, instils a culture of dependency, and has deleterious consequences for growth.

In Ireland, the debate has sometimes taken place at a more knee-jerk level on the airwaves, along the lines of: “Wouldn’t we be better off spending the €659 million Irish Aid budget in 2011 on other things?”

The answer is, no. It is not a crease-free, perfect panacea. But aid makes a real difference.

Reuben is speaking in the grounds of the Mater Hospital in Nairobi, which was founded 50 years ago by Irish Sisters of Mercy. Reuben is one of almost 2,000 people who get antiretroviral treatment from the hospital’s comprehensive care clinic. It is free, and without it children such as Reuben would not have a hope of paying for the treatment that keeps them alive and healthy.

The Irish Aid programme is almost 40 years old. The Department of Foreign Affairs, and NGOs such as Concern, Trócaire, and Goal that work on the ground, have focused their attention on long-term and sustainable development programmes. They have also focused on social and civil dimensions, such as governance, equal opportunity for women and the rule of law. On a practical level, you see the tangible difference they make to the quality of people’s lives.

THE MOST SURPRISING thing about this first visit to sub-Saharan Africa – this trip, with the Minister, takes in three countries: Uganda, Kenya and Somalia – is how positive the experience is. Currently, there is no famine or emergency on the Horn of Africa, but life boils down to endemic poverty, subsistence living, and a lack of opportunity for the majority of people. Poverty and its side-effects – malnutrition, susceptibility to disease, and much higher mortality rates – are visible everywhere we go: in the tribal Karamoja region of northern Uganda; in the threadbare refugee camps surrounding Mogadishu, the ruined capital of Somalia; and in the sprawling slums of Nairobi where families of six or seven live in tiny, leaky corrugated shacks without water or electricity.

What is so life-affirming is the disposition and optimism about a brighter future in just about everybody we meet, including the missionaries and agency staff who have dedicated their adult lives to Africa. Irish Aid projects are concerned with health, education and training as well as with implementing longer-term sustainable development policies. At a basic level, aid agencies run basic health and nutrition clinics for mothers and infants, where the extraordinary Plumpy’nut – a peanut paste that looks like an energy bar – ensures babies get nutrition vital for their wellbeing. Concern runs programmes in Mogadishu and Nairobi.

There are programmes that keep children such as Reuben healthy. And there’s the simple but effective social-protection programme, operated by Irish Aid in Uganda and by Concern in Mombasa. It’s a form of basic dole where families get a modest income (less than €8 a month). It’s regular and it allows them to plan a little, to edge away from hand-to-mouth living, and to pay for school fees. It’s also direct and benefits the local economy.

The way it is administered is ingenious: the transaction is made in pay-as-you-go credits on mobile phones, which have become electronic currency in remote and poor areas, that can be traded just about anywhere.

When it is invested in education and training, aid money gives young Africans an opportunity to aspire. There are Irish scholarships and school-building programmes in Karamoja – the poorest area in one of the poorest countries in the world – which have brought kids from dire poverty through university. In Concern-run schools in ravaged Mogadishu, 6,000 pupils from the poorest area go through the gates. In this Muslim culture, all the girls are wearing full-veiled uniforms in primary colours. In the Mukuru slum, Goal runs a project that trains adolescents and young adults as hairdressers, cooks, waiters, sign-writers, artists.

For Gilmore, the case is unarguable. “If you look at Mogadishu, there were a total of five schools. The total cost of all of that was €650,000 with 6,000 pupils getting a start in those schools. The projects have matched value and need.”

However, the longer-term policy of sustainable development will become a priority. Gilmore and senior staff in Irish Aid – and this feeds into Moyo’s argument – believe that, in the long term, policy and assistance will focus more on trade, economic investment and bolstering commercial enterprises. Irish expertise will play a part in counselling on developing agriculture, the food industry, tourism, information technology, education and energy.

At present, for example, electricity is available to only 10 per cent of Uganda’s population. For some people in remote parts of Ireland, such as Connemara and west Kerry, that were not electrified until the 1960s and 1970s, life was not far removed from subsistence. Electricity enabled, for example, dairy products to be chilled and have a longer life. The same process is beginning in some parts of Africa, but it will take a few generations.

Anomalous as it sounds, it will need a strong middle class and a buoyant private sector as agents of change and creators of employment as well as accountable governments and settled democratic regimes. And that’s where the long-term policy will focus. For now, the Irish contribution is only a drop in the ocean given the scale of the task in Africa.

In a famous short story by Raymond Carver, a baker is confronted with parents grieving after the death of their little boy. He gives them each a cinnamon roll and tells them to eat because it is a “small good thing”. Irish Aid can do small good things. It won’t change the world, but it makes a real difference to hundreds of thousands of people. The kind of difference that allows a child such as Reuben to be healthy, to be alive, to touch hearts.