by Nina Munk
“What we’re talking about here is a community that is barely surviving,” Sachs remarked. “Violent poverty, natural hazards, conflict, degradation of the environment—objectively speaking, it doesn’t get harder than this.”
Sachs had read all about Dertu, and for him the place represented an irresistible challenge: “I mean, what we are starting with here is a baseline that is not only below normal standards, but below minimum standards.” If his theories on ending poverty could work here, in one of the most deprived places on earth, they could work anywhere.
It was Ahmed Mohamed’s job to lift the people of Dertu out of extreme poverty. Hired by the Millennium Villages Project in March 2006, one year after completing his Ph.D. in Belgium, Ahmed was responsible for implementing what he referred to, admiringly, as “the Great Professor’s Ideas”—the Great Professor being Jeffrey Sachs.
Step by step, intervention by intervention, an official Millennium Villages Handbook prescribed the course of action to be followed by “change agents” assigned to each village. A 147-page, single-spaced document written by twenty-nine academics, mostly from Columbia University, the handbook features dozens of flow charts, protocols, organizational tables, benchmarks, timelines, and hopeful objectives. As Dertu’s designated change agent, Ahmed set out to eradicate extreme poverty by following the Millennium Villages Handbook to the letter.
In early 2006 he recruited a team of five educated Somalis from other NGOs and got to work. He’d had no training or experience in economic development, but he was full of optimism. With so much money flowing directly from New York into Dertu—a massive infusion of over half a million dollars during the first year—he could accomplish a great deal. Imagine the potential impact of such largesse!
“With just a few interventions—ambulances, mobile clinics, a cell network—you could make a huge difference,” Sachs assured Ahmed when they met. “With improved inputs, veterinary care, better breeding, a farmers’ cooperative, tapping the Tana River … There’s a tremendous amount to be done.”
For all that, Dertu was perhaps the most challenging of all the Millennium villages. Just getting basic supplies there from Nairobi took weeks, sometimes months. Early in Ahmed’s tenure, a mechanical part that was needed to repair one of the well’s generators took four months to arrive. When the part did arrive, no one in Dertu knew what to do with it (skilled labor being practically nonexistent among camel herders). Eventually, at considerable expense to the Millennium project, a mechanic was summoned from downcountry.
The closest “city,” the chaotic frontier town of Garissa, was only sixty miles south of Dertu, and yet the drive took four hours or more on a good day. When the rains came, the dirt track deteriorated into “soup,” as the locals call it, and the drive could take an entire day. Drivers heading to Dertu rarely made it out of second gear as their trucks bounced along the narrow track, swerving to avoid ruts and boulders and thornbushes. (There’s a good reason for the stacks of spare tires carried behind and on the roofs of Land Rovers in North Eastern Province.)
Without proper roads, how do you reach a nomadic population spread thinly over 750 square kilometers (around 300 square miles)? Ahmed and his staff spent months trekking into the bush, spreading the word, encouraging cooperation, and convincing skeptical elders to support the Millennium Villages Project. Because there were no staff quarters in Dertu, Ahmed and his team slept outside, or else they commuted across the rough terrain, back and forth to Garissa, sharing the project’s one vehicle. It wasn’t long before the vehicle, a cheap pickup truck, had to be written off.
Ahmed faced challenges, one after another, that the authors of the Millennium Villages Handbook hadn’t anticipated. Entire chapters had been devoted to improving agriculture yields, boosting school enrollment, and promoting gender equality. But nothing in the handbook told the change agents how to reduce crime. Ahmed hired police escorts to protect his team from banditry and tribal clashes. He also hired security guards (two for night, two for day) to guard the Millennium project’s compound. Nevertheless, shortly after the Millennium Villages Project was established in Dertu, Ahmed’s health coordinator, Fatuma Mohamed Shide, was clubbed senseless in a fight between two Somali subclans.
Nor did the handbook address the subject of natural disasters. By the time Ahmed accepted the job with the Millennium Villages Project in 2006, the water well in Dertu had dried up. Since 2002, the entire Horn of Africa had been suffering from drought. The situation was so dire in Dertu that Oxfam was delivering water once or twice a week in tanker trucks. With every visit, each household received a twenty-liter (5.3-gallon) allotment of water. But twenty liters was not nearly enough; many people had to walk hours, sometimes days, in search of water. Herds of cattle died. Dertu’s undernourished camels stopped producing milk.
Ahmed received approval from the higher-ups in New York to spend part of his budget on imported water. Day after day, for months, tanker trucks paid for by the Millennium Villages Project kept the people of Dertu alive.
At last, in October 2006, the heavens opened and the rains came: a drop or two at first, then the deluge. Rushing to save themselves from the floodwaters, the people of Dertu lost everything they had, which, God knows, was little enough to begin with. Whatever headway Ahmed made in his first few months on the job was washed away by the floods.
At the local dispensary, cases of malaria surged from 50 per month before the rains to 450 in December. Severe diarrhea, brought on by contaminated water, spread fast, and there were no IV fluids to treat dehydration. Then, as though the people of North Eastern Province hadn’t suffered enough, a three-year-old girl in the region was diagnosed with polio—Kenya’s first reported case in twenty-two years. With the dirt roads impassable to vehicles, the UN deployed helicopters to drop food aid and medical supplies across the province.
It wasn’t long before Rift Valley fever began spreading, transmitted from animals to humans. In Dertu alone, in a single month, six people were diagnosed with the disease; all but one died. From one day to the next, North Eastern Province was crowded with teams of medical workers: doctors and epidemiologists from the Centers for Disease Control, from Doctors Without Borders, from the World Health Organization. Until the outbreak could be contained, the sale of camel milk was strictly off-limits. A ban was placed on the sale of all animals.
For seven weeks the livestock market in Garissa, the biggest, most important livestock market in the area, was shut down. Without the sale of camel milk or livestock to sustain it, the limited economy of North Eastern Province came to a standstill. The market price of brides, a key economic indicator in North Eastern Province, declined sharply, with the result that a wife could be had in exchange for four scrawny cattle. “In these times,” Ahmed remarked, “men can marry up to four women cheaply.”
Kenya’s government stayed aloof from the disasters in North Eastern Province. Flood, disease, drought: they weren’t the government’s concern. In 2006, in the midst of the drought, members of Kenya’s parliament rewarded themselves with yet another increase in compensation. In a country where the per capita income was $770 a year, they were already earning about $100,000 a year—a salary that included tax-free perks: $10,000 a year for entertainment; $11,500 for housing; $12,000 for gasoline and auto maintenance; $5,000 for “extraneous expenses”; and on and on.
Once the floodwaters started to recede, a group of Dertu’s community leaders gathered to air their grievances and share their frustrations. (The Millennium Villages Handbook states clearly that community participation is critical to the project’s success: “Create opportunities for critical mutual and collective reflection and learning.… Host or facilitate quarterly, bi-annual or annual stakeholders review meetings for monitoring and scaling-up.”)
“Our needs are many,” cried one of the men, a tall Somali wearing an embroidered kufi. Sitting cross-legged under one of the few shade trees in Dertu, Ahmed nodded sympathetically. He’s a tall man, serious and imposing, who lo
oks older than he is. In Dertu, everyone called him “Dr. Ahmed.”
“It is only God and us who know the kinds of problems we have here,” said a woman named Sahlan Bath Hussein, her face framed by the long purple hijab she wore over a white cotton gown. She was thirty-three years old and the mother of five children. Now and then, she explained, her husband showed up in Dertu with money or gifts or bags of grain for her; otherwise he lived with his other wife close to the Dadaab refugee camps.
To support herself and her children, Sahlan had opened a tea shop, a wooden shack in the center of town where she made chapatis on a three-stone fire and served chai while her eldest child, a girl of thirteen, looked after the younger children. Month after month, coin by coin, Sahlan had set aside money to pay for medical emergencies and school fees; like many rural Africans without access to commercial banks, she had buried her money in the ground for safekeeping. The floods carried away her “soil bank,” her life savings.
“We suffered through the drought,” Sahlan continued. “We lost many animals, even our donkey. And now the flood has caused even more problems. We cannot eat our cattle or drink our milk, and the little we had has been washed away by the rains.”
Dertu’s one shopkeeper, Abdi Hussein, had seen his business collapse. In good times, his store—a small lean- to with merchandise consisting of flip-flops, hair combs, bags of sugar and cornmeal, Sunpop soda, and bars of Star Beauty soap—could bring in as much as 4,000 Kenyan shillings (Ksh) a month, about $55. Since the flood, sales had collapsed to just over 500 Ksh a month, less than $7. “What can I do?” Abdi asked Ahmed rhetorically. “I pray only that it will be better soon. Insha’Allah.” God willing.
Ahmed understood that the people of Dertu wanted change. “Please bear with us,” he said. The Millennium project’s planned “interventions” were firmly on track, he assured them, but economic development does not happen overnight.
Already Ahmed and his staff had given out mosquito nets and had vaccinated thousands of camels, cattle, sheep, donkeys, and goats. Using basic materials donated by the Millennium Villages Project and UNICEF, they’d encouraged the people of Dertu to dig and build fifteen pit latrines. To reverse the baleful effects of deforestation and erosion, and to create wind and sand barriers, they’d handed out five thousand acacia seedlings and taught people how to plant and care for the trees. A demonstration farm was under way, sorghum and maize were planted, and eighty-four hoes and eight spades were given out to herders willing to learn about agriculture.
“I can promise you,” said Ahmed, “it won’t be long before your lives improve.”
In early 2007, as buds appeared on the shrubs and the desert grasses grew high, Ahmed set out to convince the people of Dertu of the benefits of hay. “If you gather and dry the tall grass now,” he explained, “you will have food for your animals the next time the drought comes.” The people were not impressed by his ideas about drying the tall grass. “God has brought us this grass,” one man objected. “It is not ours to cut.”
Like the people of Dertu, Ahmed is both Somali and Muslim. He’d grown up in these parts; he was the son of a herdsman; he was one of them. For all that, he was viewed as an outsider in Dertu. His pleated dress pants, his starched shirts, his trim beard—those things set him apart. And more than once it was pointed out that while he was Somali, he was descended from a different sub-subclan than the people of Dertu. That alone was a reason to mistrust him.
In Saudi Arabia, Ahmed reasoned, devout Sunni Muslims cut grass; if God didn’t object to Saudis cutting grass, surely He would permit the Sunni Muslims of Dertu to do the same. No one was moved by this logic. “It is God’s gift,” someone repeated. “The more you cut, the angrier God gets—it is a bad omen.”
“Time is running out,” Ahmed said gently. “The fires are coming with the winds from Somalia, and those fires will consume all the grasses if you do not cut them first.”
An old woman named Mama Abshira confronted Ahmed, poking her finger in his face. He was interfering in their way of life, she said. Others jumped in. Soon everyone was arguing. There was a blur of confused shouting. “Please,” begged Mama Abshira. “For heaven’s sake, don’t cut our grass.”
Ahmed has a natural talent for diplomacy. When arguments broke out, he would smile agreeably and then, patiently, find a way to settle them. But attitudes are deeply ingrained in Dertu and people are suspicious of change. “The environment is changing, yet the people are not understanding,” he told me. “They believe the rains have failed because of their sins or because they did not properly celebrate a festival. I cannot convince them that droughts are part of the long-term way of life.”
Convincing people to use mosquito nets was almost as difficult as convincing them to make hay from grass. Wherever you look in Africa, you see the devastating effects of malaria: children in comas, men and women sapped of energy and unable to work.
Controlling malaria was a top priority for Jeffrey Sachs, who convinced Sumitomo Chemical to donate $2 million worth of long-lasting insecticidal mosquito nets to the Millennium Villages Project. By reducing the incidence of malaria and other mosquito-borne diseases, mosquito nets would not only save lives, he argued, they would also improve economic productivity. In other words, an investment in malaria control was an investment in Dertu’s future prosperity.
Ahmed and his team distributed more than three thousand of Sumitomo’s high-tech mosquito nets to protect the community from malaria and other mosquito-borne diseases. To make very sure that the nets were used properly, as intended, Ahmed issued a stern edict. “This is for human life,” he told the people of Dertu, “donated by someone to ensure your survival. If we see you put it over a goat, we will withdraw it.”
Traditionally, nomadic pastoralists rely on smoke to keep mosquitoes from attacking their livestock. However, using smoke as a mosquito repellent means that someone has to rekindle the fire every hour or so throughout the night. “It is easier to simply use the nets to protect the animals,” said Ahmed, explaining why in Dertu some nets were being diverted from a child’s bed to a herd of kid goats. “And in a pastoral community, the livestock have more value than humans.”
Chapter 5
Every Problem Has a Solution
In January 2007 Sachs traveled to Ruhiira, an isolated village in the highlands of southwestern Uganda that had been named a Millennium village six months earlier. There wasn’t much of anything in Ruhiira. No electricity or running water. No paved roads. It was a place of lack, of deprivation, and thus was typical of Sachs’s model villages.
The soil, at one time rich and fertile, was depleted from years of abuse. The surrounding hills had been stripped bare of trees. Without firewood at hand, villagers were forced to use rootstalks as cooking fuel. Matoke, a green banana that is boiled and then mashed, is the staple food in these parts. You won’t starve living on matoke, but you won’t thrive: in Ruhiira, four in every ten children are chronically malnourished, their growth stunted for lack of nutrients.
The first time he arrived in Ruhiira, Sachs was alarmed. As Dr. William Nyehangane, the district’s health officer, informed him, the total annual budget for health care in the area was $1.90 per person. “Unbelievable!” said Sachs. “Did you hear that? One dollar and ninety cents. One dollar and ninety cents. Unbelievable.”
At an absolute minimum, for a basic health care system to function, Sachs had calculated that a country must spend $40 per person annually. In much of sub-Saharan Africa, health care budgets are around $20 per person. Yet here the annual health care budget was less than $2 per person. In Ruhiira, where malaria was the number one cause of death for children under five, where TB was rampant, and where the odds were one in thirteen that a woman would die during pregnancy or childbirth, there was really no health care at all.
The Kabuyanda Health Center, the closest hospital to Ruhiira, was hours away by wheelbarrow, the conveyance most often used to transport the sick from one place to another. Located twenty mi
les off the national electric grid, the health center had no power. Once, for a short time, two solar panels were mounted on the roof. They disappeared. As for the nineteen-kilowatt generator parked outside the building like a totem, there wasn’t enough money in the budget to buy diesel fuel.
Without electric power, how do you provide standard medical treatment to people who are dying? Without running water, how do you wash the blood from floors and beds and open wounds? How do you sterilize surgical tools or keep your hands clean or store blood or refrigerate vaccines?
As he made his way through the hospital, Sachs looked distraught. “How many beds are there here?” he asked the young doctor on staff, Stephen Mucunguzi.
“Twenty-eight.”
“Twenty-eight for a hundred twenty-five thousand people?” repeated Sachs, trying to grasp the implications of such numbers. “Aren’t they filled, filled, filled?”
Dr. Mucunguzi showed Sachs the operating theater, a bare cement room built in 2002 that had never been used for surgery. There’d been one roadblock after another, the doctor explained: surgical equipment had been ordered but had taken three years to arrive. By the time it did arrive, the only doctor on staff had quit, leaving the hospital with no doctor at all for five months. Finally, in late December 2006, Dr. Mucunguzi had come on board, but only after the Millennium Villages Project offered to supplement his official $350-a-month salary.
In any case, the operating theater had been so shoddily constructed that without major repairs it couldn’t possibly be used for general surgery. The windows wouldn’t close. The air vents were broken. There were no floor tiles, no medical scrubs, no surgical gloves. The government promised to deliver drugs to the hospital every three months, but they never arrived on time; when they did show up, the supply was barely enough to last a fortnight.