by Nina Munk
“We are hoping it will be working in a month,” said Dr. Mucunguzi.
Sachs looked skeptical. “And running water?” he asked.
“Well, we plan to put in a water tank. We need a maximum of one month to improve the system.”
“So,” said Sachs, questioning the young doctor, “today is January fourteenth. Could we really try to have this working by March first? No later.”
“Yes, yes.”
“I think it would be good for us to have a goal.”
Back outside, squinting under the midday sun, Sachs shook his head in disbelief; he was personally offended by the situation. “They can’t go on like this,” he said. “You have one hundred forty out of a thousand children dying before their fifth birthday. The mothers carry their children ten kilometers, and they’re dead in their arms before they get to the clinic—they’re dead in their arms, or they’re in a coma.”
Elementary school children raced after Sachs as he walked down the dirt road, waving happily. “How are you? How are you?” they cried, repeating the one English greeting universally taught in East African schools. Just outside the hospital a group of women wearing ankle-length gomesi, with high puffed sleeves and wide sashes, were singing, presumably in Sachs’s honor. Sachs moved along briskly. “This can’t go on,” he continued. “This is a death sentence. This is how we allow fellow human beings to die, by doing nothing. I don’t get it, I just don’t understand it—I’ve tried, but I can’t understand what we are doing.”
Uganda’s fertility rate is among the highest in the world. At the current rate of seven children per woman, Sachs reckons the population will double in the next twenty years, from around 35 million to 70 million—this after having already doubled in the previous twenty years. Meanwhile, the amount of farmland is shrinking. “Not only has the land been cleared and deforested, but the arable land can’t keep pace with the population, so people are getting hungrier and hungrier,” he said, stepping into his UN-issued Land Rover. “They’re trapped in poverty. They can’t find fuel wood. The nutrients in the soil are depleted. And next year they’ll be trapped even deeper in poverty—because they’ll have another child and two years after that, another child, and at this rate you can’t get out of poverty.”
Back at the center of town, on the other side of Ruhiira’s low-lying hills, local dignitaries and journalists were waiting for Sachs to arrive. Unsteadily, he made his way down a steep footpath—loose dirt and small stones—toward Ruhiira’s main water supply, a stagnant, muddy water hole. Girls and women in bare feet, babies strapped to their backs, were bending over the brown water filling plastic buckets and jerry cans. Young children were transporting the water up the slope, balancing twenty-liter jerry cans on their small heads. Some of the girls were dressed in torn party dresses, pink tulle with ruffles, that might have been sent to Africa by, say, a church in Tulsa, Oklahoma.
“Look at this!” exclaimed Sachs, in a rage. “It’s completely unprotected! You’re getting runoff of excrement. There are bugs floating on the surface. This is dramatic. People should not be condemned to drink this kind of water. This kills. Massively. This is a massive killer.”
Meanwhile, one after the other, onlookers were following Sachs down the footpath: villagers, local politicians, government officials, and at least three members of Uganda’s parliament, brushing dust from their Sunday suits. A half-dozen men wearing brand-new United Nations caps joined the group. A clutch of journalists arrived: a writer for The Guardian had flown in from London, along with a photographer for Agence France-Presse, a correspondent for Nation Television Uganda, and an eager representative for UNDP News, the in-house publication of the United Nations Development Program.
Nearby, being filmed for the BBC, was Sachs’s good friend George Osborne, a British member of Parliament and a rising star in the Conservative Party. (In 2010 he would be appointed Chancellor of the Exchequer.) “We’re here at the only water source for the village,” he intoned in a plummy accent, looking right into the camera. “And as you can see, the mothers there, some of whom are pregnant, are picking up water which they’ve then got to take up the hill.”
Sachs hadn’t come to Ruhiira to predict doom; his goal was to sound the alarm, to call the world’s attention to the poverty trap, and to gather support for his proposed solution. There was a solution to poverty, he was certain of that, and the solution was “basic” and “very simple,” and it was “amazing” how fast it could work.
“Thank you for bringing us to this place,” he began, addressing the villagers off the top of his head, without notes. “We are honored that you have taken us into your community.” The crowd hushed respectfully.
“We have seen how we can work with you to improve the agriculture, with new crops and ideas to improve your income.” A translator repeated his words to the crowd in the local Bantu language, Runyankole.
“And we have seen the bed nets in your houses. Do you have bed nets in your houses?”
“Yes!”
“All right!” responded Sachs. He was getting fired up now. “And are they working? Do they help?”
“Yes!”
“We are happy to see that. We went to the school, and we saw how the school-feeding program has started, and we’re very proud of what you have done with that. And we went to the health center to see how it is being expanded, with more health workers in the community. Why do I mention all these things? Because for every problem you have, there is a solution! We want to help you find the solution!”
The people clapped. Then they began to cheer. Sachs was pleased with himself and grinned. “In five years we are going to end hunger in this community,” he continued. “In five years we are going to bring malaria completely under control. In five years we will have hospitals and clinics through the whole community. In five years you will have beautiful crops. Step by step, poverty will become something of the past!
“Tomorrow we will be in Kampala meeting with your president, and we will tell him what remarkable progress you have made here. Because we now have the evidence—you are the proof of what can be accomplished! We will tell the president what you have done, and we will talk to him about expanding the project all across Uganda. And then we will go to Kenya, to Djibouti, to Ethiopia, and we will tell all the people what is happening here. We will tell them that we can fight disease! That we can fight hunger! That we can end poverty in our lifetime!”
Now, in a traditional Ugandan gesture of approval, the equivalent of a standing ovation, the villagers stretched out their hands toward Sachs and began wiggling their fingers. Everywhere you looked, like the gentle rain from heaven, fingers wiggled and fluttered. The people of Ruhiira were raining blessings on Jeffrey Sachs.
One day later, as promised, Sachs was in Kampala meeting with Yoweri Museveni, the longtime president of Uganda. While Museveni swiveled left and right in his black leather executive chair, Sachs was making an impassioned presentation to him about the Millennium Villages Project. Museveni’s support was urgently needed, Sachs told him. The situation was dire. People were dying. With the president’s backing, the project could be expanded, village by village, all across Uganda. “The idea is a poverty eradication effort, but focusing on practical investments,” Sachs informed him. “The idea is six goals with strict timetables.”
Museveni gestured to an assistant: he wanted tea.
“First,” Sachs explained, “we want to help the farmers have a bumper harvest of food. The key is fertilizer, so in Ruhiira, to start out, we’ve done a universal distribution to every household of fifty kilograms of fertilizer and about ten kilograms of high-yield maize seeds.”
“Mmmmm,” murmured Museveni in reply. “Mmmmm.”
“And they’re having a bumper harvest,” Sachs went on, “and it’s really incredible actually. Because of the fertilizer and the good seeds, it looks like they’re going to get six tons. The crops are eight feet tall right now. It’s really incredible.”
Museveni a
ppeared restless and kept on swiveling. His tea arrived. “Mmmmm,” he said, reaching for the sugar. That same week his government’s peace talks with Joseph Kony, the deluded leader of the insurgent Lord’s Resistance Army (L.R.A.), had collapsed, yet again. For the past twenty years, the L.R.A. had terrorized northern Uganda: 1.5 million Ugandans had been displaced, their villages burned to the ground. Tens of thousands of civilians had been butchered, their limbs hacked off by bayonets, their heads smashed with rifle butts. An estimated twenty-four thousand children had been abducted.
Even more troubling to Museveni, perhaps, was the fact that he was no longer the West’s favorite African leader. For many years after seizing power in 1986, he had been a “donor darling,” which is to say that Uganda had received a disproportionate amount of foreign aid. Modern and principled, devoted to democracy and reform, Museveni was widely viewed as the model for a new generation of African leaders. He spoke eloquently about ending poverty and sectarianism. He denounced African leaders in general for their corruption. “The Honorable Excellency who is going to the United Nations in executive jets, but has a population at home of ninety percent walking barefoot, is nothing but a pathetic spectacle,” he railed in his swearing-in address.
After a time, however, some observers began to ask themselves: Wasn’t Museveni just another African “Big Man”? In 2000, he’d ordered an executive jet for himself, a $30 million Gulfstream IV. And in 2005, just before the national election, he had abruptly amended Uganda’s constitution to abolish presidential term limits—with the result that he was able to run for an unprecedented third term. During the election, his opponents were mostly kept out of sight, independent media outlets were shut down, and uncooperative journalists were detained. Museveni won handily.
Meanwhile, Uganda remains one of the most corrupt countries in the world. A study prepared for Transparency International concluded what most Ugandans already know: that the majority of their country’s elected officials are guilty of “influence peddling, vote buying, nepotism, sabotage, bribery, diversion of public resources, and embezzlement.” Year after year, as much as half of all the money in government coffers—somewhere between $100 million and $950 million a year, depending on estimates—is looted.
Now, in his office in Kampala, swiveling in his chair, Museveni seemed distracted. Sachs had moved on to the subject of Ruhiira’s water supply. “The only water is way down in the valleys, so people walk kilometers down pretty steep paths to get to a miserable, unprotected water basin,” he reported. “It is shocking, I have to say, the water situation. We went down a steep slope to a pond that they had dug, and they just collect, you know, the runoff, and it’s muddy, the excrement from the animals is coming in, bugs are coming in. Completely unprotected! And that’s their water hole! And we saw the women there, a pregnant woman, baby on her back, with a jerry can trying to get water out. It was shocking, actually.”
“Mmmmm.”
“We’re trying to figure out whether we can pump some water in,” Sachs said eagerly. “I have a donor who’s the world’s largest manufacturer of PVC piping, and he said he’ll give a huge amount of piping if we can find a way to pump. So I think we can get that solved.”
“That water,” Museveni remarked offhandedly. “They boil it. As long as you boil that water—”
“I don’t know about that,” interrupted Sachs. “There’s no fuel wood to boil anything.”
“Mmmmm.”
Sachs circled back to the subject of the Millennium Villages Project: with the right interventions, success was almost guaranteed. “My impression, Mr. President, is that this will all happen within one year,” he assured Museveni. “And it shows to me a pretty basic point, which is that when we’re talking about extreme world poverty, it shouldn’t take a lot of time to make a difference. Just a couple of years could make a huge difference—with the right targeted investments, starting with agriculture, getting inputs to the farmers, getting basic health care, getting school feeding programs, and—it’s a bigger budget item, but I’d say, you know—making sure there’s a graded road and electricity connection, that will change the whole rural landscape.”
Museveni was interested in the root meaning of the word Ruhiira. “Bantu grass, that’s what Ruhiira means,” he said, stirring his tea. “That’s what Ruhiira means.”
“Yeah,” said Sachs, hurrying to the crucial matter of Uganda’s farm productivity. “Your country’s fertilizer use is about the lowest actually in the world right now. It’s essentially zero. And what we saw in Ruhiira, they’re going to get, in maize, six tons per hectare probably. This is really a bumper crop—not just a crop, a bumper crop! It’s phenomenal! And it’s because they never had fertilizer before.”
Sachs was urging Museveni to offer bags of subsidized fertilizer and high-yield seeds to every small-hold farmer in the nation. “Go for the big scale!” he said dramatically. “Why wait? There’s no reason to wait.”
Museveni cleared his throat. “I use fertilizers once in a while,” he remarked, referring to his own farm, his own personal situation. “I’m trying to remember, when I grew maize, I harvested eight hundred bags.”
“Eight hundred,” repeated Sachs, politely.
“Yes, eight hundred—eight hundred bags. I must have been using like fifty acres. The bag is one hundred kilograms.”
“That’s eighty tons over fifty acres,” said Sachs, running the numbers off the top of his head.
“Mmmmm.” Museveni, reaching for the calculator on his desk, started tapping the keys: “That’s one point six …”
Sachs was way ahead of him. “Times two point five would be—that would be four tons per hectare.”
“Four tons?” asked Museveni, puzzled by the figure.
“Per hectare,” repeated Sachs.
“Ah, okay,” agreed Museveni. “That’s what I harvested. Yes.”
“You’re a master farmer: you got four tons,” said Sachs, complimenting the president on his crop yield and eager to return to the matter at hand. “But the average here is less than a ton,” he pointed out, referring to Uganda generally.
Museveni seemed mildly interested. Who would have thought that his nation’s small-hold farmers were so unproductive? “Mmmmm,” he remarked. “That’s very low.”
“But with fertilizer, you get four tons,” Sachs added, hoping to seize the day. “If you had all the farmers quadrupling their yields, do you know what kind of growth that would mean for this country? That’s like a twenty-five percent increase of GNP!”
Museveni settled back in his chair. On the wall behind his desk was a single framed photograph, of Museveni himself. “Yes, I see,” he said, still sipping his tea. “But there are other things to consider, Professor. You know, in these countries of Africa, we have many other problems. This is not India or China. There are no markets. There is no network. No rails. No roads. We have no political cohesion.”
The meeting with Sachs was over. The president had other commitments. Downstairs, his driver was standing by.
Chapter 6
Everything Is Written
Change came slowly to Dertu. Ahmed worried that time was running out. There was so much to do. Convincing people to cut hay or use mosquito nets was one thing; changing social conventions was something else altogether.
More than 80 percent of Dertu’s population is illiterate. Most men have three wives, and women, on average, have nine children. One woman in Dertu, Amina Abdi, had given birth to six children; all died in childhood. Another woman, Adey Mohamed, had ten children; six died before the age of five. How did they die? I asked. Adey shrugged: “I am a Muslim. I am a strong believer. If death happens, no one can prevent it. When a child is born, God has already set for him a fixed time of death. Everything is written.” She paused, then added: “Why are we put on earth if not to have children?” Even Fatuma Shide, whose job as the Millennium project’s health coordinator involved teaching people family planning and “gender empowerment,” had given b
irth to ten children; two died shortly after birth.
One evening, sitting under the moonlit sky in Dertu, I found myself talking about children with Ahmed and two members of his senior staff, Idris Sahal Kolon and Abdi Sheikh Mohamed. The khat leaves we were chewing stuck to the roof of my mouth like bits of cheap toilet paper. “The short-term goal is that children take care of you when you get old,” Idris said, unraveling the logic of large families. “The long-term goal is increasing the population of the clan to protect against tribal invasions and to maintain the dynasty.”
Idris and Abdi were startled to learn that I have only two children and, worse, that I don’t plan to have more. “Only two!” Idris exclaimed. “Please have more children. Have five or six. Do not waste yourself. Please.”
“Bill Gates, if he is so rich, why does he not have more children?” asked Abdi, whose own father had twenty-four. “America is called the land of plenty, but why do you not give birth? This Oprah Winfrey. Why does she not have children? Bill Clinton—he has only one daughter. I sympathize for him.”
“Our former president has eight children,” chimed in Idris, referring to Daniel Arap Moi.
“He is blessed with children and power,” added Abdi, suggesting that one is linked to the other.
“You should have as many children as possible,” said Idris. “Do not fear. God will take care of your children. God will be sure you can afford the medical bills. God will help you pay for the school.”
“A Somali man can think only to have more children,” Ahmed said, shaking his head. “One man in Dertu has twenty-one children. He always tells me, ‘Dr. Ahmed, I am father of twenty-one and I am not yet sixty!’ He is proud of this.”
For Jeffrey Sachs, the pattern makes good sense: people make a rational economic decision to have large families. Because child mortality rates in Dertu are among the highest in the world, parents naturally assume that a high percentage of their children will not survive. Giving birth to too many children is a kind of insurance policy, a hedge against the risk of loss: parents overcompensate.