by Nina Munk
In Dertu, children collect water, gather firewood, and herd camels, among other necessary chores. They represent cheap labor. But as living standards improve and households gain access to running water and gas stoves, children will become less economically valuable. At the same time, with better health care, more children will survive. The end result, according to Sachs, will be that fertility rates drop. In his view, prosperity is the most effective form of birth control.
Intuitively, Ahmed knew that the people of Dertu would be better off if they had fewer children—children were a liability, not an insurance policy. But to him the issue wasn’t about economics; it was about life and death. Pregnancy is risky everywhere; in Dertu, however, where just about every woman gives birth at home in her aqal, sometimes far into the bush, childbirth can be a death sentence. Even by the dismal standards of rural Africa, maternal and infant death rates in Dertu are shocking. When something goes wrong, when labor is prolonged, or the baby is trapped in the birth canal, or the mother is hemorrhaging, her family typically summons a traditional birth attendant, whose medical artillery consists of herbal potions and prayer.
Late one afternoon, while the village nurse, a young man named Mohamed Malele, was preparing to go home for the day, a nomadic herdsman appeared at the dispensary pleading for help. The herdsman’s wife had just given birth, and she was bleeding badly. Please, asked the man, could Mohamed return with him to his homestead?
When Mohamed arrived at the aqal, the woman was lying on the ground, moaning and barely conscious. Her sarong was soaked through with blood. Two other women (neighbors? relatives?) crouched over her. The newborn baby was wrapped in a cotton sarong. A young girl, about ten years old, was feeding the infant camel’s milk from a pink plastic cup.
By the time the men carried the woman to the dispensary in Dertu, it was dark. Someone held up a plastic flashlight while Mohamed looked around for a dilator and a pair of clean latex gloves. Scattered on a utility cart were dirty tweezers, an open bottle of amoxicillin tablets, and an empty box of syringes. On the floor of the dispensary, a cardboard box was overflowing with soiled gloves and used needles.
Mohamed needed water. He tried the tap at the sink; nothing but air came out. He sent the herdsman to fetch water from the tank outside, but the on-and-off valve had been put somewhere for safekeeping, in order to prevent people from stealing water, and now no one could find it. Holding a roll of gauze, Mohamed soaked up the woman’s blood. Her placenta was not fully expelled, he concluded. He tried detaching it manually. Meanwhile, lying on the vinyl examining table, the woman kept drifting in and out of consciousness. The wind had picked up, and sand was blowing into the room through the open windows.
By morning, the woman was dead. Her family came to collect her. Hastily they buried her, then returned to their homestead deep in the bush. No one seemed especially startled by her death. In this place, life was a game of chance. One day you’re sifting grain outside your aqal, and the next day you’re dead. Everything is written.
In his monthly reports, e-mailed to the Millennium Villages’ head office in New York, Ahmed listed his many accomplishments in Dertu. He was making progress, even if it wasn’t at the pace he’d hoped for. At the dispensary, he had installed a generator just big enough to power a microscope (to diagnose malaria and tuberculosis). He’d purchased a propane refrigerator to store vaccines and antivenin. A small laboratory had been built, and Ahmed had hired a lab technician whose monthly salary of 25,000 Ksh ($350) was paid by the Millennium project. Novartis, the Swiss pharmaceutical company, donated Coartem, the newest and most effective antimalarial drug. Other essential medicines were being sent from New York and Nairobi. Once a month, for a day or two at a time, nurses came from Garissa to set up temporary open-air health clinics in the bush around Dertu. They immunized children, treated the sick, and educated pastoralists in basic health and nutrition.
At Dertu’s primary school, Ahmed and his team enclosed the grounds with a tall fence to keep out warthogs and to protect the children from hyenas and jackals. They built a new classroom, installed a solar panel, and wired up two lightbulbs so the children could work after sundown. One of the Millennium project’s core interventions called for Ahmed to establish a school-feeding program that provided the children with a free lunch of beans and ugali, a thick cornmeal porridge. The results were obvious and immediate: not only did the feeding program reduce malnutrition; it also encouraged parents to send their children to school. From fewer than 300 before Ahmed’s arrival, the student population had now grown to 450.
To better serve nomadic families, Ahmed recruited an itinerant teacher: Abdullahi Bari Barow, the son of a nomadic herder, who had grown up not far from Dertu. In exchange for a camel and a monthly salary of 15,000 Ksh (about $200), Abdullahi moved with the pastoralists from place to place, wherever they set up camp. He would untie the blackboard from the back of his camel, establish his classroom under an acacia tree, and proceed to teach reading, writing, basic math, and basic English to 110 pupils (more or less) between the ages of three and twenty-eight.
For all his sound ideas, Ahmed was confined by his limited budget, which was strictly controlled from New York—with the result that Ahmed started writing letters to various NGOs, requesting money for this worthy project or that one. Pointing out that sleeping quarters would encourage nomadic herders to keep their children in school, he convinced UNICEF to build a dormitory. To provide emergency transportation from the bush to the dispensary, he asked the Danish International Development Agency to donate thirty two-wheeled donkey carts, whose passengers would include women with life-threatening birth complications (cord prolapses, hemorrhages, obstructed labor); children stung by scorpions; herders who’d been bitten by black mambas, spitting cobras, puff adders. A Swedish woman donated enough money to build a basic maternity ward in Dertu. CARE provided funding for an additional schoolteacher. USAID donated four beds to the health clinic. The UN’s Food and Agricultural Organization gave $20,000 to plant a tree nursery.
Meanwhile, Ahmed was lobbying local government officials to grade and widen the dirt road between Garissa and Dertu. “Where the money will come from I don’t know,” Ahmed said cheerfully, “but I wrote a letter to the minister of roads requesting one million shillings to build us a good road!”
To gauge progress, the Millennium Villages Project used standard metrics, measuring such things as infant mortality, maternal deaths, fertility rates, malnutrition, access to safe water, improved sanitation, primary school attendance, and so forth. At Columbia University in New York, a team of experts worked full-time gathering and organizing these data as they came in from the villages. It was time-consuming work.
For one thing, the quantity of data was enormous: just to create a baseline against which improvements could be measured, the Millennium project had devised ten different household surveys, each with dozens of questions that had to be asked by fieldworkers. For example: Do you practice birth control? How many times have you been pregnant? Did you give birth with the help of a traditional birth attendant or a health professional? In the past year, has anyone in your household not had enough to eat? How often in the past year has someone in your household been treated for malaria? Do you own a mosquito net? Do you use fertilizer? Do you own a radio? Do you own livestock? Does anyone in your household attend school? Beyond the household surveys, researchers had compiled reams of demographic and medical data: blood and stool samples were tested for parasites; head and arm circumferences were measured to assess malnutrition. They had obtained birth and death records; on and on.
Back in New York, all the data collected in the field had to be analyzed and plugged into spreadsheets. Someone had to make sense of handwritten notes, compare inconsistent medical records, discard questionable results, and send back incomplete surveys. It took eighteen months just to sort through the first round of data, never mind the follow-up data that continuously came in from the villages.
For all that, A
hmed viewed the metrics with skepticism. In rural Africa, record keeping is generally sloppy. Besides, when questioned by outsiders, villagers don’t necessarily tell the truth; sometimes they frame their answers to please the questioner. One villager, pregnant with her fifth child, freely admitted that she’d told a surveyor that she had two children. Why didn’t she tell the truth? I asked her. “You are a mzungu,” she said, using the Swahili word for a white man, “and we know that mzungu do not approve if we have many children.”
Ahmed had his own way of evaluating the success of the Millennium Villages Project: he counted the number of corrugated tin roofs in Dertu. In Africa, tin roofs are a sign of material wealth—a “status symbol,” he called them. One year into the project, by the summer of 2007, the number of tin-roofed structures in Dertu had climbed from six to about thirty. Soon they numbered nearly one hundred. Approaching Dertu, you could see them from at least a mile away, shining like beacons.
From the beginning, the goal of the Millennium Villages Project had been to support the pastoralists’ traditional nomadic way of life and, at the same time, to provide basic health and education, ensure access to clean water and sanitation, improve the quality of livestock, and build roads linking people to markets. Encouraging nomads to become “pastoralist dropouts” (as they’re known in academic circles) was no one’s objective. Nevertheless, the money pouring in from the Millennium Villages Project encouraged more and more pastoralists to abandon their nomadic life and settle in and around Dertu. A growing number of residents were immigrants from other, poorer communities. “Modern life encourages sedentary life,” remarked Ahmed.
Tin roof after tin roof, Dertu was turning into a village. Some people opened tea shops and simple restaurants. Others hawked batteries, flip-flops, and khat. Others sat around, waiting for handouts and the odd job from the Millennium project. With so much commercial activity in town, Abdi Hussein, Dertu’s first shopkeeper, now complained that he suffered from too much competition.
Inside people’s aqals, there were growing signs of material wealth: tin bowls, plastic cups, the odd bar of soap, hair oil, powdered milk, plastic sandals, even basic furniture. Abdullahi, the itinerant schoolteacher, built for his wife and newborn daughter a one-room “semipermanent” house made of mud and corrugated tin. A sheet of vinyl flooring had been placed over the sand. The room was dominated by a brown ultrasuede sofa that Abdullahi had bought in Garissa.
Madame Sofia Guhad, the school principal, was the proud owner of Dertu’s first television set, a twelve-inch model bought in Nairobi for 25,000 Ksh, about $350 or a month’s salary for her. One evening she asked me over to watch TV. Even before I entered the school compound, I could hear high-pitched sounds that turned out to be love songs performed by a Somali pop singer named Kaskey. Dressed in an orange tracksuit, he was surrounded by a wild pattern of red flames that darted here and there and spun around like a barber’s pole. A festive crowd had gathered in front of the flickering TV screen outside; no one seemed bothered by the noise and fumes coming from Madame Sofia’s secondhand diesel generator. The crowd laughed and clapped and sang along with Kaskey.
Darkness fell, and the generator coughed and ran out of fuel. Madame Sofia’s guests headed home. Flashlights were turned on and off. I could hear a truck braking, a baby crying, and the musical ringtone of a cell phone. Someone was listening to Radio Mogadishu on shortwave. Sitting on a bench outside Sahlan’s tea shop in the center of Dertu, men were chatting and drinking chai and chewing khat.
Inside, kneeling over an open fire, Sahlan was cooking ugali. Business was good; some days she served as many as fifty people, not all of them locals. Sahlan’s husband (who lived with his other wife near the Dadaab refugee camps) no longer herded camels as he once had. Instead, he’d bought himself a matatu (a minibus) and now made a decent living driving people between Dertu and Dadaab. He had become more generous with Sahlan. And she in turn treated herself to a few indulgences, among them, a bottle of musk perfume. Her face was fuller than it had been. I noticed her new hijab, black with sparkling sequins.
Now that Dertu had begun to prosper, Sahlan dared to imagine a better future. Maybe everything wasn’t written in stone after all. She envisioned sending her children to secondary school and living in a house with a tin roof. She’d buy herself a comfortable chair and a jar of face cream. Her children would support her in old age, sending remittances from their good jobs in the city. “There are many things that were with us before that are no longer,” said Sahlan, referring to life in Dertu before the Millennium Villages Project. “There was insecurity, but now we are at peace, and when there is peace there is development. Our life was a nomadic one, but now we are settled. We have a school, we have a dispensary. Now we are dreaming of what more will come to us.”
The most startling change in Dertu was the advent of mobile telephony. The village was so remote, so far off the grid, that mobile telephones represented a triumph of technology and of determination. At some point in 2007, Jeffrey Sachs persuaded his friend Carl-Henric Svanberg, the CEO of Ericsson, to donate his company’s know-how and equipment to the Millennium Villages Project.
In response, and honoring its commitment to “corporate responsibility,” Ericsson constructed a sixty-six-foot-high wind- and solar-powered cell tower in Dertu. The company then donated solar-powered cell phone chargers and gave out free handsets to six of the village elders. Meanwhile, responding to Sachs’s goal of bringing Internet connectivity to rural Africa, Sony donated laptop computers to Dertu’s primary school; a special modem would use the cell tower to connect the people of Dertu to the World Wide Web.
The day the network was launched, Svanberg and his wife arrived in Dertu by helicopter. “One of my strongest memories is from the day we launched the network in Dertu,” he recalled when he retired as CEO of Ericsson. “Their chief, one of the camel drivers, came up to me and said, ‘Today our village is reborn.’ ”
The dollar value of Ericsson’s donation was around $250,000 (more if you reckon the cost of Ericsson’s time), and its impact was immediate. Within a few months, at least one-quarter of the households in Dertu had put together enough money to buy cell phones. When solar-powered cell phone chargers proved to be slow and inefficient, one enterprising local bought a diesel generator, connected it to dozens of power strips, and charged a few shillings for each cell phone battery he recharged.
Sachs was right: it’s remarkable how much can change in a short time. Even Ahmed’s far-fetched request to the minister of roads had been granted, and now, thanks to the freshly graded (though not yet paved) road between Garissa and Dertu, the sixty-mile drive took two hours instead of four. Whereas trucks had once bypassed Dertu on their way through North Eastern Province (the preferred route was via Habaswein), they were now driving through the center of town. As well, a regular bus service now passed through Dertu on the way from Garissa to Sharitabak. Sometimes at night, when cooler temperatures made driving more comfortable, so much traffic rumbled through town that it was hard to sleep. The truck drivers spent good money in Dertu, paying for food and lodging and also, it was rumored, for prostitutes.
“We have made a big gain,” boasted Ahmed. “When I first arrived, our problems were the size of Mount Everest; now they are the size of Mount Kenya. When I came, Dertu was dark; now I see lights. When I came, the school had three hundred pupils; now we have seven hundred twenty-nine. When I came, there were six or seven tin roofs; now we have one hundred. I feel happier by far. If we continue, we will meet our goals.”
Ahmed still measured progress by counting tin roofs; in addition, he now counted piles of garbage. Dertu had become a dump site, a sure sign of newfound prosperity. (In really poor rural places there’s almost no trash: where no one buys toothpaste, there’s no empty tube to throw away.) The ditches between people’s aqals were filled with crushed boxes of McVitie’s Ginger Nuts biscuits, mangled tubes of Close-Up toothpaste, bald rubber tires, chunks of molded Styrofoam, empty boxes o
f Sportsman cigarettes, torn flip-flops, broken Bic pens, tin cans, juice cartons, and polyurethane bags.
In response to the growing problem of litter, Ahmed established an official Garbage Committee. A meeting of the elders was called, and right away six or seven young men volunteered to be sanitation workers. Ahmed presented them with a check for 60,000 Ksh ($850) to purchase wheelbarrows, rakes, and other tools of the trade. I was asked to take a photo of the group. Standing in front of a thornbush, two members of the Garbage Committee are holding out Ahmed’s check and smiling.
One morning three land surveyors appeared in Dertu—outsiders dispatched by the government of Kenya to create an official town plan. Blueprints in hand, tripods in place, they hammered rough wooden pegs into the sand, marked off official boundary lines, and made notes on their blueprints. They then proceeded to rope off big parcels of land: for a secondary school here, a hospital there, a church, a cemetery, and many mosques. There’d be playing fields, parking lots, bus stops, a well-stocked library, a community center, a botanical garden, and even, eventually, a university. The wilderness would be made like Eden.
For the most part, Ahmed was excited. Like tin roofs (or piles of garbage), the presence of land surveyors was a clear sign of progress. At the same time, the vision of a city rising from the desert made him anxious. Above all, he worried that he couldn’t satisfy the community’s unrealistic demands—demands that he, in his enthusiasm, had helped fuel.
In a twenty-page report sent to his bosses in New York, Ahmed wrote about “too much expectations from the Project” (what people expected from the Millennium Villages Project, that is). Those expectations included “construction of houses for all individuals in the village, a visit to the village by the UN Secretary General, and diversion of the River Tana to Dertu village for irrigation purposes.”