The Idealist

by Nina Munk

  As usual, Sachs had no patience for such theories. “For every problem,” he’d say again and again, “there is a solution.” The great thinkers of the Age of Enlightenment—Thomas Jefferson, John Locke, Adam Smith, Immanuel Kant, Sir Francis Bacon—those were the men Jeffrey Sachs looked to for inspiration, men in whose footsteps he believed he was following. He shared their optimism and confidence. Like them, he was sure that logic and reason triumph over ignorance and superstition.

  Sachs never doubted that Africans would use mosquito nets to protect human beings. He was equally certain that, given the opportunity, farmers would buy fertilizer. “The Enlightenment commitment to reason is not a denial of the unreasonable side of human nature,” he wrote in The End of Poverty, “but rather a belief that despite human irrationality and passions, human reason can still be harnessed—through science, nonviolent action, and historical reflection—to solve basic problems of social organization and to improve human welfare.”

  He was determined to end poverty—to put people on the ladder of development—and the fastest way to achieve that goal was to increase agricultural yields. In Sachs’s villages, farmers would initially receive fertilizer and high-quality seeds free of charge; as soon as their yields increased, they would gladly invest their own money in inputs, or so Sachs presumed. Season by season, based on that premise, the Millennium Villages Project would scale back its subsidies, from 100 percent to 50 percent to 25 percent and downward. On paper, and in Sachs’s fertile mind, success was assured.

  Southern Ugandans don’t much like corn—“school food” or “prison food” is what they call posho or ugali, the cornmeal porridge popular in other parts of East Africa. Nonetheless, maize was the crop that Jeffrey Sachs and his staff in New York decided was best for the Millennium villages. It was nutritious, drought-tolerant, and relatively easy to grow. It could be eaten fresh, or dried and ground into cornmeal.

  And so, during the long rains of September 2006, David Siriri dutifully distributed 32 tons of high-yield maize seeds and 221 tons of fertilizer to more than 7,000 households in Ruhiira. A smaller number of households, around 850, received high-yield, disease-resistant kidney bean seeds. The entire cost of the inputs, just over $300,000, was paid by the Millennium Villages Project. To prove the effectiveness of modern agricultural practices, Siriri set up forty-eight demonstration farms and sent teams of agricultural extension workers across Ruhiira’s hills to teach farmers modern “Sasakawa” planting methods.

  At harvest time in February 2007, the results were fantastic: average maize yields had increased from 1.8 tons per hectare to 3.7 tons, resulting in a bumper crop of 3,840 tons of maize. Not only were villagers well fed, they also had excess maize that, in theory, could be sold or safely stored for the lean years. All well and good, except for one fact: locally, there were no storage facilities to keep the surplus maize safe from vermin, pests, and disease. “Maize is everywhere! Under the beds, in the living rooms, in the kitchens—everywhere!” exclaimed Tumushabe Boneconcila, a widow and the mother of nine children. “And the rats are everywhere too.”

  Rats! They ate their way through bags of maize, chewed holes in plastic jerry cans, and gnawed on stacks of mosquito nets. In this remote, landlocked corner of the world, without any roads or trucks to link farmers to markets, what could be done with all that corn? Selling matoke was easy compared to selling maize. For one thing, matoke is in constant and high demand all across the country. For another, most of the country’s matoke is grown in the hills of southwestern Uganda, where Ruhiira is located, so traders have no choice but to buy their produce there. Finding markets for other crops was more complicated, Siriri discovered. Even if a buyer for Ruhiira’s excess maize was found, the cost of transport alone would wipe out any profit.

  Meanwhile, the people of Ruhiira were desperate for cash; they couldn’t afford to sit around waiting for the right opportunity to sell their maize. And so they did what poor farmers in remote regions have always done with bumper crops: they dumped their excess maize all at once, with the result that market prices collapsed. Most farmers were forced to sell their maize for far less than the cost of inputs. Others, unable to find buyers at any price, left the maize to rot.

  Scrambling to justify the project’s $300,000 investment, Siriri managed to find buyers in neighboring Rwanda willing to buy 50 tons of maize at 250 shillings a kilogram, about 35 percent above break-even point—but 50 tons was only a fraction of Ruhiira’s total yield that season. The villagers were unhappy. What was the point of growing maize? they demanded. Why grow a crop you didn’t like to eat? A crop that was hard to sell? Furthermore, compared with matoke bananas, which grew everywhere, with or without chemical fertilizers, growing maize was hard work. “The Millennium project encouraged us to grow maize,” groused a farmer named Paul, when I met him in Ruhiira, “and so I did. But the maize, it takes four months to harvest—matoke you can harvest every month. And it took me so much work to look after the maize that I didn’t have time to harvest my matoke properly.”

  “We wasted money on maize seeds and fertilizer,” Siriri acknowledged. “It is money I wish we had not spent.”

  It occurred to Siriri that there was more to advancing Ruhiira’s agricultural prospects than simply increasing yields. Every intervention, it seemed to him, had unintended consequences: time and again, by solving one problem, he created another. To solve the problem of storage, Siriri was pushing ahead with plans to build an enormous grain warehouse in Ruhiira. Going forward, farmers wouldn’t have to sell their surplus right away; instead, they could store it securely until prices were higher or until buyers had been found. That was a step in the right direction, thought Siriri. Now all he needed was to find someone to buy the beans and maize.

  Chapter 12

  Awaire, Awaire

  It was 2008. Almost two years had passed since the Millennium Villages Project had started, and in the villages, harvest by harvest, people’s lives were slowly improving. There were many noticeable changes: new classrooms and health clinics, better roads, safer drinking water, ample supplies of staple foods, the growing use of cell phones … The speed of change gave people hope: if all this could be accomplished in so short a time, imagine where they’d be in another three years. It was natural to suppose, as Sachs did, that the rate of progress would continue along a sharp upward line until, after five years of interventions, extreme poverty would be a thing of the past.

  In Ruhiira, where the Millennium Villages Project had so far invested $3.5 million, the operating theater at the Kabuyanda Health Center was finally up and running. There was still no running water, but the floor had been tiled and the windows sealed. Diesel fuel was now available for the generator. Staff quarters had been constructed: a simple concrete block comprising three rooms. And here and there on the hospital grounds, shrubs and flowers had been planted.

  A new, young doctor had joined the staff. Dr. Martin Buhamizo was a recent graduate of Uganda’s Mbarara University, where he’d earned a degree in medicine and surgery. Despite other job opportunities, he’d accepted the posting at Kabuyanda Health Center largely because the Millennium project offered him a monthly salary of 1.5 million Ugandan shillings, about $750, double the government wage for doctors in Uganda.

  Early one morning Dr. Buhamizo arrived at work to see a crowd of people outside the operating theater. One woman was lying on the ground. Another was on a makeshift stretcher, a wooden plank tied to a wheelbarrow. The diagnosis for both women was obstructed or prolonged labor. Their babies were in breech, or else they were wedged sideways behind the pelvic bone, or else the mothers’ pelvises were too small, a common problem among malnourished women. One way or another, the babies were trapped in the birth canal.

  Asking the nurse to bring a handheld Doppler monitor, Dr. Buhamizo quickly assessed the situation. Tall and lean, he was wearing a spotless white lab coat with a ballpoint pen clipped to the breast pocket. “Atwire arwaire obwire buriingwa?” he asked one of the wom
en’s relatives, gently—“How long has she been like this?”

  There was a lot of back-and-forth in Runyankole, the local Bantu language. The women, first treated in their villages by traditional healers, had followed the usual instructions for obstructed labor: they had chewed plant roots and stuffed their cervixes with the leaves of a local weed (orucwamba) to induce contractions. Only when it became clear that the women were dangerously ill did someone bring them to the health clinic. Now their babies were in distress, their heart rates low and dropping. Deprived of oxygen, they were almost certainly asphyxiating. “The mothers, they always come too late,” Dr. Buhamizo remarked. It wasn’t a judgment, just a fact.

  While the women were being carried into the operating theater, Dr. Buhamizo grabbed two jerry cans of diesel fuel from his truck and filled the generator tank. The generator was working today, and thank goodness for that, said Dr. Buhamizo. The last time it broke down, more than two weeks went by before he found a mechanic to fix it. He had learned to improvise. “I am a GP, a gynecologist and an obstetrician, a pediatrician, a pathologist—and a mechanic too,” he told me.

  Less than forty-five minutes after arriving at the clinic, Dr. Buhamizo had managed to deliver the babies. One was a severely premature girl no bigger than the palm of his hand. The other, a boy, was unconscious. “Maama,” said Dr. Buhamizo, “awaire, awaire”—“He is not well.”

  The boy had a fatal neural-tube defect known as anencephaly—his brain and skull were grossly malformed. A nurse swaddled the infant and handed him to his grandmother; within an hour he was dead in her arms. Lying on the operating table, covered in blood and a green-and-brown sarong, his mother murmured something. This was her ninth child, the second to die at birth. She urgently needed a blood transfusion, but that was out of the question: for one thing, the hospital’s refrigerator wasn’t working, and the refrigerator wasn’t working because the solar inverter was broken.

  Everything was in short supply. The staff at Kabuyanda was skeletal, with just half the number of health care workers required to operate a hospital of this size, according to the government’s own guidelines. Meanwhile, it had been five months since the government had last sent drugs and basic medical supplies. Oral rehydration solution and surgical gloves were out of stock, and any day now, Dr. Buhamizo feared, he’d be out of antiretroviral medication and antidiabetic pills and suture thread too.

  By this time, more people had arrived at the hospital, and Dr. Buhamizo was trying to deliver another child. It was not yet noon. “The head is completely stuck!” he cried out. His white lab coat was smeared with blood. It was suffocatingly hot in the operating theater. In a corner of the room, a plastic bucket was overflowing with bloody gauze and used needles and disposed placentas.

  By the time the baby made it out of the birth canal, he was limp and gasping for air. His Apgar score, which rates the health of a newborn from zero to ten (ten being perfect), was two. He weighed less than 1,400 grams, about three pounds. Dr. Buhamizo and the nurse tried to resuscitate the baby, and for a short while, his Apgar score climbed. Then his blood pressure fell precipitately, and he went into shock.

  Dizzy, I pushed my way out of the operating room. In America, in a hospital with a neonatal intensive care unit, perhaps something could have been done to save the child. Since Jeffrey Sachs’s first visit to Ruhiira in early 2007, the Kabuyanda Health Center had certainly improved. Nevertheless, in Ruhiira, the Millennium project’s staff was stretched to capacity, budgets were tight, and there was a limit to how much could be accomplished. In the hospital ward, where all twenty-eight beds were occupied by two people or more, two brand-new state-of-the-art incubators were wedged into the corner, wrapped in plastic. Donated by General Electric—“from America,” a nurse said proudly—the two machines were a sign of GE’s commitment to helping the world’s poorest people and to the Millennium Villages Project. For all GE’s good intentions, there wasn’t enough electricity in the health center to power the machines.

  By the time Dr. Buhamizo emerged from the operating room, the sun was setting. He’d been working ten hours straight. “Sometimes it’s too much,” he said. “Sometimes you get pushed past your peak and it’s too much.” Walking across the grounds of the hospital, we passed families camping outside while relatives were in the hospital. A few women were washing clothes in yellow buckets. A pot of matoke was cooking on an open three-stone fire.

  The generator was out of fuel. “We always run short of fuel,” he said. “They give us eighty or one hundred liters a month,” he added, referring to the Millennium Villages Project, “but it’s never enough.

  “It’s never enough,” he repeated, “but it is so much more than we had before. Without the Millennium project there would be no drugs, there would be no surgical equipment, there would be no way to operate the generator—I would be redundant most of the time. They say funding will continue, but someday it will stop, and when the funding stops, most likely everything we have done will be put to waste. I do not see how we are going to continue after they have left.”

  How would they continue? “I know that if you spend enough money on each person in a village, you will change their lives,” Simon Bland was saying. “If you put in enough resources—enough mzungu, foreigners, technical assistance, and money—lives change. I know that. I’ve been doing it for years. I’ve lived and worked on and managed development projects.”

  A senior officer with Britain’s Department for International Development (DFID), Bland had spent thirty years working in the field of development. He’d run DFID’s offices in Russia, in Ukraine, in Somalia, and in Kenya, implementing and overseeing countless development projects in many of the world’s poorest places. Now he was trying to decide whether DFID should back Jeffrey Sachs and his Millennium Villages Project. His main concern was “sustainability”; what would happen when funding for the Millennium Villages ran out?

  Broken water pumps, half-finished health care clinics, abandoned housing blocks, roads that lead nowhere, dams that have collapsed—Africa is strewn with the remains of well-meaning development projects, Bland pointed out. “The problem is,” he said, “when you walk away, what happens?” Who will fill the potholes and mend the pipes and pit latrines? Who will buy fuel and supply spare parts for the generators? Who will pay Dr. Buhamizo’s salary?

  Jeffrey Sachs had designed the Millennium Villages Project with a timeline of five years; at that point, according to his model, the villages would be self-sufficient. To quote an internal memo distributed to Sachs’s senior staff: “Sustainability within the Millennium Villages Project has one precise meaning: When the five-year MV funding stops … the MVs should be able to continue their economic progress without a loss of momentum, a drop in living standards, or a decline in social services.”

  But what if Sachs’s model was unrealistic? What if, after all, economic development did not advance along a straight upward line but instead, like the stock market, flatlined? By 2008, even Sachs could see that a five-year timeline was overly ambitious. People in the villages were healthier and better nourished than they had been. Nevertheless, the long-term goals of the Millennium Villages Project—to set people on the path of sustainable economic progress, to teach them self-sufficiency, to lift them out of extreme poverty—were as elusive as ever. As for scaling up, that goal too remained unfulfilled.

  Revising his timetable, Sachs announced that the Millennium Villages Project would extend for ten years instead of five. This change in timeline was by no means an admission of failure; it was a minor adjustment, he told me, a “course correction.” “There is no blueprint for what we’re doing—our ideas continue to evolve all the time,” he said. “The main thing is to add another block of time to really get the income levels significantly raised. The plane is flying and it’s gaining altitude—now we just need to ensure a smooth flight.” But where would money for the second block of time come from?

  “Rick and I went to see Jeffrey Sachs,” recalled T
om Ryan. “We sat down with him, and we asked him the simple question: ‘What’s your funding horizon? You know, looking ahead, where are you getting the money to pay for this?’ ” Sachs had raised $120 million to fund the first five years of the Millennium Villages Project, but surely he couldn’t rely on funding from a few wealthy individuals and charitable foundations forever.

  Ryan’s boss, Rick Schaden, was the majority shareholder of Quiznos, a chain of sandwich shops based in Denver. Since 1991, when he and his father bought the eighteen-store chain, Schaden had overseen the expansion of Quiznos to five thousand franchised shops. Now in his midforties, he had entered the stage of his life where he was starting to think about sharing his wealth. Embarking on what he called a “personal discovery,” he read The End of Poverty and decided to write a check for $3 million to help fund Sachs’s model villages. “Rick loved the idea of a systemic solution to a worldwide problem,” Ryan told me, “the idea that instead of giving these people fish, you’re teaching them how to fish.”

  The more involved he became in the Millennium Villages Project, however, the more Schaden suspected the project was flawed. “We talked to them about their vision and we feared for them, actually,” continued Ryan, who was chief marketing officer for Quiznos. “They were raising money from high-net-worth individuals, and they were doing a great job of it—you know, they’d raised one hundred twenty million dollars, fifty million of it from George Soros. But that’s not a sustainable approach. And we realized pretty quickly that these guys are going to have an uphill struggle.”