by Alex Perry
A child is pushed forward to read a short poem about malaria. (“Oh, malaria! What a deadly disease malaria is! Leading to fever, shivering, and high body temperature. . . .”) Then Ugandan vice president Gilbert Bukenya, whose ancestral village this happens to be, steps forward to the microphone. “The rains are beginning, and as soon as they come, all these bushes will thrash with Anopheles gambiae!” he exclaims. Then he turns to his guests: “We have tried our best, but we have failed. They blame me, I am taking the blame, so I am begging. You must know the many things we need.”
Chan responds by saying the play was touching. She adds: “Please do not blame him [the vice president]. It’s not totally his fault. Fighting malaria is all our jobs.” She announces a series of measures to help fight malaria in the area—new drugs, nets—funded by a personal $50,000 donation from Chambers. Each new gift is greeted with cheers and claps, and a chorus of drums, trumpets, and trombones. “We have done our best to respond,” says Chan. “Now can I ask three things of you?” She urges the community health workers to make sure bed nets, when they do arrive, are properly used. She asks the schoolteachers to educate their pupils about malaria. And she asks the children to tell their parents to sleep under a net. After each request, she asks: “Will you do it?” There are faint murmurs of assent. The vice president returns to the microphone. “Stand up and pledge allegiance to what the WHO secretary-general is saying!” he barks. The crowd shuffles to its feet.
Later the same day we tour a factory on the edge of Kampala belonging to Quality Chemical Industries, which makes treatment drugs for HIV/AIDS and malaria. Minister Mallinga has reappeared to stress how important it is to President Museveni that a Ugandan company manufactures Uganda’s drugs. Quality Chemical’s chief executive, Emmanuel Katangole, says his factory can produce six million tablets a day, enough to supply Uganda and the entire Great Lakes region. Everyone thinks this is a great idea, a perfect example of a sustainable, private African business that is good for both health and development. Then Katangole ruins it. “It’s our request that the WHO closes one eye and gives us special treatment,” he says. Quality Chemical, he confesses, has neglected to obtain the certification it needs for the WHO to buy its drugs. Can the WHO ignore this small oversight on this one occasion? Chan is outraged. “You ask me to close one eye, which I cannot do!” she says. “WHO will never compromise on quality!”14
It’s the end of a long day, and Chan, Chambers, and Yamada want to leave. But as they hurry for their cars, there is a chorus of loud objections. “The tree! The tree!” exclaims one man. On the edge of Quality Chemical’s executive car park is a small patch of grass and along its edge is a short line of newly planted saplings. At one end, there is a hole, a fresh sapling in a bag, and a shovel. “We’re not doing the fucking tree!” I hear a Western voice say. There is a scramble for the cars and a gunning of engines. “I think we are having a problem here! The tree has to be planted!” shouts an indignant suited woman whose lapel badge indicates she is from Quality Chemical. Another man shouts, “Yes, the tree has to be planted! We must have the photo!” But the drivers peel off for the exit, and we’re gone.
After two days of this, I’m left wondering what the point is. As I say good-bye to Chambers that night, I ask him. “Oh, this was worth it,” he smiles. “At Quality Chemical, I got the minister talking, and I asked him: ‘Why do you need these particular nets? It doesn’t make sense.’ And he said: ‘OK.’” That simple statement was enough, said Chambers. His staff could use that to pressure the minister’s staff. They could take it to the NGOs and the Global Fund. Everyone could be told to get moving. In that one word, Chambers had found leverage. “The tour was worth it,” he repeats.15
CHAPTER 9
A Big Player
Exxon Mobil might have the biggest oil operation in Nigeria and now see fighting malaria as in its best interests. But the problem is too big even for an oil giant. Protecting a hundred fifty million Nigerians from malaria would not be serving ExxonMobil’s interests; it would be bankrupting. Moreover, after half a century of drilling, Nigeria’s problems have evolved from a resource curse into world record–breaking corruption and a full-fledged civil war. Fixing all that is not something an oil company is qualified to do. What small efforts ExxonMobil does make to ease tension in the Delta only underline how out of its depth it is. In October 2010, militants ambush a car carrying Lakshmi Tombush, the Indian headmistress of a school built by ExxonMobil at Eket in the Delta, kill her driver and two police escorts, and demand $6 million for her release. She is eventually freed after the kidnappers are negotiated down to $200,000.
But since a quarter of all the people in the world who die from malaria do so in Nigeria, the success or failure of Chambers’s entire campaign depends on what he achieves there. “As Nigeria goes, so goes Africa,” he says when I catch up with him in Abuja in December 2009. Chambers estimates he needs sixty-three million bed nets to protect the country. With a little over twelve months left, he still has forty-five million to go. He needs a big player. And they don’t come much bigger than God.
Five months earlier, in June 2009, I traveled to Kibuye in western Rwanda with Steven Phillips, John Bridgeland, Gary Edson (now out of the White House and working for the Case Foundation), and Jim Copple, an aid consultant. The group was studying how religious aid groups tackle malaria.
Kibuye, a small fishing town dotted with eucalyptus trees spread over steep gullies dropping down to Lake Kivu, seemed an unlikely location to find a Christian assistance program. High above the town, on a spur jutting out into the lake from where you can see eastern DRC on a clear day, is a giant, abandoned Catholic stone church. A notice outside explains that in April 1994, 11,400 people were killed in and around the building. A second sign in town, outside the sports stadium, says 10,000 more died there the next day.
During the hundred days of Rwanda’s 1994 genocide, Hutu militias killed around 800,000 people across Rwanda, mostly Tutsis but also their Hutu “collaborators.” The area around Kibuye experienced the most comprehensive slaughter of Tutsis anywhere in the country. In Western Province, where Kibuye sits, the Tutsi population was cut from 252,000 to 8,000. When the bloodshed began in Kigali on April 7, many Tutsis in Kibuye sought shelter in the church. But on April 17, a Hutu mob threw grenades through the windows, then began shooting and hacking at the people inside with machetes. The massacre took hours. To identify anyone still living in the piles of bodies, the killers would fire tear gas inside the building and then attack anyone who coughed or sat up.
Despite being a Hutu, Father Boniface Senyezi stayed with his flock and somehow survived, hiding under their bodies. But elsewhere in Kibuye, as across Rwanda, the church was complicit in the genocide. Sixty years before, Belgian colonial pastors sowed the seeds of ethnic hatred when they divided the population into Hutu and Tutsi by measuring the width of their noses with calipers. (Hutus tend to have a flat nose, while Tutsi noses are more aquiline.) That made permanent and racial a divide that until then had been porous and determined less by ethnicity than wealth—up to that point being a Tutsi denoted enjoying a higher socioeconomic status, and a Hutu who did well could become a Tutsi. The church’s guilt only deepened when the genocide started. Most Christian leaders in Rwanda refused to condemn the killings. Much of the slaughter took place in churches, where vicars and priests had initially assured Tutsis they would be safe. Some of the massacres were even led by clergy.
Kibuye, then, was an unusual place in which to found a Christian global aid project. But a mere ten years after the genocide, the most influential Christian leader in the US, Pastor Rick Warren of Saddleback Church, did just that. Warren is an evangelist but also a pragmatist; he sums up his belief system in the title of his how-to book A Purpose-Driven Life. The book has sold millions, and Warren draws followers from across America’s races and classes. His influence can be gauged by the televised debate he hosted between Barack Obama and John McCain during the 2008 presidential campaign.<
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Warren’s big idea is to transform all the Christian churches in the developing world into primary health care centers and all priests, pastors, and vicars, and millions of their congregants, into health workers. It sounds great in theory and looked even better on a PowerPoint presentation Warren’s staff showed me at their offices in Kigali. The first slide showed a map of the Kibuye area on which the three hospitals were marked. A second slide added the twenty-five health centers. A third showed all 728 Christian churches in the area. “Even if we get just one volunteer from each church,” said Eric Munyemana, Saddleback Church’s representative in Rwanda, “it would be an unbelievable model.”
Warren calls his plan P.E.A.C.E., with every letter standing for a remedy to each of the five “global giants” that he says afflict the developing world. P is for promoting reconciliation, E for equipping leaders, A for assisting the poor, C for caring for the sick, and E for educating the next generation. Each of Rwanda’s five provinces is hosting a part of the plan, and Western Province got C, which translated to $12 million to develop health. That means fighting malaria.
“Purpose-driven” implies results. And today Rwanda is scoring such dramatic reductions in malaria and improvements in health that it is held up as an example to all Africa. But the P.E.A.C.E. plan is not part of that success. When I first visited Kibuye in June 2008, Saddleback had little to show for its four years there. The situation had changed little when I returned with Phillips and the others in 2009. Work had yet to begin on the long-promised new hospital. There was no new equipment and no new staff. The P.E.A.C.E. plan had finally trained its first group of community health workers, but they were yet to start work. “They haven’t done anything,” said Laura Hoemeke, director of Twubakane, a Rwandan health NGO. Another senior development worker in Kigali described the P.E.A.C.E. plan as little more than a travel agency for rich American Christians. “Rick Warren and his people have been coming here for years,” he said. “There have been hundreds of visits, and they’ve talked a lot, but so far there is nothing to show.” Even Munyemana admitted progress was slow but added it was also steady, saying he wanted to grow an “oak tree” not a “mushroom.”1
The reasons for the P.E.A.C.E. plan’s problems were easy to understand. First, it was willfully, deliberately staffed by people who had no idea what they were doing. “One of the things that I love about the P.E.A.C.E. plan is it’s a plan for amateurs,” Warren told his congregation at Saddleback when he was introducing the program. “It’s not a professional plan. Amateurs do it for love. In fact the word ‘amateur’ means ‘out of love.’”2 Professional aid workers, perhaps unsurprisingly, said that was plain dumb. “It’s very naïve,” said Blaise Karibushi, director of a health NGO called Access Project–Rwanda, funded by Columbia University in New York. “It takes a lot of work and planning to make development aid work. If all the churches are going to distribute drugs or diagnose disease, there are going to have to be trained people; there are going to have to be some serious logistics. It’s not simple. It’s certainly not as simple as Warren says it is.”3 Even the P.E.A.C.E. plan’s own staff recognized the problem. Antoine Rutayisire, who was helping oversee Warren’s operations in Rwanda as vice chair of the Rwandan National Unity and Reconciliation Commission, said most of Rwanda’s clergy were not up to the job Warren envisaged for them. “Sixty-five percent of all pastors only have primary school education,” he said. “They cannot cope with all the issues we ask of them. They just mouth some spiritual platitudes that do not inspire anybody.”4
The P.E.A.C.E. plan had a second big flaw: it relied almost entirely on unpaid volunteers. And as Dr. Lennie Bazira Kyomuhangi, who was planning to redevelop Kibuye Hospital alongside Warren, said: “The issue of volunteerism is going to pose a great challenge for us. Most people don’t believe they should do anything for free, particularly when they see millions of dollars coming in and they don’t get any.”5 On my first visit to Kibuye, it struck me as almost immoral to ask people to work for nothing in one of the world’s poorest countries, particularly when those doing the asking arrived in a pair of private helicopters, as the Saddleback staff did. Warren told his congregation: “If somebody calls you an amateur, you take that as a compliment. Because you’re not doing it for money, you’re not doing it for fame, you’re doing it out of love.”6 What Warren failed to grasp is that with an average per capita income of $510 in 2009, very few Rwandans can afford to do it out of love, and most are compelled to do almost everything for money.
There is a broader problem here. By combining health and religion, Warren is mixing two things that can blend poorly. Health is about trying to build the best physical life in the here and now. Religion is about spirituality and the afterlife. By strict logic, these are competing concerns—you have to die, after all, to make the central religious journey. In development, religion and aid are also often at cross-purposes. Christian aid groups that proselytize alongside their work provoke accusations that their real purpose is not to assist people but to yoke them under an alien culture, blackmailing the poor with promises of development. Many groups admit their primary goal is not assistance. When I ask Eric Munyemana whether his priority is saving lives or saving souls, he replies without hesitation: “Saving souls.”7
Phillips and the others leave Kibuye with mixed feelings about Warren’s project. The lack of urgency is galling. Copple worries that even if the P.E.A.C.E. plan gets going, a project that relies on volunteers cannot last. And though Warren sees the Christian church as nothing but positive in Rwanda, its involvement in the genocide is a poisoned legacy that will last generations.
Nigeria is another unpromising location for a faith-based aid effort. Here too religion is known as much for its deadly violence as its pastoral care. The southern edge of the Sahara is where North African Islam meets southern African Christianity, and from west to east the encounters are often bloody. In Somalia, Islamists fight Ethiopians, whose country is home to the oldest Christian churches in Africa. In Sudan, Christians and Muslims find themselves on either side of a divide that has cost two million lives since 1956 and, in July 2011, was due to become a solid border between north and south. West Africa even has its own branch of al Qaeda, which kidnaps and executes Western tourists in Niger, Mali, and Mauritania.
In Nigeria, the green plateau that runs across the middle of the country has seen a series of religious pogroms in the last decade—Christian-on-Muslim and Muslim-on-Christian—in which more than six thousand have died. The brutality has produced hard-line sects and gangs of extremists on both sides, the most infamous of which is the Islamist Boko Haram, which stages mass attacks on Christians and security forces in support of its demand for the imposition of Sharia law across Nigeria. Also hailing from the area is the Christmas Day bomber, Umar Farouk Abdulmutallab, who tried to detonate explosives sewn into his underpants on December 25, 2009, on a Northwest Airlines flight to Detroit. Chambers visits Abuja that same month. Days after he leaves, forty people die as an Islamic sect battles the security forces in the streets of Bauchi, three hours’ drive to the east.
But linking up with religion is Chambers’s only option. Business is too small to cope with all of Nigeria’s malaria. The government boasts an outstanding health minister in Babatunde Osotimehin, but, beyond him, many officials are inept or corrupt. Likewise, Onno Rühl, the World Bank’s country head, has adopted fighting malaria as a very personal battle—but while he has the money, he doesn’t have enough people. “I don’t think we have a choice,” says Chambers. “I do not think Nigeria can achieve what it needs to without the leadership of the faith communities. They’re essential.”8 Tom Woods is from the Center of Interfaith Action (CIFA), a US lobbying and coordinating group that is helping to organize Chambers’s visit. He agrees. “The international community is scared it’s going to pump $1.2 billion into Nigeria and walk away with nothing,” he says.9
Islam and aid have a mixed history in Nigeria. In 2003, some northern state governors and
religious leaders imposed a yearlong ban on polio vaccinations, claiming the medicines were contaminated by Western powers to spread sterility and HIV/AIDS among Muslims. The embargo effectively stalled the entire global drive to eradicate polio. But once the imams and local authorities relented and a mass vaccination campaign was carried out with their assistance, by 2010 polio was all but wiped out.
Woods argues that co-opting religion could have similar advantages for fighting malaria. First, “you have these incredible hierarchies. You can just do things by fiat.” Second, there is the sheer number of priests and imams across the country—a total of around a million, says Woods. Third, religious organizations are part of the community. “We are not going to see people having huge events in Geneva,” he says. “You’re going to see people who care about Nigerians every day, who are used to working around difficulties. They’re already engaged; they’re already administering to the poorest of the poor. We’re just asking them to add this to their everyday work. It’s actually amazing nobody has done this before.”