Alex in Estero

Great Expectations: Some Advice to the Next Minerva Fellows

Experiences in life are shaped largely by expectations. Attempting to predict outcomes in order to get some grasp on a future full of uncertainty may be one of our most natural tendencies. The unpredictability of the future challenges us, exposes our weaknesses, and can lead to self-doubt.

It’s hard to remember now what my expectations were when I took off from Logan Airport last July. I’m sure I expected that my experience would be full of challenges and triumphs, successes and failures, and it was. During the month since I returned to the U.S. I have been at Union, giving presentations to various classes, participating in events like question and answer sessions and Steinmetz Symposium, and trying to help prepare the next group of nine fellows. I have come to believe that while there may be no way to prepare fellows for the journey of self-discovery and exploration that they are about to begin, there are ways to prepare them to be successful at the work they are doing. To this end, I have compiled a list of ten tips for the nine fellows that will be heading to Ecuador, Uganda, Cambodia, South Africa, and India this July.

1. Be a sponge. Absorb everything you see and hear, and try to remember as much as you can from every conversation, road sign, and side comment. Ask questions! Every moment is an opportunity to learn more about where you are, the events that have shaped that particular place, the people who live there, and what you can do to help.

2. Do not fear failure. Before you leave you will be told often to be patient when you first arrive and to just listen; “don’t do anything at first,” some might tell you. But as passionate and energetic 22-year-olds it will be hard for you to sit on the sidelines for very long. In the case of Shelby and me, we jumped right in and made lots of mistakes. We failed often and made decisions we later regretted. But failure is as important to community development as success is. In fact, if you learn from failure, it can and will be a precursor to success. As a Minerva Fellow you should see your role as largely experimental and thus your failures as a productive way of eliminating possible solutions. I am adamant that we will need to fail a lot in communities like Estero in order to experience long-term, sustained success.

3. Practice self-assessment. In this kind of work one must always be critical of his ideas and initiatives. With any program you hope to develop, ask first whether the impetus for the program is coming from the people you are working with or from you. Before you begin implementing an idea, take a step back, talk with people, and make sure that the idea will actually solve the problem you are hoping to address. Always see if you can come up with a way to evaluate a project’s effectiveness and impact. And do not fear the results: even if they do not show what you had hoped for, you can always learn a great deal from these kinds of assessments, and it is never too late to go back to the drawing board. Patience is a virtue.

4. Make it your own. The Minerva Fellowship offers a different experience for each fellow. Of the more than 30 individuals who have participated in the program over the last four years, I bet all of us would agree that each has had a unique and different experience. The Minerva Fellowship is what you make of it, so take the next nine months to focus on your passions, hone skills, and figure out how you can make the most meaningful impact on the place you are living.

5. Success is undefined. The fellowship brings with it a lot of pressures. During the month of May the returning fellows help teach Hal Fried’s social entrepreneurship class, and each of us presents on the various projects we were involved with. I remember sitting in the classroom last year and being amazed by all that the previous fellows had accomplished. I couldn’t help but wonder whether I would ever be able to live up to the expectations that the previous fellows had seemingly set. Now, one year later, I’ve realized that there is no recipe for success in the fellowship. Not only is every placement different but every fellow is unique. In fact, your uniqueness is a large part of why you were picked for the program in the first place. So, as long as you approach this experience committed to making the most of your time, you will succeed in learning a great deal about yourself and the place you are living and in having an impact on the lives of others. In other words, all of you will succeed.

6. Good intentions are not enough. Anybody who tells you that poverty remains a problem because everyone in the developed world is too aloof or cold-hearted to care is wrong. Poverty persists not because there is a lack of initiative or interest with regard to the developing world, but because even the best-intentioned efforts often fail to have the desired effect. In some cases, well-intentioned projects may even cause more harm than good. So be wary of this and always try to anticipate what the outcome of a planned project will actually be (versus what you wish it might be).

7. Think long term. Though nine months seems like a long time right now, you will soon realize that it is a very short period of time in the lifespan of the places you will be living. Nine months will not be enough to achieve most of what you would like to accomplish, and that’s okay. Nobody expects you, or wants you, to go and change these places overnight. So always keep in mind that the projects you are involved with are much bigger than you are. Your goal should be to make it easy for future volunteers or workers in your position to continue along the path you’ve created. Sustainability is the goal, so you should always be preparing for the day when you will “take yourself out of the equation,” in the words of Amanda Wald.

8. “Do it.” Kate Murphy, Minerva Fellows 3, offered this advice to us this time last year, and I liked it. When an opportunity to do something presents itself, do it. Seems simple enough, but the point is that you shouldn’t hold back. The adventure you are embarking upon is a once in a lifetime opportunity, no matter how much traveling or living abroad you may do in the future. So whenever you are unsure of whether to go on that hike, get up at 4am to go fishing, or get on the bus to who knows where, think of Kate and remember what she would say: “go for it.”

9. Take care of your body and mind. Always take time to do things that relax you and that you enjoy. I recommend getting a kindle if you can, so you can read a lot and continue learning every day. Always respond to any medical issue with attention, as you never know how serious it could be. Living in foreign places also means interacting with bacteria that your body is not accustomed to fighting, and it means confronting diseases that you have never seen before and may not really understand. Thus, you should not rely on self-medicating, and should always seek out the best available medical advice and care. I can attest that what may seem like a small mosquito bite could actually kill you.

10. Details matter. Much of the value of the Minerva Fellowship lies in its focus on scaling down to the micro level, so concentrate on the details. A misconception in development work is that big problems require sweeping solutions, and that these solutions can be implemented and scaled up all at the same time. You should not feel that only ideas with the possibility of having a widespread impact are worth pursuing; affecting one life in a positive way is a huge success. In my case, in order to stay grounded and committed, when I hear or read statistics about global poverty, I think of the mothers that hosted me, the guys I played soccer with, and the students I worked with in Estero. For me, it’s all about people, not statistics. And in order to change those statistics, we will first need to understand people, just as the fellowship allows you to do. As Dean Karlan writes in More Than Good Intentions,  “[Development] needs to be on the ground. If we want to solve poverty, we need to know what it is in real—not abstract—terms. We need to know how it smells, tastes, and feels to the touch.”

Promises

We make promises for many reasons. Sometimes we have a desired outcome in mind, and so we make promises to ourselves or to others in hopes that doing so might enable that outcome in some way, that promising might make what we want more likely to happen. Other times we promise because we think it is best. We assume that the individual whom we make the promise to will forget our promise or not hold us to fulfilling it. And still other times we promise because we are too weak to say no, to tell others the truth. We succumb to emotions like compulsion and guilt. During the final weeks in Estero I wanted to make promises for all of these reasons. I wanted to tell everyone that I would be back again soon, and that I would help make everyone’s dreams a reality. In my final days in Estero I felt what my friends and families in Estero have always felt—the loneliness and stagnancy of poverty.

When you spend enough time in a place you can start to forget how different your circumstances are from those of the people you are living with. My first night in Estero I remember feeling the permanence of poverty like a huge, exhausting weight pushing my shoulders to the ground. I saw poverty in the filth that covered every wall and surface and in the small holes in the cement walls that were too small for an escape. I saw it in the way that people took pride in even the most seemingly meaningless and insignificant possessions, as if it mattered less what the object was than the simple fact that nobody was poised to take it away. But over the course of these nine months I stopped seeing my surroundings in this way. Cement houses that previously appeared barren and lifeless became my homes, their occupants my families. Complete immersion is what some people would call it. I think I prefer Atticus’ description in To Kill a Mockingbird of walking around in another person’s shoes for a while, to which I might add that in such a case one sometimes starts to forget that he switched shoes in the first place.

However, my final days in Estero and the prospect of leaving reminded me of how divergent my path through life has been and will be from that of the people there. I started to feel guilty because I saw in the people’s eyes, in the way they spoke to me, that I was transforming from their friend or brother into a mere reminder of their solitude. I was becoming a reaffirmation of their fear that help is only temporary, that any respite from the brutal realities of subsistence farming and fishing is brief and fleeting. I suddenly began to question whether bringing increased joy, quality, and substance to people’s lives for a relatively brief time was our greatest or cruelest contribution.

Promising became tempting because it offered the possibility of remaining alive in my friends’ eyes, of giving them reason to think of me as still living and breathing as opposed to a relic of an increasingly hazy past. I tried to avoid making explicit promises, to be vague and honest, but I saw that such reassurances were useless against the hardened and distrustful face of poverty. And even promises might find a disbelieving audience, as they were nothing new either.

I will never forget the day that I left Estero de Plátano. Leaving a place is hard but leaving people you love is much harder. On that day our friend Lucho took us in his truck to the Esmeraldas airport along with his entire family and our friends Julio, Vismar, Gordito, and Elsa. We sat in the back of the same truck that had carried a dead pig for our “despedida” only two days before. When we arrived at the airport our flight was delayed, and Shelby and I felt very lucky to be granted an extra hour with these people who have been so good to us. I saw that hour as a last chance to convince the people of Estero, ever doubtful that volunteers will return, that I would be back someday. They did not seem convinced.

All of us had much time to prepare for the departure, and yet when the moment came for us to leave, nobody seemed ready. Even Lucho, the same guy who had killed a pig with his bare hands less than 48 hours before and who seems in many ways to be Estero’s classic alpha male, began crying uncontrollably when we said goodbye. His 5 year old son Luis, not understanding why we were leaving, where we were going, and why he was not coming with us, ran after us through the airport. He probably would have made it through the Esmeraldas airport’s lackadaisical security detail had his mother Carmen not caught up with him just in time. Elsa told us both that she had nine children instead of just her seven biological ones, and that we were as much a part of her family as the rest of them. Vismar and Gordito said that they would never forget us and think of us always.

Both on that day and in our subsequent airport goodbye to Eddy and Julio, two of our Estero friends who came to Quito for our last two days in Ecuador to see us off, Shelby and I tried to assure everyone that this was not “adios,” but rather “hasta luego.” I truly believe that I will maintain the relationship I have developed with that small coastal town throughout my life, and I certainly feel a responsibility to do so. I already miss Estero. I miss the screams and giggles of the little kids, being called Alejandro, and eating ceviche. I miss silence and its acceptance, and knowing that we do not need to fill every moment with words. I miss the color of the ocean on a sunny day, when the sun penetrates the surface and turns it a greenish blue. I miss Estero so much that I am already promising myself that I will return. But the difficulty with promises is that they claim a form of control on the future that we do not actually possess. And when future circumstances are very different from present ones, promising, even to oneself, is quite risky. 

My Final Weeks in Estero

In a post back in July or August (“Así es la vida”) I wrote about how my time in Ecuador had already made me reach a greater acceptance of life’s fortune and misfortune, and I feel that, as my departure from South America draws near, my experience has come full circle. My three weeks in Quito in March (one of them in a hospital room) recovering from cellulitis, reminded me that we often cannot control the circumstances that shape our lives but we can always choose how to respond to them. I left Estero on the night of February 28^th concerned about my leg but completely unaware of how serious my condition was. I left Estero assuming that I would be returning soon to spend my last six weeks with my friends and families there. But in life, plans often go awry, things happen, circumstances change. I ultimately learned a great deal from my experience in Quito about the importance of treating even seemingly minor medical issues seriously; about how fortunate I am to have all of my limbs; about the vast discrepancy between the health care available for most Ecuadorians and that available only for the elite few; about using positive and proactive thinking to turn setbacks into challenges to be overcome; and about how hard it can be to sleep one wink in a hospital.

 

The hardest part of being bed-ridden in Quito was being forced to recognize that my time as a volunteer, project coordinator, community organizer, scholarship program administrator, and teacher in Estero was essentially over. I realized that whatever remaining days I might be able to spend in Estero would be few. A couple of days to say goodbye and pass the hours with my friends was all I could hope for. There would be no more problems to solve, ideas to implement, or projects to tweak and improve. In my Minerva Fellowship interview over a year ago I told the committee that my greatest fear in considering the fellowship was that, when the time came to leave my placement, I would feel that I had not done enough. Though I am very proud of the work Shelby and I have done in Estero, I couldn’t help but be reminded of this fear while in Quito, as I watched my time in Ecuador disappear.

However, while my work in Estero was over, my responsibility to the community and to the families that had taken me in over these months had not gone away and never would. When, on Saturday, March 24^th, I was finally able to return to Estero, I decided to commit myself fully to being the best possible brother, friend, and son to the people who have become such an important part of my life over the last nine months. So during the two weeks I had in Estero, before Shelby and I left on Monday, April 9^th, to go to Peru, I did my best to maximize every moment of every day; to relish every hug from the handful of little kids whom I have grown to adore; to fully appreciate every swim in the ocean; to remember each conversation that I would never want to forget; and to savor every bite of fresh fish or seafood that I ate. Though March was full of events that I could not control, I decided that I would leave Estero on my terms, without regrets.

My last two weeks in Estero were memorable. From playing soccer for the last time on Estero’s slanted and overgrown field to leading a trip to the town of Mompiche with a group of high school students, the days were busy but wonderful. Shelby and I created a “semana de juegos” (week of games and activities), and played sports and games every day during our last week with the students we had worked with throughout the year. And, in saying my final goodbyes, I received countless gifts from the various families I had stayed with and from friends of mine. Everyone told me that they hoped their gifts would remind me of them when I was back in “mi país.” But I do not think I could forget Estero, or the people who were so important to my experience there, even if I tried. Estero, even in its laziest, most disorganized, and dysfunctional form, has a raw charm that is irresistible. There is a quality so unique about that tiny little town that even when traveling elsewhere, as I am now, I am only directly reminded of Estero when I encounter a moment or a place that sharply contrasts with Estero’s unpretentiousness.

We ended the final week with a despedida, or farewell party, on Saturday night, to which we invited the entire town. We bought a huge pig (over 140 pounds) from our friend Lucho and, with the help of the women’s cooking group, served pork dinner with rice and fried plátanos to everyone in the town. From 9 that night until 7 the following morning we danced and celebrated with our closest friends.

Today I am sitting in a hostel in Cusco, Peru, and I already feel worlds away from Estero de Plátano. Leaving Estero was extremely difficult, as I will detail in my next post, but it is a testament to the work that Shelby and I have done that what I feel now is not regret or disappointment, but rather a strong dose of nostalgia. My final days in Estero, though very sad and emotional, convinced me that Shelby and I have had almost as significant an influence on the lives of many people in Estero as they have had on ours, and recognizing this has brought feelings of both gratification and guilt.

Ecuador Under Correa: Perception is Everything

Since leaving the hospital two weeks ago, I have been staying with my friend Tomas in Quito while recuperating from my leg infection. I recently finished the three antibiotics that I had been taking and have my final visit with the doctor this Thursday. I have been exercising every day to regain the strength in my leg and build up my stamina and immune system. I am hoping to be able to return to Estero as early as this Friday, March 23^rd, but will wait to hear from the doctor tomorrow before making a decision.

Though Quito continues to be a place that I enjoy most in small doses, being here for an extended period of time has allowed me to become more aware of political happenings in Ecuador that tend to escape me when I am in Estero without access to any substantive news. While I have written about President Correa in this blog before, I have never done so with much clarity or conviction. But during my days in Quito I have increasingly found that this sort of uncertainty about Correa’s intentions as well as hesitation when it comes to assessing his initiatives is common among Ecuadorians. Taxi drivers, convenience store owners, and well-educated affluent twenty-three-year-olds all talk about Correa with the same sense of cautious optimism mixed with a sort of fatalistic skepticism. Almost everyone is impressed with Correa’s energy and ambition, but frightened by his authoritarian tendencies. Interestingly, many of Correa’s assets and achievements can easily, if considered from a different point of view, be twisted into proof of his anti-liberal-democratic inclinations.

Take, for instance, Correa’s ambitious communications campaign. In a country that has suffered greatly under corrupt, cronyistic leadership for decades, Correa has made it his mission to improve transparency and accountability in his government. Correa speaks to the nation every Saturday afternoon, often for more than three or four hours, to tell everyone in (usually tedious) detail about what he has done during that week. Additionally, the Ministry of Communication interrupts regular programming on basic cable channels every Monday at 8 pm to present a 20-30 minute update on the federal government’s domestic initiatives in areas ranging from education and health care to tourism and infrastructure development. Such frequent communication with the people would seem to be a positive sign of a government becoming increasingly responsible to the people who have elected it.

But not so fast: as I have pondered throughout the last eight months, where does one draw the line between communication with the goal of increasing government accountability and self-promoting propaganda? (Fascinatingly, the word “propaganda” in Spanish does not have the same negative connotations as it does in English; in Spanish, “propaganda” can refer to any form of advertising displayed in a public place, regardless of the truthfulness of its content). While Correa’s weekly addresses, though self-serving, would fit into the former category in my view, Correa’s government has recently undertaken an ambitious advertising campaign that seems entirely motivated by self-interest and paranoia, and which is undoubtedly propagandistic in nature. The advertisements, which are intended to organize public support behind a proposed reform that would limit news organizations’ ability to cover the 2013 presidential election (and thus, in theory, their ability to criticize the president), are ubiquitous on Quito radio stations. Every time I get into a taxi I hear another advertisement featuring a “concerned citizen” outlining the supposed differences between acceptable speech and libel, arguing that those who unfairly criticize the President are from an “old guard” of politically powerful wealthy elites who want to undo Correa’s social justice reforms, and imploring citizens to support the President’s efforts to limit slanderous attacks on anyone. Were Correa one of many voices on the issue, it would be a different matter, but in the wake of his successful $40-million lawsuit against four editors of Ecuador’s largest newspaper, El Universo, (Correa sued the editorial page editor and three others in 2010 for publishing a piece that accused the President of ordering the military to fire bullets into a hospital during a police protest in September 2010; in February of this year the Supreme Court upheld a lower court decision that charged the offenders with libel and imposed hefty fines as well as three year prison sentences for each of them), opposition voices have been all but silenced in the national news media. Many people I have spoken with in Quito are frightened that Correa’s tendency toward stifling opposition voices and limiting free speech is building each day.

If perspective is everything when it comes to assessing President Correa, then his infrastructure agenda is no exception. As I mentioned in earlier blogs, signs of public works are everywhere, particularly in Esmeraldas, which has long been considered Ecuador’s least developed province. The current government has built asphalt roads and concrete and steel bridges in places where erosion and extensive rain made dirt roads impassable during certain parts of the year. People’s lives have no doubt been improved by these projects, and many Ecuadorians have been put to work in construction. But the many signs placed at the sites of such projects— “these roads are built with your hands,” or “the citizen revolution is achieved through public works”—fail to mention that it is China, not the Ecuadorian government, that is funding much of Ecuador’s infrastructure agenda, and not out of altruistic goodwill. China has increasingly developed agreements with South American countries like Venezuela and Ecuador, offering capital to invest in infrastructure in exchange for hefty supplies of oil and other natural resources. On March 5^th President Correa gave Ecuadorians a sense of what being beholden to China may imply in the future, signing a mining contract that allows the Chinese-owned company Ecuacorriente to begin a $1.4 billion project to extract copper and other metals from a mineral-rich area in southern Ecuador.

In response to the government’s decision, residents from the towns that will be affected by the open-pit mining project have descended upon Quito, planning an organized mass protest for tomorrow, March 22^nd.  Over the last three weeks they have made a remarkable journey, mostly by foot, to arrive in the nation’s capitol and speak out against the first mining exploitation agreement in the country’s history. President Correa, unsurprisingly, has been as cruel to the protesters as he is to all of his detractors, first threatening bus companies with dire consequences if they adjusted their routes to accommodate the protesters, and now initiating a smear campaign against the group’s leader and spokesperson. That the same man who recently sued a handful of newspaper editors for defamation of his character is now initiating a campaign aimed at doing the exact same to another person would be comically ironic were it not a scary premonition of increased repression to come. It would seem that Correa, a self-proclaimed proponent of equality, does not believe that he should have to play by the same rules as his fellow citizens.

At lunch one day last week, Tomas’ father compared President Correa to Machiavelli, and it seems to me that the President is increasingly following the advice that Machiavelli lays out in The Prince. Having spent over eight months in Ecuador, I no longer feel like just a passive observer, but rather someone who is a bit more invested in the fate of the country. There are many potential outcomes for Ecuador. The country has recently experienced annual GDP growth of 6-8%, is home to an abundance of highly valued natural resources, and has a well-educated President who has finally adopted social justice policies that aim to provide greater opportunities for everyone. On the other hand, as I have tried to express in this post, the President’s propensity for repressive tactics and his intolerance of opposition are alarmingly Machiavellian. I believe the future direction of Ecuador will ultimately depend on the decisions made about natural resource exploitation: whether to drill in Yasuní National Park or preserve one of the most biodiverse sections of the Ecuadorian Amazon; whether to mine precious metals or leave indigenous Andean communities and their lands intact; whether to tear up the Pacific coast’s beaches to extract black sand to make titanium or leave these natural treasures as they are. In all of these cases, the outcome is still very much uncertain; however, the one outcome I would bet on is that Correa, despite his insistence in his weekly addresses that the government serve “the people’s” best interest, will not be interested in hearing “the people’s” opinions when it comes time to make his decision.

Details Matter: A New Manifesto for Minerva Fellows

A major psychological challenge to development work is to overcome the size discrepancy between the overwhelming statistics that highlight huge problems at the root of global poverty and the comparative smallness of the individual trying to initiate change. Because hearing statistics like “one billion people live on less than $1 per day” makes us feel small and powerless, we all enjoy feel-good stories about social entrepreneurs who are changing the world. Success stories give us hope that one individual really can make a difference; however, an unfortunate consequence of this way of coping with global poverty’s size inconsistency is the tendency to see only those solutions that can be broadened to a wide scale as being worth pursuing.

In Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, MIT economists Abhjit Banerjee and Esther Duflo interrogate the mainstream notion in development economics that big problems require sweeping solutions. They criticize both “supply wallahs,” who promote aid in all cases as a way of empowering the poor to escape poverty traps, and “demand wallahs,” who argue that poverty traps are a fantasy and that aid is inherently inefficient and ineffective. The authors contend that both groups, in their quest for definitive and far-reaching answers to the most challenging questions that confront the development community, tend to oversimplify problems and thus their prospective solutions, usually searching for a “silver bullet,” or single solution, to fight poverty. Banerjee and Duflo argue that there is an alternative to engaging the never-ending battle between aid’s proponents and its critics: rather than discuss poverty on an abstract, ideological level, the authors focus on trying to ask specific, concrete questions whose answers might help improve the lives of the poor.

The philosophy that Banerjee and Duflo advocate seems simple enough—“attend to the details, understand how people decide, and be willing to experiment”—but its adoption can have a profound effect on the implementation of development policy. The authors suggest that development policies tend to have in common what they call the “three I’s problem”: ideology, ignorance, and inertia. Too often, such policies are based on good ideas and noble principles, but do not take into account the practical and logistical challenges to effective implementation. In many cases, programs are developed with minimal knowledge of the conditions in a particular place (ignorance), and these programs are continued, even if unsuccessful, simply because nobody has put in the effort to critically analyze them and search for ways to improve them (inertia). Above all, development policies fail because the creators of such policies, in their impatient quest for big results, tend to overlook the important questions and ignore useful evidence, in doing so disregarding a set of details that could mean the difference between success and failure.

One development phenomenon that Banerjee and Duflo examine in detail is microcredit. Microcredit has been hailed as one of the greatest successes in the history of development policy, and for good reason. The sheer number of people it has reached through offering small capital loans speaks to its success. But as Banerjee and Duflo argue, microcredit has its flaws. For instance, numerous studies have shown that while microloan recipients frequently become more financially responsible than their nonrecipient counterparts, microcredit has not been the small business creator that it was promised to be. Micro-lending institutions have hedged their risk by offering only relatively small loans at very high interest rates, and by creating a group lending model that means everyone sinks or swims together. Yet many lending institutions have been unwilling to acknowledge that these methods of averting risk naturally diminish the loan recipient’s chances of rapidly pulling his/her family out of poverty. Instead of examining how the current microcredit model may be improved and recognizing that microcredit is just one of many tools that will be needed to help the poor, many banks have stubbornly defended the status quo, offering stories in place of evidence as “proof” that microcredit is the panacea we have all been waiting for.

Another example the authors consider is health insurance. Many people see in the poor a large pool of prospective health insurance recipients, for they are a group that is naturally exposed to more risk than the wealthy. So, when initial attempts to sell health insurance (typically offering coverage only against catastrophic scenarios, and not inpatient services, due to the informality of health services in developing countries) to poor people in developing countries failed, many “logical” explanations emerged: “governments have overprovided disaster relief in the past”; “poor people are too uneducated to understand the concept of health insurance”; “poor people are blissfully ignorant of risk and unconcerned about their health.” But the authors’ more thorough examination of the issue reveals that these conclusions were based on ideological assumptions, and not critical analysis. After conducting a series of randomized control trials, Banerjee and Duflo were able to reach a more complex set of conclusions that help answer the question of why poor people do not want health insurance. Because insurance companies have decided that it is only feasible to cover people against catastrophic scenarios, “time inconsistency,” or the difficulty of thinking, planning, and paying for a future occurrence that may not happen, is a major problem. As the authors explain, the payout of benefits “would not only take place in the future, but in a particularly unpleasant future that no one really wants to think about.” Additionally, prospective clients worry about credibility, as entering into a contract means trusting the discretion of the insurer. Banerjee and Duflo found that when health insurance company representatives visited the homes of prospective clients with a representative of another organization that community members were already familiar with, the likelihood of selling the insurance package increased greatly.

Banerjee and Duflo’s approach to development economics is fascinating, but many readers may find it discouraging to hear that poverty will not be ended overnight. Indeed, some might even argue that theirs is a defeatist approach, since it acknowledges, and indeed emphasizes, that we are unlikely to end poverty in any of our lifetimes. But the more important idea to glean from the book is that every initiative that is well thought out and well implemented, regardless of its scope, makes a difference. Of course we must aim to expand successful programs, but the most important piece of a given development policy, the authors contend, is the first step; we must first understand the present circumstances in great detail in order to implement policies that will be effective in changing those circumstances.

To Minerva Fellows, Banerjee and Duflo’s approach should feel empowering, for we are given the opportunity to go to a relatively small place, understand it very well, and ultimately make an impact on the people who live there. Our successes serve as proof that working at the margins, on a micro level, is far more productive than waiting around for big ideas to solve the problem of poverty.  We are not in a position to change the statistics that highlight the immensity of the poverty problem, but that may well be the program’s greatest asset: to provide nine individuals each year with the opportunity to hear the word “poverty” and think of faces, not statistics. The Minerva Fellows will not change the world, but if we are thorough and patient enough to understand even the smallest details of the places where we live, we can be among those who provide an example of how changing the world might be done. 

From a Hospital Room in Quito

Over the last eight months I have written posts for this blog from houses, hotels, and dozens of internet cafes in many towns and cities in Ecuador. But today I am writing from a place I never expected to end up: the Metropolitan Hospital in Quito. Over the four-day span from Friday, February 24th to Monday, February 27th, what appeared to be a typical insect bite turned into a severe case of cellulitis on the back of my right leg. On Tuesday, February 28th, with a red, golf-ball-sized bump on my right calf, I decided that I needed to go to Quito to be examined. On Wednesday morning I saw an infectious disease specialist, who, after opening the bump and attempting to remove the puss, determined that the bacteria were spreading so rapidly that I would need to undergo an operation. By early afternoon I had been admitted to Quito’s best private hospital and by 6:30 PM I was being anesthetized for the hour-long surgery.

By the time of the operation, my entire right leg had ballooned to almost twice the size of my left one, severely swollen and the skin hard as a rock. The surgeon carved a hole a bit larger than the size of a quarter out of my skin to extract the bacteria and dead tissue and cleaned the inside of my leg thoroughly. The doctor and surgeon were satisfied with the results of the operation. But in order to fully kill the infection, caused by a highly resistant strain of bacteria called MRSA, I will need to remain in the hospital for a number of days receiving a very strong antibiotic intravenously. This is the only antibiotic that is effective against MRSA and it can only be taken intravenously.

The speed with which the bacteria were controlled seems to have been essential: had I been seen any later, the doctor believes that the aggressive infection could well have caused permanent nerve damage. And so I feel very fortunate for many reasons, but above all for the members of the Sevilla family, who played a critical role in getting me the best care that Ecuador has to offer just in the nick of time. Tomás Sevilla is a very good friend of mine from Union, who grew up in Quito and has now returned to work here full time. When I was chosen for the Minerva Fellowship, Tomás insisted that his family would help with anything and everything while I was here. At graduation, in a moment that my mom remembers vividly, Tomas’ father, Esteban, told my parents that he would treat me like his own son; and he, as well as his wife Julia, have been true to his word. The doctor who saw me on Wednesday morning was recommended by the Sevillas, and is also a close friend of theirs. They call him “Dr. House” because of his eccentricity and his ego, but also because of his ability to quickly diagnose a problem and always choose the right solution. In my case, he was able to diagnose the infection in about five seconds, and make important and assertive decisions. He had assumed that the bacteria was MRSA, and thus had ensured that I receive the correct antibiotic from the very beginning.

While I was being brought to the hospital Wednesday morning, the doctor called Julia, and told her to come right away. Within ten minutes she had not only arrived, but was already lobbying the staff members at the desk to give me a hospital room (at the time I was in the emergency wing). Due undoubtedly to her persistence and charm, the hospital staff allowed me to bypass an extensive waiting list and placed me in the next available room. Moreover, both she and the doctor managed to convince the surgeon, already overwhelmed with patients, to do the operation on very short notice that same evening. In short, my relationship with the Sevilla family could well have saved my leg.

My experience over the last week highlights some realities of Ecuador’s health care system. While I am currently under fabulous care at the Hospital Metropolitano, for the majority of Ecuadorians private medical care is not an option. In order to provide health care for all, the government has ambitiously opened health centers in even the smallest towns in rural Ecuador, Estero included, but if Estero is any example, many of them are understaffed and lack even basic medicines. Furthermore, what staff does occupy the health centers tends to have minimal training in medicine, and is known to take five- and six-day weekends. In Estero, for instance, a “doctor” is expected to work Thursdays and Fridays, but he rarely comes both days, while the “nurses,” who arrive to work three or four days per week, have likely only completed high school. When I went to the health center to ask the nurses about the bump on my leg, they checked my blood pressure, asked when I would be leaving Estero, asked if I might be able to stay any longer, and then gave me a hefty supply of antibiotics (40 pills to be exact), to be taken four times daily for ten days. When I asked what the antibiotics were for, they said not to worry, that they were strong and would cure whatever the problem was. Needless to say, I never began the cycle of generic antibiotics that would have been powerless against MRSA and could well have caused my body to build a resistance to the antibiotic. 

Due to the sad state of Estero’s health center, when someone in Estero becomes very sick, he or she will travel to Atacames to see a doctor there. But Atacames is a place that has developed and grown rapidly, and as a result its health center cannot handle the volume of patients it receives: when Shelby had strep throat, she waited over five hours in the Atacames emergency room, only to be terribly misdiagnosed.

This comparison demonstrates the size of the gap between the top-notch medical care available to Quito’s elite and the highly inadequate care provided in the province of Esmeraldas. This gap is representative of a vast urban-rural divide in Ecuador, with quality of life being substantially higher, by nearly all accounts, in cities than in rural areas. As a result, top Ecuadorian doctors, educated at some of the best medical schools in the world, would never move to a place like Esmeraldas and practice medicine there. In response to this problem, the government has mandated that recent medical graduates in Ecuador spend one year working at a health center in a small rural community, but this program has seemingly had inconsistent results at best.

For the time being I am spending all of my hours trying to recover as fully and quickly as possible. Hospital life is pretty unexciting, but I am trying to make the most of it, reading as much as I can and doing some exercises with my right leg, which is still too weak to walk on. During my first few days, it seemed I was something of a fascination to the staff, as nurses, doctors, and medical students would come in at any and every moment. But when a medical student turned on all of the lights at 5 am just to ask me how I was feeling, I made it clear that I would be feeling much better with three more interrupted hours of sleep. For now, either that interaction or my improving health seems to have cut the number of unwanted visitors down. It’s funny what eight months in Estero has done to me: the sounds of babies crying and roosters crowing has become as easy to fall asleep to as a Coldplay song, while the well-intentioned voice of a thirty year old medical student is what drives me over the edge. Four days in a Quito hospital has reminded me that one need not cross borders to experience acute culture shock.

Voluntourism: Whom is it for?

Over the last seven months Shelby and I have worked with more than a dozen short-term volunteers from the Yanapuma Foundation and the British organization Gap Force. My experiences with these volunteers have taught me a great deal about the increasingly popular phenomenon called “volontourism,” that seeks to combine travel with opportunities to volunteer in communities around the world. The question that has always come to my mind is whom are these volunteers really working for? In other words, what are their true goals of volunteering and whom do they hope will benefit from their work?

The answers to this question have been mixed, but the overwhelming majority of volunteers have seemed more concerned with themselves than with the community they are placed in. A recent volunteer, for instance, came for ten days to Estero and had an agenda: “I need to feel like I’m making a difference,” she told us. Though we were already teaching eight classes per week, she decided that was not enough (unconcerned, of course, with the fact that anything she rashly started we may become committed to continuing), and searched for us during every moment of free time to do more. She generously donated money to help pay for a trip to a water park nearby; however, we had already planned a trip the coming weekend to Rio Muchacho, and the additional trip two days earlier was overwhelming to arrange at the last minute. Because she had come with unrealistic expectations she left disappointed, despite having participated in two of the busiest weeks we have ever had in Estero: 16 classes and 2 trips later, the only people more exhausted than Shelby and I seemed to be the kids.

The Gap Force group that came to work on the playground in November presented another equally self-interested face of voluntourism. They worked extremely hard on the playground, but saw the completion of the project more as a necessary evil than as a valuable part of their overall experience. Most of them went to Atacames every two or three days and every weekend night. And rather than spend their afternoons and evenings with their host families, they would usually spend free time only with one another, drinking by themselves. With one or two exceptions they seemed to come from very wealthy families in the U.S. and Western Europe and some of them may have been talked into going on the trip by their parents. This group did not seem very concerned with “making a difference.” On the contrary, most of them made little effort to develop relationships with people in the community and complained frequently that they could not access the internet on their ipads or make calls on their iphones (part of the reason they gave for such frequent trips to Atacames). Maybe most telling was their decision to cover the outer wall of one school building, which I had told them they could use to paint a mural, with outlines of their bodies and the various nicknames they had created for one another. The whole school now has to look at this wall every day.

Far and away the best experience we have had was with a young woman named Vanessa. Vanessa, an American who grew up in a Jamaican family, had found out about Estero through Yanapuma but did not arrive with an agenda or with hopes of changing the place. She offered to help whenever it was needed and was very supportive of all of our initiatives. But she told us from the beginning that she saw volunteering more than anything as a way of learning about people. “I like to visit places where people live,” she explained, and so during her four month trip around Ecuador and Peru she had spent the majority of her time in small communities like Estero. In her five weeks in Estero she made lasting relationships with many people, and is still remembered fondly and talked about by many members of the community, a rarity for short-term volunteers.

From these three cases and a handful of other experiences with voluntourists, I have been able to better understand the appeal of this phenomenon but also its many shortcomings. One problem is clearly the mentality that many prospective volunteers arrive to a community with, but this may not be entirely their fault, as many organizations’ promotion of volontourism seems to encourage an overly ambitious and overly self-interested mindset. Many organizations clearly embellish the impact that a prospective volunteer may have, while others may not actually realize that such volunteers can often be as much of a burden as a help. Still others seem to be outright dishonest at times. Gap Force, for instance, tells volunteers that they will be doing marine conservation work along the coast of Ecuador, which is simply not true.

So, unrealistic as it may seem, voluntourism would benefit from more honesty and transparency. Host organizations should be clearer with prospective volunteers as to what kind of work they will actually be doing and volunteers should be more honest with themselves in recognizing that rather than strive to change the world they would be far better striving to enjoy their time in the place they are visiting. Far from being the ideal combination between leisure and doing good, voluntourism seems more than anything to be a concept conjured up to make people feel virtuous. And while it is, at its very best, a fine way to learn about a people and a place, it is unlikely to help significantly in the fight against global poverty.