Mountains beyond Mountains: Reflections on International Development
A while ago I read a book called “Mountains beyond Mountains” by Tracy Kidder. It tells the true story of Paul Farmer, an American doctor and activist who spent his time starting medical projects in Haiti, Russia and Peru and fighting with international organizations like the WHO for the rights of the poor to receive quality and affordable medical care. The book was very interesting to me because I’ve been working in international development for a few years now, and the more I see how things are run and decisions are made, the more I start to believe that international organizations may be doing more harm than good. Paul Farmer seems to have the same belief, as evinced by the below excerpt:
He parked beside the ruin of a small cement factory. Plants were growing helter-skelter high up on the rusted structure. A hundred yards away stood a concrete buttress dam. These days, when Farmer wasn’t in Haiti, he gave lots of speeches, sometimes several in one day, and in every one I heard, he talked about the dam. It appeared in all the books he had published by 2000 and in the books that he had helped to write and edit, and also in many of his journal articles – forty-two of those by then. As a scholar and writer, Farmer had taken his greatest paints to assert the interconnectedness of the rich and poor parts of the world, and the dam was his favourite case study.
It stops up Haiti’s largest river, the Artibonite. It’s called the Peligre Dam and the impounded waters behind, the Lac de Peligre. The U.S. Army Corps of Engineers had planned it. Brown & Root of Texas, among others, built the structure in the mid-1950s during the reign of one of Haiti’s American-supported dictators, with money from the U.S. Export-Import Bank. It was advertised as “a development project, ” and no doubt some of the people behind its creation believed it a gift to Haiti. But no one seems to have given much thought to the peasant farmers who lived in the valley upstream.
The project was intended to improve irrigation and to generate power. It wasn’t as though the peasants of the central plateau didn’t need and want modern technology, Farmer said. But, as they themselves often remarked, they didn’t even get electricity or water for their land. Most didn’t get money either. In fact, the sam was meant to benefit agribusinesses downstream, mostly American-owned back then, and also to supply electricity to Port-au-Prince, especially to the homes of the numerically tiny, wealthy Haitian elite and to foreign owned assembly plants. Since the flooding of the valley, many peasant girls and boys from Cange, children of what Farmer called “the water refugees, ” had left home looking for work in the capital, where they cooked and cleaned and stitched Mickey Mouse dolls and baseballs, more than a few of them nowadays returning home with AIDS.
Although this particular so-called “development project” was carried out not by an international organization but by the US army, the story provides an excellent example of the type of harm that has been perpetrated by international organizations upon the world’s poor around the world. It is for this reason that many left-wing activists call for a complete boycott of these organizations by local NGOs. Farmer, however, did not follow this methodology. Rather, he spent his career cooperating with these organizations in trying to change their policies. He did this while publicly detailing everything wrong they’re doing in his writing and scholarly work. The difference is that he believed that these organizations were capable of doing good, we just have to do our part in steering them in the right direction. I wonder if he’s right. Although part of me believes that organizations like the World Bank and IMF are so politicized that their policies can necessarily never be pro-poor – and this belief is further strengthened by the havoc their ERSAPs (economic reform & structural adjustment programmes) have wreaked upon Egypt’s socio-economic structure – another part of me looks at what Farmer managed to accomplish. After years of attending mind-numbingly boring meetings and pretentious gala dinners with international donors, while simultaneously ignoring their methods and doing his own thing in the field, he finally succeeded in getting the WHO to change a major policy that dictates the way it deals with HIV/AIDS. Countless lives have been saved because their original policy was so misdirected that it considered an entire group of people as good as dead, because they were too expensive to cure on a mass scale. Farmer, through his own work in Haiti, Russia and Peru, forced them to believe otherwise. Although his work is substantial, on a global scale it would have still been considered limited had he not managed to take it global through backing from the WHO.
It makes me wonder, whether we like it or not these organizations wield enormous power over how governments deal with their less privileged citizens. No matter how unethical and unfair we believe this to be, it is a fact that we have to deal with. Have we reached a point where fighting against it no longer makes sense?