Keep the rubber side down

When I arrived in Africa in May 2005, I decided to bring my mountain bike. In fact it was a fairly nice piece of equipment and I thought it would be a nice way to explore during what I thought would be 2-3 years on the continent.

But during my first week in Dar es Salaam, I received a sobering message about what riding here can entail. We heard that one of our guards had taken a machete to the head as someone stole his rather old, Chinese, single-speed bike. We went to visit him in the hospital and, thankfully, he was conscious and we were told that he was going to be okay.

As I left the hospital, my head was spinning, not only about what had happened to him, but the kind of environment I was now in. I had just moved to Tanzania and I was still adjusting to my new reality. I was already getting used to expats sitting around talking about the latest crime that happened to them or someone they knew. This poor guy was riding a relatively cheap bike and got smacked. I could only imagine what someone would do to get mine. I ended up using it sparingly in Dar until I moved to Kibondo (rural NW Tanzania) where I would use it more. I had one or two interesting moments there but overall it was a much nicer place to ride.

riding near one of the refugee camps where we worked

* * *

In early November I had a bit of a bike accident while sailing past the snarled Monday morning Nairobi traffic. It was nothing sinister but rather a simple clipping of a pedal on a cement divider. My mountain bike flipped and I took a nosedive onto the bike path. It happened rather fast and didn’t involve any pedestrians, motorcycles or cars. Just my own, somewhat uncoordinated, self.

I was wearing a helmet but that did nothing to protect my front paws. As I got to my feet, I knew right away that I had at least broken my right wrist (technically the end of the radius in my forearm) and probably my left thumb as well. My flash self-diagnosis ended up being correct, far from being my first fractures of this kind.

For better or worse, I made the decision to soldier on to the office and call Priya from there. With hands shaking a bit from the freshness of the accident, I gritted my teeth and eventually was able to get my chain back on. As I was doing so, a beggar with bad timing decided to try to hit me up for some change. I don’t know if he saw the accident or noticed my scuffed-up clothing, but it probably wouldn’t have stopped him from taking his chances on a temporarily immobile foreigner. I raised my head briefly from looking down at my chain and greasy fingers and gave him a look I’m not proud of. But it did nonetheless quickly deliver a message that he needed to move on.

Thankfully the bike was mostly unscathed (given that it had conveniently landed on me). I mounted and trudged up the hill, albeit a bit wobbly. It soon dawned on me that hands are quite useful when riding a bike. Not only do they assist in supporting your torso, it’s how you change gears and access your brakes. I momentarily questioned the wisdom of my decision to carry on but after a few minutes, it appeared that I was going to make it the full mile and a half or so to our office building. Once at my desk, I called Priya. She dropped what she was doing and would proceed to spend the next five+ hours with me navigating the emergency/accidents process at the hospital.

Thankfully I haven’t spent much time in the healthcare system here. I hope it stays that way. This particular trip was a mix of surprising efficiencies and surprising inefficiencies. But the entire process took way more time than was necessary, and it even could have been longer had we not pushed a bit. Priya facilitated some things for them and I opted out of getting measured for a sling. Otherwise it would have been even longer.

One thing that was interesting was that the x-ray of my right forearm/hand revealed evidence of half-dozen or so previous breaks from years’ past, including a bone chip floating among the carpal bones in my wrist. My left x-ray was more modest with only three or four previous breaks. Not good memories.

a more sedate ride with family in Nairobi

As we got in our Uber, I stared at my forearm cast and thumb splint with my mind racing, thinking about how the day’s events would impact the next couple of months. I was in considerable pain but I was distracted by my thoughts. My trip to Somalia the following week would necessarily be canceled. Without the use of either thumb and the fingers on my right hand, no opening containers, no buttons, zippers, shoe laces, typing, driving, writing, etc. etc. until further notice. Ugh. Except for walking, I was hard-pressed to think of things that I would still be able to do.

I find the expression “all thumbs” a bit puzzling. I’ve never used it but I’m familiar with the fact that it means “clumsy” or “awkward”. Try having no thumbs. Now we’re talking clumsy. It’s amazing how critical those things are. Once again, I am reminded of the challenges faced by the disabled. Mine, thankfully, are just for a few weeks.

Cherries and Cockroaches

The psychologist, Paul Rozin, has said that a single cockroach will completely wreck the appeal of a bowl of cherries, but a cherry will do nothing at all for a bowl of cockroaches.

I read a book recently called Thinking, Fast and Slow by Daniel Kahneman. Among millions of other things, he argues that people tend to remember the negative much more than the positive. If I say five positive things about you and one negative, you’ll invariably dwell on the negative thing I said. It’s human nature.

This sort of thing prompts us to want to avoid negative outcomes at all cost. We like good things but we put much more energy into avoiding bad things. Studies show that golfers tend to shoot better when avoiding a bogey rather than shooting for above par. Animals apparently do the same. Alpha males tend to win more fights when preserving territory or their role in their leadership of the herd (or pride in the case of lions). Defense rather than offense.

All this tends to keep things closer to the status quo. I’ve seen this manifest itself in many circumstances, including my job. While donors, organizations, governments, etc. all want to generate positive outcomes (improve quality of life), the reality is that we invariably expend more energy on avoiding negative outcomes (saving lives). Generally speaking, that’s a good thing. But it can make us all risk averse and possibly miss some opportunities.

* * *

We’re in the middle of a severe drought in the Horn of Africa. We need to get aid to the neediest as quickly as possible. We’ve improved on this over the years but we still have much to learn. Ten years ago there was a big emphasis on trucking water to people during severe droughts. We still do that on occasion but it’s cumbersome and expensive. The world began to realize there may be a quicker and better way to do this (other than expensive modifications to watershed management). What if we just gave needy people cash and let the drivers of the private sector fill the needs? Much of the world has been averse to the idea of giving poor people money. Too risky, it is said. We need to tell them what they need. Or, they’re probably destitute because they don’t know how to make good decisions with money.

In fact the reality is quite different. The data shows that the poor generally prioritize well when provided cash. They don’t have the luxury of being able to make mistakes. We can always find, and point out, exceptions, but generally speaking, the poor, particularly the abject poor, are far more efficient with limited resources that the middle and upper class.

The concept of using cash as a tool to reach the needy has been around for a long time but it has taken a long time for people to warm to the idea. As phones have made their way to the deepest corners of Somalia, cell coverage (strangely) being as good as what you find in the US, a key piece of the puzzle was already in place. Another essential ingredient was an easy-to-use money transfer service. This has also been in place for several years. Moreover, this allow cash to get to them far more quickly and, with electronic transfers, much more safely.

The last big piece is whether or not people would have access to what they need, whether or not they have money. In Somalia, the private sector has proven to be very efficient at keeping supply chains open in some of the most adverse conditions. If people have money, the private sector can generally make it happen, whether it’s delivering water, food or medicine. Imposing UN or other organization logistics can distort markets, add expense, create redundancies and/or simply not provide value added.

* * *

Cash transfers have worked well and they’ve now become an essential tool in the toolbox. But they’re not perfect. How do you identify those in need, particularly if they are in a remote location? Who verifies that the phone numbers you have correspond to the people you identified? Has the list of recipients been kept confidential such that they aren’t subsequently targeted by predators? What if the private sector fails? In smaller markets, it can contribute to inflation.

The point is, cash transfers, previously considered unthinkable, have been used around the world to get aid quickly and efficiently to the needy – more resources making it to the hands of the those in need and less squandered on the logistics of aid delivery. We're hopeful that donors will step up and continue to  make these resources available in the weeks and months ahead. It shouldn't be used in all circumstances but for some situations it works amazingly well.

The humanitarian world is, and always will be, rife with cockroaches. There have been bad experiences where the cockroaches have beat the system, infiltrated the cherry bowl, and diverted aid. While it's not pleasant, it’s important not to become overly focused on the bad and lose sight of the good.