All about the money

“What do you think about international development?”

I get asked that question a lot. Fellow volunteers, a friend who works for a private foundation, a former USAID employee, an NGO worker – they’ve all asked it, in one form or another.

“What do you think of international development?”

I think every volunteer asks themselves that question at some point. We see a lot of NGOs doing a lot of stuff – some good stuff, some bad stuff – and often times we see it from the perspective of Cambodians. Our neighbors, co-workers, and students tell us about the NGO, and it’s usually a mixed bag. Afterwards, we’re left thinking, “Huh. What do I think of international development?”

I never have a good answer ready when someone asks. “It’s complicated,” I say. Then I usually give a platitude-laden response – people try hard, nothing is perfect, it’s so complex, cultural differences, aid dependence, building capacity, yada yada yada. There are a bunch of ways to use words and phrases indicating you know all about development without ever saying anything meaningful about it.

That’s all bullshit, though. I’m just scared to tell them what I really think. I’m afraid it will make me look stupid. I’m afraid they’ll pity me for my naiveté. I think it will make things uncomfortable. Most of all, I’m afraid they don’t actually care.

But if you don’t care, that’s cool. You can just stop reading. And if you think I’m stupid, I won’t be able to read it on your face. So you can get my real answer.

What do I think about International Development?

International development is structurally racist, suffers from the crippling bureaucracy demanded by donor governments, and utilizes people’s natural inclination to do good but traps them in a system that sets them up for failure. It is inherently flawed because it begins with a premise that we are rich because of something we do, they are poor because of something they do, and in order to correct this imbalance we must teach them what we do and how to do it like us.

Now, I know that answer is like a conversation-killing checklist: race, economics, politics, exploitation. I might as well hold up a sign saying, “No more fun here!” Hard to go back to entertaining anecdotes about how I pooped myself in the street once, or how I accidentally asked my host-mother if I could "fuck the dishes.” Anti-establishment diatribes tends to derail small-talk pretty effectively. It’s also not what I’m supposed to think.

As a Peace Corps volunteer, I’m supposed to have gone through this whole process and gained an appreciation for the nuances, tensions, and problems with enacting aid in poor communities here in Cambodia. At the beginning, during conversations with people who are far more experienced in international development than myself, I was told people in my community would be, to varying degrees, lazy, corrupt, difficult to deal with, waiting on foreign aid, and/or self-serving.

Those aren't the words they use, of course. 'Lazy' becomes 'different cultural attitudes toward work', 'corrupt' becomes 'lacking institutional support', 'waiting for handouts' becomes 'aid dependent'. But dressing up the language in academic, detached terms doesn't remove the racism, and it definitely doesn't make it true. 

The Truth

The truth is, I’ve learned none of these things - in fact, I’ve learned the opposite. For the development aspect of my Peace Corps service, all of the real difficulties I’ve faced have come from Americans, not Cambodians. Grants that get denied because they “set bad precedents” for my community, grants that are changed because they don’t meet the donor criteria arbitrarily set by a bureaucrat in Washington D.C., entire projects vetoed because they don’t fit within the current scheme of “appropriate” international development.

Ostensibly, as a Peace Corps volunteer who’s lived in my community for a year and a half, I would have the most intricate knowledge of what my community needs – apart from the community members themselves, of course. Yet this experience and knowledge does not translate to trust or money from higher-ups when it comes to attempting actual development.

And here's the scary part - even given all this, I believe the Peace Corp's reputation as a grassroots, effective development agency is deserved. I think they (or we) probably do an as-good or better job of ensuring the community's needs are considered properly when developing a project than any other organization out there. It's just not good enough.

What I’ve realized is that it’s not the people of Cambodia’s fault that development work is so hard, it’s the fault of the development itself.

It’s important not to mistake this with another common refrain – that “(Country X) gets too much aid.” This is dangerous and narrow-minded thinking. If the aid in a country is not helping the country properly, the solution is not to decrease the amount of aid the country receives – it’s to change the type of aid offered to that country. The distinction is important. Cambodia has not received too much aid, as some people think – it’s received too much bad aid.

"Good Aid" vs "Bad Aid"

"Bad aid" is a project that is designed and/or implemented by foreign-funded and foreign-operated agencies. Much of the development work funded by big aid agencies and NGOs are big projects. They try to connect a resource or product with a community that needs it. Wells, water filters, sanitation stations - it could be anything. Instead of outsourcing that work to the recipient themselves, by just giving them the money, they assume they can do a better job. The organization prioritizes the community's needs for them, rather than letting the community do so itself. 

The aid agency then employs smart, well-intentioned young people from western donor countries to come in for a year or two and form a plan.

No matter how well-intentioned, however, this plan will inevitably fail, because it starts with the flawed premise that a 25-year-old international development major from America knows more about the needs of a Cambodian villager than the Cambodian villager does. But, of course, they don’t.

In response to this failure, the people who wrote the plan will note all the difficulties they faced during implementation – cultural differences, social nuances they didn’t understand, institutional corruption – and shift blame to those things. They will collect their salary - many times the salary of a local worker, money that could have been given directly to a person in need - and they’ll go home. They’ll tell their friends how hard international development is, how complicated it is, never noting the inherent biases in that attitude, and the idea that development is inherently complex will further perpetuate itself.

I think that idea is wrong. I believe that poverty is not a complicated issue. Poverty is not difficult, and it’s not complex. It’s simple – people are impoverished because they don’t have enough money. If we want less poor people, we should give them more money. Giving people money - “good aid.”

Poor people + money = less poor people.

I know that sounds like I can’t be serious. It’s so naïve. I get that. It really doesn’t sound very smart, does it? For example, compare the following sentences. 

• “Giving poor people money makes them less poor."

• “The cultural differences and nascent institutions associated with socially oriented economic development in developing nations makes sustainable, capacity-building development projects difficult to execute without heavy involvement of invested local partners.” 

The former sounds like the musings of a fourth-grader, while the latter sounds like it came from a master’s thesis. And yet, maybe simple isn't all bad. Maybe a fourth-grader could do a better job of solving poverty than we've managed to do so far.

People are poor because they don’t have enough money – so why not just give them more?

That will never work.

I know. “Giving money to poor people” isn’t a very popular strategy. But what if it did work, and we just didn’t know it?

The first objection seems pretty obvious, particularly if you follow debates over welfare in the U.S. – if you just give people money, they’ll work less. Turns out, that’s not true. 

Over at Poverty Action Lab, a team of researchers from MIT and Harvard analyzed 7 trials in 6 different countries and found absolutely no evidence that cash grants discouraged work. To quote from their report:

“We do not observe a significant effect of belonging to a transfer program on employment or hours of work in any of the seven programs… We re-analyze the data from 7 randomized controlled trials of government-run cash transfer programs in six developing countries throughout the world, and find no systematic evidence that cash transfer programs discourage work.”

Which doesn’t surprise me. The villagers in my community wouldn’t stop working if they got more money. They’d spend that money on things like healthcare, education for their children, smartphones, motorbikes, home repairs, farm equipment – the results would be as varied as the personalities of the individuals. But none of them would take that money and go, “Oh, OK, I guess I have enough money now, I should probably stop working.” That’s not really how poverty works, and anyone who thinks a small cash grant will discourage work has probably never lived in an impoverished community.

OK, so cash grants might not discourage work. But does the money actually go toward improving the lives of the recipient? Well… in most cases, yes.

GiveWell, a non-profit that ranks charities based on their cost-effectiveness – dollar-in, output-out – also likes the idea of unconditional cash grants. Here’s a quote from a report they made:

"This trial indicated that unconditional cash grants lead to large increases in recipients' consumption, assets, business investment, and revenue… Bottom line: Cash transfers have the strongest track record we've seen for a non-health intervention, and are a priority program of ours."

Indeed, one of their recommended charities for 2015 is GiveDirectly, an organization that gives unconditional cash grants to poor people in Kenya and Uganda. 90% of the money a donor gives ends up in the hands of a recipient – which is hugely efficient compared to most other development programs. GiveDirectly was started by a group of economics students who studied various development techniques and found direct cash grants to be by far the best – yet couldn’t find an existing organization that focused on them. So they started one.

Innovations for Poverty Action (IPA), a group with 600 employees that focuses on statistical research to evaluate development programs, also supports the idea of cash grants, and they’ve found it to be effective even when the aid is targeted – for example, a program that gave unconditional cash grants but also gave parents information about school enrollment was as effective at enrolling new students in school as putting that condition on the grant itself. People don’t need to be told to send their children to school – they just need the opportunity. 

The Transfer Project, a collaboration of UNICEF and University of North Carolina, tracked the results of direct cash grant programs in seven different countries in Africa and found the quality of life of recipients improved significantly after cash grants.

These projects are hugely efficient, eliminating the need for a large staff of western workers to manage and oversee projects. They are highly effective, ensuring the money doesn't get lost through the many layers of government or institutions it must pass through before reaching the hands of an aid recipient. And they are empowering, giving people the choice of how and when to spend their money. 

So if the research suggests cash transfers are impactful, cost-effective, and simple, there’s an obvious question.

Why don't we just give poor people money?

Part of the reason is institutional inertia – change takes time. These programs are relatively new, starting within the past 5 years, and they're still on a smaller scale than most development projects. But real change will never come unless the current attitudes that development agencies endorse change dramatically, shifting from a top-down development approach to a bottom-up alleviation of poverty.

I don't think this attitude comes from conscious racism or cultural imperialism. Aid and development workers, by and large, are incredibly underpaid, compassionate people who have moved away from their homes and families in order to make a positive difference in the world. They're not trying to fail, they're trying to help.

I think many times, if you’ve made a career out of international development, you simply don’t want to believe that your job could be replaced by a direct cash transfer app on a smartphone. If you had spent your life studying how to get money from rich people to poor people in the best way, and the answer all along was “just give it to them”, you might be a bit put-out too.

And that’s fair, that’s a pretty human feeling. But at the end of the day, the goal should be directing as many dollars from aid organizations to aid recipients as possible. There will always be a role for development specialists – translators, researchers, health workers, crisis responders, skill sharers. But their role should be as limited as possible, far more limited than it is today, to ensure that the donor money is spent where it should be spent – on the people that need it most. The only people who stand to benefit more from a big bureaucracy that manages complex development projects today are the western aid workers themselves.

So what do I think about international development? I think if we want people to have more money, we should give it to them. I think if we were serious about ending poverty, we would end it. And I think that the power to do both these things already rests in our government coffers and wallets – all we need to do is start giving it away.

A sweet, delicious death

Can eating a mangosteen with sugar really kill you?

About a month and a half into my Peace Corps service in Cambodia, I was talking to my training host mother about mangosteens. Previously, I’d mentioned how I’d never seen the fruit in America before and I said I thought they were delicious. So every day for the remainder of my training, she bought me a kilogram of mangosteens, peeled them for me, and insisted I eat them before leaving the dinner table. Which I happily did.

Some mangosteens. 

One day we're sitting around, her with the peeling mangosteens, me with the eating mangosteens, and I ask her if she’s ever eaten a mangosteen with the spicy salt commonly eaten on other fruits.

She laughs and shakes her head no. But then, quite suddenly, her face becomes serious. She takes a half-peeled mangosteen, holds it up, looks me directly in the eyes, and says heavily, 

"Don't ever eat this fruit with sugar on it. You will die."

At first, I thought I didn't understand her because of the language barrier, so I asked her to repeat herself.

"Don't ever eat this fruit with sugar on it. You will die."

Ok. Well that is what she said. What a funny thing to believe, I thought. I wonder if it is a common belief in Cambodia.

Turns out, nearly everyone in Cambodia believes this to be true. After asking several people about it, I decided to ask my language teacher. My teacher is incredibly smart, college-educated, and very willing to openly discuss the cultural and linguistic differences between Cambodia and America. She’d answered countless of my questions already, so I trusted her to explain why this was such a popular belief.

"Why do people in Cambodia think if you eat a mangosteen with sugar, you will die?" I asked her one day after class. 

"Because you will die," she said. 

"No, you won't," I said. "It's a fruit and sugar. Those things can't kill you." 

"I don't know why," she said. "But it's true. You will die." 

“Ok. Well, have you ever seen anyone die from it?” 

“No. Just stories. I don’t know why I believe it, but I do. Everyone does.”

Well that’s just silly. You can't just go believing things that you can't prove. No one could explain why it would kill you, they just accepted that it would. It was irrational, it was unscientific, and it was just plain strange.

The importance of not being the bad guy

Fast-forward six months. I'm reading a book called "Seeing Like a State" by an anthropologist named James C. Scott. I'm going to briefly summarize one of his points, because it’s relevant.

Scott argues that there exists a form of knowledge, which he terms "metis", that is inherently local, practical, and experiential. Metis is often an 'approximate' or 'unwhole' truth, and can look unscientific and irrational when viewed from the outside. But metis always develops from real-world experience, and is thus often valuable knowledge for a given situation.

For example: If you were on a boat in a storm, who would you rather pilot your boat: A guy who has a formal navigational education and has read many books on piloting boats like this one? Or a sailor with years of experience on this particular vessel, in conditions like this? One has rational, scientific information, but the other has "metis". 

His argument is that while you'd obviously choose the experienced sailor, very often in history, governments that have sought to 'plan' various things - cities, agriculture, social interactions - have trusted the educated scientist or bureaucrat and devalued the local knowledge of "metis". They trusted the guy with the degree to pilot their boat, and ended up crashing the whole thing.

So this part of the book got me thinking - what about mangosteens and sugar? This seems like a perfect analogy. Except I'm the one saying, "But science, universally applicable principles, fruit and sugar, it is fine! Your local knowledge is wrong, it’s backward, and it’s unscientific! Just think about it!"

I was Scott’s bad guy, the guy who made the wrong choice. I was on the wrong side. I devalued local knowledge in favor of my own thoughts about knowledge and education. I crashed the boat.

I don’t want to be the bad guy though. So what can I do? Well, I thought, I guess I’ll have to learn about eating mangosteens with sugar.

So... Will eating a Mangosteen with sugar really kill you?

When you Google "Mangosteens and sugar", the first result is a thread from a forum of expats in Cambodia, and the expats are mocking Khmer people for the belief that eating a fruit with sugar would result in death. Not very classy and also, upon reflection, disturbingly similar to what me and my fellow volunteers had done, albeit privately, when we first learned of the belief.

Dig a little deeper though, and you can find one medical study regarding chemicals found in mangosteens called xanthones, and their interactions with insulin and glucose in the bloodstream. To quote from their abstract:

“Taken together, these data demonstrate that [components of mangosteens] attenuate LPS-mediated inflammation and insulin resistance in human adipocytes.”

In other words, mangosteens can actually reduce the insulin resistance of cells in the body, giving them a greater capacity to absorb glucose.

In fact, there are a bunch of "pro-mangosteen” organizations out there - like this one, or this one - that promote the fruit’s consumption to treat or help alleviate symptoms of diabetes. Since the xanthones in mangosteens reduce the insulin resistance of cells, they can actually help diabetics process glucose - provided those patients are still producing small amounts of insulin.

So, wait. It turns out mangosteens are not just “fruit”, but have unique interactions with sugar and insulin. Which raises all kinds of questions. What happens if the patient isn't producing insulin, but their cells become less resistant to it after eating a mangosteen? What happens in cells with normal insulin resistance when they are hit with a Mangosteen (allowing more insulin intake) and sugar (a huge smack of glucose)? What about people who have been insulin-resistant for a long time, but with a Mangosteen and sugar would be less resistant and full of glucose? What about differences in children, or in pre-diabetics, or the elderly, or the immuno-compromised, or…

The list goes on, and I have no idea about any of it. I never even took college-level science. And science is lacking here, as I couldn't find any sort of study about any of these issues. After all, mangosteen consumption isn't that high in the West. Why would science bother?

This is all interesting, but will it kill you?

I have no idea. However, I think a few things are worth noting:

·       Mangosteens affect insulin resistance (and thus glucose intake) when consumed.

·       When consumed with sugar by a diabetic or pre-diabetic, the biological result of that consumption could be manifestly changed by the combinatory effects of the mangosteen and the sugar together, as opposed to taking both separately. It would also be different than eating any other fruit with sugar.

·       Were there to be a biological response, it would likely be acute (shock, dehydration, low/high blood sugar spikes) rather than any sort of chronic condition.

·       Many Cambodians lack proper medical knowledge and facilities to treat diabetic emergencies which would be less severe in the states, meaning a case of abnormally high- or low-blood sugar could be life-threatening.

·       Cambodia has a high and rising rate of diabetes, perhaps partially attributable to the Khmer Rogue. A 2004 study found that up to 25% of adults in Cambodia had some sort of glucose intolerance, and two thirds were unaware of their condition.

So. It seems that in most cases, eating a mangosteen with sugar will not result in death. However, given the fragile balance of insulin and glucose that most diabetics must maintain in order to have good health, and given the high rate of diabetes, particularly undiagnosed diabetes, in Cambodia, it may not be such a good idea for a Cambodian to try it. In fact, it doesn't seem so strange that an undiagnosed diabetic eating a mangosteen with a heap of sugar on top could result in a medical emergency requiring treatment that may not be easily accessible in most parts of Cambodia.

What I learned
In dismissing both my host-mother and my teacher's knowledge out-of-hand, I was exhibiting a bias toward rational, scientific thought that is inherent in almost everyone raised in an educational system developed from Enlightenment principles – i.e., “the West.”

Without much critical analysis, we place implicit trust and faith in the institutions of science and specialization. Which is fine, I'm not saying science is bad. But it’s important to notice that, by its very nature, it is exclusionary. By establishing universal principles and dictums, it becomes rigid and inflexible in many ways. If information doesn’t adhere to the principle, we generally toss out the information rather than re-examine the principle – particularly when it comes to snap judgments about new information.

Of course, science can adapt. It can study mangosteens in more detail, and analyze the compounds and their effects on the body - as that one study did. It requires extensive research, significant funding, and very skilled labor, but it’s possible. Just not very likely.

Before science does any of this, however, and with a much smaller investment, the Cambodian people have noticed a phenomenon and used their experience to develop a practical work-around that bypasses the need to worry about the issue altogether. In this case, the "metis" form of knowledge outpaced the science - and perhaps even inspired the original scientific study in the first place. The knowledge appeared irrational and unscientific, but in fact it was highly situational, practical, and useful. Potentially even life-saving.

When presented with this form of knowledge, I didn't even recognize it as knowledge. I labeled it as superstition or urban legend and tossed it aside. I may not have called it "traditional" and "backward" in my head, but I may as well have for all the serious consideration I gave it.

In doing so, I embodied one of the worst tendencies of Westerners and, by extension, their governments – to impose static and rigid views of what is valuable information and what is not upon other cultures. The most visible example of this practice is in foreign aid organizations, where the paradigm of the developed country sharing skills and knowledge to help the less-developed country presupposes a "better" type of knowledge and skill.

Often, when a Western government comes to share “technical expertise” or “skilled labor”, it is not actually engaging in sharing. Rather, it is engaging in a one-way transfer of knowledge in order to replace a “less-developed” system with a “more-developed” alternative, one which is based on science and reason rather than “traditional practice.” This method of aid can be valuable and helpful, but it also runs the risk of ignoring and destroying local, situational, practical knowledge, which can often be more useful or valuable to those who live in the country.

Part of any aid worker's struggle is to try and avoid falling into this trap. You never want to impose your views on another culture, but often times you can do so without realizing it. I may have come to Cambodia as a teacher, but sugar and mangosteens will help me remember that I should always be a student first.