9/28/06: NPR
New York Times columnist Nicholas Kristof and contest-winning journalism graduate student Casey Parks were interviewed on returning from Central Africa by Brian Lehrer of WNYC.
Brian Lehrer: ...In the US, we have 5% of the world's population, 30% of the world's wealth... Are we creating or just hoarding global wealth? Most of us don't feel rich as individuals but when we are so rich as a nation -- and while tens of thousands of children die every day from hunger-related causes in the world, what is our responsibility? When scarcity contributes to genocide in a place like Darfur, what is our responsibility then? And in the context of our national elections, how different are Democrats and Republicans on these issues? We'll have this conversation not in debate form but with New York Times columnist, Nicholas Kristof, just back from reporting on poverty in Africa, and the student essay contest winner he took with him, Casey Parks, a student at the University of Missouri Graduate School of Journalism who had never been out of the country before -- one of the reasons she was chosen... We're delighted to have them back. Maybe you saw the two heartbreaking columns that Nick wrote from Cameroon about the woman named Prudence who died in childbirth from no access to care.... Casey -- you told us before you left that you had seen poverty in Mississippi growing up but you were curious to see how different poverty looked in Africa. How would you begin to describe the difference?
Casey Parks: I imagined that it would be different but I didn't feel that difference at all before I went. In Mississippi the people I know who are poor can always get food stamps or always get medical care. We saw so many people who... all they eat is casava which basically has no nutritional value. We saw so many people dying from malaria because they don't have mosquito nets or because they're living out in the bushes because of instability in certain countries. We met so many people who have no access to healthcare. Who,even if they could pay for the healthcare can't get anywhwere near hospitals because they're too far away and the roads are too bad. This is a completely other level. I expected it would be different but not at all like what I actually experienced.
BL: How different from what you expected? Was it shocking? Did it make you see the world any differently?
CP: Certainly it did! It's really strange for me to be back in the US and try to make sense of the US after seeing all this. You know, I didn't really feel it. I knew the numbers. But the numbers didn't resonate. There were numbers that are easy to forget or TV programs that I'd flipped through. When you actually talk to someone -- when you look them in the eye and you see.... You know, the kids break everyone's heart. When you look at a kid who has absolutely nothing to eat or you see a huge family sharing the smallest of meals that has no nutritional value, it's hard to come back and go out to a restaurant and feel good about yourself.
BL: I guess that's why Nicholas Kristof writes so much about stories of individuals. Nick, I've read a lot of newspaper columns in my life but I don't think I'll ever forget the two you wrote about Prudence, the woman whose life and death struggle during childbirth you told over two columns like a medical and political suspense story. My god, what a tragic story! No modern medical care. A doctor who left her in the hospital without operating for days when she finally got there -- because she didn't have $100. What was the moral of that story to you ?
Nicholas Kristof: Well, you know these kinds of things happen every day. About once a minute. Half a million women die a year in childbirth and it's really because neither donor nations like the US nor the recipient nations like Cameroon make it a priority. The number of women dying in childbirth has been stuck for the past 25 years. As Casey said, you can know that intellectually. But for me just being there by Prudence's bedside and just seeing her fade away for totally needless reasons... you can't put it away. Also I think that sometimes there's a tendency for us in this country to think, well, people in the developing world are used to death and suffering because they experience so much of it. Anybody who was there by Prudence's bedside -- saw her husband begging for us to help save her, see her mother and her sisters stay there every night by her bedside -- would not have said that.
BL: Casey, I read a lot of the blog that you kept in Africa. You were obviously very affected by the death of Prudence. What are you left thinking about now that you're back? CP: There are so many things... My first reaction was to get mad at the doctor while we were there because he promised us he was going to do her surgery and then he just left and he didn't do it. I was so angry at him. Then you get back and you think, well, he was the only doctor in that whole city, and what can we do about that, and even if I donate money to this one clinic how are people going to get to the clinic? I just keep going through things in my brain like how can I make this better? how can I make this better? And I'm not sure... We have a couple of ideas, but it's hard to implement them. One we've been talking about is maybe med students could do their residencies in a place like Yokadouma, Cameroon. What's happening is that doctors are leaving Cameroon because their currency was depreciated and then their wages were cut so doctors are making way less money in Cameroon than they can in bordering countries. So there are very few left. But maybe if a medical student went and spent three months residency there, there would be better medical coverage there. If you rotate people coming in and out -- three months in a place like Yokadouma would not be terrible. It would be a great experience and students could definitely do it.
BL: ...[Invites callers to call the show.] Nick, to bring Prudence's story to a political level, this is an area where you identified a clear difference between Democrats and Republicans because of their positions toward the World Population Fund. Can you talk about that?
NK: The UN Population Fund is one of the umbrella groups that has really tried to address maternal mortality. And it has done so all around the world -- in countries like Cameroon. Indeed, in other parts of Cameroon, they have provided kits and services to improve prenatal care and to reduct maternal mortality. Elsewhere in Africa I've seen that work. In Niger I saw a woman who arrived half-dead at the hospital and because of UNFPA's work, she was saved. But it's not functional in the hospital we visited where Prudence died. The reason is that the Bush administration has cut off all US funding for UNFPA. UNFPA is an unfortunate abbreviation for the UN Population Fund. The Bush administration did that because UNFPA's work in China and supposed ties to abortions there. Those charges about the China involvement are completely false. But in any case, it seems ludicrous to cut off all funding for the Population Fund's work in Africa today because of issues in China.
BL: Just as an aside, do you think those charges about China are false? China doesn't engage in forced abortions because of their one-child rule?
NK: The allegations about China are absolutely true. China does engage in coercive abortions, coercive use of IUD's. For example, they knock down the homes of people who have an extra child in breach of the family-planning policy. But in fact UNFPA in China has been constantly trying to get China to moderate those policies and to make family planning policies more lenient. In fact, one of the great triumphs of UNFPA in China was that they pushed China to change the IUD that they were indeed forcibly inserting in women to one that caused many fewer health problems and indeed will end up saving an awful lot of Chinese lives.
BL: So we have economic constructive engagement with China but not UN Population Fund constructive engagement!
NK: That's a very good parallel because in fact that's exactly what it is! The UN Population Fund has made a tremendous positive difference in ameliorating [inaudible] a coercive policy.
BL: And of course the other side: you also wrote in another column about the AIDS epidemic in Africa last week. You had high praise for President Bush's AIDS-fighting initiative. So how do you see his record on that?
NK: On AIDS I think he's done better than any previous president. He's dramatically improved AIDS funding. Also the program has become more flexible over time. It started out with too many restrictions and it's still... for my money it incorporates too many restrictions that emphasize abstinence-only education. But in fact when you actually go around on the ground, they really are implemented pretty broadly, pretty loosely, in most places. There are something like 9 million people whose lives who are on the slate to be saved because of that program on AIDS that President Bush introduced. That's a case where I think he's done great work!
BL: Everyone's debating Bush's vs. Clinton's antiterrorism records this week. Is it worth comparing their anti-AIDS records?
NK: Well, I think everybody who looks at the issues thinks that Bush has done far, far more than President Clinton did when he was in office. Now, in his defense, Clinton notes -- and he's right -- that he had to work with a Republican Congress that was very hostile to foreign aid of all kinds. And more broadly that AIDS in Africa was not the issue that it became later on. I think those are valid excuses but still, in some sense, they are excuses. I don't think President Clinton pushed as hard as he could have for help in fighting AIDS in Africa. President Bush, to his credit, has really made a tremendous... you go to southern Africa, you go around, and there really are AIDS programs that are saving lives right and left. When you have a pregnant woman in a country like Zambia who has HIV, there are programs now in place, a simply injection one can provide that will dramatically reduce the chance that her baby is going to have HIV as well.
BL: ...Some of you have heard me say on this show before that if journalism is really concerned with what is most important, we would have the same lead story every day: "30,000 children died in the world today of hunger-related causes. Most of those deaths were preventable." But we lead more often with what's new than what's enduringly big. Nicholas Kristof, my guest, who often writes about poverty around the world and an essay contest winner he took with him to see some of the world's worst poverty, Casey Parks from the University of Missouri Graduate School of Journalism. Nick, given the things that you focus on in your columns, I imagine that those UNICEF numbers, that 30,000 children die in the world on a daily basis because of hunger-related causes really do drive your sense of journalistic priorities, don't they?
NK: Yes. If you think about what we in journalism do well, we're good at covering government announcements and politics. We're good at covering things that happen on any one day. What we tend to be really bad at is covering things that happen every day and especially things that aren't governmental or political. BL: Isn't it ironic! If it happened once. If one day all of a sudden 30,000 children died from some preventable, hunger-related cause, and it didn't happen the next day, maybe it would be massive news! In a way that it isn't if it happens everyday. And frankly many of our listeners hadn't heard of that state until I just said it!
CP: I think if one child died from a preventable cause it would be big news. If it happened in one day.
BL: If it hadn't been happening and then all of a sudden it happened.
NK: Poor people would be much better of if deaths were intermittent and happened... In Darfur, aid workers have been so appalled at what's been going on that it's been suggested that if bodies there could be brought back to the UN so people could actually see what victimization looks like then there would be more of a reaction. Certainly the same is true of deaths from malaria, by hunger and all these other things that happen every day.
Caller1: I wanted to say that I feel it's America's responsibility -- aside from the idealism that it's our responsibility because we can -- I feel it's our responsibility because it's also our fault. I believe that first-world farmers fuel third-world starvation by providing food to locations where it creates a population boom that's... larger than agriculture can support.
NK: I don't agree with that exactly in that form. I do agree that in general it's thought that agricultural subsidies in the west, and Europe is the biggest single culprit there, do dramatically hurt Africa which should be a big food exporter. It's comparative advantage lies in cultivating food. We hurt poor countries very much by subsidizing agriculture and reducing commodity prices. It is more complicated, though. There are indeed some poor countries that are net food importers. Those countries benefit and others lose. The single agricultural program that hurts everybody in poor countries, though, is our cotton subsidy. That's the US. It hurts countries all over west Africa that produce cotton. One easy way to help Africa tremendously would be to cut our commodity price supports in the US.
Caller2: I lived in Bangladesh for six years and in Africa, in southern Africa, and in the Philippines. I saw poverty in a different way. I think what happens in America is even if we grow up seeing and hearing poverty, we don't smell it. We don't smell the excrement or the open sewers, whether they're in the streets of Dacca, Bangladesh or in the small towns of mountainous Yugoslavia -- or even here in the states where there's that kind of poverty. We're distant from it. We're mostly concerned with taking care of our families and our small circle of friends.
CP: I can certainly relate to that. The one thing I regret the most about the blog and the videos is that I can't make people smell. Prudence's death hit me most, being able to smell her room. I've spent plenty of time in hospitals in my life and I've never, ever, in my entire life smelled anything like that room.
BL: The way the media is progressing -- multimedia -- we may not be far off from that! But Casey, you saw poverty. You grew up, to some degree, around poverty in the US. Seeing this poverty which strikes you as being of another type, even. We have a hard enough time funding it. Our poverty programs in America, on the political level. Given what you saw and given what you'd already known, how to we distribute scarce resources?
CP: I don't know. That's one thing I've been thinking about too since I got back, is that poverty over there is completely different and completely worse. But also, if that point is made too well, what happens to those people who are poor in America. I don't know about how to spread those resources out at all...
NK: I think there are a lot of problems we want to address. There are problems of poverty in this country -- or education, or healthcare, or climate change -- and just because we want to address issues of poverty abroad doesn't mean that's our sole obsession or sole focus. We can do several things at once. It's a mistake to think of poverty as one global issue that includes the US and the situation abroad because the situation in a poor African country is an order of magnitude different and where you can save a few lives with a $5 mosquito net to prevent malaria, that is something we absolutely have an imperative to do.
BL: Casey, do you feel less bad for poor people in this country after seeing poverty in Africa? Do you feel like you even want to tell them to "come on! get it together! you have so much opportunity here compared to places you don't even think exist?"
CP: I don't know if I could go up to someone who's suffering in their own poverty and tell them that directly, but certainly I'm thinking that... I'm still thinking I don't have a lot of money and I don't. But just the other day I was sick and my mother from Georgia had antibiotics called into me in New York in, like, five minutes. Meanwhile, I watched a woman die because there are no antibiotics in the entire city because the whole city can't afford antibiotics... It's a whole other thing. But back to resources: I think it's important that there be a direct way of giving. Sometimes you have these huge organizations and the money gets widely dispersed.... We saw a few things over there.... there was money given directly to projects. That works really well. We saw a lot of Catholic missionaries who, with a little bit of money, were doing a lot. It made a huge difference.
Caller3: I came back recently from a medical mission to Haiti. I'm a physician. We were serving a community on the southwest corner of Haiti, a city called Dame-Marie, a city of 40,000 with no sewage. We set up a primitive little clinic. There was no running water. No sterile conditions. We could only do very, very limited incisions or surgical procedures. The thing is, Haiti is in our hemisphere. It's just miles off the coast of America. It's the poorest country in our hemisphere. I think it's great that money is being devoted to treatment of AIDS in Africa, but I think that we have to look in our own hemisphere. We have to look at countries like Haiti, countries like Honduras, where situations obtain that Mr. Kristof is talking about. There's no infrastructure. There are very few physicians. In fact, the physicians that there are in Haiti -- many of them come from Cuba. Castro mandates that every graduating physician spend a year in rural Haiti. What little healthcare is available is coming from the Cubans. Politically, my best understanding from the reading I've done is that the Bush administration more or less allowed the ouster of Aristide. Aristide was no prize. There was unbelievable corruption... What happened was that the situation wasn't good under Aristide but after he was out it deteriorated to total chaos where people couldn't go out in the streets, couldn't go out in the communities. What little was available....
BL: Another situation, you're saying, where the US participated in regime change and then didn't provide the necessary security.
Caller3: That's right.
NK: I think we don't, often enough, think of providing security as a key part of the foreign aid package. But it is. In so many parts of the world, we think of foreign aid in terms of building clinics or building schools. But really the worst thing that could happen to a country is for security to collapse. There's no point building schools right now in a place like Chad when you have the whole menace of Darfur crossing the border and Chad being about to fall apart. One of the best things we can do is work with the rest of the international community and provide security in places like Haiti, or in Africa, so that other services can, in turn, follow.
Caller4: I want to congratulate Mr. Kristof. He really has been a cheerleader and a great individual in doing these things and bring it to the fore. I just want to press this and say that I was in Africa in a program called Operation Crossroads Africa which really dates me! It goes back to the dates of Reverend Jim Robinson.... and when they were still in Liberia. And I was Liberia and Sierra Leone building stuff with a bunch of American students in this program.
BL: Did you say "when there was still a Liberia"? There is still a Liberia, isn't there?
Caller4: I thought it had changed into a different country.
NK: No, it's still Liberia. It's gone through some pretty rough times...
Caller4: Anyway, it was a basket case then and Mr. Tubman is long gone, thank goodness! But even then, as the food was being off-lifted from the ships, there were armed men coming in and just stealing it. And then of course, how do we deal with this problem of robbery and the ruling classes stealing much of the money being donated by the US? It went on then, it's going on now. It's one of the main reasons -- 90% of the reason -- why the money is not being.. and the goods are not being turned to the benefit of the people.
BL: You know, I can tell you that when we've done call-ins on how to help Africa -- and I've asked specifically for African callers -- we get many, many African callers who say "Look, don't waste your money on the country that I came from until the corruption ends." Otherwise it is just a waste. Casey, I wonder your point of view on this as a young journalist having just made this one trip to several African countries. I did notice on your blog that you mused about local responsibility vs. international responsibility.
CP: One thing about what he was saying about security and things being stolen... In the northern part of the Central African Republic right now, most of the people are too scared to do anything because there are so many rebels. Or the army is coming through and burning down villages because they're trying to stop rebels or bandits. And so what's happened is that most of the people up there have gone into the bushes and are now far away from their food supply, far away from their wells, and into areas where there are greater mosquitoes. So we were in one village where the day before we'd been there three children had died in one day. The aid programs aren't allowed to get up there. And if they can, they can't distribute food properly because everyone has scattered and they can't... it's not easy to go to one place and start distributing. They'd have to go through the bushes to find all these people. The security problem is very definitely a huge issue that has to be solved before they can make good use of the aid.
BL: Nick, it seems to me, having watched this issue for a while, there was a time when there was a real, clear liberal-conservative divide on this. Where the liberal position was just get the aid money in and yes, there's some corruption everywhere, and you have to deal with it, but we have to get as much aid money in as we can. And the conservative position was no, these governments are corrupt and maybe they were using it as a way to block aid money because they didn't believe in foreign aid anyway. But now there's a fair amount of consensus. That a) there should be substantial aid, in Africa, and b) the corruption really does have to be dealt with as part and parcel of that.
NK: Yes, and I think we're also getting better at knowing what aid is effective. Corruption is a huge problem. There's a sense that we need to improve efforts to fight that corruption. Also that health interventions tend to be the most effective kind and the easier ones to resist corruption over time. I think in terms of the political [inaudible] in this country, what has really changed has been on the right. Jesse Helms once famously said that foreign aid was money down a rat hole. That really reflected the view on the right for a long time. Over the past five years or so, the right, and particularly the Christian right, has started to come around and be much more enthusiastic for antimalarial programs, or anti-AIDS programs, and indeed that's why...
BL: Is it a Christian thing? Does it have anything to do with the Christian Right or, conspiratorially, missionary work?
NK: It's certainly related. Part of it that there are a lot of Christian missionaries who went over and saw people dying right and left and wrote back. That generated some greater empathy for the problem. There is some evangelizing to it, but it's not just about saving souls. You get people like Sam Brownback who I disagree with on just about every possible issue...
BL: Christian Right Senator from Kansas...
NK: Exactly. He has been a real leader on issues like fighting malaria, for example, and Michael Gerson who's an evangelical in the White House was the one who really pushed President Bush to go ahead with AIDS programs. The right is still more skeptical of aid than the left, but it's not nearly as starkly divided as it was a decade ago.
BL: Casey -- one last thing. I noticed on your blog that you referred to a question one of our callers asked before you left... if you were worried about being a kind of voyeur -- being safely from America just observing poverty in Africa. Did you feel like a voyeur when you were there?
CP: For the most part, no. But there was a point closer to the end of the trip where I thought, I cannot take any more pictures. I was worried. You know, everyone likes to get a heartbreaking photo and it feels good to have your heart broken sometimes. We were in this clinic in northern C.A.R., and there was this kid who was so malnourished. He'd already been at this Doctors Without Borders clinic for five days, so I have no idea what he'd looked like five days before, but I was thinking about how many pictures like that I'd seen in my life. They'd always been this background or the thing that makes movies sad and how different it is to actually see it. It's something I kept in mind the entire trip. Every day I asked myself, Am I doing this right? or am I accidentally becoming a voyeur? am I doing what I came here to do which is to allow others to see so things get better.
BL: "It feels good to have your heart broken sometimes"! What a line! I guess, Nicholas Kristoff, you'd better watch your back there as New York Times columnist. You've got somebody coming up behind you in this field!
NK: It's been great to see Casey show me up on both her blog and in her video! She's been terrific!