Wednesday, August 6, 2008

A numbers game

It is easy to become accustomed to the contradictions present every day in Juba. Then all of the sudden I remember I'm not only in Africa, but am also in one of the least developed countries in the world, with what is estimated to be one of the highest maternal mortality rates and infant mortality rates in the world. It's estimated because no one has concrete or reliable statistics, and sadly the statistics that do exist must be negotiated with the government before they can be made public. I've been slowly coming to the conclusion that, of the things I have learned so far in school, some of the most valuable have been from stories I've heard from professors or other students. Not that learning the meaning of p-hat and the difference between specificity and sensitivity isn't useful. They are (hopefully) what will help me get a job upon graduation. But it's the stories and experiences in countries, often terrible and heartbreaking, that have really stayed with me.

For instance, to paraphrase a particularly poignant one, we had a professor who works in nutrition and only taught one class but told a story about working in the earthquake in Bangladesh many years ago. He was given a week to lead an assessment of the housing and nutrition status of the entire population to determine the need for aid in the immediate aftermath of the disaster. The only way to access many of the areas was by helicopter so he and a team of surveyors would drop into entirely isolated locations, do a rapid survey and get pulled out again. At the end of the survey they estimated that (I don't remember the numbers here, so these are just examples) 2/3 of the population did not have adequate housing. They determined whether housing was adequate by the presence of walls and a roof, as long as the basics were present to protect people from weather it was thought to be enough. He brought this data back to his organization and they looked at it and saw they simply couldn't meet the need, there wasn't enough money or staff. So rather than let everyone see that the organization was underfunded and couldn't help all the people who needed it, they insisted he change his definition of adequate housing to anything that provided shelter from rain, ie a tarp, a house where all the walls have fallen down that the reports about the disaster that came out of Bangladesh claimed that 1/3 of the population was in need of support.

When you think of it as simply shifting a few numbers on a spreadsheet, it doesn't seem like such a hard thing to do. But when you consider that you're deciding that tens of thousands of people won't have access to shelter and will therefore be more likely to die of exposure and a litany of illnesses, it's shameful. But that is apparently the case with most statistics. I've been told that in some countries infant and child and maternal mortality rates that are reported by many organizations are negotiated with the government before they are released. The rates are decreased or increased depending on whether the government wants to display progress to satisfy one set of donors, or a decline to increase aid funding. It's a sad state of affairs and could make some people lose faith in the nonprofit/aid industry. My reaction is just the opposite. Call me an optimist but I think it can only get better and if nothing else there is a recognition of how important the work of NGOs is, as well as the importance of engaging the local community to make the progress and change sustainable. Sounds like rhetoric to anyone involved in this work, but I actually believe it. And I figure if South Sudan couldn't knock it out of me, maybe nothing will.

1 comment:

  1. I know that I certainly don't know what specificity and sensitivity mean... and the only reason I remember p-hat is, well, because of P-hat. I like what you have to say about numbers-- I feel like lots of public healthy folks think that statistics are supposed to be the life blood of public health. But those statistics, as you point out, are often negotiations-- not infallible facts or truths. Thanks for the update,