IMPACT

Amy Lehman, Aid Worker, Warns Against 'Magic Bullet' Solutions Like Anti-Malaria Bed Nets

07/31/2015 10:48 EDT | Updated 07/31/2015 11:59 EDT

This weekend the Googleplex in Silicon Valley will be hosting the Effective Altruism Global conference, a gathering of science tech philanthropists and entrepreneurs who want to use their business and book smarts to optimize the world. This year's speakers include the likes of Tesla and SpaceX founder Elon Musk, Skype co-founder Jaan Tallinn and Google.org director Jacquelline Fuller.

But for Dr. Amy Lehman, a famed aid worker and physician who operates in the Lake Tanganyika Basin in Sub-Saharan Africa, it's important these elite altruists keep one thing in mind: "The idea that it is super simple and the solutions are out there waiting to be plucked, that's simply not true."

"I know this is unsatisfying from the narrative perspective because we like 'Boom, we fucking fixed it!' But that's rarely how it works. There is no fucking magic bullet. There really isn't."

Lehman was in Toronto recently to speak about her plan for a floating hospital at the Ideacity conference. But as you can see in the video above, the self-described "skeptic and contrarian" also went on a riveting rant about the problems with donors and foundations seeking the "cheapest possible solution for millions of people that can be deployed in a scalable way."

She used the Bill Gates-promoted plan to fight malaria by providing millions of cheap mosquito nets — which has caused as many issues as it has solved where she works, despite malaria being the region's number one killer — as a parable for the problems with aid and development.

Afterward, she sat down with The Huffington Post Canada to elaborate on her concerns and ways to address them.

amy lehman

"The space is broken, but I also want to be very clear and say that I am not one of those people in the camp that says philanthropy is bad and/or wrong or that aid is bad and/or wrong," she begins.

Of course, she has some qualifiers for that statement.

"No one likes to be wrong. No one likes to invest a lot of money in something that doesn't pan out and do what it was supposed to do. So my sense about philanthropy and aid and development is that it's very hard because there are very few things that are single issue things. They are intrinsically intertwined and interdependent. If we're siloed as a sector, where person working on problem X doesn't talk to person working on problem Y, it's inherently inefficient and it might even [make it worse]."

This, she says, is what has happened with bed nets. While she says they have been "a very powerful and effective tool in many places around the world," there have also been major problems due to misuse when deployed in water-based communities because people have been using them to fish.

Her study in Tanzania found that 87.2 per cent (!) of households were doing this, as the New York Times reported, and because they have much smaller holes than regular fishing nets, they’re emptying out the lake of small fish and decimating the food chain. Moreover, the nets are imbued with permethrin, a carcinogenic and water-soluble insecticide. Not only is this getting into the water people use for cooking and cleaning, but the mosquitoes are also developing a resistance to permethrin “because that's how biological organisms work.”

But she says she has been met with silence or pushback when explaining her concerns, which includes the low cost preventing product innovation, to the aid and development community.

So why are people using bed nets to fish?

"We talk to Congolese women who said 'we know what we're doing is wrong but our children are starving and we don't know what else to do.' Thinking about your own future is way too abstract. If you're too busy thinking about your everyday survival needs, long-term decision-making is maybe not going to turn out the way you anticipated.”

In other words, it doesn't make sense to address malaria in a vacuum without also addressing issues like food insecurity and basic livelihoods. But Lehman isn’t one to just complain about a problem, so she has started a research group with a behavioural economist from the University of Chicago (where she’s originally from) and a developmental/environmental economist from Tufts University to conduct a “massive follow-on study of malaria control and alternative vector control devices.”

Though we didn't discuss EA Global specifically, we did talk about what she might say to the power brokers of the aid and development space.

"If I could sit them down in a room and they would actually listen to what I have to say? Being really intelligent is one thing, and that's really important, but having humility is another really important thing. Nobody ever begins the desire to intervene with a statement like 'I don't know what's going on here so I'm going to be really committed to learning a little bit more deeply so that we can develop in partnership with the community that we are supposed to be developing these products for.'

"I don't want to harp too much on the global elite," she adds. "We need rich people. We need rich institutions. But we also need them to be very scientific and rigorous and humble about how they deploy these amounts of cash. Sometimes humility and great wealth and power don't always go hand-in-hand."

Lehman did promote an approach shared by one of EA Global's speakers from GiveDirectly, an aid group that hands out no-strings-attached money to the world's poorest people.

"They basically give people money, and they give individuals the right to decide what to do with that money. It turns out that what people do with that money is very sensible stuff for their lives. Is it the case that some people, here or there, spend the money on things that we might judge as a poor decision? Yes, that exists. But for the most part they don't. For the most part they make decisions that are very apropos to their personal circumstances."

Being a doctor, Lehman has been working on her own solution to help deal with the complexity of health concerns around Lake Tanganyika, which is the longest lake in the world, contains 20 per cent of the planet's fresh water and is surrounded by the not-always-stable nations of Congo, Burundi, Tanzania, and Zambia.

With limited cellphone capacity and even worse road infrastructure, her life's work is to build a floating clinic.

"The idea of the ship is that you take the regional hospital and you bring it to the region. It moves around the lake and has some emergency service provision but we can have health care workers do a rotation with us on the ship.

Unfortunately, she has yet to raise the approximately $40 million needed to build the floating hospital and the annual three to five million dollars in running costs. She says that price is apparently too high for organizations looking only for the cheapest, most scalable solutions.

"My ship doesn't cost a nickel, but if you look at the cost effectiveness analysis of the ship, it's actually cheap. That's the thing. If you look at the coverage of that facility as well as the research that could happen using that ship as a platform, it's very synergistic."

She adds that being an international project, rather than just serving one of the lake nations, is in itself helpful because promoting regional dialogue also reduces conflict.

But she's patient, and hopes that others in the aid and development space would be as well. At the very least, her final words should hit home for those pitching in from the tech sphere.

"This shit is complicated. For me, the only way to deal with the complexity is to understand we have to work much more slowly because the things we assume are going to work, don't always work. We have to be willing to re-tool and be very honest. This is iteration and innovation just like anything else."

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