A preview of the unpublished book A CIVILIZATION WITHOUT A VISION WILL PERISH: AN INDEPENDENT SEARCH FOR THE TRUTH by David Willis. CHAPTER 1: INDIFFERENCE TO POVERTY (Part 43). This blog is a continuation of the review of The End of Poverty: How We Can Make it Happen in Our Life Time, by Jeffrey Sachs, published in 2005
Chapter One: A Global Family Portrait
Malawi: The Perfect storm
As we arrive in the village, we see no able-bodied young men at all. In fact, older women and dozens of children greet us, but there is not a young man or woman of working age in sight. Where, we ask, are the workers? Out in the fields?
The aid worker who has led us to the village shakes his head sadly and says no. They are nearly all dead. The village has been devastated by AIDS, which has ravaged this part of Malawi for several years now.
There are just five men between 20 and 40 years of age left in the village. They are not there this morning because they are all attending the funeral of a fellow villager who died of AIDS the day before.
The margin of survival is extraordinarily narrow; sometimes it closes entirely. One woman we meet in front of her mud hut has 15 orphaned grandchildren.
She points to the withered crops that have died in the fields next to her hut. Her small plot, perhaps a half hectare (a little more than an acre) in all, would be too small to feed her family even if the rains had been plentiful.
The problem of small farm size and drought are compounded by yet another problem: the soil nutrients have been depleted so significantly in this part of Malawi that crop yields reach only about one ton of maize per hectare with good rains, compared with three tons per hectare that would be typical of healthy soils.
She reaches into her apron and pulls out a handful of semirotten, bug-infested millet, which will be the basis for the gruel she will prepare for the meal that evening. It will be the one meal the children have that day.
I ask her about the health of her children. She points to a child of about four and says that the small girl contracted malaria the week before. When they got to the hospital, there was no quinine, the antimalarial medicine, available that day. With the child in high fever, the grandmother and grandchild were sent home and told to return the next day.
In a small miracle, when they returned the next day after another 10-kilometer trek, the quinine had come in, and the child responded to treatment and survived.
More than one million African children, and perhaps as many as three million, succumb to malaria each year.
This horrific catastrophe occurs despite the fact that the disease is partly preventable – through the use of bed nets and other environmental controls that do not reach the impoverished villages of Malawi and most of the rest of the continent – and completely treatable.
There is simply no conceivable excuse for this disease to be taking millions of lives each year.
Our guide to Nthandire is a Christian aid worker, a dedicated and compassionate Malawian working for a local nongovernmental organization (NGO). He and his colleagues work against all odds to help villages such as this one. The NGO has almost no financing available and survives from meager contributions.
There are only poor in this village. No clinic nearby. No safe water source. No crops in the fields. And notably, no aid.
Attending school is now a hit-and-miss affair. Children are in and out of school with illness. Their attendance depends on how urgently they are needed at home to fetch water and firewood, or to care for siblings or cousins; on whether they can afford to buy supplies, a uniform, and pay local fees; and on the safety of walking several kilometers to the school itself.
We fly to the second city of the country, Blantyre, where we visit the main hospital of Malawi and experience our second shock of the day.
This hospital is the place where the government of Malawi is keen to begin a treatment program for the roughly 900,000 Malawians infected with the HIV virus and currently dying of AIDS because of lack of treatment.
The hospital has set up a walk-in clinic for people who can afford to pay the dollar a day cost of the antiretroviral combination therapy, based on Malawi’s arrangements with the Indian generic drug producer Cipla, which has pioneered the provision of low cost antiretroviral drugs to poor countries.
At the time of our visit, this treatment site is providing anti-AIDS drugs on a daily basis to about 400 people who can afford it – 400 people in a country where 900,000 are infected. For the rest, there is essentially no access to anti-AIDS medicine.
Democracy is bound to be fragile in an impoverished country where incomes are around 50 cents per person per day, or around $180 per person per year, and where the stresses of mass disease, famine, and climate shock are pervasive.
Amazingly, the Malawians have done it, while the international community has largely stood by through all of this suffering.
Malawi put together one of the earliest and best conceived strategies for bringing treatment to its dying population, and gave an enormously thoughtful response to the challenges of managing a new system of drug delivery, patient counseling and education, community outreach, and the financial flows that would accompany the process of training doctors.
Yet the international processes are cruel. The donor governments – including the United States and Europeans – told Malawi to scale back its proposal sharply because the first proposal was “too ambitious and too costly.”
After a long struggle, Malawi received funding to save just 25,000 at the end of five years – a death warrant from the international community for the people of this country.
Carol Bellamy of UNICEF has rightly described Malawi’s plight as the perfect storm, a storm that brings together climatic disaster, impoverishment, the AIDS pandemic, and the long-standing burdens of malaria, schistosomiasis, and other diseases. In the face of this horrific maelstrom, the world community has so far displayed a fair bit of hand-wringing and even some high-minded rhetoric, but precious little action.