AMAZING collaboration between military, USAID, and not-for-profit

Wow! I recently heard a speech by Dr. William H. Foege, a world renowned epidemiologist who was key to the campaign that basically has eradicated smallpox (of course, with the exception of in Afghanistan and a few other war-torn areas), among other incredibly notable achievements. In his speech, Dr. Foege claimed that there would be an anti-malarial vaccine produced within the next 2-3 years, which is astonishing news from a very credible source.

This morning's news brings the announcement that the military, USAID and a not-for-profit called IDRI are collaborating to produce an anti-malarial vaccine. It's an incredible story, and if the effort is successful, the world will be changed. Here's the press release URL: http://m.prnewswire.com/news-releases/idri-usaid-strike-new-collaboration-for-malaria-vaccine-development-127868588.html.

I'm (slowly) writing a piece about the military's role in global health, and this kind of activity illustrates the real contributions that the U.S. government, writ large, can make. I hope it is successful!

Louie Palu photos and essay

Photographer Louie Palau has a compelling piece on the Virginia Quarterly Review called "Total War" here at this URL:http://www.vqronline.org/articles/2010/spring/palu-total-war/, or click on this blog title. A Canadian doc tries to save an Afghan with a gut wound. His photos are evocative and powerful. I'd like to upload one to capture your attention, but I'm sure they are copyrighted.

Navy Corpsmen try to save an Afghan girl

I came across some compelling journalism from Afghanistan (where else?) by a young guy named Elliott D. Woods in the Virginia Quarterly Review. There's a particularly germane piece on how some Corpsmen tried to save a little Afghan girl who was blown up by an IED. It's called "Our Deepest Sympathy." Worth looking over, truly, as are the rest of his stories from "Assignment Afghanistan" at this URL: http://www.assignmentafghanistan.org or click on the title of this post.

The Global Health Initiative

The President's Global Health Initiative is great--nested within his policy for Foreign Development it lays out a way forward for health development. Eight countries were selected for "fast track" focus: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda. (I would have loved to watch the political debate about which countries were selected.) The paper posted on the White House website (click on the title of this blog to go there) says the eight countries:

will receive additional technical and management support to quickly implement and learn from GHI’s approach, including integrated programs and investments across the health priorities, fostering greater country ownership and targeting health systems activities that deliver results. These countries will provide enhanced opportunities to build upon existing public health programs; improve program performance; and work in close collaboration with partner governments, across U.S. government agencies, and with global partners.

The GHI is a $63 billion program. It will be interesting to see how this, and the foreign development programs, perform. And, I wonder how the DoD is focused on these priority countries, if at all?

More on sustainability

Patricia McArdle wrote an oped descrying unsustainable development. She didn't point fingers at the military, this time, but did use the "s" word (sustainability) to advocate for solar and wind power. She apparently works for a solar cooker NGO. The punting around of the word sustainability is becoming almost comical, and I would laugh were I not so overwhelmingly wanting to bang my head against my desk when I read it.

CERP spending

A good report on CERP spending appeared in the PRISM magazine (from the National Defense University) from March. It's one of the more balanced and insightful discussions about CERP spending. The debate about CERP spending is unending because there is no theory or reliable research being done to support the theory and inform a strategy. So there are many opinions, stated firmly and provocatively, but only partially informed. Get two people together over a cup of coffee with opinions on CERP and you have an automatic debate. In the end they each might be using the words "CERP spending" but talking about completely different contexts, uses, goals and outcomes. However, it will sound like a cogent debate. That's why we need more study, and less polemics (refering to my 2-part complaint about the Congressional report on foreign assistance).

Evaluating U.S. Foreign Assistance to Afghanistan-- A Two Part Complaint

So, I've read the report prepared by the Senate Foreign Affairs Committee on assistance in Afghanistan and it's completely bizarre, as I feared. Here's how it starts:

"...we believe the administration can be more effective in how it spends aid in Afghanistan. U.S. assistance should meet three basic conditions before money is spent: our projects should be necessary, achievable, and sustainable." (page 2).

I wonder who wrote those two sentences? They are classic. Let's pause for one moment and examine the thesis of this incredible piece of work.

First, it says the administration can be more effective in how it spends aid. What does that mean, exactly? That the money should get more 'bang' for each 'buck'? For example, for every dollar spent, Afghans should get 60 cents in actual assistance -- like meals, water, roads and so forth? Because one OXFAM report claims that something like 40% of foreign assistance is returned to the country of initiation in salaries and payments to project managers and monitors from that country. OR, does that sentence mean that for every dollar spent we should see a resulting decrease in violence in any given area? Or, does that mean that for every dollar spent, the Afghan markets grow by some proportional amount? Or, perhaps it means that for every dollar spent, we should be able to get out of there faster? Or maybe that we have quicker mechanisms for spending the money? Congress appropriates it one day, and it's spent within a week or two? or...? No clear acknowledgement or recognition that money is being spent in Afghanistan in an incredibly complicated context strikes me as irresponsible.

Next, it says that "U.S. assistance should meet three basic conditions before money is spent: our projects should be necessary, achievable, and sustainable." Should US assistance be necessary, achievable and sustainable? Or should projects be necessary achievable and sustainable? Those are two separate things. Here's why.

First, let's look at assistance. Let's say the authors are trying to say that assistance should be necessary, achievable and sustainable. That would imply that there would be clear goals, objectives and programmatic for spending aid money in Afghanistan, which I can tell you is not happening. So, for a project like the District Delivery Program (which I have first hand knowledge of and which was a project to build sub-national governance), before spending money, USAID should have established what the overarching goal was, what the intermediate objectives were, and then how to determine whether those goals were met and the timeline for taking those measurements. If they did this, it was in secret. And I'm pretty sure that although there is some programmatic language for the billions that are being spent in Afghanistan, measures are not really measuring effects. Dear reader, you and I could dream up a great-sounding programmatic justification for spending money in Afghanistan. Delivering the results is quite another monster all together. Who knows if the planned actions are achievable in a war zone being conducted in a fourth world nation. And CERTAINLY the assistance is not sustainable by the Afghan government because that's why it's called assistance. If the Afghan government had enough money to spend on all the development international donors are supporting, then we wouldn't need to assist. Right? Or am I missing something here. Hopefully we are not giving money to countries that don't need assistance.

Next, let's look at the assertion from the standpoint that it means that projects should be necessary, achievable and sustainable. In a fourth world country, where literacy is about 25%, and life expectancy is about 45 years old, any spending can be justified. Any at all. The Afghans need everything. And the more we give, the more they need. What are we trying to achieve by all this giving? Well, that depends. In a lot of cases, we give because it makes us feel good. Soldiers spend money because they are shocked by the conditions, or because a local village leader buttered up a Marine and next thing you know the market has some brand new toilet facilities. USAID spends money because they are told to do so. They are being goaded, prodded and pushed into 'supporting the military' as they say in country. So, let's say all the expenses over the past year in Helmand province were to a) make us feel good, and b) show USAID support to military actions. Did they succeed? Well, you could go there and ask around--ask soldiers and aid workers if they felt good, and ask the military if USAID is spending dollars in support of operations. I think you would find positive results. So, the spending could right away be called necessary and achievable just based on those two justifications--feel good-ism and supporting the military. Are projects sustainable? No, because they are foreign assistance. We just went over that. Are the projects that are being constructed achievable? Yes, most everything is achievable, and very little is not getting completed. From cell phone towers to market toilets to roads to water turbines, projects are being completed all across Afghanistan.

The thesis for this report is askew and politically motivated. The report goes on to make many other circular claims. Like this one, on page 2. Most of the assistance is being spent on short term stabilization programs (undefined, of course). Notice the words "short" and "term". One paragraph later it complains:

"The evidence that stabilization programs promote stability in Afghanistan is limited. Some research suggests the opposite, and development best practices question the efficacy of using aid as a stabilization tool over the long run."

Notice the conflation of applying "development best practices" and "stabilization over the long run". And refer back to the discussion about how most money is being used for stabilization in the short run. So, if it's being used for short term gains, then what's the problem and why is the next paragraph discussing "development best practices" as if that's what is going on?

Another example of circular logic is here:

"The administration is pursuing an assistance strategy based on counterinsurgency theories that deserve careful, ongoing scrutiny to see if they yield intended results."

There is a confusion of reasons for spending in Afghanistan. Not all reasons are mutually exclusive. We could be spending money in a kinetic environment to, say, get a village cleaned up and the men back to doing something productive. It might also start boosting the micro-economic environment as people have a bit to spend and a small market might open up. This may be short-term gain, but it also might not be harmful to long term prosperity. It's a crapshoot. But it seems to me that the development folks are wisely questioning spending in support of a counterinsurgency campaign, but they are unwisely not questioning long term development practices as well. Because to be completely honest, we just don't know what's what and how best to spend money when in a post-conflict environment. It's all unknown and conditional.

Here's the real issue:

"There must also be unity of effort across the U.S. Government and international community. If we conclude that a civilian program lacks achievable goals and needs to be scaled back, no other actors should take over the effort. Too often, when our civilians determine that a project is infeasible, we simply transfer the program
to other actors, such as the U.S. military or other donors."

The report is more bluster than utility. All hat and no cattle.

Sustainability

The Washington Post reported that a Congressional study will be released today that announces--shock of all shocks--the development in Afghanistan is NOT SUSTAINABLE! (Here's the post link: http://www.washingtonpost.com/national/national-security/afghan-nation-building-programs-not-sustainable-report-says/2011/06/07/AG5cPSLH_story.html)

Wow. Shock of all shocks--did we spend our tax dollars to come to this conclusion? Because they missed the question--sustainability is not The Question. The question should be: are we spending our development dollars to legitmize the Afghan government? It's all about legitimacy, not sustainability for Jimminy Cricket's sake. If you stop and examine the Afghan budget you'll find out that international donations OFF THE BUDGET account for about 82% of the total spending in Afghanistan, according to the Afghans. (And they can't really get their arms around all the spending. So it's probably more.) What does that mean? That means that for every 100 gazillion U.S. dollars donated by international donors, only 18 percent go thru the Afghan system and help build a government that can function and provide services, and the other 82 gazillion dollars go directly to contractors in the field who then do who-knows-what with it.

Normally, the sustainability mantra is leveled at DoD by the State Department and USAID, as if DoD spending is all the whole cause of "unsustainability" in Afghanistan. This is ridiculous and circular. The Development/Diplomacy community say that DoD should a) build sustainable structures, and not structures that fall down because the Afghans will be psychologically influenced (Seriously. No Joke, that's what they say.); and b) they also point to CERP spending and say that it's all unsustainable. SERIOUSLY? Here's the side of the argument that never gets discussed: there are only so many contractors in Afghanistan, and really, we are all using the same unskilled labor. USAID, for example, is building equally shaky roads, bridges and canals, buildings and so forth because we are all using the same unskilled labor! And, I'd like to know what survey shows that the Afghans will be psychologically influenced by the soundness of the development projects? The second argument is equally as bizarre. CERP spending is only a fraction of the total aid money being poured in to Afghanistan. When USAID, for example, builds a road, they also don't dump money into the ministry that is responsible for maintaining that road. Hence, the next winter/spring flood, the road washes out, and voila, the road was unsustainable, just as if CERP money had built it.

Even if you level the unsustainable argument against both the State Department and USAID and DoD all together, it still doesn't make sense. Because the bigger point that nobody wants to discuss because it's too hard, and it's much easier to wrangle among ourselves, is this question: if we don't dump money into a country like Afghanistan where there is about a 75% illiteracy rate, where people expect to live to the age of about 45, and where infant and maternal mortality rates are some of the worst in the world...then what is the alternative? I'd like to hear an alternative proposal from the development experts and the cast of staffers who concluded that aid to Afghanistan is not sustainable. (I wonder if they looked at aid to any other of the countries we assist? I'd bet they'd find out it too was not sustainable, because that's why it's called-- you guessed it-- aid. If the country could afford the programs itself, and thereby have sustainble programming, we wouldn't be giving it aid.)

Sustainability is one of those wonderful rosy terms that everyone likes to use--and of course, we can all agree that everything should be sustainable. But it's not pragmatic, and to my mind the wrong question for Afghanistan. The right question is: is our spending creating legitimacy? They are two different questions.

I'll be interested to see the Congressional report.

USAID feels bullied? Do we care?

OK, I have to say that it's amazing to wake up in the morning, open the paper to read about how screwed up USAID is, and then read that they are feeling "bullied" into supporting military efforts in Afghanistan. First of all, who cares what they are feeling? I only bring this point up because in my experience, it's not uncommon to hear from USAID staff objections like this (in country) as if they are somehow valid and reasonable perspectives to be discussing in the middle of an armed conflict. Logically, how can you respond to this kind of statement? "Wow, sorry you feel bullied, shall we stop the war and have some apple tea and investigate those feelings?" "Tell me more about it? What in your childhood would bring this feeling up?" I know i am sounding snarky, but I absolutely cannot understand this institutional stance and culture. And it was constantly used in Afghanistan. Sorry, we can't make a decision on how to fund this MOST CRITICAL sub-national development program because we are considering how mean the military is. I actually sat in a meeting at the U.S. embassy where the senior leader spent 55 minutes in discourse about how awful it was that he didn't know the phone numbers of all the (5? or 7?) military people who were working in Afghan ministries. All he had to do was ask for a list and we would have provided it. Next topic! Like, I dunno, how to fund that most critical program?

I worked on a program called the District Delivery Program, which was really a pretty well-thought out program. It took USAID more than 3 months to review a 20-page document outlining costs that they had themselves helped to prepare and approve it. Three months is like an eternity in Afghanistan. Especially when we are going to experience a draw down soon. It was the oddest experience I have ever had. The people were great--smart, dedicated and diligent, but just nearly completely ineffective.

USAID has fielded all kinds of people into remote areas of Afghanistan with little strategy and/or supervision as well. That's part of the much-trumpted "civilian surge". They are bureacratically not set up to deal with what is going on in Afghanistan and they seem to be making no real attempts to amend their internal processes to the context. Probably because they are feeling bullied.

I know in one province that USAID was funding more than 50 programs and that NOBODY checked on those programs on a routine and systematic fashion. They didn't have the staff, the mobility, or the responsibility. That's your tax dollars hard at work. USAID routinely use the self-reported data from their contractors as their evaluation of their contracts. So for example, in the Post you can read that the primary contractor claims his program a huge success because he hired X,000 of hours of Afghans to clean their own canals. Really? Did anyone go check? I mean, if you ask me if my efforts were successful, and make award of my next pay check contingent on my own response, then yes, I can tell you that the work I do is probably the most valuable in the world, let me just think of how to describe it to you.

Here's the article in the Post: http://www.washingtonpost.com/world/us-military-dismayed-by-delays-in-3-key-development-projects-in-afghanistan/2011/04/22/AFD6jq8E_story.html?hpid=z2

The Soft Power Debate

Kenneth Adelman takes aim at Joseph Nye's "Soft Power" construct in this Foreign Policy article: http://www.foreignpolicy.com/articles/2011/04/18/not_so_smart_power?page=full

"Huge recipients of U.S. foreign aid -- Egypt, Pakistan, and the like -- voted no more in tune with American values than similar countries that received no, or less, U.S. foreign aid. Instead, their votes correlated closely with those of Cuba, which wasn't a big foreign-aid donor.

That finding, surprising at the time, remains true. Four of the largest U.S. foreign-aid recipients today -- Egypt, Israel, Pakistan, and Afghanistan -- all take contrary positions on issues of critical importance to the White House. South Vietnam once got gobs -- gobs upon gobs -- of U.S. foreign aid. That didn't help much. Likewise with Egypt, Iran, Pakistan, Zaire (now the "Democratic" Republic of the Congo), and other "friendly" (read: graciously willing to take U.S. money) countries.

The conclusion seems clear: The relationship between "the United States' ability to positively influence events abroad," as Nye puts it, and the amount of U.S. foreign aid a country receives is unclear at best. For decades now, the United States has been the No. 1 foreign-aid donor -- it has given the most money to poor countries -- so it can't move up any on that scale. But this hasn't translated in making America the most popular or most influential country around the world. Quite the contrary."

I'm starting to be more and more skeptical of "soft power" myself. Especially when it seems to be used as an excuse to act upon our impulses to do good, rather than a real tool to promote American agendas AND do good. It seems, sometimes, as if we are a nation of dysfunctional d0-goodism, dumping billions of dollars of aid into places like Afghanistan where it ultimately fuels corruption and does little for the people. Less might be more, sometimes. The problem with "soft power" is that we indiscriminantly use that concept to dump aid with little measure of ROI (return on investment). And I'm even now beginning to think that we de-legitimize countries where we dump aid. Like Afghanistan.

UPMC Biosecurity Center

Amazing what is getting posted on the web. Here's the University of Pittsburg Medical Center's Biosecurity Center's one-day seminar on US Investment in Global Health Security on YouTube: http://www.upmc-biosecurity.org/website/

Two-fer: Libya and Legitimacy

Today's post has two themes: Libya (and where are the hospital ships?), and Legitimacy worries.

Yesterday's Washington Post ran a front-page photo of Libyans on board a ferry. The caption read that the ferry has been turned into a hospital ship, essentially. Which, of course, prompted me to figure out where is the Comfort and the Mercy. Odd that we are sending armed drones and special advisers, 'humanitarian defense equipment' like body armor and HMMWV's. But no relief capability. It strikes me as perhaps short sighted. Though, maybe not. I'll get to that in a moment.

Anyhow, I was looking around on the web to see where the Mercy and Comfort are, and found this interesting blog: http://blog.usni.org/2010/01/25/time-to-reactivate-the-usns-mercy-t-ah-19/

There was quite a lively debate about the Mercy and the Comfort. The Mercy website is not forthcoming with information about where it is at the moment, and it seems as if it might be in dry dock (from surfing various web pages). Here's the Mercy's web page: http://www.med.navy.mil/sites/usnsmercy/Pages/default.aspx

It seems like "soft power" is not an option at this moment, and I wonder why. Maybe our doctrine is too muddled? Maybe sending a hospital ship full of interagency partners to a war zone is a non-starter? Maybe we don't have an agile-enough capability? The Chinese hospital ship, the "Peace Ark" is nowhere to be found, at the moment, either. Tho I did find a note that the Chinese had offered it to the Japanese. (Yes, that's not a typo.) China is "all about" Aftica--it's resources will provide power to the Chinese for decades to come (while we are distractedly thinking of power in terms of military might). I was suprised that I didn't see the Peace Ark being offered up.

Back to my thoughts about the non-crisis humanitarian assistance missions of these ships: I was chatting with a colleague recently who has thought a lot about the legitimacy of governments-- or, the lack of legitimacy where these hospital ships do their service. It suddenly dawned on me that the U.S. might be cutting off its nose to spite its face, in a manner, with these non-crisis humanitarian missions. So, for example, in the context where DoD sends a hospital ship to a country that is not in conflict to provide medical care, there is a greater risk of further exposing the inability of the country's legitimate government to provide basic services to its citizens. Sort of an awkward sentence, so let me try again. What I'm suggesting is that in countries where there are fragile governments (most really poor countries), dependence on foreign assistance is generally endemic. There are typically a gazillion donors and NGOs earnestly working hard to help the people, and the people do not expect their own government to provide medical care (hypothetically).Even though DoD gets permission from the host-nation, I wonder if stopping in and doing some non-emergency humanitarian action might be good for the people who received the care, it might make us feel good about ourselves, but harming the overall system? Are we deligitimizing the already-fragile government? Has anyone studied this? Or are we happy to be doing great deeds of service, and hoping it all works out in the end.

That's the twofer today.

Google search trend tool

Google has a really interesting search trend tool available. You can track search trends (like "military" shown on the right) across time and in location. It provides a graph indicating normalized trends as well as a graph that shows any news stories and volume of news stories related to the search trend. It's amazing!

Google searches can predict the flu!!

Holy COW! I'm probably the last person in public health to know this, but the rate of google searches for "flu" closely matches the actual incidence of flu! I didn't read the journal article (yet) but you have GOT to look at this--it's amazing. The implications are huge. Google search as a surveillance tool is actually a really great idea!

"Google Flu Trends estimates flu activity for a number of countries by using aggregated search query data. The system provides users and public health officials with near real-time estimates of flu activity in their region. Traditional surveillance reports come directly from doctors and other health service professionals, sometimes with a delay of up to 1-2 weeks."



Here's the URL (or click on the heading)

http://www.google.org/flutrends/about/how.html

Team Rubicon

And here is a group of enterprising former military guys doing good. Team Rubicon (also, there's an interesting explanation of them on Ted): http://teamrubiconusa.org/

They like to hire veterans because veterans like to serve. I'm too much of a nerd to go along with that (my brain: wait, what's the incidence of volunteerism for volunteerism sake in the general population as compared to the incidence in the military? hmmmm would make a good dissertation). Nonetheless, it's interesting. And cool and adventurous. One of their friends and colleagues, a young former Marine, committed suicide. It's tragic to read about.

DoD video about Medical Stability Operations

Check out DoD's video about Haiti at this link: http://intlhealth.fhpr.osd.mil/videosIDIntCivMilPrthps.mil.aspx

USAID is going to be more effective

Robert Swope over at D3 (http://www.robertswope.com/) posted the contents of a speech by Rajiv Shah, the USAID Administrator. The upshot of the speech: USAID programs are going to be monitored and evaluated for their effectiveness. While I applaud this thought, I wonder how this will be accomplished. USAID is essentially a huge contracting agency. The agency cuts contracts with local NGOs (called "implementing partners") to do the work, and other contractors to see if the work was done (or they just let the implementing partner report about how the work was getting done). In one province in remote Afghanistan, for example, there were allegely more than 50 programs on going. There was one USAID representative and it was not his job to see if the women in the job program were actually getting the required literacy training or not. He spent his day at the FOB because he had no transportation. This is not the entire picture, by the way, of what USAID does--there were numerous incredibly dedicated individuals posted to remote and dangerous locations all by themselves living off the military (again-- a somewhat hostile relationship) doing great work. But in terms of contracting...no way USAID has any idea about what's going on in all those contracts all over Afghanistan. No Way. So, how to implement some kind of control? Well, that would require growing the organization to do monitoring. That's not going to happen obviously. We'll just have to wait to see how this plays out. It's a good idea, but I am not sure it's feasible.

Here's the speech:http://www.usaid.gov/press/speeches/2011/sp110119.html

Where Have I Been?

I've been back from Afghanistan for about 6 months now. The time has shot by. But my thoughts keep returning. It's not uncommon, actually, and I wonder if it's some kind of sickness?

In any case, where I have been? Trying to get reestablished at work, to begin with. Trying to piece together relationships that probably felt abandoned by friends and colleagues. Although the internet is a help, we didn't have real access during my time in Afghanistan. And I was only gone from home for about 15 months total.

I've been watching and reading the "3D" debate again--reading how swimmingly things are going in the "interagency". This completely contradicts my experiences in Afghanistan where the diplomatic and development circles hated people in uniform. Just because we wore the uniform. The hatred and tension was indescribable. I'd like to write about it, or even perhaps make a web product with interviews and short articles, perhaps video clips illustrating the hatred felt on both sides. How are we to succeed when there is this much tension and hatred? The Afghans play us against each other, too. So while the pundits back in DC make their personal fortunes talking about how great it is that the S/CRS office is up and running here in DC, there is little discussion about the embattled PRTs or civilian platforms in Afghanistan. It's ridiculous.

It feels overwhelming to read things here about how we are getting along when in reality, where it REALLY COUNTS (e.g. in Afghanistan or even in Iraq still) we are not getting along. If the taxpayer only knew.

I've been debating whether to keep this blog going, to post, think about this issue more or just move on. I am still not clear, to be honest. I have such a dirty feeling about the entire experience, I'm not sure I want to wallow in it. Then again, sometimes these fights and issues are those most worth thinking about.

So that's where I've been-- putting my life back together, doing yard work, getting in to the swing of things at work, celebrating a friend's new citizenship, going out to dinner. All these activities that I didn't get to do while I was in training and then deployed. It's a good life we lead. Deceptively good. We are priviledged people. I think I'll keep posting things and developing this blog little by little. After all, it's the community that's the prize, to paraphrase from a friend in the US Embassy in Kabul.

New Journal of Global Health

It looks like Columbia University is creating a new journal of Global Health (URL here: http://www.ghjournal.org/). It claims that it will be more solutions oriented. There is a call for submissions to the first edition right now. I will be interested to see what the themes will break down to be. What strikes me about Global Health is that the field work is done in 'silos' -- by disease. Of course this is often driven by funding sources. Polio-interested money drives polio campaigns regardless of other contextual problems which might be more urgent. And I'm not picking on Polio campaigns, just using that as an example.

The Militarization of Aid

Haven't had a chance to read this yet, but the Harvard Political Review has a pretty good overview of the debate about the militarization of aid. What's amazing about this issue is that it's one sided. The military really doesn't have a view about it. I suppose if aid agencies started fighting wars, the defense department might have some heartache.

Here's the link: http://hpronline.org/arusa/the-3ds-of-foreign-affairs

Army Reserve and National Guard Suicide Rates

Interesting reports today about increased suicide rates in the Army Reserve and National Guard. I haven't looked at the actual data, but I wonder if the rates are actually increased or if the reporting has improved both in terms of quality and quantity, hence we now know more about the population. We don't actually know that much about the Reserve and National Guard population because it is so transitory. It only gets together one time a month. Units are being filled with people from various parts of the US for deployment then split up again once everyone comes home.

I can say that I dearly miss the colleagues I served with in Afghanistan. We are spread across the Southeastern US, rather than in a one-block radius on a military post in Kabul. Many were added to my reserve unit at the last minute--me included--and we were the "loose ends" group, as one of my friends called us. Always behind in training, always at late night sessions trying to catch up while the rest of the unit prepared. I don't know if their mental health is poor--they are too far away, and I am too consumed with getting myself back to work to tune in to them. We have texted and called for brief chats. Amazingly, I didn't have time to have a "social" life in Afghanistan, working 16 hour days, but I knew that they were always there. Funny people with vivid interesting lives, doing the best they could do in a hard environment. And now there's a little hole where they were. I'm back at work in a supportive environment, with super colleagues. But most have never worn body armor, fired an M4, run to catch a helo carrying 40 pounds of gear in 120 degree heat while herding frightened Afghans and trying to act like the situation was all normal, or worse yet, stood at a memorial for 5 young soldiers killed by a crazed attacker, or hung out with a 3-star general at 1:30 in the morning and listened to his stories of other's bravery and loss, watching him weep and laugh under the pallid flourescent lights. While I'm glad to be home, it's just a different world, with its own demands and rigors. If you come home and don't have support, I can see where your spirit would nosedive.

war or health?

Blood and Milk Blog

So, I'm slow on the uptake here. I just figured out that there's a brilliant blogger who has been blogging about International Aid and Public Health for quite a while, and who has even contributed comments to one of my rants. Check out the Blood and Milk Blog for some good reading.

The Great "Pointing of Fingers" Game: USAID and NGOs versus DoD.

The Washington Post ran a series two weeks ago about the issues surrounding the military's use of the Commander's Emergency Response Program monies to rebuild Iraq and Afghanistan. Nothing new was divulged--the program is unproven and therefore subject to attack. There is no real strategy for its use, and examples of wasted effort abound. Ho hum.

A letter to the editor appeared in response to the articles, which I have copied:

Washington Post
January 11, 2011
Military-Led Aid Projects Doomed To Fail In Afghanistan
It is no surprise that military aid projects in Afghanistan are "crumbling under Afghan stewardship" ["In Afghan hands, aid projects neglected," front page, Jan. 4]. The troops are armed with good intentions, but they often neglect basic development principles, owing to a lack of expertise on aid and mounting military and political pressures.

Afghanistan's National Solidarity Program is a better alternative. Under this proven model, called "community-driven reconstruction," local engagement and accountability are as important as bricks and mortar. Afghan staff members from agencies such as mine help organize village groups and determine what they need most and who will be responsible for the viability of a school, clinic or road. It's laborious work that emphasizes local knowledge and local ownership as well as sustained commitment - indispensable if Afghanistan development is to have any hope of success.

Military-led projects erode established humanitarian principles of impartiality and independence, fail to win hearts and minds and - we now know - are ineffective. The White House, the State Department, the Pentagon and Congress need to act on the growing evidence showing that the militarization of aid is folly.

Michael Kocher, New York
The writer is vice president for International Programs at the International Rescue Committee.
Editor's Note: The article by Josh Boak appeared in the Current News Early Bird, January 4, 2011.

The author is elegant in his ability to touch on all the "points" against DoD, making bizarre assertions based on faulty assumptions that are oft repeated. For example, in his editorial about Afghanistan, Mr. Kocher claims that "military-led projects erode established humanitarian practices...". I wonder if Mr. Kocher realizes that there is a war in Afghanistan? The military is not engaged in trying to influence the social development of Afghanistan for humanitarian reasons, but rather as a way to win the counter insurgency.

Second, the Afghan National Solidarity Program is not "proven", nor is it an alternative. Afghanistan is not a landscape that can only contain EITHER the military OR the Afghan National Solidary Program as the author seems to assert. And particularly since neither program is proven.

Finally, the conclusion that Congress et al should act on 'growing evidence' against militarization of aid is quite a leap of logic. Wait, I thought we were talking about Afghanistan?

The continued rhetoric from USAID and the NGOs against the military is provocative, for sure. However it's not neccessarily productive. What is needed is less provocation and more serious analysis and discourse about the complicated context we find ourselves in. The continued claims against the military's effectiveness at 'nation building' are well worth investigating. The pragmatic problem, however, is that there are no alternatives regardless of what any analysis would find. For example, in Afghanistan, it was my experience that USAID wouldn't work in areas which are too unsafe (undefined), and they also won't work in areas which are too safe and developed as it would be a waste of resources. Sure, the military is inefficient and cumbersome and makes mistakes. Inexpert. But what's the alternative? The cries from USAID and the NGOs would be more effective if they were backed up with an alternative course of action that is proven and effective. As the book "The White Man's Burden" describes, we have spent billions in aid and assistance, and yet the world seems no more friendly nor less impoverished.

War and Health blogs

You've got to hand it to War and Health/Conflict Health guru (nearly as insane as being called a "Drug Czar") Chris Albon. PhD candidate and world traveller, Chris has NEVER missed a beat. While I was contributing to the mire in the land-of-no-internet (aka a NATO command in Afghanistan), Chris was in South Africa with an equally challenging lack of internet access. The difference was that he somehow managed to maintain his blog and I did not. This editorial, highlighted by Chris is really interesting: http://conflicthealth.com/must-read-jefferson%e2%80%99s-army-of-nation-builders/.

Hats off to the brilliant Chris Albon. Read Conflict Health early and often. There aren't many blogs with such high quality and relevancy.

Mortality rates decrease in Afghanistan

http://www.nytimes.com/2011/01/08/world/asia/08wounded.html

The New York Times has an interesting article about the reduction in mortality rates from injuries in Afghanistan.

News Flash: Climate Change will cause Disease

So, the drum beat of disease as a national security threat continues. Nothing new in this piece in the Kansas City press (click on title), but I have Laurie Garrett's book, "Betrayal of Trust" here on my desk in line to be read. It will be interesting to see if this crescendos -- issues seem to wax and wane.

New Assistant Secretary of Defense for Health Affairs

Dr. Jonathan Woodson has finally been confirmed as the new Assistant Secretary of Defense for Health Affairs! This is good news. TRICARE is the largest health care system in the world and the Assistant Secretary runs it, as well as the extended rest of the military health system. There is mounting pressure to reduce the costs of providing health care services to beneficiaries (which number around 9.6 million and include soldiers in Afghanistan, retirees in Germany, and families here in the states). The acting secretaries (which have been numerous) can only 'stay the course' and not make any significant changes. Hence any reform is nearly impossible. So it is good news that we finally have someone appointed, and shame on Congress for taking so long as Dr. Woodson was nominated in April of 2010.