Friday, April 29, 2011

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:

Wednesday, April 27, 2011

The Soft Power Debate

Kenneth Adelman takes aim at Joseph Nye's "Soft Power" construct in this Foreign Policy article:

"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.

Monday, April 25, 2011

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:

Saturday, April 23, 2011

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:

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:

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.

Thursday, April 21, 2011

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)

Saturday, April 16, 2011

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):

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:

Thursday, April 14, 2011

USAID is going to be more effective

Robert Swope over at D3 ( 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 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:

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.