I served in Liberia 2018-2019. I was a teacher. I saw and heard a lot of awful things but the HIV murder story you told shocked me.
I was a teacher.
For a while I had a rule in the classroom that anybody in class had to be working. One day I saw a pregnant 14-year old girl sleeping on the bench. She looked so exhausted. I didn't have the heart to wake her up. After that the rule was that you can't disturb the class.
Often students would come to class without a pencil or the money to buy one.
The students often hadn't eaten anything all day.
I saw the same pattern of NGOs throwing out money without understanding the situation on the ground.
I could tell a hundred details and stories like this but you captured the essence of it pretty well.
"This did not make sense, because the road running through Lavumisa was a dirt road colored with the vivid red earth of eSwatini. Therefore, any car washed at the Lavumisa car wash would soon need washing again."
A service that requires a customer return within minutes? On the contrary this seems like a fantastic theoretical business!
Really beautiful article, I appreciate your writing it. Was struck by how many individual paragraphs carry their own individual insights into how the world works. And the efforts of individuals to surmount or work within that.
This has given me a lot to think about. Because of the obvious political implications of the story, I think it's important to point out that even if a lot of the efforts at changing peoples' behaviours failed, widespread ART has meant that the life expectancy in eSwatini has risen by 13 years since your time there. Maybe it's fine if DOGE cuts the equivalent of the half-built useless carwash, but they also cut PEPFAR and that will kill large numbers of people and far outweigh all benefit from everything else they do.
Also worth noting that the car wash was not funded by the US. I said this in the piece, but a lot of people (especially on Twitter/X) seem to have missed that detail, so I figured I’d make a note.
This is interesting and seems believable and in line with other bloggers like Scott alexander and his voluntary work to Haiti. But there isn't any information that inclines a person to be in favour of extending or cutting foreign aid, it is just that person making those decisions are probable gonna make a better decision if they have more information specific to these programs
I am working on the follow-up. But yeah, to be honest I am not trying to present any of this as an ideological argument. I’m more trying to present my experience, with details about what seemed salient to me, and the aspects that I think probably need the most attention as people consider true reform of the system.
I don’t think these programs should all be suddenly shut down, but imho, some of that is simply because people are dependent on the programs and we (powerful nations like the USA) co-created that dependency, so we should be more responsible for it.
Inasmuch as I have a personal agenda for change in the world, I think more in terms of truth and spiritual wholeness. Maybe that helps explain why this post seems ambiguous for some readers - I suspect the post comes across very differently for different readers because, at heart, across most of my work, I am hoping to communicate something subtle.
I felt a conflict between two models here, one is 'I didn't want to publish this but because it is politicized I feel I have to' , and the other is 'I wanted to share this experience anyway and now seems a good time since some people would be interested' . I don't wanna judge your motivation and me and most people here are thankful for intimate and personal information for free, but I also thought that if you were trying to make an argument it was too subtle to be efficient . I also tend to follow politics that most people so I probably make some weird implications about things,if I read that thing a year ago I would make different comments. Ultimately I believe wealthy nations and people can with little use of time and resources create immense benefits to community with that level of poverty and information like these is probably gonna be a net positive to people who care and act on these issues
I sincerely enjoyed reading this. It captured many things that are difficult to capture: good intentions lost in the shuffle, dubious intentions humored just so there’s funding, half-baked projects abandoned, the almost comedic impossibility of verifying anything as an outsider in a foreign locale, and basically the mishmash of guesswork and complexity that make needed on-the-ground change nearly a fool’s errand to attempt. I worked in similar contexts and it was crushing to see just how rare it is to get money and people routed to places that could really use it—then only to see just how wide of the mark those resources land. And not necessarily because of incompetence or wrongdoing, but because coordinating communities is magnificently hard. It’s our greatest challenge as people anywhere, always has been. Anyway, thank you for your nuanced framing and intellectually honest perspective.
Thank you for the super interesting and thoughtful essay, it was really enlightening to hear about the well-meaning nonsense work going on due to all the strange incentives put in place.
This was a really interesting post. I hope you continue with it. I can really see the inherent difficulty in trying to address cultural issues that contribute to the spread of HIV without doing anything that looks like you're trying to damage or upset the local culture. I'm sure there were times when it felt super frustrating and times when it felt really rewarding. I'm curious about how all of the aid money flowing in distorts local economies and which efforts you think are doing the most good.
I’m not an economist, but yeah, it’s clear to the naked eye that one result of all the aid money is mass distortion of markets. Whether that’s good or bad, overall, is hard for me to say - free markets have problems too!
I still believe PC is fundamentally a good program (I’ll talk about this more in the follow-up post when I write it). But PC is also incredibly inexpensive compared to most US foreign aid stuff, and it generally isn’t trying to make infrastructure change or anything. It operates primarily on the local community levels, and it’s hard to describe both (a) how precious that is and (b) how rare it is.
For anyone looking for a program to donate to, I think Doctors Without Borders (it is a French program and its original name is Medecins Sans Frontieres, or MSF) is exceptional both in implementation and in community connection. When I was in the field, some of the only other development/aid workers we ever saw out in the rural areas were from MSF.
Is it? I mean there's a lot of nuance and interlocking details throughout the essay. However, for someone like me who is extremely skeptical of having my tax dollars sent overseas to help others and build "soft power" there's really only one conclusion. Everything described in this essay was a massive waste of money and effort which achieved nothing. Even worse, the end of the essay explains rather saliently why it was never even possible for this effort to succeed in any meaningful way.
There's a lot of noble purpose here and good intentions. But frankly, I have zero desire to spend one penny of my tax dollars helping people on the other side of the world who I don't care about.
Soft power programs can be an effective tool in a country’s geostrategy (the Marshall Plan comes to mind). I think most taxpayers would be ok with spending some money on genuine humanitarian efforts that build goodwill and influence, especially in a multi-polar world where hostile powers are in competition with us on every front (which, I assure you, China is and has been for decades).
This essay actually helped distill the problem for me - activist NGOs, regardless of their ideology, should be subject to strict financial controls and transparency if they want to be part of the process. I’m not interested in paying for someone’s half-baked ideological project they dreamed up 10,000 miles away. If you can make an empirical case for “This $1m will save 500,00 lives without alienating the locals” I’m fine with it.
I liked the piece for its insight into general health philanthropy and specifically sexual health philanthropy rather than tax-funded foreign aid specifically, for what it's worth. I wasn't reading it as a case for or against foreign aid but rather as a description of what happens to it, like in Albert O. Hirschman's work on developmental economics (that work seems like it sometimes led to less aid and sometimes more, but always to better-targeted aid whether less or more). In that sense, it was well-written and great for me.
The question that is left unanswered is « what was in the report? » and if that is too specific and could get someone in trouble, what would be generally considered helpful?
Well, yes. But how does money help with « difficult conversations » when having them with a husband can get you killed? It would seem to me, and I am a woman from Madagascar, so I understand the issues surrounding culture, that finding ways to make women economically independent is more helpful than risking a beating for asking a man to wear a condom. So how is sex education and help with difficult conversation going to help when men don’t want to, or need to, cooperate?
PS - I edited an earlier reply to your comments in a way that moved my comment to a different place in the thread. (I'm just making a note of that, in case someone reads these comments and gets confused about the order that they are in)
It's a great question. There is an assumption among some people who work with sex workers (and other populations at risk for disease transmission) that sex workers have some ability to set boundaries. As you note, not everyone has this ability, and there are many structural issues that make it harder.
I think the general idea is that if you can't intervene in the broader structural issues, then there may be places where it's still possible to help people, in the interstices of the system. But in many cases, to do that sort of work, it helps for a person to make some kind of peace with the larger problems. It's not easy.
Then what’s the point of sending money? It seems to me that there is no good reason to send money, or to send Peace Corps volunteers to societies in which you can’t effect change.
On my end, I have found a school, run by local people, and I pay for kids’ tuition. My money goes further, they decide how to spend it, and by paying tuition, it enables their mothers to find employment or training during regular hours instead of relying on sex work for their income,
I will no longer support any NGO or government entities that purport to help. They don’t. They are corrupt. I just find small village schools and send them money directly.
I'm not sure I understand this question - do you mean, the report that Samkeliso showed me in his office?
I described the report briefly in the post: "As I sat in Samkeliso’s office and skimmed the report, I saw immediately that, once upon a time, his program had actually implemented all the actual, real, no-BS best practices for public health NGOs working within a community: They had humbly asked the women what they needed. And the women told them. As the report explained, sex workers in southern eSwatini wanted things like sex education, and they wanted help navigating difficult conversations about condom use, and so on."
Or, did you mean the Integration Report that I filed with Peace Corps? I described that report as well at the end of my post, briefly. The Integration Reports filed by my cohort were filed within the first few months at our sites. They were primarily intended to simply update Peace Corps about what we had learned, and what sort of work we were planning to do. I included an appendix about Samkeliso's report in my report, but I asked them to keep the appendix under wraps, because I didn't want to get him in trouble for showing it to me.
Hm, I’m not sure where you’re getting your information. I have definitely heard of, e.g., NGOs attempting to train sex workers to do textile work as part of the Rescue Mentality (unfortunately this is a good example of an intervention that tends not to stick, because sex work is way more lucrative than making t-shirts). I’ve also heard of NGOs that require more functional business models for things they provide seed funding to, vs the one I mention in the above post.
I imagine that if NGOs were trying to support something that looked similar to a sweatshop then that would be widely perceived as bad, though. Is that what you mean about terrible working conditions? Maybe I’m missing your point but, like… for the people in those countries who are okay working at sweatshops, the sweatshops will already exist, right?
Eswatini already has a large textile industry. It has trade preferences under AGOA for textiles. Industrialists are probably better at setting up industries than NGOs. Eswatini's problems are more specifically due to health issues like HIV, it's GDP per capita isn't extremely low.
I served in Liberia 2018-2019. I was a teacher. I saw and heard a lot of awful things but the HIV murder story you told shocked me.
I was a teacher.
For a while I had a rule in the classroom that anybody in class had to be working. One day I saw a pregnant 14-year old girl sleeping on the bench. She looked so exhausted. I didn't have the heart to wake her up. After that the rule was that you can't disturb the class.
Often students would come to class without a pencil or the money to buy one.
The students often hadn't eaten anything all day.
I saw the same pattern of NGOs throwing out money without understanding the situation on the ground.
I could tell a hundred details and stories like this but you captured the essence of it pretty well.
❤️
Fantastic essay. A cheeky disagreement:
"This did not make sense, because the road running through Lavumisa was a dirt road colored with the vivid red earth of eSwatini. Therefore, any car washed at the Lavumisa car wash would soon need washing again."
A service that requires a customer return within minutes? On the contrary this seems like a fantastic theoretical business!
Really beautiful article, I appreciate your writing it. Was struck by how many individual paragraphs carry their own individual insights into how the world works. And the efforts of individuals to surmount or work within that.
Thank you!
This has given me a lot to think about. Because of the obvious political implications of the story, I think it's important to point out that even if a lot of the efforts at changing peoples' behaviours failed, widespread ART has meant that the life expectancy in eSwatini has risen by 13 years since your time there. Maybe it's fine if DOGE cuts the equivalent of the half-built useless carwash, but they also cut PEPFAR and that will kill large numbers of people and far outweigh all benefit from everything else they do.
Also worth noting that the car wash was not funded by the US. I said this in the piece, but a lot of people (especially on Twitter/X) seem to have missed that detail, so I figured I’d make a note.
Agreed
I can't overstate how depressing I found this to be. Thank you for writing it out.
This is interesting and seems believable and in line with other bloggers like Scott alexander and his voluntary work to Haiti. But there isn't any information that inclines a person to be in favour of extending or cutting foreign aid, it is just that person making those decisions are probable gonna make a better decision if they have more information specific to these programs
I am working on the follow-up. But yeah, to be honest I am not trying to present any of this as an ideological argument. I’m more trying to present my experience, with details about what seemed salient to me, and the aspects that I think probably need the most attention as people consider true reform of the system.
I don’t think these programs should all be suddenly shut down, but imho, some of that is simply because people are dependent on the programs and we (powerful nations like the USA) co-created that dependency, so we should be more responsible for it.
Inasmuch as I have a personal agenda for change in the world, I think more in terms of truth and spiritual wholeness. Maybe that helps explain why this post seems ambiguous for some readers - I suspect the post comes across very differently for different readers because, at heart, across most of my work, I am hoping to communicate something subtle.
I felt a conflict between two models here, one is 'I didn't want to publish this but because it is politicized I feel I have to' , and the other is 'I wanted to share this experience anyway and now seems a good time since some people would be interested' . I don't wanna judge your motivation and me and most people here are thankful for intimate and personal information for free, but I also thought that if you were trying to make an argument it was too subtle to be efficient . I also tend to follow politics that most people so I probably make some weird implications about things,if I read that thing a year ago I would make different comments. Ultimately I believe wealthy nations and people can with little use of time and resources create immense benefits to community with that level of poverty and information like these is probably gonna be a net positive to people who care and act on these issues
I sincerely enjoyed reading this. It captured many things that are difficult to capture: good intentions lost in the shuffle, dubious intentions humored just so there’s funding, half-baked projects abandoned, the almost comedic impossibility of verifying anything as an outsider in a foreign locale, and basically the mishmash of guesswork and complexity that make needed on-the-ground change nearly a fool’s errand to attempt. I worked in similar contexts and it was crushing to see just how rare it is to get money and people routed to places that could really use it—then only to see just how wide of the mark those resources land. And not necessarily because of incompetence or wrongdoing, but because coordinating communities is magnificently hard. It’s our greatest challenge as people anywhere, always has been. Anyway, thank you for your nuanced framing and intellectually honest perspective.
Thank you for the super interesting and thoughtful essay, it was really enlightening to hear about the well-meaning nonsense work going on due to all the strange incentives put in place.
This was a really interesting post. I hope you continue with it. I can really see the inherent difficulty in trying to address cultural issues that contribute to the spread of HIV without doing anything that looks like you're trying to damage or upset the local culture. I'm sure there were times when it felt super frustrating and times when it felt really rewarding. I'm curious about how all of the aid money flowing in distorts local economies and which efforts you think are doing the most good.
I’m not an economist, but yeah, it’s clear to the naked eye that one result of all the aid money is mass distortion of markets. Whether that’s good or bad, overall, is hard for me to say - free markets have problems too!
I still believe PC is fundamentally a good program (I’ll talk about this more in the follow-up post when I write it). But PC is also incredibly inexpensive compared to most US foreign aid stuff, and it generally isn’t trying to make infrastructure change or anything. It operates primarily on the local community levels, and it’s hard to describe both (a) how precious that is and (b) how rare it is.
For anyone looking for a program to donate to, I think Doctors Without Borders (it is a French program and its original name is Medecins Sans Frontieres, or MSF) is exceptional both in implementation and in community connection. When I was in the field, some of the only other development/aid workers we ever saw out in the rural areas were from MSF.
This was well written and a great illustration of how a lot of things people try to overly simplify are actually quite nuanced.
Is it? I mean there's a lot of nuance and interlocking details throughout the essay. However, for someone like me who is extremely skeptical of having my tax dollars sent overseas to help others and build "soft power" there's really only one conclusion. Everything described in this essay was a massive waste of money and effort which achieved nothing. Even worse, the end of the essay explains rather saliently why it was never even possible for this effort to succeed in any meaningful way.
There's a lot of noble purpose here and good intentions. But frankly, I have zero desire to spend one penny of my tax dollars helping people on the other side of the world who I don't care about.
Soft power programs can be an effective tool in a country’s geostrategy (the Marshall Plan comes to mind). I think most taxpayers would be ok with spending some money on genuine humanitarian efforts that build goodwill and influence, especially in a multi-polar world where hostile powers are in competition with us on every front (which, I assure you, China is and has been for decades).
This essay actually helped distill the problem for me - activist NGOs, regardless of their ideology, should be subject to strict financial controls and transparency if they want to be part of the process. I’m not interested in paying for someone’s half-baked ideological project they dreamed up 10,000 miles away. If you can make an empirical case for “This $1m will save 500,00 lives without alienating the locals” I’m fine with it.
I liked the piece for its insight into general health philanthropy and specifically sexual health philanthropy rather than tax-funded foreign aid specifically, for what it's worth. I wasn't reading it as a case for or against foreign aid but rather as a description of what happens to it, like in Albert O. Hirschman's work on developmental economics (that work seems like it sometimes led to less aid and sometimes more, but always to better-targeted aid whether less or more). In that sense, it was well-written and great for me.
🙏
Great storytelling!
The question that is left unanswered is « what was in the report? » and if that is too specific and could get someone in trouble, what would be generally considered helpful?
Well, yes. But how does money help with « difficult conversations » when having them with a husband can get you killed? It would seem to me, and I am a woman from Madagascar, so I understand the issues surrounding culture, that finding ways to make women economically independent is more helpful than risking a beating for asking a man to wear a condom. So how is sex education and help with difficult conversation going to help when men don’t want to, or need to, cooperate?
PS - I edited an earlier reply to your comments in a way that moved my comment to a different place in the thread. (I'm just making a note of that, in case someone reads these comments and gets confused about the order that they are in)
It's a great question. There is an assumption among some people who work with sex workers (and other populations at risk for disease transmission) that sex workers have some ability to set boundaries. As you note, not everyone has this ability, and there are many structural issues that make it harder.
I think the general idea is that if you can't intervene in the broader structural issues, then there may be places where it's still possible to help people, in the interstices of the system. But in many cases, to do that sort of work, it helps for a person to make some kind of peace with the larger problems. It's not easy.
Then what’s the point of sending money? It seems to me that there is no good reason to send money, or to send Peace Corps volunteers to societies in which you can’t effect change.
On my end, I have found a school, run by local people, and I pay for kids’ tuition. My money goes further, they decide how to spend it, and by paying tuition, it enables their mothers to find employment or training during regular hours instead of relying on sex work for their income,
I will no longer support any NGO or government entities that purport to help. They don’t. They are corrupt. I just find small village schools and send them money directly.
It seems you are confident that you've found work that is genuinely helpful. Congratulations! That's great.
Local solution to local problems!
I'm not sure I understand this question - do you mean, the report that Samkeliso showed me in his office?
I described the report briefly in the post: "As I sat in Samkeliso’s office and skimmed the report, I saw immediately that, once upon a time, his program had actually implemented all the actual, real, no-BS best practices for public health NGOs working within a community: They had humbly asked the women what they needed. And the women told them. As the report explained, sex workers in southern eSwatini wanted things like sex education, and they wanted help navigating difficult conversations about condom use, and so on."
Or, did you mean the Integration Report that I filed with Peace Corps? I described that report as well at the end of my post, briefly. The Integration Reports filed by my cohort were filed within the first few months at our sites. They were primarily intended to simply update Peace Corps about what we had learned, and what sort of work we were planning to do. I included an appendix about Samkeliso's report in my report, but I asked them to keep the appendix under wraps, because I didn't want to get him in trouble for showing it to me.
That first image looks like the wetlands around the Murray Darling Basin in central NSW!
Hm, I’m not sure where you’re getting your information. I have definitely heard of, e.g., NGOs attempting to train sex workers to do textile work as part of the Rescue Mentality (unfortunately this is a good example of an intervention that tends not to stick, because sex work is way more lucrative than making t-shirts). I’ve also heard of NGOs that require more functional business models for things they provide seed funding to, vs the one I mention in the above post.
I imagine that if NGOs were trying to support something that looked similar to a sweatshop then that would be widely perceived as bad, though. Is that what you mean about terrible working conditions? Maybe I’m missing your point but, like… for the people in those countries who are okay working at sweatshops, the sweatshops will already exist, right?
Eswatini already has a large textile industry. It has trade preferences under AGOA for textiles. Industrialists are probably better at setting up industries than NGOs. Eswatini's problems are more specifically due to health issues like HIV, it's GDP per capita isn't extremely low.
https://en.wikipedia.org/wiki/Economy_of_Eswatini