walkitout (walkitout) wrote,

the inadvertant reading list for bureaucratic mishandling of Serious Issues

That's a couple books in a row now that I've read books about really big problems (Population Control, AIDS) and what People Have Done About Them. Pisani mentions (obliquely and not favorably, through references to Contraception Safaris) some of what Connelly covers, which makes sense because there was surely overlap between her years of reporting in Asia and what Suharto and etc. got up to in an effort to stop people from having (as many) children. By the time she returned as an epidemiologist and field worker, the Population Control stuff had morphed (the money had washed out of the system and gone elsewhere).

The books are, obviously, very different. Connelly is a historian/digger through archives. Pisani is a scientist/active participant. Connelly can look at the full arc. Pisani is right in the middle of it, altho she perceives the end and predicts what will come next (and I'm betting she's right, too -- global warming is where the crazy money will next wash through, attracting more oinkers at the trough). There are several differences. The Population Control movement was a late gasp of colonialism (including people who had actually been running the colonies until they got run off), obviously white, obviously male. The AIDS movement, from the beginning, was inclusive in a way that Population Control wasn't until after the money ebbed: racially, including people with AIDS, including sex workers, and I'm not sure how to say this, but not only was it not a single gender thing, it wasn't just a two gender thing, either.

Some of the inclusiveness is truly built into the bureaucracy from the top down, in a way that Pisani at times ridicules (since people are included repping countries that _have_ no AIDS, for example). And misguided exclusivity still needs to be ferreted out. This sort of surprised me when Pisani talked about writing surveillance cookbooks that treated "sex workers" as separate from "drug injectors". For that matter, treated "people who buy sex" as separate from "people who sell sex". I read _My Secret Life_ by Walter and enough about molly culture in England to know that if you've got a category, you've got people who are violating the category. And that's in a culture that's readily relatable to our own. Move ten thousand plus miles away and introduce a whole other history/social structure/religious environment? Forget it.

I've read a variety of similar things lately, as an aside. There was a NYT article about stream restoration that included several things that just went thud for me: removing the logs from a Pacific Northwest stream to improve flow?!? And then being surprised that you just wiped out fish habitat and have to restore it. Have you ever _seen_ water in the Pacific Northwest? Better still, "discovering" that streams near Lancaster, PA had a century or two worth of pond-sediment, as opposed to stream sediment. Duh. Look, it was Pennsylvania in the 18th and 19th centuries. Don't you _think_ it had to look like Western Europe from slightly earlier, i.e. every fucking waterway in sight has been channelized, with a dam, a pond, and a mill? Before the Europeans got to it, those "streams" were braided is-that-a-water-ways. And that's what's going to come back if you try to "restore" it. This is right up there with my neighbors here complaining that their streams are turning into swamps. Well, duh! This is New England. It would _all_ be either swamp (bog, whatever) or rock if left to itself. And then meadow and then forest. If you want something different, be prepared to kill a _lot_ of animals, and do a lot to make the water do something different.

To return to the topic at hand. Connelly and Pisani share a sort of appalled shock at how bureaucrats in "development" tend to get very focused on how "efficient" they are at spending the money coming in -- an efficiency defined NOT in terms related to actually addressing the problem at hand. And agencies which can spend money fast, get more money to spend than agencies who spend money slowly, without regard to, say, actually addressing the problem at hand. Also, preconceived ideas drive how the money can be spent and often those preconceived ideas are driven by politics very distant from the problem at hand and are remarkably impervious to attempts to change them (Bush and abstinence, IUDs and Population Control, etc.).

Connelly and Pisani also perceive that their particular subject was getting a disproportionate amount of money/resources -- there were a lot of places that desperately needed something different than more IUDs or ARVs or whatever. Connelly, it seemed to me, really bought the idea that more money should be going to "development" (women's rights and education, say) rather than supplying more contraception. Pisani's perspective is a little different, but related. She thinks you can do a lot quickly to slow or halt the spread of AIDS more cheaply than doing general "development" and betting on that stopping the spread of AIDS.

Obviously, Connelly's conclusion with population control leads directly to what Pisani was experiencing. The Population Control folks thought they could ignore (or sap!) development issues/funding in favor of contraception. They got hammered partly because they were distributing bad contraception inefficiently and inadequately and partly because (this is the bad part) they were creating huge medical problems (dead/dying/bleeding women and to a lesser degree men) because of the kind of contraception they were pushing (sterilization and IUDs, generally delivered by non-medical personnel with minimal training in an unsafe context -- Pisani's Contraception Safaris).

The AIDS, crowd, by contrast, isn't doing near the harm that the Population Control crowd was: passing out condoms, lube and clean needles are highly unlikely to do any harm and often help (until they run out). Pushing abstinence isn't going to help anyone particularly, but at least it doesn't (directly) create a tetanus epidemic (like at least one contraception safari -- and this was vasectomies). There's a level on which, after reading Connelly, I want to take Pisani and say, damn, girl, this is _so much better_ than a decade or so earlier! Even when she's complaining about the Chinese ignoring their AIDS problem until a weird blood collection program amplified a small number of cases I kept thinking, better that than the kind of intrusiveness that characterized the first decades of the One Child policy.

I have no hope that future Serious Issues will be addressed effectively and efficiently by bureaucracies (of any sort), whatever those issues might be. There's no indication whatsoever that net progress has been made between the two campaigns, at least, not from these two books. Pisani makes it clear that NGOs don't save any money, and often have little to no real impact; governments can accomplish a lot more, much more cheaply, if they have an effective action to take and can target it appropriately. But NGOs are often the source of the effective action -- they're good at figuring out what does and doesn't work, sort of like a prototyper (altho she doesn't use that term). Yet it does seem like there has been some inefficient but effective work done, which makes me wonder if all that money sloshing around (which Connelly and Pisani are both dismayed by) might be a necessary part of the lifecycle of Fixing a Problem. There's going to be some waste, maybe too much research, too little research, the wrong research, a solution that doesn't work at all, a solution that causes too many other problems, a solution that works but is targeted inappropriately, etc.

I wasn't looking to read about this kind of thing when I picked up these books. _Wisdom of Whores_ was a great title and I love me some great title. Also, she was clearly a nerd which is just hugely wonderful. Connelly was presenting a detailed, well-researched history of a movement I was curious not to have heard much from lately. It never dawned on me these two might be related.

I pulled _Mainstreaming Midwives_ off the shelf. One wonders if this, too, is somehow connected. Certainly, _The Ask_ is. ;-)

Reading List so Far: _The Wisdom of Whores_, by Elisabeth Pisani and _Fatal Mis-Conceptions_ by Matthew Connelly

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