SUVs in Africa = international health and humility

I arrived in the town of Choma, Zambia Sunday night to observe and provide feedback for the facilitators of the HIV prevention program I am working on as they practice in preparation for implementation. Located on the main road between Livingstone and Lusaka in the southern province of Zambia, Choma has roughly 40,000 people and a bustling main street. It also, apparently, has as many NGOs as it does people.

Everywhere I look, I see Land cruisers, big Toyota off-road trucks and other Japanese-made off-road vehicles that proudly display their various NGO affiliations, including World Vision, Hope International, CDC, USAID, AFRICARE, DFID and many, many others. They are easy to distinguish not only by the fact that they dwarf the other vehicles, but that despite the roads being incredibly dusty they manage to stay sparkling in the sun (thanks to daily car washes), as if to underscore that they were funded by perfect, sparkling, developed countries.

Seeing how I myself am traveling in one of the giant, gorgeous white Toyota trucks complete with a nifty CDC logo on either side, I certainly can’t claim to be any different. But I can’t help recalling when I was a thrifty backpacker traveling through Laos and Cambodia, and the scorn with which the locals viewed the innumerable NGO vehicles that clogged their streets, and the air of self-importance that comes with the neo-colonial ritual of international organizations sending people to “save” the unhealthy and dying locals. Back then, I both wanted to be an international health care worker, and understood the frustration of the people who I spoke with who felt that money was being squandered or not going to the right people, or was being extorted and siphoned off bit by bit.

But now I am that international health care worker, and I can’t help but look around at all of the vehicles and offices in this small town, and wonder how much of a difference they are making. Of course, many of them are making a huge difference – but I wonder whether the citizens of Choma are getting tired of the endless parade of organizations and information/sensitization programs. Even more importantly, are any of the programs making a lasting, sustainable difference for when the money dries up and the organizations leave to begin a new program in a new country? Will the program I am helping to implement be successful not only in my eyes but in the behavior and health outcomes of the community?

It is not that I am jaded (I haven’t been at it long enough) – although I certainly do know that many programs never see the results they set out to achieve. If anything, it has to do with my amazement at the sheer numbers of international public health workers that are living and working here in Africa and elsewhere in the world, and how so many can all be working in one small town (reminds me of how every time I read an article about research conducted in Kenya, it has been conducted in the same province/town [Nyanza province/Kisumu]). And it is also a healthy dose of humility as I am driven around in a fancy white truck by a driver for the local NGO I am working with (how embarrassing), knowing I am just another international health worker here for a brief period.