Examples of much improved slide design from the 2013 International EM Teaching Course's "Powerpoint Resuscitation Workshop".

1. +
The Flip Side
of Foreign Aid
NGOs, the developing
world, and the philanthropy
industrial complex
Amy Walsh
International Emergency Medicine Fellow
August 16, 2012

2. +
A few disclaimers…

Almost all individuals working in aid organizations clearly want
to do good

The problem comes when people think that good intentions
alone are enough

We need to evaluate the outcomes of what we are doing, rather
than accepting that we want badly to help and that’s good
enough

3. +
How I became jaded…

I arrived in Haiti, three weeks after the
earthquake

Our clinic was set up in the courtyard of
the nursing school

No group knew what the other groups
were doing, so other groups would send
us PICU type patients despite our having
the same resources as they did to care
for them.

The UN was driving around in airconditioned white Land Cruisers, eating
lobster dinners at the country club with
scotch and cigarettes

4. +
Objectives

Recognize the dire results of unintended consequences and
poor planning

Discuss how our stereotypes of the developing world color our
evaluation of their need for our help

Recognize that US, UN, and large NGO policies are designed
with self-interest and self-preservation in mind.

Discuss how we can improve our provision of international
health care and international development assistance

5. +
Unintended consequences

In The Road to Hell, by Michael Marin, he had been planning to
start a well program in the desert and met with an expert, who
he expected to praise his plan

The expert told him, “During rainy season this well will provide
extra water for the nomads. It will allow them to have bigger
herds. When the dry season comes, the nomads will begin to
migrate toward your well or any permanent source of water.
They will arrive with larger herds and begin to denude the land
closest to the well…As soon as it is more than a day’s walk
from the water to the grass, the cows will die. “ He explained
goats and sheep will die after a two day walk, camels after a
week, and after the camels the people will die.

6. +
Unintended consequences

Polman argues that “sowing horror to reap aid and reaping aid to
sow horror” is “the logic of the humanitarian era”

For example:




Christian aid groups set up “redemption” programs to buy the freedom
of Sudanese slaves, which drove up market incentives for slavers to
take more captives
In Ethiopia and Somalia in 1980s-1990s, politically instigated, localized
famines attracted food aid that allowed governments to feed their own
armies while they further destroyed and displaced targeted population
groups
Aid fortified Khmer Rouge killers lived in camps on the Thai-Cambodia
border, enabling them to visit ten years of war, terror, and misery upon
Cambodians
And Rwanda as well. The genocidaires continue to wage campaigns of
extermination and rape to this day.

7. +
Unintended consequences

Bob Geldof led Band Aid and Live
Aid to raise money for Ethiopia,
raising more than $104 million.

This money was spent not in
compliance with conditions laid
down by a donor government, but
rather by the Ethiopian regime.

Aid workers arrived with the
money, and food aid was used as
bait to lure starving villagers into
camps. They were held there
awaiting deportation to state
farms. A life of forced labor lay
ahead.

8. +
Unintended consequences

The government army took a
share of the food aid and even
requisitioned trucks from aid
organizations to move people
out.

About 600,000 people were
moved and 100,000 died.

When asked about that figure,
Geldof felt the fact that aid was
available was more important
than the circumstances in which
it was delivered.

9. +
Unintended consequences

There is no regulation of NGOs, and anyone with enough
money can show up at a crisis and pitch their flag.

Vacationing American doctors turned up in Sierra
Leone, sponsored by their churches and performed lifethreatening and life taking operations without proper aftercare