Category Archives: Health care

Doing Development the Right Way: A Conversation with Charles Piot

Anthropologist Charlie Piot has been conducting research on the political economy and history of rural West Africa for over thirty years. His first book, Remotely Global: Village Modernity in West Africa (1999), has gained wide attention for re-theorizing a classic, out-of-the-way place as existing within the modern and the global.

 

His next book, Nostalgia for the Future: West Africa after the Cold War (2010), explored shifts in Togolese political culture during the 1990s, when NGOs and charismatic churches reorganized social and political life in the absence of the state.

His current project focuses on Togolese who apply for, and attempt to game, the US Diversity Visa Lottery.

You can find out more about Charles Piot’s work on his Duke University website here.

While pursuing his own research in Togo, Piot now brings undergraduate students from his U.S. campus (Duke University) for short stays in the West African villages of the Kabre people where he has made a second home.  While there over summer and winter breaks, the students have developed and pursued their own, small-scale development projects.  In developing these projects, the students aim to tap into both their own skills and the needs of the villagers.

Neophytes are notoriously doomed to fail in such culturally and politically sensitive work. But these students are lucky to have Professor Piot to guide them in the exceptionally thoughtful and informed way that anthropologists do best.  Many of the projects have already proven transformative, while the failures have proven instructive.

Piot has worked with the students to publish a striking collection of essays chronicling their efforts.  The result: Doing Development in West Africa: A Reader by and for Undergraduates (Duke University Press, 2016).

Anthropologist Brad Weiss calls the book “an innovative . . . eminently readable and teachable text valuable to courses in international relations, political science, and anthropology.”

The book was “Highly recommended” for libraries by Choice.

Recently, Charlie and I had a conversation online about the book.  During part of our conversation, Charlie was actually back in the villages, checking up on recent projects and tweaking them to make improvements.  I think you’ll find the conversation fascinating.

CP: Charles Piot

AG: Alma Gottlieb

 

AG:  This book features projects that your undergraduate students at Duke have undertaken in a rural area of Togo where you’ve conducted research among the Kabre people for a few decades.  What inspired you to compile a book of essays by and about research in West Africa done by American undergrads?

CP: The idea for the book was entirely student-driven!  One year’s group of students with academic leanings – all three went on to graduate study, with one now pursuing a PhD in medical anthropology – asked if they might write up the results of their summer projects in an Independent Study class.

I agreed and put them through the paces – first week, produce an abstract; second week, an Introduction; and so on.  Before you knew it, they each had short articles, which were surprisingly strong.  One of the students asked if we couldn’t try to publish them, and of course I said, “Sure”–while secretly imagining that we’d end up publishing them on a website of our own design.

But one thing led to another.  We added more essays the following year.  We found some money to fly in to Duke an anthropologist (John Hawkins) who had published a similar book of student essays, and he gave us outstanding editorial advice.  We had lunch with a Duke University Press editor who was super-supportive of the idea – for him, it was a novelty, a book by undergraduates for undergraduates about development – and said he’d send the essays out for review.  But then, of course, the real work of producing a book – of editing and fitting all the pieces together – began.

Then, too, the projects themselves have always drawn me in.  These projects – all, student-designed – are interesting and doing important work in the villages.  And they tell interesting cultural stories.

Recipient of the Writer’s Collective Award for Best Poem (with a Duke Student), in a Kabre Village (Togo)

 

Finally, the problems and challenges of development in West Africa are vexing and fascinating.  I didn’t used to think so.  In fact, in years past, I would run the other way when I saw a development worker.  But now I find issues of development not only urgent but also (as Lévi-Strauss might have said) “good to think with.”

2017 Group of Duke University Students in a Kabre Village (Togo) 

 

AG:  Let’s start with that last comment.  As an Africanist, I spent three decades lecturing to students about the failures of large-scale “development” programs across Africa.  I suspect you did, too.  Yet we both find ourselves now working with small-scale “development” projects in our fieldsites.  Or maybe, it’s because we found so much wrong with those large-scale programs that we’ve both now embraced much more local, small-scale projects, in spaces we know well.  (Your work with these projects in Togo is exactly why Philip Graham and I invited you to join the Advisory Board of the Beng Community Fund that we founded, to create small-scale projects with Beng villagers in Côte d’Ivoire.)

In helping your students design their micro-projects, do you find yourself thinking explicitly about the failures of so many past IMF (etc.)-funded projects in Africa, and working with these students to design projects that will avoid those well-documented problems?

 

CP: Everything we do in Togo is tied to the spectre of development’s many failures that you reference.  My own feeling is that many of those failures, whether large-scale or small, are due to the failure to understand or engage with local culture.  How can you introduce new systems of debt (that come in with a microfinance project) if you don’t understand local notions of debt?  How can you design farming or health projects if you don’t understand local labor and cultivation practices, the way gender and labor intersect, and even local conceptions of the body?  But, astonishingly, most development projects never get down in the weeds of the local like this.  They assume the benefits of their projects will be obvious to all.  So they hire technicians and economists and agronomists, who are all well-versed in the Western sciences—but, rarely, anthropologists!

All of our projects in Togo – a microfinance opportunity for teens, a village health insurance system, computer classes, a writers’ collective – attempt to draw on local knowledge from the get-go, from design to implementation.  If we’ve had any success at all–and I believe we have– it’s because of our attention to local culture and history.

But there are no guarantees!  Indeed, as a provocation, I tell the students they shouldn’t get their hopes up too much, they should remain humble (and assume that locals know much more than they do – about farming, their bodies, local institutions), and even expect failure.  But such failure can be instructive in informing future efforts.

Another blind spot of many development projects is sustainability and follow-up.  Do they ever think about the time, five or ten years down the road, when the outside director or project manager will no longer be there?  Usually not.  This is a topic I’m preoccupied with right now.  What will happen to these projects after I stop taking students to Togo?  And what happens each year after we leave?  Do the computer classes live on, does the microfinance project continue to function?  I’m actually in Togo right now for a few weeks for that very reason, to follow up on all of the projects and continue to brainstorm the question of sustainability.

Charlie Piot Drinking Sorghum Beer with a Local Chief in a Togolese Village

 

AG: That’s fantastic that you’re writing about this from the village–using Internet supplied by one of your students’ projects.  That would certainly be one of the success stories.   Can you talk about the projects that have been the most–and least–sustainable?  In the case of the projects that are faltering, are the obstacles more technical, or sociological, or economic, or emotional . . .or a combination of some or all the above?  Are there things you now realize you could do in the future to make new student projects more sustainable?

Wireless Relay Station outside a Kabre Village (Togo) Demonstrated by Duke Student

 

CP: A nice question!  I’ll respond by discussing two examples of projects of ours that have had mixed success.

First, the health insurance system we’ve set up in a village clinic.  With this project, member families get free consultation and pay 25% the normal cost of medications, all for $4 a year per family.  The project has had fluctuating membership since it began 10 years ago, with only 25 families out of 200 currently enrolled.  And this, despite the fact that all insurees are unanimous in their praise of the benefits of the system.  Every year, we interview members and non-members to try to get to the bottom of why more families aren’t signing up.

Some of their responses: the health insurance scheme requires payment on a schedule, while the local system of payment and debt is more accommodating to unforeseen contingencies; the indigenous system of medicines is also efficacious and cheaper (you never “thank” a healer until after you are cured, with payment in kind – some beer, a chicken); some worry that paying for a cure before you fall sick might (through mystical means) bring on the sickness; others want to know if they can get their money back at the end of the year if they never attend the clinic.  All these responses make us realize how culturally shaped the idea of “health insurance” is!

The second example involves the cyber café.

                Muddy Flip-flops Left outside the Entrance to the Kudwe Cyber Café                          in a Kabre Village (Togo)

 

The computer classes we’ve offered while we’re there have been wildly successful.

Schoolroom Chalkboard Demonstrating the French Keyboard in a Kabre Village (Togo)

And we’ve found a high school student, a real wiz, who took our classes, to teach them to others after we left.  That could make the project sustainable beyond our presence.

Students inside Classroom in a Kabre Village (Togo)

But last month, when I was visiting the villages, I discovered that the cyber café has been closed to classes since we left last August, because the person responsible was transferred to a town fifty miles away,  and the person taking over hasn’t yet done what they call a “transfer of power” (passation de service), because no one has yet compiled an inventory of the materials in the cyber café.

So, as you can see, these are not technical problems–they’re social and cultural.  And while both projects are “successful” – the health plan works well for some families, and we’ve taught computer and Internet skills to several hundred youth in the villages – they’ve nevertheless fallen short of realizing their full potential.

 

AG: You’re unusually honest in assessing the weak spots of promising projects. I’m guessing this is because your training as an anthropologist compels you to see the social fissures that are invisible to the directors of so many large-scale development projects, who often focus on the technical components alone.  Our propensity as anthropologists to see the invisible but powerful lines of the social universe may make it easy for us to spot problems that elude the gaze of others.

But, does that skill also enable us to fix the problems?  For example, once you discovered the personnel problem with the cyber café, did you perceive any viable way to tackle it?

The insurance situation strikes me as even more challenging, because there, you’re dealing with a clash of values, and that’s almost always far trickier to address than other challenges.

Thinking about both these projects–with their encouraging yet mixed successes–I wonder if you have thoughts about how the next group of Duke students you bring to Togo might brainstorm solutions that could further address this thorny but critical question of sustainability.

CP: I do think our training as anthropologists aims our attention to the social life of communities, with all its messiness and conflict and fissure.  Do these insights also enable us to find solutions to the problems of development in small-scale contexts like this?  In principle, yes.

To stay with the example of the cyber café we’ve installed: despite the frustrating loss of time – eight months of inactivity – my students and I have familiarity with the lines of authority at the cyber café and in the larger community, and we know what jealousies might be in play—so we are able to brainstorm solutions with local allies.

In this case, a promising outcome is in progress – and one that may vault the cyber-café into a whole new orbit of activity, with a private entrepreneur from a different ethnic group managing it, while adding a photo-copier and printer, and installing a money transfer kiosk. (Local wisdom is to go outside the community to look for a manager, as locals might attempt to poach on the goodwill of a family member or close acquaintance, quickly bankrupting the enterprise.)  So – perhaps!  Only time will tell if this will be a failure-into-success story.  If it does, even a success will surely generate its own new round of challenges and setbacks.

But, development in such a context is always like this.  If we’re lucky, we might take three steps forward for every two steps back.  And, in any case, staying with the challenges has its own rewards.

2017 Teen Microfinance Awardees (and Family Member Guarantors) in a Kabre Village (Togo)

 

An Anthropologist at the Women’s March on Washington, Part 1: Finding Communitas, Feminist Style

Mass of Demonstrators in Front of Capitol 1, cropped
(photo by Alma Gottlieb)
The doors of our metro car opened and closed, opened and closed with increasingly alarming dysfunction.  On any other day, the many more dozens of people jammed into our subway car than (for safety reasons) should have occupied our tight, air-deprived space would have panicked–jostled, elbowed, and accused one another.  Instead, taking the occasion as an opportunity to befriend new neighbors, we asked from where and how far our companions had traveled, asked where they were staying, asked if the growing-short-of-breath needed water.  In other words, we bonded.
Anthropologists have a name for that feeling of spontaneous community that developed in an unlikely place: we call it, “communitas.”  Coined by the great Victor Turner (one of my long-ago mentors), the term originally referred to feelings of solidarity forged in African initiation rituals.  But anthropologists now apply the word to all sorts of places beyond rain forest groves.  Two days ago, an urban subway offered my first sighting of communitas in Washington, D.C.–but certainly not my last.  On Jan. 21, 2017, feminism and anthropology converged, as women around the country–and around the world–forged a sense of communitas that, unlike many temporary feelings of communitas, may well have lasting effects beyond the day’s euphoria.
Indeed, after it was over, yesterday’s march in the nation’s capital felt, if anything, infinitely grander and more important when we learned of the 600 or so sister marches around the world attracting some 2 million protestors, begun on Facebook and coordinated by the miracle of social media.
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I’m old enough to have intense teenage memories of participating in the huge marches on Washington of the 1960s, supporting civil rights and protesting the Vietnam War.  But my anthropologist friend, Linda Seligmann, and I were accompanied to yesterday’s march by three young women (aged 17 to 21 years old) who had never participated in such a momentous event.
A, H, Mina, Charlotte on Subway
(photo by Linda Seligmann)
I watched their wide-eyed wonder with delight as some 500,000+ strangers, mostly women, found a new pink-knit-capped sisterhood.
Mass of Demonstrators, Pink Hats, cropped more
(photo by Alma Gottlieb)
My day’s companions had their own somatic challenges.  One became dizzy and nearly fainted in the overcrowded, under-oxygenated metro car we occupied for nearly two hours; another exercised all her willpower to control her bladder, when toilet facilities proved elusive during six hours of enforced standing.  And yet, they never complained, never begged for an exit strategy.  Instead, they felt that strong pull of communitas.
I, myself, felt the tug of an old back injury asserting itself as those six hours of standing activated muscular fatigue.  And yet, communitas asserted a stronger pull.
After three hours of listening to inspirational speeches, many in the crowd became restless. “Start the march!  Start the march!” some began chanting.  And, indeed, some began marching (or, truth to tell, shuffling, amidst the thousands of protesters barely able to move), while others remained at the rally, to listen to yet more speakers.  Yet even that splintering of attention didn’t fracture our sense of common purpose.  Among those who stayed behind and those who forged on, communitas asserted a stronger pull.
Some protest signs and speeches signaled disturbing acts of police abuse across our troubled land.  And yet, even when faced with police officers and security guards trying to direct our unruly numbers, communitas won out, as protesters and cops responded with noticeable civility to one another.
The people who flocked to the nation’s capital looked more diverse than those at any march in my memory.  Judging by what I saw and heard, the event attracted white, brown and black folks; Christians, Jews, Muslims, and Hindus; straight people, gay people, drag queens, and everything-in-between; breastfeeding babies and grandmothers in wheelchairs; sighted walkers and white-caned walkers; people sporting designer clothes and others wearing hand-me-downs; groups of teachers and groups of students; executives and labor union members; English-speaking and Spanish-speaking youth.
Latina Girls with Posters
(photo by Alma Gottlieb)
And yet, despite this extraordinarily diverse concatenation of humanity, we forged communitas.
Muslim Woman Holding Poster (LS Photo) cropped
(photo by Linda Seligmann)
Or perhaps I should say, because of that extraordinarily diverse concatenation of humanity, we forged communitas.
Poster-We Are All Immigrants (LS Photo)
(photo by Linda Seligmann)
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I don’t mean to paint an overly Pollyana-ish portrait of an admittedly extraordinary day.  The challenges to maintaining momentum and organizing such a diverse constituency into a viable political movement are far from trivial.
But in the right circumstances, communitas can also cast a long shadow that can even produce some staying power.  Maybe, just maybe, it may prove powerful enough to help the organizers of these diverse groups–both those with impressive experience, and those just cutting their eye teeth on their first demonstration–mobilize the global energy, incorporating both love and anger, that asserted itself yesterday on all seven continents.