Category Archives: Health insurance

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)