Good intentions

“The road to hell is paved with good intentions.”



“Good intentions may do as much harm as malevolence if they lack understanding.”
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“I had not been impressed by my first close-up look at big aid organisations. And I’m still not impressed today. I have seen them do too much harm with badly planned interventions, and act with too little respect for the people they are supposed to be helping…

As I have become more deeply involved in aid work I have also become more deeply concerned at many widespread practices which do more harm than good…

An underlying problem is that most aid agencies need to justify their existence and fall into a trap of thinking that being seen to do something, even if it is not helpful in the long term, is better than appearing to do nothing in the short term.

It’s easy to feel that way – children are dying; something must be done. But sometimes, nothing is better than introducing poor-quality initiatives which do not improve healthcare outcomes. There have been too many cases where interventions have harmed people…

A further trap is that once a commitment has been made – which is nearly always in the many millions of dollars – it’s easier to keep throwing money at the problem rather than cutting the losses and investing time and money into looking for a better solution. Everyone is in too deep to be able to walk away. This insistence on sticking with the discredited remedies diverts money from the potentially effective solutions.

The fault in many cases is sloppy science. Anyone following proper scientific methods would not be having these problems. In the rush to be seen to be doing something, solutions don’t get the initial rigorous experimental testing and independent testing they need to ensure they are effective and safe…

Development agencies have an ongoing political problem because they have to be donor-focused. If people give you money, they want to see you doing something with it. That also drives them to do things and to be seen to be doing something at any cost – even when that cost is people’s lives…

Aid is already a business. Organisations compete with each other for funding. I have known senior aid workers to rejoice out loud when a hurricane or tsunami occurs. That’s an attention-getting event that they can do a fundraiser around. It will be on television. The money will come in and the overheads will be taken care of for a few more months.

A huge amount of the resources and energy of large aid organisation is also applied to the media and building the edifice of the organisation. There is a lot of self-promotion. To get that you need to have a quick fix so you can show you’re doing something and there is something for the camera’s to look at…

I conducted a comprehensive analysis of how effective major development agencies, such as WHO and UNICEF, our potential competitors, were at making quality healthcare accessible to the poorest of the poor… Sadly, my research uncovered a litany of well-meaning healthcare interventions that had caused, and continue to cause, preventable death in countries that put their trust in many agencies. Poor science is being deployed with fatal consequences…”

In Eritrea:

“Over a few years I saw the unintended unfortunate consequences of aid going wrong- when the United Nations peacekeeping force and other major organisations came to town, things started to deteriorate.

This was a conservative society with no premarital sex. Girls who slipped up were cast out of their families and often reduced to prostitution. Yet the girls were also friendly and loved to meet foreigners and talk to them about what the rest of the world was like. Inevitably this led to seductions. Then a five-star hotel was build, which was a very attractive place to encourage girls back to. It also gave the aid workers somewhere to stay at $US350 a night so they were even further removed from the real life of the country. Their excuse was that they needed to be near the airport but I think they needed to be near the bars and swimming pool…”

IMCE programme in Africa:

“In January 2010 a report published in the English medical journal The Lancet showed that a $27 million UNICEF programme – IMCI, or Integrated Management of Childhood Illness – that combined numerous strategies and was deployed across several African countries for several years had failed. In fact, some kids who were not on the programme had a higher survival rate than kids who were on it…

In 2007 a Lancet editorial slammed UNICEF over its self-congratulatory claims that the UN agency had produced a steep fall in child mortality with IMCI and that its global healthcare programmes had reduced under-five infant mortality…

Six days after receiving this article and prior to its publication in The Lancet, UNICEF called a press conference announcing ‘A major public health success”. The Lancent concluded that UNICEF was acting contrarily to responsible scientific norms that one would have expected the agency to have upheld. Worse, it risked inadvertently corroding its own long-term credibility…”

In India:

“Aid efforts can go wrong in any number of ways, at every step along the chain. Complicated exercises such as vaccination programmes are extremely problematic. Vaccines go off like a cut lunch in the sun, losing their activity in as little as eight weeks in ambient temperatures. They’ve got to be kept cold, but getting a cold chain that streams right through the programme in a developing country is near impossible.

People end up not getting the true vaccination, or being given double the dose because somebody miscalculated things, which is what happened in one case where the High Court of Assam in India found UNICEF guilty of causing the death of kids who were administered a toxic dose of vitamin A. UNICEF implemented a blanket vitamin A supplementation campaign in two districts of Assam in 2001. In giving judgement, the Chief Justice said that the health workers involved in the programme were not properly trained and briefed and had administered greater doses than many of the children could tolerate… What makes this story more tragic is that a comprehensive scientific survey conducted by the Indian Council for Medical Research in 1999 showed that vitamin A deficiency was not a public health problem in these areas… UNICEF has a global programme to roll out vitamin A supplementation and clearly it did this in Assam without determining whether it was required. It was simply a waste of money and cost the lives of those who put their trust in their caregivers. They were simply killed in ‘action’.”

In Bangladesh:

Perhaps the worst example of what I’m talking about is the litany of mistakes that were made in Bangladesh following a cholera outbreak in the early 1970s. In trying to fix this problem, UNICEF made all the errors outlined above and ended up responsible to what has been described as the biggest mass poisoning in history.

The aid organisation spent millions of dollars over many years of drilling a million or more backyard tube wells in an effort to provide clean water for the population… If they had planned better, had some basic quality standards, SOPs and adopted WHO guidelines for water testing, they would have found that the water from more than half of these wells they sank was tainted with carcinogenic arsenic… By 1993, the general population was showing telltale signs of chronic arsenic poisoning, including skin lesions, cancer of the skin, bladder, kidney and lungs, and neurological and pulmonary diseases.

Four years later, in 1997, despite evidence that the arsenic-contaminated tube wells were causing a major pandemic, UNICEF stated in its ‘in country’ report for Bangladesh that it has surpassed its goal of providing 80 per cent of the population with access to ‘safe’ drinking water in the form of tube wells, ring wells and taps by 2000…

The aid organisation’s actions bred huge mistrust among the locals who had complained for a long time that they were seeing people with outbreaks of blisters on their hands – a symptom of arsenic poisoning – and were pretty much ignored…”

The Life Straw Personal debacle:

“This was a personal water purification system – a straw with a mouthpiece and filters that purports to make water safe to drink even if it’s got every pathogen known to man. Having spent most of my life as an analytical chemist and the other half designing state-of-the-art pharmaceutical-grade water purification systems, I knew that it did not work…Millions of these have been deployed by the major aid organisations because the manufacturer published data that says it works… It’s causing more deaths because it lulls you into a false sense of security. You are more likely to drink from a contaminated water source than you would before because you think the Life Straw will protect you.

Even worse – someone is flogging knock-offs of these useless tool. They look just like the Life Straw but don’t have anything in them at all. People pirate anything and everything in the developing world. Probably 25-50 per cent of drugs distributed are wither subpotent or have nothing in them. There is no shortage, despite of Fred Hollows’ fervent wish, of people happy to make money out of sick people. It is a shambles out there.”

(from ‘Rebel with a cause’ by Ray Avery)

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Sir Ray Avery is the founder and CEO of award winning development agency Medicine Mondiale.

Established in 2003 Medicine Mondiale manages a global network of Scientific,Clinical and business  experts who donate their knowledge and time to develop medical solutions which make quality healthcare accessible to everyone.

Medicine Mondiale is committed to:

  • Developing and commercializing innovative affordable products and technologies that make a significant and measurable impact on improving access to quality healthcare on a global scale.
  • Creating an International Network which promotes the development of sustainable enterprises,products and technologies which improve access to quality healthcare outcomes on a global scale.
  • To develop strategic alliances with national and International academic and research based organizations, and commercial entities which combine fundamental academic research with applied research which fast track the commercialization of novel healthcare technologies.
  • Through a combination of advocacy and global surveillance initiatives, monitor the quality and safety and efficacy of global healthcare initiatives promoted by multinational businesses,Government and Non Government Organizations,with the aim of improving the quality and cost effectiveness of Global Healthcare initiatives.