Win-win situations, peace of mind, and other first-world luxuries

It’s been the perfect weekend.  A beautiful drive through tea gardens, misty mountains, and remote canals.  After finishing up a light lunch at a luxurious resort, we piled back in our rented van to start the drive back to Dhaka.

We’re on a winding country road heading back to the highway. We came around a sharp bend quickly and found ourselves on a collision course with an oncoming lorry filled with bricks. Luckily for us, he swerved and dented just the back of our van.  But unfortunately for him, the other side of the car took the brunt of the impact when he hit a tree, shattering the windshield and badly damaging the front side.

Both cars stopped, and our driver got out. A worker in the other truck jumped off the back and began to howl in agony while gripping his hand, not unlike the professional soccer players do when trying to convince the referee of foul play. The other driver was angry and on his phone, making calls. The police happened to be heading our direction, and stopped when they saw what’s going on.  Locals started congregating as well.

A few minutes later our driver hopped back in the car, and we started to drive away. 

“Where are we going?” We asked. 

He said, “They said that we could go.” 

That was easy. For about five minutes, anyway.

Looking good and surviving in places too lonely for lonely planet

I just finished reading the newly released “Expat etiquette:how to look good in bad places.”  It’s a great read for anyone heading to a developing country for the first time—especially if you’ll be staying for more than a few weeks. 

Expat Etiquette is one of the most readable travel guides I’ve ever come across.  It’s got some truly amazing anecdotes and enough humor to stay interesting, even when it’s listing out the various diseases you may need to diagnose yourself with.  It’s totally pragmatic, with sections like “how to use a squat toilet,” and “how to choose a restaurant unlikely to make you sick, ““how to not annoy the hell out of other ex-pats,” and “how to not get killed on the road,” and other skills that you might not have known you needed until you got there and learned them the hard way.  More than anything, adjusting to like in a third world context requires accepting a different mindset and orientation to the world—where things more often go wrong than right, scarcity is a daily part of life for most, life is wildly unfair, nice guys finish last, and that really, you’re totally on your own and no one else really cares what happens to you.  This may all be true in your hometown, but here there’s no way to avoid looking these types of realities in the eye in places like Dhaka, Kabul, and Khartoum.  The sooner you adjust, the sooner you can start to enjoy a new place and get things done. But as the book reminds you constantly, you'll still want to make sure you keep a stash of emergency toilet paper nearby, no matter how acclimated you become.  

Nothing in Expat Etiquette is groundbreaking, but it’s the stuff that no one really tells you and is extremely helpful to know up front.   There’s a few missing chapters that I have identified, so maybe I’ll write up an accompanying guide with fun issues like:

• How to avoid getting roped into other people’s financial problems
• What to do when you get lost (and determine just how lost you are)
• How to manage a maid effectively and avoid getting robbed
• “Your country please?” How to shut down unwanted conversations on the street
• Boil your milk and rinse your rice: how to avoid getting sick from your own cooking

For those who are headed to Dhaka specifically, I've written up some travel tips already.  Comments welcome!

Shout out to Wronging Rights’ post on Expat Etiquette—glad to have found it. See what else I'm reading, if you're hungry for other recommendations.

Nothing is as simple as it looks

One of the great privileges of working at BRAC is the occasional opportunity to hear our founder, Fazle Hasan Abed, speak.  Last Wednesday, we congratulated our first cadre of international Young Professionals on the completion of their training period in Bangladesh, and he offered some comments.
I've heard him speak several times about BRAC's experience in the 1980s with the Oral Therapy Extension Program (OTEP) (succinctly summarized in the New Yorker and more richly described in A Simple Solution, a must-read for any public health practitioner).  But today he offered some details that were new to me.
In brief, brief detail: the OTEP program was an effort to ameliorate the massive death toll of children from diarrheal disease --it claimed almost 1 in 5 kids before their fifth birthday.  Once scientists realized that you could prevent death from diarrheal disease through an IV (that essentially replenished fluids and electrolytes), the logical next realization was that by drinking a mixture of water, salt, and sugar, you could do the same thing.  Given the dearth of health facilities in Bangladesh, and the challenges of transporting ready-made oral rehydration solution (ORS) all over the country, BRAC chose the strategy of teaching moms how to make it at home.
The story gets really interesting when the monitoring team goes out to evaluate the program after it reached its first 30,000 households--it found that while many mothers could make the solution, only a handful (~6%) actually USED it when their children had diarrhea.  Upon a bit more investigation, they found that the field workers, who were teaching mothers about the solution, didn't actually use it in their own homes! So BRAC brought the field workers in, gave them a tour of the Cholera Hospital where many were being treated with the solution, and also gave a scientific explanation of how the solution worked.  Satisfied that the workers now had "drank the koolaid" (or at least the ORS!!), they asked them to go door-to-door for another 30,000 households and teach them about it.

Making education attainable for all: why Bangladesh needs low-cost, private schools

(Originally published as part of an online "edudebate" by WISE, an initiative of the Qatar Foundation)

In 2012, over two hundred thousand students applied for admission to the prestigious Dhaka University.  Only 6,000 can matriculate, putting Dhaka University’s acceptance rate at under 3%.  One in 37 applicants was accepted (as a point of comparison—Harvard College admits about one in 17 applicants).  In recent years, dozens of private universities have sprung up in Bangladesh, sensing the desperate demand for graduate and post-graduate opportunities.  Unlike public institutions like Dhaka University, which are virtually free of cost, private universities routinely charge USD 1,200 per year, putting them out of reach of many families in a country where the average GDP per capita is USD 750. The competitiveness highlights both the educational aspirations of the rising youth, as well as the inadequacy of the current supply.

Yet most don’t even make it to the point of applying to university. In Bangladesh, the greatest attrition happens at the secondary school level—fewer than half of the nation’s youth enroll.  A full 80% of poor students (those in the bottom 40% of households, by assets) drop out by class nine.  Girls often drop out when they are married—two in three marry before the legal age of 18—and other youth may drop out to pursue income-generating activities.

While these “pull” factors are often emphasized, recently there’s an expanding focus on the “push” factors, namely cost and quality of education. Though school fees are usually reasonable, the expectation is that students will also bear a number of less obvious expenses—most notoriously private coaching or tuition.  A internal survey conducted by BRAC and Pearson surveying over 1,000 households found monthly educational expenses in Dhaka were around $50, and coaching accounted for over half of the cost.  The survey also found that households with a monthly income of $ 193 or less tended to spend $2 on monthly school fees and $33 on tuition ($35 a month), whereas households with an income over $257 spend $6 on school fees and a staggering $141 on private coaching ($147). Despite the high prices, a recent study on competence found that class 5 students tested only marginally better than their out-of-school counterparts.  Many other studies corroborate that while enrollment is high, learning outcomes remain a significant challenge across public and private schools.

The challenge of scaling digitally

(this piece was originally posted on the Stanford Social Innovation Review website on April 18, 2014)

Organizations like BRAC are built on the philosophy that development happens when people sit together. Though we work in a variety of sectors—including agriculture, health, education, and microfinance—community organization is a pillar of our model. And across our 12 countries of operation, including Bangladesh where we have our global headquarters, more than 95 percent of our staff members are based in the field.

Consequently, like many community-based organizations in Bangladesh, BRAC is deeply skeptical about emerging technologies: They seem to lack the critical human dimension of grassroots interaction that has proven instrumental for decades. If we move to dispersing loans and stipends via mobile money, for example, will staff and clients still have the same quality of rapport that weekly home visits and community meetings foster? Could algorithms and data-driven decisions replace field smarts and experience? At our second-annual Frugal Innovation Forum last month in Savar, Bangladesh, we tackled this issue head on by asking: Is it possible to “go digital”—to incorporate more technology, digital finance, and data-driven decision making into service delivery—without losing strong relationships with clients and communities? Building on last year’s forum, our constant emphasis on scale—whether digital tools would enable us to better serve our millions of clients or not—is implied in the question. We invited practitioners, including many from South Asia and East Africa who were utilizing or considering utilizing technology, digital financial services, or data in innovative ways, to share their experiences with us. We also shared some of our early experiences on these themes from BRAC. Here are some of our takeaways:

Frugal tools for change: the notebook

Thursday evening I was invited to hear Brett Wigdortz, Founder and CEO of Teach First, the UK-based partner of Teach for All (formerly Teach for America).  The basic, very simplified premise is to get high potential women and men graduating from university to spend two years teaching in the classroom of a disadvantaged or low-income school.  Many are spreading the model worldwide, and this year the first cohort of Teach for Bangladesh teachers are classrooms across Dhaka.

Teach First has achieved some amazing improvements in the education quality provided to low-income students, especially in London.  Nationally they account for 2 out of every 7 teachers in low-income schools, and also have a number of alumni (they call them "ambassadors") as head teachers, and policy-makers.  Teach First recently became one of the top recruiters of graduating university students in England.  It's no wonder that the president of a British teacher college recently mentioned in a speech that Teach First has "detoxified the teaching profession" and made it an exciting option for many young adults.

Revisiting the starfish story

I’m sure you’ve heard some version of the Starfish story:

An old man comes out on the beach one morning, and like every other morning, he sees that the ocean’s tides have washed up dozens of star fish.  There is a young boy patiently picking up starfish, one by one, and tossing them back into the ocean.  “What are you doing, son?”  The old man asked, “there are hundreds of starfish beached.  You’ll never be able to get them all back in the water.  What difference does it make to toss a few back?”

And then punch line: 

The boy silently throws one back to the sea and says, “It made a difference to that one.”

And there we have it.  The notion that what matters is just what we do—the number we help.

This thinking pervades development.  Look at any annual report and you’ll see the “number of people served” in various forms—i.e. number of surgeries performed, assets distributed, people trained.  We’ll call this the “starfish mentality.”

My problem with this mentality is that is ignores the denominator—that is, what is the size of the total population that need this support?  Is it 50 or 5 million?  What percentage of the people that needed help were you able to reach?

At an event last week in Chennai, I was really inspired by a story that I heard about India's Aravind Eye Hospital.  After avidly reading about them for years, it was really exciting to hear in first person about their operations and strategy.

Aravind is the largest eye hospital in the world.  They perform many surgeries to restore eyesight and using a tiered pricing structure, are able to provide a number of free and reduced costs procedures while remaining sustainable.  They perform close to 370,000 eye surgeries a year, which just as a point of comparison, is about equal to the entire number of eye surgeries performed in England annually!