Wednesday, September 24, 2014

How to Fix The World. The Global Health Conference Pt. 1. Ted Talk of the Week #2 and #4!

Last post:                                     My Story:                                         Next One

Recently I went to a conference on Global Health for medical students in Australia, and it was one of the most inspiring weeks of my life.
The talks and discussions we were exposed to were amazing. Their central theme, of converting knowledge into action, inspiring. The interactions and discussions I had with 700 other, just as passionate and caring students (not to mention the amazing speakers and organisations), uplifting.

But I felt one of the best messages the conference put forward was that Global Health isn't just going to be solved by doctors.
The issues aren't gonna be fixed by flying doctors and drugs into the field... In fact, in many cases, that's one of the least effective things we can do.

We need to think systematically, together and work WITH those we're trying to help
if we want to make a difference in our world.

And of the many inspiring speakers who spoke at the event, one told us broadly HOW we, as both future physicians and, possibly, future leaders in these fields, should think about improving the third world.  And he, and a few other speakers, are who I'm going to talk about in this first of many posts on the whole event.

Rowan Gilles:

Youngest ever President of Medicans Sans Frontieres (Doctors Without Borders)
Surgical Fellow
Doctor Administrator

When I heard that this man was giving a talk, I was prepared for the regaling of tales of horrors seen in war and disaster zones in the third world; whether it be his own or that of one of the thousands of medical aid volunteers he'd held under his purview. I'd seen a few talks of that nature by MSF members before, and they were all inspiring. Maybe, I figured, because he was the president of the organisation, he'd outline the importance of it remaining neutral, and other political and logistical aspects of the organisation so they could fulfil their charter of providing medical aid to the side who needed it more in warzones.

Though MSF does do necessary work, I'd wondered whether Doctors Without Borders could solely cure the world of its major health crises, and hence, was dubious that his views would outline how we could fix this world.
I mean, if you thought about it, wouldn't it be more effective to direct our efforts towards preventing such issues in the first place? To try and combat or mitigate the motivators of these conflicts in the first place?  To develop economies and communities to a level where health issues wouldn't tear open like gaping wounds when disasters happened?

Well, to my surprise, that idea was exactly what Dr Gilles talked about. 

He rightly didn't downplay the importance of organisations like MSF and UNICEF who help bandage major health issues when they emerge.  But he challenged us to think of how we can make ALL aid and charity efforts go the furthest.

And his talk gave lots of logical ideas on how to do achieve that, which other speakers would end up giving fabulous in depth advice on. So I'm structuring this first post on the Global Health Conference and including other key speakers in it, as they give great examples  of what he was trying to teach us.

So how do we make charities most effective?
  • ·         1) First we need to think long about what we're doing, and look at everything in the world as a system. We need to make sure we understand the key issues which cause health issues, and how to work our way around governments, corporations and conflicts, and how to best nudge them to support good policy/business/peace stratergies, or else figure a way to work around them in order to attack an issue from its most vulnerable side.
  • ·         2) Next study the area and understand the causes behind the key issues and plan for how to combat or deal with them most effectively before intervening. Often in third world nations, decent infrastructural, economic and healthcare systems are simply not in place, so thorough surveys and  logistical planning needs to occur to make sure every part of the supply chain works.
  • ·         3) Finally, when you do intervene, make sure you set goals, and evaluate your impact as you go. And be prepared to make the tough decision to shelve your efforts if they're not as effective as others; in a good number of cases, there'll already be someone doing something better than you. Either help them, or learn off them.

1) Deep, Systematic thinking:

As mentioned above, fixing global health issues isn't as simple as flying in doctors or medications. We need to ensure sustainable, long term plans are made and that requires coordination between multiple fields. Not for profits, governments and organisations such as Doctors Without Borders  and the Red Cross need to think about how to make their resources go the furthest and help the most people, for the longest amount of time. And that requires forward, wide thinking and long term planning that impact the most crucial issues. Indeed, many of these issues won't be fixed quickly or easily.

Jose Ramos-Horta

Ex President and liberator of East Timor (Timor-Leste)
Youngest ever person to address the UN Security Council
Peace and Security envoy for the UN Secretary-General
The keynote speaker for the event was Jose Ramos, ex Prime-Minister of East Timor, the 1996 Nobel Peace Prize winner, and the UN's special  Representative and head of its Peacekeeping Office. He totally agrees with this sentiment, especially in the case of war. Though his speech wasn't as personal or as novel or as inspiring as others (don't get me wrong, his story of how he led Timor-Leste to independence could easily be made into a best-selling novel), everything he made in regards to resolving such conflicts let us know, early into the conference, that these issues weren't simple. He rightly offered no "silver bullet" to end all conflicts. Because there is none.

Fixing conflicts like the genocides occurring in Congo and Sudan and potentially international conflicts such as that in Syria, and the crisis in Gaza would take years to accomplish. And interventions aren't as simple as they seem. Though it's morally imperative that we do everything to deal with nations with genocide inciting dictators and warlords, we have to first establish who's accountable, evaluate our impact and our own losses in dealing with the situation and, horrifying as it seems, negotiate around other countries' and our own vested interests in their resources. 

In the case of Syria, Gaza, Ukraine and, since his talk, Iraq, facilitating discussion is only a first step. Finding out how to best intervene through sanctions and other peaceful means is a difficult task that requires great economic and political thinking; compromises between different larger powers through diplomacy is rare for a reason. He spelt out conflicts, their causes and possible avenues of solving them in the future; all of which required systematic, broad thinking. Somehow we must foster this discussion more and more.

He, like Gilles, stressed that the dollars and effort we spend that silver bullet would be better spent on fixing the systems we had in place. Indeed, fixing those issues would probably cost less and end up leaving the nation better equipped to progress than just finding it. 

And he also believed, like me, that governments alone weren't the solution to global poverty and global health. That businesses and individuals should be involved and that we should encourage them to view human development as a good investment.

His talk, one of the first of the conference, quickly set the stage and made it clear that the broad implications of these conflicts and of global health as a whole requires perspectives and expertise beyond that of solely medicine.

Dr Allesandro Demaio

Professor of Global Health at the Copenhagen School of Global Health
Fellow in Global Health and Non-Communicable Diseases at Harvard
Founder of NCD-FREE

The idea of facilitating discussion between different fields was a common theme of many of the talks, and Dr Allesandro Demaio agrees. He encouraged us to think broadly on topics of global health, and encouraged us to interact with as many people from as many fields as possible so that we have the best chances of fixing this world.

Allesandro is a public health expert, and Global Health fellow at Harvard University, and particularly focused on the idea of non-communicable-diseases, which we often know as lifestyle diseases (essentially, those that aren't infectious in nature such as heart disease and diabetes) in the third world.

Third world medicine is behind ours in many ways. Many diseases that we'd see once in a lifetime as physicians in developed nations; things like systemic tuberculosis or Malaria, still plague millions of people, despite them being easily preventable. It's easy to forget, with these shockingly bad diseases being so common that developing nations face equal, and sometimes larger burdens of diseases such as cancer, diabetes and heart disease.

Allesandro believes good health policy and advocacy, the act of promoting ideas to governments, is the best way of achieving such ends, and he targeted his speech towards our power in doing so as doctors in the first world. He stressed to us the importance of being politically active and to use our voice, as trusted, (supposedly) knowledgeable members of society to advocate for good public health. 

And I agree, as doctors we definitely have a role beyond just treating patients who present to us in the clinic. Indeed, it could be argued, we'd be more effective in treating our patients by advocating for policies that prevent sickness in the first place.

But I felt his focus on solely advocacy as a way to fix major issues was a bit narrow-minded. When I asked him if we should also involve businesses and other stakeholders who have vested interests in targeting more of their products to people who are more likely to be obese and have NCDs, he seemed closed off to the idea, stating that "if there was a profit, they'd be in there already". 

I agree with him on that front, it's hard to convince companies promoting good health to market to those who have higher rates of obesity, smoking and alchoholism (usually those of lower economic status) in developed nations; who can only afford so much. There would be some stakeholders who could make a profit while reducing health risks though, I'm sure (cheap gyms are an example).
 But when I floated the idea of making reliable, broad-spectrum cost-benefit analyses which highlight the economic benefits that implementing public health policies (eg. subsidies for fresh produce or larger measures such as the fat tax) his eyes seemed to light up with ideas. Instead of advocating for public health on a "social service", "good for your health" basis solely, we should also be marketing it as a method of reducing health-burdens that stress the economy.  Hopefully, he'll collaborate with a few macro-economists to get cost-benefit analyses of such policies up-scaled into a broad context; one that governments will be more willing to pass, as public health will now be framed as health-savings (in both dollars spent in healthcare and economic activity lost) rather than expenditure in the budget.   

He also encouraged doctors and medical students to interact with people from other fields, emphasising its importance, and that's something that I definitely agree with. He suggested meeting up for coffees as a great way of doing so. And that our global health societies, which most medical schools in Australia do have, should invite and allow other students from different fields of study to our events, which unfortunately, most schools don't at the moment. I told an on-watcher who'd asked how to get knowledge of some other fields easily that  watching a TED talk every night to someone too as a great way; and Demaio agreed that that's another effective way of doing it. To those who've read this far - I'd definitely encourage it. It's a great idea of gaining knowledge about how the world works, as often, they give a brief, laymen targeted background on the topic at hand (not to mention - it's pretty damn interesting). 

Teaching The Teachers; The most effective way of Giving Aid

The way we give much of our aid right now is by sending over resources and 

2) Analysing The Challenges and Planning Around Them:

Understanding how different parts of the world and different aspects of economics and governance work, is helpful, but we also have to know what's actually happening on the ground to ensure any resources diverted towards human development go far. In the third world though that can often be a challenge. And we tend to assume that we know what the issues are, and what poor people need, and, sadly, assume they don't have WANTS. And this often leads to ineffective charity operations.

But it's not only this that causes ineffectiveness of charitable effectiveness. We can often have "too many cooks in the pot"; too many people trying to help out. Our efforts, the resources we divert to curb health challenges are often diluted by having too many people on the ground trying to help the same cause. 

A good - confronting point he made, was that we need to check our ego at the door when we want to help others. As medical students particularly, a lot of us want to volunteer and help out in real third world climates (most medical schools in Australia encourage students to take electives overseas). But we really have to think... are we actually going to make a difference there? Or are we just going to get in people's way in our efforts to try and feel good about ourselves?

Similar ideals and issues may happen in the field of charity as well. And this was a question a lot of us found ourselves asking as the days progressed and we began to think deeper about Global Health. 

Do We Have Too Many Charities?

The topic of a debate held at the event.

Whether or not this is true was a topic debated at the conference by prominent Global Health experts and advocates including Dr Cam Hollows, following in on the footsteps of his father, Fred Hollows (founder of the Hollows Foundation), James Harrison, a coordinator of Kickstart Kids International and Dr Trung Ton, a co-chair for Global Health Connect.

The points they brought up for both sides were excellent. Having lots of charities on the ground can be good; they can be targeted to specific vulnerable groups more effectively and wholesomely with smaller overheads (not to mention, donors can get in touch with managers and teams easily, making them feel more involved). However, smaller charities and NGOs don't have the wide scope larger charities do to tackle root causes of issues. So though they're important, and do great work in helping certain groups of people, they often don't fix root causes for disease.

At the moment, it's arguable that there are too many charities and NGOs on the ground, and that they're fixing issues that aren't necessarily the most concerning in a region. Often, smaller organisations (this applies for poorly managed larger charities too) are poorly equipped to deal with the situations that occur in there; due to lack of appropriate resources or poorly diverted efforts. For example, as Rowan Gilles suggested, setting up a surgical facility and equipping it with modern anaesthetic/medicine delivery systems may seem a good idea, but they often lie unused, as teams don't have adequate training to use them. 

This becomes clear when you look at the many horrible decisions Doctors Without Borders volunteers are forced to make in their efforts to help disaster prone areas. Should you operate and save a baby who was born with a birth defect in their anal canal that left it almost completely obstructed when that baby will die in a few months as the family couldn't possibly afford the follow up surgeries? Decisions like this aren't exclusive to disaster struck regions' doctors, but widespread in those who volunteer in nations with poor access to healthcare.

Lucy Perry

CEO of Hamlin Fistula Institute
Stylist, Designer, Photographer, Designer and Publisher
Moved from a Volunteer to CEO in 8 years. 

Perhaps you can see now that setting up a facility in the first place may have been the wrong option. Often, local doctors aren't adequately trained enough or non-existent in the region in the first place. Instead, sending experienced doctors and nurses over there to teach a team of doctors to perform surgeries in resource poor setting would be more effective. Indeed, training midwives and establishing primary care style centres to help mothers deliver babies safely is even more effective than training a team of doctors to surgically repair birth canals post delivery. 

These are all realisations Lucy Perry, the CEO of Hamlin Fistula Hospital, an NGO that helps mothers in Ethiopia suffering from obstetric fistulas (holes between the vaginal and anal canal) caused by long, difficult labours, had.

Originally, the organisation, founded by Dr Catherine Hamlin (who, despite being 91, STILL operates to repair such fistulas, which I think is AMAZING), was centred around one hospital, repairing such birth defects in Ethiopia. But over time, Hamlin and co. realised the issue would be best fought on two fronts - by reducing the incidence of these obstetric fistulas through maternal education programs and the establishment of system wide, locally targeted and placed birth centres (manned by newly trained midwives) and by training doctors to perform surgeries to repair the fistulas in those mothers who still had them.

Perry told us of the horrible conditions mothers who had such fistulas had after giving birth. Aside from the intense pain, bleeding and infection risk it posed, they'd lose all control of their bladders, effectively disabling them from all tasks. Women who had this condition could often be found dying in huts outside of the village; ostracised by their families and communities. A horrible affliction, yes, with bleak outcomes for the ladies who'd suffer from it. But, with a mixture of humour, warming stories and the clear logic behind their charity's efforts to combat the issue, she left us that day feeling hopeful about the future. That was amazing.

There are many other examples of successful charity organisations that had planned ahead, looked at the evidence they had and tailored aid efforts to the direct needs of people. But unfortunately, there are way too many charity ventures which set out attempting to fix a wrong in the world but fail to do so when on the ground due to poor planning and consideration of local conditions and cultures... 

Sending out tampons for women in nations where a vast majoritydidn't have underwear to line them on (or else where women coulnd't afford such "luxuries") is an example of a poorly thought out aid effort. 
Giving out free condoms to African men to curb HIV infection rates is a great idea. Sending over white ones, which don't get used for aesthetic reasons (think about it) is not. 
Putting together funds to help fund orphanages also seems very noble. But when the number of orphanage spaces vastly outweighs the number of orphans in Cambodia, you get people abusing the system (in this case by making children pretend to be orphans so that more money flows in to people. 

Luckily the first two examples were fixed by the charities involved, but orphanages continue to be built that aren't just used by frauds, but also less effective, dollar-for-dollar and sometimes more damaging than financially supporting extended family members of orphans to encourage them to take them in.

Analysing What's Happening and Getting Data.

It becomes clear that it's imperative that we plan, and think carefully about our interventions on the ground. But before we do that, we have to ask ourselves... in regions where hardly anyone has access to fresh water, yet alone the internet, roads or post office facilities, how do we conduct surveys of what's needed? 

In the cases of small charities, getting that data on the ground while doing the work isn't difficult and poses little challenges. And being small organisations, they can adjust to any new data or insight of an area they're helping without majorly halting their operations in comparison to larger ones that have to deliver broad systems. Small charities also have the benefit of being able to work from WITHIN the communities, using their people, rather than providing relief and support from outside from outsiders. Integrating and interacting with the local people is not only a great way to find out how best to help them, it also increases the chances of charity efforts being successful. And many organisations who presented at the conference, including Traumaid International, Hero Condoms and Pollinate Energy did do this in different ways - and the next Global Health Conference post will be talking not only about the importance of doing this, but the HOW of it too (so make sure you've subscribed to the blog or that you've liked the Facebook Page so you don't miss it!).

But what about larger organisations? And what about governments (whether it be internal through social reform or external through aid)? How can we better their knowledge of the issues so that they can help their people out as best as possible?

Joel Selanikio

CEO and Co-Founder of Magpi (Datadyne)
Wall Street Journal 2009 Innovative Technology Award Winner
Lemelson MIT Award for Sustainability

Well - this (conveniently, also my TED talk of the week for this week) may hold the answer.

In this TED talk, Joel Selanikio (who unfortunately, did not talk at our GHC) explains the issues with collecting data in the third world. Currently, all the stats we have on diseases and on the infrastructure in place there are based on estimates. And these estimates are based on very hard to commission and audit censuses. 

In order to get data sets to work off, teams of researchers literally take tons of paper out into the villages, and go from village to village, asking each and every person their name, age, sex, disease status and so on. They physically have to record this data on cumbersome sheets of paper, somehow maintaining accuracy and ensuring they don't miss anyone in the process, and then drive them back, literally 4-wheel drive at a time where they get to the next stage. Then people have to manually enter this data into computers where they can be further analysed and then published in a census style format.

The task is behemoth in countries all over the world, but the strain is even more pronounced in developing nations with more than 100,000,000 people, many of whom live in remote areas.

Joel realised this needed to become more efficient; if possible, digitalised. But that it also had to stay cheap, so that governments and charities could actually use it. And it's when he was watching the first Die Hard movie that he realised the answer didn't lie in a "silver bullet" new technology, but in our past ones... because old technology can do the simple job of data entry perfectly fine. It doesn't require millions in development, it doesn't cost heaps to manufacture and it doesn't require huge knowledge to use either. The task of surveying poor communities has now become quicker and cheaper than ever before. 

I believe the most important thing he realised was that he had to make this wide-reaching in order for it to be effective. Sure, he could individually go out and train surveyers, 1 group, one country at a time, on how to use his device and gain the personal satisfaction of having helped so many people. But he decided to do it the most effective way and make the technology so simple, and the training so easy to convey that it could almost be self learnt. And the latter is exactly what he did. And now his old school device is spreading fast throughout nations and charities and will hopefully change the way in which data is collected.  

UNICEF'S SMS Solution:

Another new, exciting approach to making this data collection very easy, and most importantly, live is just around the corner. Very recently launched is this: UNICEF's RapidPro system. 

Where data used to be collected in censuses, which, as I explained before, would be so time and resource consuming (not to mention inefficient) and yet so inaccurate due to the haphazard surveying method, using SMS's to collect data is promising to make it even faster.

It may surprise you to know that most people in the developing world, even those living in extreme poverty, have a cell phone. Unlike ever before, they can interact with the world around them! Essentially, RapidPro allows you to create your own, simple surveys; asking any questions and collects and reads the data for you (and allows you to read individual responses too as required) in REAL TIME. So you don't have to wait 10 years for a census (plus however long it takes to actually conduct the survey), and you don't have to rely on outdated, inaccurate data to start understanding issues on the ground.

It's simple. It's effective. It's live. And it can be integrated into large databases. And it will probably revolutionise how we go about collecting data and send our aid and charity to a whole new level of effectiveness. And the best thing is - it's free for any one person or organisation to use for whatever they need it for. From finding out whether a remote community has access to healthcare, to seeing women have to travel for water, to helping people in immediate need in disaster zones... the possibilities and potential uses for this is innumerable.

All of this means that we can help more people. Find our more about this here:

3) Evaluating Our Efforts As We Go:

Rowan Gilles stressed the importance of 1 aspect above all when it comes to making sound plans to tackle global issues; and that's that we always evaluate the impact we're making as we go, and try and improve our processes as we do so. 

He stressed, that even though it may be a hard choice to do so at times, that we'd always be better off cutting off a program that didn't help too many people short and starting again on a whole new, better thought one. 

Now the methods of conducting surveys that I showed above are viable for not only finding out what's there and what's not, but also for this evaluation process. And hopefully they will revolutionise this field as well. 

But without fail, all of the organisations that ran workshops at our events maintained a connection to the people even after they'delivered their services. And whenever they saw something wasn't working well, they made a change and grew from it, rather than persisting with ineffective programs. It's why they are all so successful.

The Hamlin Fistula Institute (talked about above) realised after a while that flying over and performing surgeries for a month or two a year wasn't enough. And so they changed their model to a "teach the teacher" one, so that as many people as possible could be helped.

That was a systemic change, realised over time with lots of data, and it's a great one that's changed thousands of lives. Talking to the people you helped is often just as effective in achieving that. 

Hero Condoms, a cool social enterprise which gives a free condom to someone in Africa for every condom sold here in the Australia, did the same thing and they found out so much from simply talking to people on the ground who were getting their condoms. Not only did they realise that the whole concept of a "free condom" sometimes turned people away from using them; it implied that the condoms were from a "reject" pile, so they were either broken or given in pity, they also realised many small things which made a huge impact on condom usage in Botswana, a country where HIV/AIDS affects 1/4 people! Some of these small things that could be fixed easily included making sure condoms were clear, instead of white (as you can imagine... a white condom wouldn't look... natural... on an African male) and making sure the packets were easy to handle, and giving them options, and flavours. And after making those small changes, and incorporating a local researcher in their planning and scientific process, they've increased condom usage in certain regions significantly!

Similarly, Health Habitats, a foundation which believes improving a person's living environment will improve their overall health, also found gaps in their facilities' usage by keeping in contact and surveying how their input had made a difference. They were building toilets for villages in Nepal, and including a system which allowed them to use the biogass derived from wastes for cooking. Not only would this be a huge step in sanitation, it also made cooking easier, homes safer (less fuel burned inside homes means less chances of dangerous toxin inhalation and less chances of fires too) and freed up income that would otherwise be spent on fuel. But people weren't using it, they found in their surveys later on, and by asking further, they realised it wasn't the idea that the technology is dirty that stopped most people from using it, but rather fear of it flaring up; a legitimate one, considering no-one had been taught how to use it. Once they did teach them, the usage of it went up and their future projects will now always include that too - and they'll be better off for it. 

These amazing charities will all be discussed in future posts on Global Health. The importance of delivering culturally appropriate care will be next, and the amazing new concept of social enterprises the one after that - again - make sure you've subscribed to the blog or on Facebook so that you know when it comes out!

How Can YOU Help?

These solutions all seem so distant, so far, so systemic. And it may seem like you can't make a difference. But all of these ideas have one feature in common: They're trying to get the most bang for your buck. They're all trying to maximise effectiveness.

And as many of you regular readers know, I believe effectiveness is paramount to how much of an impact we can make in other peoples' lives. If every life is equal, then we should try to save as many people as possible by saving the lives which can be saved easiest. It turns out - they're the ones who need it the most. 

And how can you do that? By choosing to make your impact as large as possible by choosing to give to more effective organisations. 

Brenton Mayer and Daneil Charles

Fellow medical students.
Former Giving What We Can Interns
Pretty cool guys

These 2 gentlemen gave an awesome presentation convincing people not only why they should give but how to do so as well. And their talk was centred around the idea of Effective Altruism, indeed, it was very similar to this TED TALK, given by Peter Singer.

Their talk was based on the topic of effective altruism -  the idea that when we give to charities and causes (and we definitely should), we should give to the ones that make the biggest impact; the ones that save the most lives.

The idea is based on the concept that every life has equal value. If we assume that's correct (which most of you reading this will agree with) then it makes perfect, logical sense that we give mostly to charities which combat easily preventable diseases that many in the third world face; as when it comes to saving lives, dollar for dollar, they're the most effective ones.

It's hard to research all the charities in the world and evaluate which ones are the most effective. But luckily, there's an organisation which does that all for you; Giving What We Can.

That organisation also purports that we give up a certain proportion of our income towards these effective charities. As future doctors who stand to earn so much money over our careers, they showed us that we could give a good chunk of our income (up to a third) to charity and still remain in the top 10% of Australia when it comes to wealth. And he told us why too.

Most doctors come into the profession wanting to help people and save lives. But when you think about it, for every one of us who made it into the course, there are 10 waiting to get in. And they too are the "cream of the crop" when it comes to brainpower. If they were to take your place, they'd be just as good as you when it comes to medicine. If you think about it, doctors practice according to protocols, making judgements as to which is the best one for each person, and they always work in teams. Only very exceptional doctors regularly catch diagnoses and treat people on a regular basis. So though we may believe we're doing our bit already, in truth, we'd probably only save one or two extra lives a year that someone else who would've taken our role could have done (and that's if we're REALLY GOOD).

Compare that to giving $50,000, a tiny portion of our average income (that wouldn't, by any means, bleed us dry) to a very effective organisation such as the Against Malaria Foundation - you'd be able to purchase 2,000 mosquito nets and save hundreds of lives a year, not to mention allow thousands who'd otherwise have been unable to work and provide for the families the opportunity to keep doing so.

It's a great idea and you should definitely get onto it!

My suggestion to them:   

I loved their presentation - every part of it! I'd already heard of this concept myself and I believe in it 100% as well. But I asked them this question, based on an essay which I posted on this blog earlier. We had a great discussion afterwards on this topic and these chats were the best thing about GHC2014! 

 "Effectiveness is great and we should try and make our dollars go furthest when we give to charity, I agree. But the second part of it - altruism - I don't necessarily agree is the only way to go about helping the poor. Charity, aid, giving etc. all comes with a connotation of sacrifice. And the fact that the GFC in 2007 resulted in our worldwide giving (both government and private) dropping from $1.2trillion to $0.7billion, not to mention our tiny proportions given as nations as a percentage of GNI is evidence enough that people and governments routinely deem that sacrifice too much.
Not everyone, not every profession can afford to give as much as you guys suggest to charity. Especially us, as non/meagerly earning medical students."

The problem, I believe, lies in the fact that when we urge others to give to charity, we only target their compassion... we effectively guilt trip them into giving.
Why not also convince them by showing people how we can give without that sacrifice? Why not show them how we can benefit from giving aid?
And there are so many ways we can do that already. So many ways we can help out before we start earning our ridiculous incomes as doctors.
Eg - for us students, microfinance organisations like allow you not only to give out loans to the poorest, which they pay back to the NGO on the ground once they're on their feet, but also give you the option to withdraw money if you need the money on a rainy day. It's a great motivator - to get you saving - that allows you to improve lives. I chuck in $25 a week into a kiva loan and now have reached a point where $50 gets repaid to me every fortnight or so - which I reloan over and over growing my impact further and further.
Buying Red products when you're shopping (things like Coca cola - or Starbucks/Apple products which are red in colour) doesn't cost you anything, but 10-50% of profits from their sales goes directly to the global fund - a highly effective charity fighting and researching HIV/AIDS.
Govts/Corporations also benefit form giving to charity. When we develop countries up, their demand for our services/technology/resources increases too. China's huge demand for our ore is a major reason why we stayed afloat during the GFC. India's buying our uranium now because they need more energy (as Jose Ramos-Horta pointed out) and Indonesia wants to buy more and more of our beef... it's gotten to a point where we're now exporting so much that the media is reporting on how they're treated!
Similarly, corporations like Microsoft/Samsung/Cisco stand to benefit heaps by directly investing into third world development not only because they get more people into those middle classes, buying their products and services, but because they get great positive brand image (80something percent of people agree they'd buy products of similar quality/price from a company that gave more to charity) and also a more motivated productive workforce.
You could say these are indirect benefits, that are theory in a way, but that doesn't meant they don't exist. Indeed, they should be studied more I argue. But imagine if businesses/govts could put the effects of charity in the "credit" column rather than the "debit" one... Especially if we could pin a number on it per dollar invested. We'd certainly see more of it happening that's for sure. There are heaps of direct benefits too for governments and businesses alike. Businesses, as I mentioned above, get a more motivated, productive workforce and improved brand image/free press/more customers more likely to be loyal for their good deads which leads to increased sales while governments of countries often use the aid as a mechanism to boost their own nations' economic activity; not to mention a more skilled, diverse workforce.
I've already written this up, with heaps of evidence to back up what I'm saying as well, over here: - so make sure you check it out.

Social Enterprises - A Preview of Part 3:

I saw many other amazing talks and gained many more insights at this Global Health Conference on this topic - other ways that we can help out without that sacrifice. Social enterprises are a twist on traditional charities - in that they make profits and sell products in order to keep themselves helping the people they wanna help. Some of those, I've mentioned in the post above, such as Hero-Condoms - an organisation which sells quality condoms, at competative prices but who donate everything to deliver contraception to HIV/AIDS stricken Bosnia. Similar enterprises, such as ThankYou Water (you buy a bottle of water and all the profits go to giving water to those in the third world) - and they allow US as regular people to help others in need going about our Day-To-Day Business!

I'll talk about these, and about why we need to always deliver aid and charity with proper consultation and consideration of the people we're delivering to, and cultural perceptions that leave people even more vulnerable to diseases in the third world in later posts so watch out for them!

Peter Singer - Humanist, who gave an amazing talk on Effective Altruism!


  1. Hello am Susan from Texas, I want to tell the world how I got cured from herpes simplex virus using the Dr Ekpiku herbal medicine. Naturally, I didn't believe that herpes is curable Until I came in contact with this man, he proved to me that herpes is curable and after using His herbal drug, i became cured!! This is indeed a surprise to me and I am happy for the wonderful work. For contact, here is His email: or text/call me (270) 693-5854 for more infor. Thanks and God bless you all.

    1. Quick Cure I will advice you to contact Dr Chukwu madu herbal home [ ) where all problems are solve without stress and delay. My family was getting drawn in sickness, we were all affected one after the other and medical prescription was not helping us. Till a friends doctor direct us to contact Dr.Chukwu madu for quick cure and total cleaning. Dr .Chukwu madu is a miracle worker. It is never too late with Dr CHUKWU MADU HERABL HOME contact him today with { } you can also contact him on Whatsapp +2347030936239, 
      He also Cure
      1) HIV/AIDs Virus
      2) Hepatitis B and C
      3) Herpes
      4) Cancer
      5) ZIKA VIRUS
      6) COPD
      7) STROKE.
      8) Erectile Dysfunction
      9) Trichomoniasis
      10) Chlaydia
      11) Gonorrhea
      12) HPV
      13) Syphilis  
      14) Corona Virus

  2. I can’t believe this. A great testimony that i must share to all HERPES SIMPLEX VIRUS patient in the world i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites of how dr Ero prepare herbal medicine that cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the pills the doctor gave to me. Right now i can tell you that few months now i have not had any pain,delay in treatment leads to death. Here is his email:( whatsapp him with +2348073673757 .

  3. Its a miracle that I am alive today. I encounter HERPES SIMPLEX VIRUS (HSV1/2) for good four (4) years, six (6) months and twelve (12) day with my calculations, before I meet the great Dr. Sambo. I am DEBORAH BALOGH from Fresno California, united state of America and I was affected with herpes virus. Herpes is a viral infection cause by the Herpes simplex virus, marked by painful, watery blister in the skin or mucous membrane or on the genitals. This was what I suffered for good four years. I have visited CVS Pharmacy in Fresno for treatment but no improvement. I meet Dr. Sambo online while I was searching for herpes cure I read a testimony about his work. I give a try that now becomes a testimony in my life. I contacted Dr. Sambo via his E-mail and he did not responds to me in time and I went back to the same testimony for his mobile number and I called him immediately +1(267)527-9481 and he respond to my call. He welcome me as a daughter and I explain my four years situation to him and he said is done just as I have contacted him and I believed in him. Dr. Sambo sends me some herbal medication for herpes cure and he gave me instruction on what to do and I obeyed his instruction. Changes started after three days of applying the herbal medication. I went to the same CVS Pharmacy in Fresno for test and i was herpes negative. I do not know how to thanks Dr. Sambo for saving my life. To God be the Glory, I am living healthy with my family today.Indeed, Dr. Sambo is a great man Dr. SamboWhatsApp him now +1(267)527-9481 God bless Dr. Sambo for his good work...

  4. Hello everyone I want to appreciate the great work of Dr. Ehoh , I have been diagnose of herpes simplex virus for years,I’ve lost all hope and that there is no cure and I have been taken medicine to sustain myself till I got to know about Dr. Eboh through a friend who he cured of Hiv. I contacted him and he sent me his herbal remedy which I took as he directed me to do for some days and I went to the hospital after consuming his Herbal medicine and I was confirmed Herpes Negative after years of pains and suffering , it is indeed a miracle, his web site: is a great man, I have heard so much about how he hashelp lot of people, if you have any issue you can contact him for help.via: or add him on whatsapp can contact me for more information via:

  5. Quick Cure I will advice you to contact Dr Chukwu madu herbal home [ ) where all problems are solve without stress and delay. My family was getting drawn in sickness, we were all affected one after the other and medical prescription was not helping us. Till a friends doctor direct us to contact Dr.Chukwu madu for quick cure and total cleaning. Dr .Chukwu madu is a miracle worker. It is never too late with Dr CHUKWU MADU HERABL HOME contact him today with { } you can also contact him on Whatsapp +2347030936239, 
    He also Cure
    1) HIV/AIDs Virus
    2) Hepatitis B and C
    3) Herpes
    4) Cancer
    6) COPD
    7) STROKE.
    8) Erectile Dysfunction
    9) Trichomoniasis
    10) Chlaydia
    11) Gonorrhea
    12) HPV
    13) Syphilis  
    14) Corona Virus


It's your turn!
What are your thoughts? Any similar experiences? Want to talk about something?