The Good of Small Things

A few nights ago, I went out for a curry with a doctor friend who’s just returned from a year working in Africa.  She was telling me all about the experience and about its difficulties.  Some of these difficulties are straightforwardly down to poverty; others are down to mismanagement or – if not exactly mismanagement – the absence of proper management.

Take, for example, the time my friend arrived for work in the morning to discover that one of her patients had died during the night.  The patient was in his mid-teens and asthmatic; it was an asthma attack that killed him.  It turned out that nothing could have been done to help him, because there were no inhalers kept on the ward; had there been, his life could probably have been saved.  There were no inhalers on the ward because there was nowhere to keep them; and the dispensary was closed at night and over the weekends.  If you unpack this state of affairs, it’s hard to avoid reaching the conclusion that the life was lost not for want of drugs or money, but for want of a lockable cupboard on the ward.  So my friend and her husband provided one.

Why do I mention this here?  Well, I’ve blogged before about the public health importance of providing latrines, and I think that this story is consonant with it: the lesson seems to be is that it’s all very well to bemoan the lack of medical infrastructure in the South, but it’s also often the case that a great deal of good could be done by forgetting the big picture and looking at the details.  This can be difficult, of course; and charities know that, if they want to raise money, they have to convince donors that they’re doing big, sexy stuff.  If you talk about eradicating polio, people will give money.  If you talk about building cupboards, or providing trolleys, or providing any number of apparently trivial things… well, they’ll probably go to the charity next door, which is talking about eradicating polio.  And there’s nothing really blameable about this: it’s just that we want to think that our donations are doing good, and a cupboard simply isn’t a visibly optimific sort of thing.

Still, it’s a nice illustration of the point that making a potentially big change in the world doesn’t necessarily mean doing a great deal; and the marginal extra return on big gestures may not always be proportionate to the size of that gesture.

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