good morning Hank it's Tuesday so later
this month we'll be making a big
announcement about working with partners
in health Sierra Leone but before that I
thought it might be helpful to consider
why Sierra Leone is so poor now poverty
is complex and we are not going to get
to the bottom of it in a YouTube video
but I do think this can be some helpful
context
okay so Sierra Leone located here is a
nation of around seven and a half
million people it's ethnically and
religiously diverse most Sierra Leoneans
are descendants of people who've long
lived in West Africa but many former
slaves in the British Empire were
resettled here and so there are Sierra
Leoneans who trace their descent to
Canada or to England to Nigeria and many
other places and while I was in Sierra
Leone earlier this year someone told me
that to understand its impoverishment I
should look at a map showing all the
railroad tracks that were built in
Sierra Leone while it was a British
colony as you can see the train tracks
didn't really connect cities to each
other they connected the mineral-rich
areas of Sierra Leone to the coast of
Sierra Leone so those minerals could be
exported and this is a very important
thing to understand about colonization
it was in the business of resource
extraction and so the systems that were
built in colonies were resource
extraction systems there was not much
colonial investment in say health
systems or education systems and since
Sierra Leone achieved independence in
1961 it has struggled to transition away
from resource extraction and to build
the kinds of systems infrastructure
health care even mail delivery that
would lead to a more balanced economy
and a healthier population now it's easy
to blame these failures on a single
cause like say corruption but while
corruption is a serious problem in poor
countries around the world the bigger
problem by far is that it's very hard to
build health and education and
infrastructure systems in communities
that have been built around resource
extraction that's true all over the
world but also a community just cannot
spend what it does not have like if
Sierra Leone spent the same percentage
of its economy on health care and
education as say the United Kingdom does
Sierra Leone would have about forty five
dollars per person per year to spend on
health care and a similar amount per
child per year to spend on education
that's just obviously inadequate like in
the u.s. we spend over ten
thousand dollars per person per year on
health care and over 12,000 dollars per
child per year on education okay so all
these challenges were compounded in
Sierra Leone by a long and extremely
violent civil war which lasted from 1991
to 2002 tens of thousands of people died
millions were displaced the health care
system was devastated HIV infections
increased deaths from every cause
increased and education and professional
development were interrupted as schools
closed or students had to flee violence
like dr. Beeler berry who founded the
widely respected well body clinic in
Sierra Leone had to leave his studies
for a time to escape to a refugee camp
and I heard similar stories from several
health care workers because the civil
war was on all sides partly funded by
trade in diamonds and other valuable
minerals the war was especially
devastating to Sierra Leone's diamond
mining district kono and as we traveled
through kono I kept thinking about that
old Faulkner line about how the past is
never dead it's not even past in the end
the government paid for a mercenary army
and weaponry in part by selling the
rights to the country's largest diamond
concession and so today almost none of
the wealth generated by Kono's diamond
mines ends up in kono and this has led
to a paradox that is common in poor
countries while kono is one of the
richest parts of West Africa by some
measures in terms of poverty rates
malnutrition disease burden and child
and maternal mortality it is one of the
poorest and least healthy places in the
world because while diamond mining
produces a lot of money there aren't
actually that many jobs for Sierra
Leoneans in the mines meanwhile all
around the mine just outside the fence
you will see many people working at
breaking stone to eventually be sold as
gravel this is how you end up with a
country where a hundred million dollars
in diamonds gets exported annually and
six percent of all women die in
childbirth and this poverty can become a
vicious cycle I think the Ebola outbreak
really epitomizes how impoverished and
fragile health care systems can lead to
emergencies when a bola first appeared
in Sierra Leone in 2014 the entire
country had about 150 doctors for
context my home state of Indiana has a
similar population and over
sixteen thousand doctors lack of running
water made sterilization difficult there
weren't enough gloves or surgical masks
and this systemic weakness is the reason
that Ebola could ravage a country like
Sierra Leone but not say the United
States or Spain
we met in a bulwa survivor who now works
for Partners in Health and who shared a
bed with his son at Ana bola treatment
facility both he and his son survived
but his wife died just a few beds over
so about one in three days how he killed
fall so I told them no my son not groups
I'm going to share the same bed with my
son so nice comfort I have no problem so
was the online struggling for 90s
you brought my wife Corso she died
that's what when I asked dr. berry his
memory of treating patients there he
told me waning and seeing my patients
the Ebola crisis was caused by a fragile
health care system and it led to a more
fragile health care system and that
vicious cycle is often the story of
poverty so I understand that these
problems can feel far away and like they
aren't our problems but first you can't
separate the wealth of nations like the
United States and the United Kingdom
from the poverty of Sierra Leone you
just can't we industrialized with their
natural resources and we built lucrative
systems of trade by trading in West
African slaves but also secondly if
these problems aren't our problems I'm
troubled by how we're defining us like I
don't want to be part of an us that
makes of them of the world's most
vulnerable people and I think the idea
that Sierra Leone can somehow solve its
own problems in isolation wrongly
imagines that its problems exist in
isolation now of course one of the risks
of philanthropic work is that it's
possible to make things worse or to
create new problems while trying to
solve old ones and I think it's
important to be aware of those risks and
to try to minimize them by grounding
your work in listening and deep
partnership but I just think it's
inaccurate to say that nothing can be
done or that investment is pointless I
have seen the difference that Partners
in Health and the Sierra Leonean
Ministry of Health have made in the kono
district even with extremely limited
resources I mean five years ago the
hospital in kono had no electricity and
very few supplies and as a result almost
no patients today it is well staffed and
well supplied and widely utilized
there's a blood bank and a functioning
operating room for c-sections and other
procedures now it's still totally
inadequate there are only 40 maternal
beds for a population of 550,000 people
but the progress is real
and I believe that progress will
continue if the Ministry of Health in
partnership with organizations like PIH
is able to make the kinds of long-term
investments that address long-term
problems so why is Sierra Leone poor
because it's systems have for centuries
been structured around resource
extraction because of war because of
disease burden and because of
colonialism and its legacies but I am
hopeful not because I think these
problems are easy to solve but
because I have seen the extraordinary
commitment of Sierra Leonean health care
workers to their patients and because
those patients have helped me to
understand that despair is not the right
response to big problems even
existential problems there is nothing
natural or inevitable about Sierra
Leone's poverty and so I don't think
it's permanent we have much evidence
from around the world that over time
systems can get stronger more moms can
survive childbirth and more children can
survive childhood educational
opportunities can improve and
infrastructure can begin to connect
people to each other and not just
minerals to ports Hank I'll see you on
Friday