Vanity Fair
Next months issue of Vanity Fair has a whole issue devoted to Africa as part of the (RED) campaign.
A percentage of the cover price goes to helping wipe out poverty, but if you don't support the (RED) idea, and would rather buy Metro/Playboy/Your regular monthly magazine on principle instead, so more 5 year olds will continue to die unnecessarily of malaria, that's fine.
But if you go to the website you can see many of the articles in the issue, plus videos.The issue is guest edited by U2's Bono. If you don't want to go the the website, Ive pasted some of the articles in comments, including Bono's editorial and an interview with Madonna.
2 comments:
Guest Editor's Letter
Photograph by Annie Leibovitz.
Message 2U
by Bono July 2007
Let me explain what I'm doing here, and there.
By "there," I don't mean my day job as singer with Irish postpunk combo U2.
By "there," I mean data—the organization which campaigns on debt, aids, and trade in Africa.
By "there," I mean the One Campaign—which is becoming like the National Rifle Association in its firepower, but acts in the interests of the world's poor.
By "there," I mean (Product) Red—which piggybacks the excitement and energy of the commercial world to buy lifesaving aids drugs for Africans who cannot afford them.
And by "there," I mean Edun—the missus's clothing line that wants to inject some dignity through doing business with the continent where every street corner boasts an entrepreneur.
These all relate to the same place and the same idea: that Africa is the proving ground for whether or not we really believe in equality.
For example, we are witnessing a general desire and drift toward action on climate change, a very positive thing. But imagine for a moment that 10 million children were going to lose their lives next year due to the earth's overheating. A state of emergency would be declared, and you would be reading about little else. Well, next year, more than 10 million children's lives will be lost unnecessarily to extreme poverty, and you'll hear very little about it. Nearly half will be on the continent of Africa, where H.I.V./ aids is killing teachers faster than you can train them and where you can witness entire villages in which the children are the parents. All over the world, countless children will die as a result of mosquito bites, dirty water, and diarrhea. It's not a natural catastrophe—it's a completely avoidable one. Diarrhea may be inconvenient in our house, but it's not a death sentence.
This is happening at a time of great geopolitical unrest. The majority of people in the world no longer idolize Western ideals of justice, freedom, and equality. They don't believe we believe in them. As a student and fan of this great country, America, and the ideas at the heart of it, I think the wider world needs to see a demonstration of those "American" values, through pharmacology, agro-ecology, and technological help for those in extreme circumstances, in their hour of need. These are dangerous times—it's cheaper and smarter to make friends of potential enemies than to defend yourself against them later. Ask the four-star general James L. Jones, former nato commander and one link in the American chain of command who back in 2002 foresaw difficulties ahead in Iraq.
That's the context for what you could call a "swarm-of-bees strategy": ganging up on these problems from every side.
data is an advocacy and policy operation based in Washington, D.C., London, and Berlin and targeting the G-8 capitals.
The One Campaign to Make Poverty History is an umbrella group of different NGOs and grassroots activists from across the political spectrum who believe these issues are about justice, not charity. Nearly three million Americans so far have signed up for the One Campaign, pledging to help the world's poor. Soccer stars, soccer moms, NGOs and C.E.O.'s, punk-rockers and churchgoers … the only places that haven't been active are Main Street, the shopping malls.
So Bobby Shriver—chairman of data and a hero on the issue of debt cancellation, who sold an arcane economic issue to congressional members on both sides of the aisle—and I started (Product) Red, so called because red is the color of emergencies, and that is the only way to describe the aids pandemic. We believed that to ignore the neon and creative force afforded by corporate America would be to ignore the truth about where most Americans live and work. A few years ago I was with the great Robert Rubin, former U.S. Treasury secretary under President Clinton. He said if we are serious about our stuff we will have to improve on two fronts: (1) communicating to America the scale of the problem, and (2) convincing America that the problem can be solved. He added the challenge that we would need the kinds of marketing budgets Nike and Gap have at their disposal.
He was right. Without our corporate partners—American Express, Apple, Emporio Armani, Converse, Gap, and Motorola—we could never afford such bright neon, or the acres of bold billboarding. These companies are heroic (and—shock, horror—we want them to make money for their shareholders because that will make (Red) sustainable). In the project's first nine months, $25 million has gone directly from (Red) partners to the Global Fund, which grants money to health-care organizations around the world to fight aids, tuberculosis, and malaria. That is more than Australia, Switzerland, and China contributed last year.
As you read this—historic—issue of Vanity Fair, the Global Fund is benefiting, but that's not the main reason we kidnapped this publication's extraordinary photographers and storytellers. We needed help in describing the continent of Africa as an opportunity, as an adventure, not a burden. Our habit—and we have to kick it—is to reduce this mesmerizing, entrepreneurial, dynamic continent of 53 diverse countries to a hopeless deathbed of war, disease, and corruption. Binyavanga Wainaina's piece on Kenya is an eye- and mind-opener. From here, what's needed is a leg up, not a handout. Targeted debt cancellation and aid mean 20 million more African kids are in school, 1.3 million Africans are on lifesaving drugs. Amazing.
So now I hope you better understand the "here," i.e., my signing up as guest editor.
Lastly, I've always imagined that if I hadn't been a singer I would have been a journalist. But, in truth, my bandmates saved me from disappointment, as I'm no natural editor. The fact that we have 20 covers for one issue bears testament to that. I am flat out of hyperbole to describe Annie Leibovitz—a devoted mother who set out on a world tour to photograph these cover stars—and inchoate in the company of such a team of wordsmiths and image-makers. And then there's Graydon, a true rock star. (Checklist: mad hair, natty dresser, de rigueur unrepentant smoking, etc. I looked like his manager.) He is the dramatist that we've been looking for. By the way, he tried to change the name of our band to 2U—it was his last defense against my challenge to call this issue Fair Vanity.
Telling African Stories
Danny Glover's new production company, Louverture Films, is allowing him to work on the material that is closest to his heart.
by Austin Merrill VF.COM June 12, 2007
Danny Glover stood in front of the crowd at Philadelphia's Ritz East Theater and dug into a bag of popcorn. "When I was 20 years old, which is now 40 years ago, I read Julius Nyerere's writing on African socialism," he said to the audience, which was there for a screening of Bamako, the debut feature from Glover's fast-growing production company, Louverture Films. "Nyerere was the first president of Tanzania. I majored in economics, and I was so moved by his writing and his vision of Africa as self-sufficient and independent that I wanted to go to Tanzania and work for his government."
Joslyn Barnes and Danny Glover, partners in Louverture Films. Photograph by Mark Seliger.
"Well," he said with a casual laugh, "that didn't happen."
Glover never moved to Tanzania, but his interest in Africa has only deepened over the last four decades. He still acts in big-budget pictures—recently, in Shooter and Dreamgirls; next year, in Michel Gondry's Be Kind Rewind—but Louverture, which specializes in cinema from the developing world, allows him to work on the material that is closest to his heart. Bamako, by the Mauritania-born director Abderrahmane Sissako, is a lyrical and seething condemnation of the World Bank's policies in Africa.
"From my time as a student and throughout my adult life I've had some engagement with Africa," he told the crowd at the Ritz, "whether it was the liberation movements in the early 1970s to end Portuguese colonialism in Mozambique and Guinea-Bissau and Angola, or as a goodwill ambassador at U.N.D.P. [the United Nations Development Program], or through my theatrical work." But it wasn't until 2005, when he joined forces with screenwriter Joslyn Barnes to create Louverture, that Glover's film work about Africa really began to gain momentum.
Barnes, who had worked at the United Nations for several years in addition to writing screenplays, met Glover in Senegal during the making of Bàttu, a film that Barnes had written for the Malian director Cheick Oumar Sissoko, and in which Glover had a cameo role. "Danny told me his long history of trying to get a film made about the Haitian revolution and the revolution's leader, Toussaint Louverture," Barnes said. "This was a story that I had always been interested in, but the whole epic sweep just seemed so impossible to tell unless you could get a big studio behind it, which would be very unlikely."
Glover asked Barnes to write a treatment for a Toussaint biopic, and they began to work together. Along the way, they found they had mutual friends in Africa and in the film and activist communities. "We'd both spent a lot of time on the continent," Barnes said. "And we decided to create a company to make the kinds of films that we felt weren't in the marketplace, and to support the filmmakers we knew in Africa. Then it broadened to other parts of the global south." With Bamako finishing its theater run and Africa Unite, a Bob Marley documentary, coming out soon, Louverture is now gearing up to make Toussaint and Touti in Harlem, a comedy by the Ghanaian director John Akomfrah. The company also has projects underway in the Middle East, South Asia, Latin America, and the United States.
As Hollywood shines an ever growing spotlight on Africa, few stars can match Glover's résumé of involvement with the continent. After graduating from San Francisco State University, in 1972, where he studied African politics and fell in love with the music of Miriam Makeba, Glover got a job with San Francisco's Office of Community Development. For the next six years he was immersed in the city's delicate and emotionally charged world of housing, politics, and race. ("'Gentrification' is a current word," he told me. "'Redevelopment' was the byword then.") He looked to the African-independence movement for inspiration and read widely from the writings of Leopold Senghor and Kwame Nkrumah, the first presidents, respectively, of Senegal and Ghana. Some of Glover's earliest stage acting was in plays by Athol Fugard, the South African playwright known for his socially and politically engaged work. Later, he would befriend Ousmane Sembène, the Senegalese director who is considered the father of African cinema. (Sembène died on June 9, at age 84.)
After Glover left his community-development job and gained fame and financial stability as an actor, he began to look for ways to support African filmmaking. He took roles in movies about Africa, helped create the Pan African Film Festival in Los Angeles, in the early 1990s, and became a regular attendee and judge at fespaco, Africa's most important film festival, which takes place every two years in Ouagadougou, the capital of Burkina Faso.
Glover is glad that Africa has gotten so much recent attention from celebrities, but he's wary too. "I think we have to be very careful with how we frame this around the work we do as artists," he said. "People come at it with the best intentions. They want to do good. But it's easy to jump in and talk about this stuff without understanding the plethora of misinformation that's out there about Africa. What we can do best as artists is to enhance the discussion around all this, to create something that allows us to home in on all the questions surrounding a complex situation."
Toussaint is "an epic story, comparable in scope to Gandhi and Lawrence of Arabia and Braveheart," said Glover, who plans to direct the film himself, something he's never done for the big screen. "This project has become my dream. I've lived with it a long time. It's almost like a child discovering a secret hiding place—but why doesn't anyone know about this secret place? Why can't I bring anyone to it? Anybody who read the story would find it provocative."
For now, though, it is Bamako that has put Louverture Films on the map, winning praise from critics and sparking debate across the country. In Europe, aid groups have used the film to try to pressure the World Bank into adopting policies of greater transparency, looser loan restrictions, and genuine debt relief. Glover's whistle-stop U.S. promotional tour included theaters in Minneapolis, Boston, Washington, and New York. His post-screening panel discussions have given him a chance to challenge people's perceptions of humanitarian assistance and find ways to link Bamako's story to problems in America.
"The question in my mind, whether it's in Africa, in Latin America, or in the Lower Ninth in New Orleans, is what do you mean by development? What are the options?" said Glover to the audience in Philadelphia. "Show this film to the men, women, and children who have been displaced by Katrina, and they'd get it. They'd understand the parallels and connections between this story and the story of their own lives.… Some people say that's over there, and I'm over here. Well, we're all the same thing, I'm telling you. Go down to New Orleans, you'll see right there. New Orleans is global south meets global north."
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Jeffrey Sachs's $200 Billion Dream
Jeffrey Sachs—visionary economist, savior of Bolivia, Poland, and other struggling nations, adviser to the U.N. and movie stars—won't settle for less than the global eradication of extreme poverty. And he hasn't got a second to waste.
by Nina Munk July 2007
In the respected opinion of Jeffrey David Sachs—distinguished Quetelet Professor of Sustainable Development at Columbia University, director of the Earth Institute, and special adviser to the secretary-general of the United Nations—the problem of extreme poverty can be solved. In fact, the problem can be solved "easily." "We have enough on the planet to make sure, easily, that people aren't dying of their poverty. That's the basic truth," he tells me firmly, without a doubt.
It's November 2006, and Sachs has just addressed the General Assembly of the United Nations. His message is straightforward: "Millions of people die every year for the stupid reason they are too poor to stay alive.… That is a plight we can end." Afterward, as the two of us have lunch in the crowded U.N. cafeteria, overlooking New York's East River, he continues: "The basic truth is that for less than a percent of the income of the rich world nobody has to die of poverty on the planet. That's really a powerful truth."
Sachs, 52, is devoting his life to this all-powerful truth. As one exhausted member of his staff explained to me, "It feels like we're running a campaign—all the time."
Day after day, without pausing for air, it seems, Sachs makes one speech after another (as many as three in one day). At the same time, he meets heads of state, holds press conferences, attends symposiums, lobbies government officials and legislators, participates in panel discussions, gives interviews, writes opinion pieces for newspapers and magazines, and connects with anyone, absolutely anyone, who might help him spread the word.
One week in early December, Sachs scheduled three overnight flights in five days. First, after a full day of teaching at Columbia, he flew from New York to Rio de Janeiro, São Paulo, and Brasília for two days of meetings with President Luiz Inacio Lula da Silva's Cabinet. From there he headed to Washington to attend the White House Summit on Malaria, hosted by President and Mrs. Bush. Afterward he left for San Francisco, where he made a presentation to the founders of Google. That same day, a Friday, he flew home to New York. Over the weekend he attended a dinner with Ban Ki-moon, the incoming secretary-general of the United Nations. As far as I can tell, the only time Sachs slows down is when he sleeps, never more than four or five hours a night. His wife, Sonia Ehrlich, a pediatrician and the mother of his three children, has been quoted saying (more than once), "I'm a happily married single parent."
According to Sachs, his job is to be "a pest." Bono, who wrote the foreword to Sachs's best-selling book, The End of Poverty, makes the same point, more or less poetically: "He's an irritant," Bono told me, paying Sachs a compliment. "He's the squeaky wheel that roars."
Mark Malloch Brown, who was deputy secretary-general of the United Nations under Kofi Annan, described Sachs to me as "this magnificent battering ram." In unadorned English he added, not without respect, "He's a bully. For the record, he's a bully."
Never mind. To Sachs, the end of poverty justifies the means. By hook or by crook, relentlessly, he has done more than anyone else to move the issue of global poverty into the mainstream—to force the developed world to consider his utopian thesis: with enough focus, enough determination, and, especially, enough money, extreme poverty can finally be eradicated.
Once, when I asked what kept him going at this frenzied pace, he snapped back, "If you haven't noticed, people are dying. It's an emergency."
I had noticed. It's a Sunday in mid-January, and I'm in sub-Saharan Africa. A few of us have trekked to Ruhiira, an isolated village in the highlands of southwestern Uganda. Having passed the equator some time ago, we're now, according to my map, 20 miles or so from the borders of Rwanda and Tanzania.
There's not much of anything in Ruhiira. No electricity or running water. No roads to speak of. We're in a place of lack, of deprivation, of absence. This is the dead land. The soil, once rich and fertile, is utterly depleted from years of abuse. The surrounding hills have been plundered, stripped bare of trees. With no firewood at hand, villagers are forced to dig up banana rootstalks to use as cooking fuel. Matoke, a green starch banana that people boil and then mash, is the staple in these parts; it's about the only thing that grows freely. You won't starve on matoke, I'm told, but you certainly won't thrive. In Ruhiira, 4 in every 10 children are chronically malnourished; their growth has been stunted.
Unsteadily, we make our way down a long and steep and narrow footpath—loose dirt and small stones. At the bottom of the hill we come upon the village's main water supply: a stagnant, filthy water hole with bugs floating on the surface. Women in bare feet, with babies strapped to their backs, bend over to fill plastic buckets and jerricans. Some of the women wear sarongs. Others are dressed in ankle-length gomesi, the traditional dress of Uganda, with high puffed sleeves and wide sashes.
Young children too are helping to collect water. A few of the smallest girls, incongruously, are dressed in torn party dresses, pink, with ruffles, that might have been collected by, say, a church in Tulsa, Oklahoma. I notice one young boy's badly swollen feet: they're a sign of a medical condition known as kwashiorkor, or severe protein deficiency. It's what happens when someone lives on bananas alone, a doctor in our group informs me.
Hunger won't kill these children, despite appearances. Instead, they'll most likely die of malaria. One day they'll fall into a malaria coma—fever, convulsions—and never come out of it. For African children under five years of age, malaria is the No. 1 cause of death. In Ruhiira, it's endemic.
More and more observers arrive; one after the other they scramble down the footpath to get a good look at the women and children standing beside the cesspool. A dozen men wearing brand-new United Nations caps join us. Behind them, snapping photo after photo, is a graduate student from Germany, a sunburned woman in an emerald-green muumuu.
Plenty of journalists have also gathered around the water hole. Over there, that way, being filmed for the BBC, and using Ruhiira's contaminated water as a colorful and authentic backdrop, is George Osborne, a member of Britain's Parliament and a rising star in the Conservative Party. "We're here at the only water source for the village," he intones, looking right into the camera. "And as you can see, the mothers there, some of whom are pregnant, are picking up water which they've then got to take up the hill."
Still more spectators arrive. I meet four sincere, nice-looking Canadian men, square-jawed and blond: Ryan, Tyler, Joel, and John. They're volunteers with a Christian mission whose aim is to bring clean water to villages in the area. "What's going on?" asks Tyler.
What's going on today, in a nutshell, is Jeffrey Sachs: he's the reason we're here in Ruhiira staring at women and children doing what they do every day whether we're here or not—collecting dirty water in jerricans and plastic pails, and carrying it up the hill.
About a year ago, Sachs named Ruhiira a "Millennium Village," one of 79 villages in 10 African countries where his controversial theories on ending extreme poverty are being tested. He approaches alleviating poverty as if it were a rigorous scientific experiment, allocating exactly $110 per person each year for five years to implement a prescribed set of basic "interventions": fertilizer and high-yield seeds, clean water, rudimentary health care, basic education, mosquito bed nets, and a communication link to the outside world. The results are tested and monitored, his goal being to prove that the same scientific model can be used on a grand scale to save the lives of hundreds of millions of people trapped by poverty.
The first of Sachs's Millennium Villages was in Sauri, Kenya, where intervention began almost three years ago. Since then, production of maize in Sauri has more than tripled, while the incidence of malaria in the village has fallen by two-thirds. As well, lured perhaps by the free school lunches, more children than ever are attending the Bar Sauri Primary School. These are the sorts of results Sachs hopes to replicate all across sub-Saharan Africa, starting first in villages and countries that are relatively stable, receptive to change, and eager to work with him.
One of Sachs's biggest supporters is the financier and philanthropist George Soros, who recently donated $50 million to the Millennium Villages Project. (The project is a partnership among the U.N., Columbia, and Sachs's own nonprofit organization, Millennium Promise.) According to Soros, whose foundation gives away between $350 million and $400 million a year, investing in Sachs offered an attractive "risk-reward ratio." "Even though it's a large amount of money, $50 million, I thought there was really little downside," Soros told me. "As a humanitarian action, it was a good investment on its own But if it succeeded, then of course you would get a reward that would be way out of proportion to the investment made."
In short, Ruhiira is a kind of petri dish in the laboratory of Jeff Sachs. And here today, at the center of this tableau, is Sachs himself, standing among the water gatherers of Ruhiira. Wearing a pale-blue dress shirt, he squints awkwardly, uncomfortably, in the sunlight. His head, with its thick sandy-brown hair, seems unusually large for his slight frame. As usual, he's badly shaven. The crowd hushes respectfully.
"Thank you for bringing us to this place," he begins, addressing the villagers off the top of his head, without notes. "We are honored that you have taken us into your community."
His deep midwestern voice is resonant, deliberate. "We have seen how we can work with you to improve the agriculture, with new crops and ideas to improve your income." A translator repeats his words to the crowd in the local Bantu language, Runyankole.
"And we have seen the bed nets in your houses. Do you have bed nets in your houses?"
"Yes!"
"All right!" responds Sachs. He's getting fired up now, and his voice gets stronger. "And are they working? Do they help?"
"Yes!"
"We are happy to see that. We went to the school and we saw how the school feeding program has started and we're very proud of what you have done with that. And we went to the health center to see how it is being expanded, with more health workers in the community.
"Why do I mention all these things? Because for every problem you have, there is a solution! We want to help you find the solution!"
The people clap. Then they begin to cheer. Sachs is pleased with himself and he grins. Now, in a traditional Ugandan gesture that is the equivalent of a standing ovation, the villagers, all of them, stretch out their hands toward Sachs and begin wiggling their fingers. Everywhere you look, like the gentle rain from heaven, fingers wiggle and flutter. The people of Ruhiira are raining blessings on Jeff Sachs, the merciful one.
For many years, during the 1980s and 1990s, Sachs was known as "Dr. Shock," the brilliant macro-economist from Harvard who prescribed radical fiscal and monetary discipline, so-called shock therapy, to countries emerging from Communism. These days, he's better known glibly in the media as "Bono's guru" and as the professor in MTV's masterful documentary The Diary of Angelina Jolie and Dr. Jeffrey Sachs in Africa. In the movie, Jolie calls him "one of the smartest people in the world."
When it was released two years ago, Sachs's latest book, The End of Poverty, was excerpted for a cover story in Time magazine. It also made The New York Times best-seller list; more than 230,000 copies have been sold in the United States, an extraordinary accomplishment for what can be, truthfully, a dreary slog with only charts and graphs for company.
In some of his fine-tuned speeches, Sachs presents his audience with an ethical choice: "Either you decide to leave people to die or you decide to do something about it." Who in the world can resist that call to action? After all, one billion people on the planet are scraping by, barely, on less than a dollar a day. Industrialization has passed them by. They have not been lifted out of poverty by what proponents of free markets like to call "the rising tide." For Sachs, the way to end extreme poverty is obvious; his one question is, How long will it take the rest of us to come around?
"Have you seen children dying?" he asks his audience. We're in Montreal, at an all-day conference devoted to poverty. Bill Clinton will be speaking later in the day. So will Mia Farrow. But, for now, above Sachs's head, projected on a giant screen, is a photograph he took a few months ago at Zomba Central Hospital, in Malawi. Row after row of small children in malaria comas are lying on the bare floor, their yellow eyes rolled back.
"I never thought in the 21st century, growing up in the 20th century, I'd ever see that," Sachs exclaims, outraged by the shortsightedness implicit in that photograph. "Lack of a bed net. Lack of a dollar medicine. Lack of an oral rehydration solution in time to save a child dehydrated from a diarrheal infection. Lack of antibiotics to cure a child of acute lower respiratory infection contracted from living in a hut where dung is burned to cook the meals in a smoke-filled chamber."
His catalogue goes on: "Lack of a five-cent immunization, so that you have hundreds of thousands of children dying of vaccine-preventable diseases. Half a million mothers dying in childbirth because there's no obstetrician or even emergency care to stop the hemorrhaging, to deliver a child in breech, to do a C-section. The most straightforward things that we've known how to do for centuries …
frica is a lost cause, Sachs's critics are happy to tell you. It's a hopeless proposition. Corrupt. Over the past 50 years, more than $500 billion in foreign aid to Africa has gone down the drain; why would anyone in his right mind pour good money after bad? Sachs has learned to ignore that litany of complaints and others like them: "Maybe it's having had the good experience of hearing, as I have many, many times, 'Impossible, impossible, impossible, impossible, impossible—obvious.' If you've gone through that over a period of 25 years, it helps you to filter out a lot of what you're told."
More than a few people I spoke to in the field of international development suggested that Sachs is blinded by ego and ambition. "There's a certain messianic quality about him," George Soros explained, "and it needs to be kept under critical control."
Still, if you spend enough time with Sachs, as I have, you may come around to his point of view: if the history of international development is a history of failure, it is because too many people in the field are complacent, or incompetent, or not accountable.
We're at the Entebbe airport, in Uganda, waiting to board our flight to Nairobi. Grabbing another handful of peanuts, settling onto a leather sofa in the waiting room, Sachs thinks out loud: "People generally view systems as unchanging. They have very static views of things. They don't really see how change comes about."
How does change come about? A few days later, in Nairobi, I meet Charity Ngilu, Kenya's dynamic minister for health. When she took office, in 2002, her priority was to somehow contain the fast-moving epidemics of aids, tuberculosis, and malaria that were ravaging the country. But Kenya faced severe shortages: of doctors and nurses, of medicines, and of such basic supplies as surgical gloves, IV fluids, even hospital food. The health-care system—exhausted, chronically underfunded—had collapsed.
That's when and where Sachs came in. Passionately, he argued Ngilu's case to the World Bank, to the International Monetary Fund, to major foreign-aid donors, and to Kenya's bureaucrats themselves. As a result of his and others' determined work on her behalf, Ngilu attests, Kenya's health budget, while still bare-bones, was increased 20 percent last year and another 45 percent this year. In the past two years, Kenya has managed to hire an additional 3,018 health-care workers and the government recently distributed 3.4 million insecticide-treated bed nets. Meanwhile, new cases of H.I.V./ aids have fallen even as the number of patients receiving anti-retroviral treatment has sharply increased.
"If it wasn't for Professor Jeffrey Sachs, we would not have moved forward," Ngilu states, when we meet at her office in Nairobi. "Those people who are on treatment would still be dying. Those children who are under bed nets would be dead. Women would not be accessing care." Pausing, she shakes her head as if imagining her job without the good professor's help: "The support he has given me!"
Paul Farmer, the renowned medical doctor and humanitarian, whose organization, Partners in Health, cares for people in the poorest, most godforsaken corners of the world, explained to me, "Just five years ago, people like me who were trying to take care of the destitute sick with diseases like aids, we had almost nobody on our side. We had everyone saying, 'It's not doable, it's too complicated, you need a health infrastructure, it's not sustainable.' Then Jeff got involved in this and said, 'Buck up, stop whining, and start getting work done.'"
One of Sachs's most significant contributions to the cause of ending world poverty is a gigantic report, published by the World Health Organization in 2001 and titled Macroeconomics and Health: Investing in Health for Economic Development.
The W.H.O. report lays out the facts in stark terms. Every day, 22,000 people on the planet die of poverty. Spending money on health care in the world's poorest countries is more than a humanitarian imperative, Sachs's report argues; it is also the key to driving economic growth. Co-opting the rhetoric of corporate America, cunningly, the report manages to transform a health catastrophe into a business proposition: saving lives can offer huge returns to investors. With an annual investment of $66 billion, the report states, we could be saving eight million lives a year and generating economic benefits worth $360 billion a year.
In the skilled hands of Jeff Sachs, macro-economist, such gigantic, almost unimaginable figures are made to sound reasonable, even modest. "He's not embarrassed by large numbers. And he's not apologetic for large numbers," said Richard Feachem, who served on the commission for Sachs's report and recently stepped down as the executive director of the Geneva-based Global Fund to Fight aids, Tuberculosis and Malaria. "What he's saying is 'If it needs billions for health and development, don't be ashamed to ask for it.' And, by the way, to anyone who says, 'Oh, that's a lot of money,' say, 'Well, by whose standards?' because by the standards of military expenditure it's not a lot of money."
The total annual sum spent on health care in sub-Saharan Africa is typically $20 per person or less. To put that into perspective, in the United States we spend about $6,000 per person each year on health care.
In Ruhiira, where TB and malaria are rampant and, according to unicef, where one in 13 women will die during pregnancy or in childbirth (the odds are one in 2,500 in the United States), there really is no health care to speak of. The closest hospital is three to four hours away by wheelbarrow, the vehicle most often used to transport the sick from place to place.
I visit the hospital with Sachs. Located 20 miles off the national electric grid, the Kabuiyanda Health Centre has no power or running water. At one time, for a short period, two solar panels had been mounted on the roof. They were stolen. As for the 19-kilowatt generator parked outside the building like a totem, there's not enough money in the budget for fuel.
Without electric power, how do you provide standard medical treatment to people who are dying? Without running water, how do you sterilize surgical tools and wash the blood from floors and beds and open wounds? How do you keep your hands clean or refrigerate medicine and vaccines? As we make our way through the hospital, Sachs looks distraught.
"How many beds are there here?" he asks the young doctor on staff, Stephen Mucunguzi.
"Twenty-eight."
"Twenty-eight beds for 125,000 people?" repeats Sachs, trying to grasp the implication of those figures. "Aren't they filled, filled, filled?"
Dr. Mucunguzi leads us to the operating theater, a plain cement room built in 2002. For several reasons it has never been used for surgery. First of all, it took three years for surgical equipment to arrive after it was ordered. Then, just after the equipment arrived, the only doctor on staff quit, and for almost five months the hospital had no doctor at all. Finally, in late December 2006, Dr. Mucunguzi accepted the job, but only after Sachs's Millennium Villages Project offered to supplement his official $315-a-month salary.
Further problems have plagued the hospital. So shoddy was the original construction of the operating theater that, until repairs are carried out, it cannot be used for general surgery. "We are hoping it will be working in a month," says Dr. Mucunguzi.
Sachs looks skeptical. "And running water?" he asks.
"Well, we plan to put in a water tank. We need a maximum of one month to improve the system."
"So," says Sachs, questioning the young doctor, "today is January 14. Could we really try to have this working by March 1? No later."
"Yes, yes."
"I think it would be good for us to have a goal."
That evening, at dinner with Dr. William Nyehangane, the district's health officer, Sachs discovers that the total annual budget for health care in the area that includes Ruhiira is only $1.90 per person. "Unbelievable!" shouts Sachs. "Unbelievable!
"Did you hear that?" he asks no one in particular. "One dollar and 90 cents. One dollar and 90 cents. Unbelievable."
As a young child growing up in Oak Park, Michigan, Jeff Sachs had a preternatural mind. At 12 or 13 years of age, in middle school, he won a mathematics contest for gifted children, with the result that he spent his summer taking college-level math courses at Oakland University, in Rochester, Michigan. One time, not uncharacteristically, when a high-school teacher assigned a 5-page essay, Sachs handed in 40 pages. "He never had a rebellious day in his life," according to his sister, Andrea Sachs.
You will not be surprised to hear that Jeff Sachs was named class valedictorian when he graduated, in 1972. Nothing less was expected of him, apparently. "His father was extremely bright and was top of his class. We just assumed our children would be the same," his mother, Joan Sachs, told me.
Jeff Sachs's father, Theodore, was a legend in Detroit. A labor and constitutional lawyer who successfully argued several cases before the U.S. Supreme Court (including Scholle v. Hare, in 1962, which helped establish the principle of "one man, one vote" for legislative apportionment), Ted Sachs was said to have one of his generation's finest legal minds. He was stunning in the courtroom, and he was admired for his deep commitment to social justice. "It was his primary goal to do good for others, and he did," Joan Sachs said of her husband, who died in 2001.
It was taken for granted that Jeff Sachs would attend his father's alma mater, the University of Michigan, and that he too would become a lawyer. In the worst case, his family imagined, he'd become a medical doctor. Instead, when he was 17 years old Sachs left Oak Park to study economics at Harvard.
Martin Feldstein, the well-known economist and a longtime professor at Harvard, remembers meeting Sachs for the first time. "I was teaching the graduate macro-economics course," Feldstein recalled. "And he came along—remember, he's a second-year undergraduate, so he's about 19 years old—and he says, 'Well, I'd like to take your course.'" Warning Sachs that he was an unforgiving and demanding teacher, Feldstein discouraged him and advised the young man to stay away from trouble. "I'll take my chances," replied Sachs.
Sachs received an A in Feldstein's class, then stayed on at Harvard for graduate school. A scant three years after being awarded his Ph.D. in economics, with a focus on international macro-economics, he was granted tenure and made a full professor at the university. It was 1983, and he was 28 years old.
It was during his freshman year at Harvard, at a screening of The Sorrow and the Pity, Marcel Ophüls's four-hour documentary, that Sachs met his future wife, Sonia Ehrlich. She quickly got a sense of his single-mindedness. "In the beginning, Jeff would say, 'Wait until I finish my undergrad thesis,'" Ehrlich once told The Boston Globe, describing her husband's promise to eventually slow down. "Then it was 'Wait until I get my PhD thesis' and 'Wait until I get tenured.' Then it was 'Wait until I finish my first book.' Then Bolivia came up.
"It really took me a while to realize this was his modus vivendi," she concluded. "I stopped waiting and began enjoying the positive."
In 1985, Sachs found himself in the Andean mountains of La Paz, Bolivia, acting as an adviser to the country's president, Victor Páz. Desperately poor and chaotic, Bolivia, with its then annualized inflation rate of 25,000 percent, was spiraling out of control. Sachs identified the root problem: runaway government spending leading to a textbook case of hyperinflation, the likes of which no one had seen since 1923, when Germany's Weimar Republic just kept on printing money.
Consulting academic articles on hyperinflation, and recalling his undergraduate training, Sachs designed an austerity plan to jump-start Bolivia. It called for huge cuts in government spending, massive layoffs of state employees, the end of fixed gasoline prices, a complete overhaul of the tax system, debt cancellation, and, above all, an abrupt shift to a free-market economy.
With its country in disarray, the government of Bolivia followed Sachs's advice. It had few other options.
Sachs's plan for Bolivia actually worked: strict fiscal and monetary discipline quickly lowered the country's annual inflation rate to about 15 percent. "Shock therapy," as the plan was later called (to Sachs's chagrin), would become Sachs's trademark. From Bolivia, he proceeded, in 1989, to Poland. When the so-called Sachs Plan, conceived with his colleague David Lipton, was implemented in Poland, it followed the authors' road map and timetable almost exactly. Slovenia and Mongolia came next.
Sachs, then 35, had become an international star in policy circles; some people even referred to him as the most influential economist since John Maynard Keynes. Then, in the early 1990s, at the government's invitation, he attempted to straighten out Russia's economy.
In hindsight, Sachs was probably naïve. Assuming that his reforms could be imposed on Russia as they had been on Bolivia and Poland, he was defeated by a massively bloated and stubborn economy. Russia was not resuscitated by Sachs's shock therapy; on the contrary, Russia was ravaged while Sachs and his ideas were ignored. The country's state assets were looted, and everything valuable wound up in the hands of a few clever men.
In Sachs's view, his failure to reform the country was due, in his words, to "the triumph of politics over economics." One way or another, Sachs and his Harvard colleagues were widely blamed for Russia's failed transition to capitalism. To the delight of many of Sachs's harshest critics—in particular, liberals who viewed economic shock therapy as coldhearted and mechanical—Russia became the blot on his escutcheon.
When I ask Sachs about his failure in Russia, he becomes agitated, prickly, like a hedgehog: "Do I consider Russia a failure of the West? Yes, definitely. Do I consider it a personal failure? No, I find that absolutely preposterous. I don't understand why somebody doesn't ask Robert Rubin, or ask Dick Cheney, or ask Larry Summers, or ask anybody that actually had power at the time about it." He's had it with this line of questioning: "It's preposterous by now, and tired. And it's tiresome, and it's a tired question, and it's absolutely absurd."
According to his account in The End of Poverty, Sachs's focus on extreme poverty began in 1995, when, for the first time, he traveled to sub-Saharan Africa: "Never, not even in the highlands of Bolivia, where illness is rife, had I confronted so much illness and death." Early in his career, when he was thinking about ways of improving people's lives, Sachs had been convinced of the power of open markets, free trade, deregulation, privatization, and fiscal discipline. Now, perhaps in response to this first trip to Africa, he started to promote benevolent intervention.
Some people believe that Sachs's crusade to wipe out poverty is the direct result of his failure in Russia, that he's atoning for his public errors of judgment and compensating for them. Sachs dismisses that simpleminded theory out of hand. As far as he is concerned, his work in the developing world is not all that different from his earlier work in Bolivia and Poland. In an e-mail, he explains to me that his goal has always been "to take on complex challenges and bring to bear expertise in economics and other disciplines to find workable solutions." What I think he means is this: it doesn't matter whether you're using shock therapy to save a nation's economy or prescribing interventions for a village to save human beings. The messianic pattern is the same.
We're sitting cross-legged under one of the few shade trees in Dertu, a parched, inhospitable stretch of land about 85 miles from the Somali border in Kenya. A group of community leaders has gathered to air their grievances and share their frustrations. The temperature hovers around 100 degrees in the shade. I am offered warm sweet tea with powdered milk.
"Our needs are many," begins one of the men, a tall Somali wearing an embroidered kufi. "We suffered through the drought," continues someone else. "We lost many animals, even our donkey. And now the flood has caused even more problems. The little we had has been washed away by the rains."
Of all Jeff Sachs's 79 Millennium Villages, Dertu, a sprawling settlement in Kenya's wretched North Eastern Province, may be the most challenging. The place is marked by catastrophe: drought, famine, floods, pestilence, tribulation—biblical woes. "It is only God and us who know the kinds of problems we have had here," says Sahalan Badi.
One year ago, during the five-year drought that affected the Horn of Africa, the nomadic herders of this region were forced to walk for hours, sometimes days, in search of water. Even their camels were dying.
At last the rains came, in October 2006, a drop or two at first, afterward the deluge. Rushing to save themselves from the floodwaters, Sahalan Badi and her family lost everything they had, which, God knows, was little enough to begin with.
Now, using basic materials donated by Sachs's Millennium Villages Project and by unicef, the people of Dertu are learning to dig and build their own pit latrines. As well, in the hope of encouraging the business of trading camels and cattle, the project has funded the Dertu Millennium Livestock Market, whose long-term goal is for the settlement to keep itself out of poverty and, if things go well, to move up a rung on the economic ladder. The Millennium Villages Project aims to teach people self-sufficiency.
At the same time, problematically, a growing number of households in Dertu have become dependent on international food aid. Month after month, accustomed to the ritual by this time, the people line up for rations: a jug of cooking oil, enriched porridge for children, bags of rice and maize. The local homes—small domed huts made of twigs and held together with ropes of camel leather—are patched with empty grain bags reading, usaid: from the american people.
Less than 10 percent of Dertu's population is literate. Female genital mutilation is a normal and accepted practice: almost every girl is circumcised at the age of six. Most men have three wives, and the women, on average, have nine children. There are bitter tribal clashes. Just recently, Fatuma Shide, the Millennium Villages Project's local health coordinator, was beaten during a fight between two clans. Bleeding heavily, she had to be rushed to the nearest hospital, a drive of more than four hours over rough terrain.
Today, Ahmed Mohamed, the leader of Dertu's Millennium Villages Project, is trying to explain to the local people the benefits of hay. If you gather and dry the tall grass now, he tells them, you will have food for your animals the next time the drought comes.
The son of a nomad—the eldest son of 19 children—Mohamed grew up in this area, moving between northern Kenya, southern Ethiopia, and Somalia, wherever conditions were favorable for his father's herd of camels. He speaks the same language as the people of Dertu; he is one of them. For all that, they are not receptive to his ideas about drying the tall grass.
"God has brought us this grass," one man objects. "It is not ours to cut." Mohamed nods patiently. An old woman confronts him, and others join in. Mohamed is interfering in their way of life, they say. Soon everyone is shouting. Mohamed translates for me: "They are saying it is God's gift and the more you cut, the angrier God gets. It's a bad omen, they say." Gesticulating wildly, the old woman pokes her finger in Mohamed's face. "Please," she begs him, "for heaven's sake don't cut our grass."
In Dertu, attitudes are deeply ingrained. It can be difficult, for instance, to convince a nomadic herdsman that anything is as valuable as his camels or his goats. A few months ago, the Millennium Villages Project handed out 3,000 insecticide-treated bed nets to help protect the community from malaria and Rift Valley fever. To make sure the nets would be used as planned, Mohamed issued an edict: "We told them, 'This is for human life, donated by someone to ensure your survival. If we see you put it on a goat, we will withdraw it.'"
Traditionally, the people of Dertu have used smoke to keep mosquitoes from attacking their livestock. But using smoke as a mosquito repellent means that someone has to feed the fire every hour or so through the night. "It is easier to simply use the nets to protect the animals," said Mohamed, explaining to me why some nets are diverted from a child's bed to a herd of kid goats. "And in a pastoral community, the livestock have more value than the humans."
Leaving the region of Dertu, sitting in the back of an ancient Land Rover, I'm reminded of a meeting I had with Simon Bland, head of Britain's Department for International Development in Kenya. Referring to the Millennium Villages Project, and to Sachs in particular, Bland laid it out for me in plain terms: "I want to say, 'What concept are you trying to prove?' Because I know that if you spend enough money on each person in a village you will change their lives. If you put in enough resources—enough foreigners, technical assistance, and money—lives change. We know that. I've been doing it for years. I've lived and worked on and managed [development] projects.
"The problem is," he added, "when you walk away, what happens?"
Last year, the United States spent $499 billion on its military. In sharp contrast, it spent $22.7 billion on foreign aid. Measured in dollars, the sum of $22.7 billion makes the U.S. the biggest foreign-aid donor in the world. Still, considered as a percentage of the country's G.N.P., America's foreign-aid budget, at only 0.17 percent, is almost negligible.
Here are points of comparison: Britain and France give away 0.52 and 0.47 percent of their G.N.P., respectively. The goal established by the U.N. is for every developed country to contribute at least 0.7 percent of its G.N.P. to foreign aid.
People who argue against increasing America's foreign aid point out that poor countries, especially poor African countries, are often run by tyrants who loot their public treasuries. Foreign aid keeps those tyrants in power by helping them buy votes; either that or the money winds up in a numbered bank account somewhere. Sachs, though, is impatient with arguments about corruption in Africa; they're a convenient excuse for doing nothing, as far as he is concerned.
Another standard argument against increasing foreign aid goes like this: we've spent billions already, and so far we've had almost no return on our investment.
Responding to this defeatist line of thinking, Sachs argues that foreign aid has failed to produce obvious results because we have spent too little. In his favorite analogy he compares the current situation in Africa to a forest fire: if you try to put out the fire with one hose, and the fire continues to rage, do you conclude that fighting fires is hopeless? From Sachs's point of view, the only logical conclusion is: you don't have enough firefighters.
That said, how many firefighters do we need? How much money would it take to eradicate poverty? Sachs's estimates are somewhere in the range of $200 to $250 billion a year. That huge figure is double what the developed world now spends on foreign aid. It's almost the entire G.N.P. of Denmark.
To Sachs, $200 billion is an absolute bargain. "It's much cheaper than giving food aid," he told me, as though he were stating the obvious. "It's much cheaper than having wars, and it's much cheaper than having mass migration." Here's the bottom line: it is less than 1 percent of the total income of the "rich world." That's how rich we really are.
"Look," Sachs elaborated, in case I hadn't understood what he'd said. "This is not the great titanic battle of morality that I'm on. I'm not saying the only way for the rich and the poor to live together is if the rich cut their living standards by half, give up their cars, understand modern life is a false contrivance and a false consciousness that is destroying the planet and is enslaving and impoverishing the poor and that we have to move away from globalization in the corporate world, which owns politics and dominates … " His voice trailed off.
"I don't believe that stuff anyway, but that's not the kind of battle that this is about," he added. "We're just talking about 1 percent of our income in the world for the need to avert potential calamity."
Yoweri Museveni, the longtime president of Uganda, seems distracted today. That's not surprising, when you think about it. After all, just this week, his government's peace talks with Uganda's brutal insurgent group, the Lord's Resistance Army, have collapsed. More troubling to Museveni, perhaps, is that he's no longer the West's favorite African leader.
For many years after he seized power in 1986, Museveni was considered to be the model of a new generation of African leaders—modern and principled, devoted to democracy and reform. Then, in 2005, just in time for the national election, Museveni abruptly changed Uganda's constitution, which meant he could run for an unprecedented third term. During the election, his opponents were largely kept out of sight, and Museveni won handily. In the West, some observers are now asking themselves, Is Museveni just another African "big man" after all?
One way or another, Museveni looks like someone with a lot on his mind. Today, in his office in Kampala, sitting in a black leather executive chair, he keeps swiveling back and forth. Jeff Sachs, meanwhile, is making an impassioned presentation about ending poverty in Uganda.
"The idea is a poverty-eradication effort, but focusing on practical investments," Sachs informs the president. "The idea is six goals with strict timetables."
Museveni may or may not be listening. He gestures to an assistant: he wants some tea.
"First," Sachs explains, "we want to help the farmers have a bumper harvest of food."
"Mmmmm," murmurs Museveni in reply. "Mmmmm."
"And they're having a bumper harvest," Sachs goes on, referring specifically to maize in Ruhiira, his Millennium Village in southwestern Uganda, "and it's really incredible actually, because of the fertilizer and the good seeds, they're getting six tons per hectare."
Museveni appears restless and he keeps swiveling. His tea has arrived. "Mmmmm," he says.
Sachs moves on to the subject of Ruhiira's water supply. "It was daunting, I have to say, the water situation," he reports, "because we went down a steep slope to a pond that they had dug, and they just collect, you know, the runoff, and it's muddy, the excrement from the animals is coming in, bugs are coming in. Completely unprotected. And that's their water hole! And we saw the women there, a pregnant woman, baby on her back, with a jerrican trying to get water out. It was shocking, actually."
Museveni is not so shocked, it seems to me. Or he may be thinking of something else. "Mmmmm."
Sachs outlines his plan of interventions. "My impression, Mr. President, is that this will all happen within one year," he says. "And it shows to me a pretty basic point, which is that … when we're talking about extreme world poverty, it shouldn't take a lot of time to make a difference."
Museveni's support is needed urgently, Sachs wants to say. The situation is dire. People are dying. It's an emergency.
Museveni is interested in the root meaning of the word ruhiira: "Burnt grass, that's what ruhiira means," he informs us, stirring his tea. "That's what ruhiira means."
"Yeah," says Sachs, hurrying to the crucial matter of Uganda's farm productivity. "What we saw in Ruhiira, they're going to get, in maize, six tons per hectare probably. This is really a bumper crop—not just a crop, a bumper crop. And it's because they never had fertilizer before."
Sachs is urging Museveni to launch a nationwide voucher program: offer bags of fertilizer and high-yield seeds to every small-hold farmer in the nation, he suggests. "Go for the big scale," he says dramatically. "Why wait? There's no reason to wait."
Museveni clears his throat. "I use fertilizers once in a while," he remarks, referring to his personal farm, his own situation. "I'm trying to remember: when I grew maize, I harvested 800 bags."
"Eight hundred," repeats Sachs, politely.
"Yes, 800. Eight hundred bags. I must have been using like 50 acres. The bag is 100 kilograms."
"That's 80 tons over 50 acres," says Sachs, running the numbers off the top of his head.
"Mmmmm." Museveni, reaching for the calculator on his desk, starts tapping the keys: "That's 1.6 … "
Sachs is way ahead of him. "Times 2.5 would be … " he says, before concluding, "That would be four tons per hectare."
"Four tons?" asks Museveni, puzzled by the figure.
"Per hectare," repeats Sachs.
"Ah, O.K.," agrees Museveni. "That's what I harvested. Yes."
"You're a master farmer: you got four tons," says Sachs, complimenting the president on his crop yield and anxious to return to the matter at hand. "But the average here is less than a ton," he points out, referring to Uganda. "But with fertilizer you get four tons," Sachs adds, hoping to seize the day. "If you had all the farmers quadrupling their yields, do you know what kind of growth that would mean for this country? That's like a 25 percent increase of G.N.P.!"
Museveni has settled back into his chair. As he sips his sweet tea, his response to Sachs is: "Mmmmm." On the wall directly behind his desk is a single framed photograph, of Museveni.
Later I ask Sachs: what was his impression of the meeting with Museveni? Sachs seems startled, taken aback by my question. Was there any doubt it had been a success? "I thought it was a very good meeting," he answers, with the utmost sincerity.
Nina Munk is a Vanity Fair contributing editor.
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Meanwhile, in the Next White House …
It hasn't been a frequent question as the presidential campaign heats up, but it's among the most important. So V.F. asked current presidential candidates what they would do for Africa.
by Bono July 2007
When I was growing up in Dublin, people like my father were in love with America. The United States had not just liberated Europe, but rebuilt Europe after the war with the aid and trade of the Marshall Plan. Brand U.S.A. was at its brightest. My earliest memory of America is watching Neil Armstong take a walk on the moon. Wow, I thought to myself, these Yanks are crazy.
Fast-forward, and a part of me is still that child with his mouth open at this great idea called America—sometimes in disbelief, but mostly with the surety that there's nothing you Americans can't do if y'all want to do it.
In the 21st century, what does America want to do? The 2008 election might give some clues. Whoever wins holds the most powerful office in the world, which is why the world itself is so interested. As an Irish bystander, I think the candidate most likely to succeed is the one who most people believe can build respect for the American flag in the wider world. Figuring out how to do that is America's great challenge. Our global challenge is figuring out what to do about the extreme, stupid poverty which sees millions die each year because they are too poor to live. Nowhere more than in Africa.
Is it too much of a stretch to think these challenges could be connected? It's hard to hate a country which puts your kids in school and gives medication to save your husband's life. We asked the candidates what they would do for the poorest in the world, if they got the job.
Democratic candidates
Hillary Rodham Clinton, senator, New York I would start by providing funds to put all of Africa's children in school. Education is the foundation on which the life of a child and the future of a nation are built. Education is women's rights and human rights, because girls and boys deserve the same chance to chart their own course. Education is health care, because accurate information about aids and H.I.V. saves lives. Education is economics, because there is a straight path from a good school to a good job. If my bill to achieve universal basic education, the Education for All Act, does not become law before January 1, 2009, that will be my first priority. Of course, we should also help Africa with proven economic-development strategies and with building health systems to support now affordable treatment for H.I.V./aids. But with universal education, Africans will soon work themselves out of extreme poverty.
John Edwards, former senator, North Carolina The problems of Africa are both a moral challenge and a threat to our security. We cannot be safe alongside countries torn apart by aids, other diseases, and extreme poverty. It is a disgrace that 100 million poor children have no schooling. As president, I will lead a worldwide effort to teach them. I will work with drug companies to share aids drugs across Africa, and double our investment in clean water to avoid preventable diseases. Finally, I will expand micro-finance to give people tools to rise out of poverty. An ambitious $5 billion investment could change the face of Africa.
Barack Obama, senator, Illinois In Kenya, my father's homeland, I witnessed the struggles and suffering caused by poverty and H.I.V./aids, reinforcing my belief in our common responsibility to uphold our common humanity. As president, by 2012, I will double to $50 billion annually our foreign investments, much of which will go to sustainable development and poverty reduction, and I will expand the President's Emergency Plan for aids Relief (pepfar) by providing at least $1 billion a year in new money. America must do more than take a few steps—we must lead a global march to make this a more just and equitable world.
Chris Dodd, senator, Connecticut We must work to achieve the U.N. Millennium Development Goals—halving global poverty, reducing maternal mortality by three-quarters, providing primary education for all children, and reducing child mortality by two-thirds. The I.M.F. should sell a portion of its gold reserves and use the proceeds to establish a trust fund with interest generated devoted to financing the debts of poor countries. Countries ravaged by H.I.V./aids, malaria, and tuberculosis will never be free of poverty. My support for the Global Fund and pepfar will continue, removing restrictions that impair their effectiveness.
Joseph Biden, senator, Delaware First, I'd end the war in Iraq. That would restore the freedom, flexibility, and credibility we need. On H.I.V./aids, I'd stop playing domestic politics by diverting vital resources to abstinence-only programs that don't work. Violence against women contributes to the spread of disease; I'd work to protect them. Conflict cripples our assistance programs. We must end the Darfur genocide and empower Africans at peacekeeping. Our thirst for African oil fuels inequality, conflict, and environmental disaster. That's another reason to diversify. I have worked with Bono to relieve Africa's debt; now we have to build the capacity of its countries to govern effectively and create sustainable economies.
Dennis Kucinich, representative, Ohio Extreme poverty is the medium in which diseases flourish. As president, I will appeal to the heart of the American people to commit fully to the Millennium Development Goals. I will work to ensure a peace economy based on fair trade; reform international monetary and trade structures; write trade agreements based on human rights, workers' rights, and the environment; lead the way to deliver generic drugs; sign the Kyoto [Protocol] and all arms treaties; and restore America's role as an honorable global partner.
Bill Richardson, governor, New Mexico We must stop treating Africa as an afterthought. As president, I will work to launch a multilateral Marshall Plan that helps Africans prevent societal collapse. This new plan will improve access to medical treatment, expand education opportunities, and stimulate economic development. The plan must also anticipate and respond to the impact that global warming will have upon African food and water supplies. It's time for us to act.
Republican candidates
Sam Brownback, senator, Kansas As president, I would travel to Africa again and encourage as many Americans as possible to do the same. When you get to know the nameless 200 million Africans who go hungry every day and the millions more who die each year of waterborne and tropical diseases, malaria, and aids, people will be changed forever. I would also change the way we spend our aid in Africa, focusing on four areas—water, food, health, and education—with benchmarks that measure success in the number of lives saved. The money we spend should reflect the values of our nation. By uniting with the people of Africa in their fight against aids and extreme poverty, America will remain great by standing on the goodness and compassion of the American people.
John McCain, senator, Arizona Fighting disease and extreme poverty in Africa is in America's strategic and moral interests. If elected, I will fund aids treatment and prevention at levels befitting a wealthy and great nation, and establish a goal of eradicating malaria—the No. 1 killer of African children under five—from the continent. I would link other forms of aid to good governance and economic reform, because no amount of assistance can succeed when governments fail their people. And I would pursue policies that enable African entrepreneurs and exporters to increase their access to international markets.
Rudolph Giuliani, former mayor, New York City Africa offers so much hope for the future. More Americans need to see how helping Africa today will help to create a world of increased peace and decency tomorrow. That's why the next president needs to continue and expand the administration's effort to help Africa overcome aids. But the most important thing we can do to help Africa build a better future is not just increase aid but increase trade. Increasing U.S. aid to Africa is important, but giving aid without conditions for reform perpetuates bad policies and poverty. Ultimately, it's better to give people a hand-up rather than a handout.
Mitt Romney, former governor, Massachusetts We are all created by God, and when so many are suffering, we must help our neighbors in need. Extreme poverty and aids in Africa represent a global crisis. We must build on America's historic efforts to bring hope and build a safe world. This requires bringing the same focus and unified action to efforts that show America's heart as we do to those showing America's military might. New partnerships with the international community, private sector, and African leaders can mobilize the power of our health-care, education, and development efforts, and build sustainable solutions vital to Africa and the world.
Tommy Thompson, former governor, Wisconsin I would bring more of America's spirit of entrepreneurship and volunteerism to pepfar by establishing a new volunteer corps of doctors, dentists, nurses, hospital managers, and other health professionals, who would spend three months to two years at work in the field. The idea would be not to replace local workers but to train more of them, and bring existing ones the latest skills and best practices. We should provide incentives for private companies (hospitals, universities) to allow their employees to take sabbaticals for such service.
Mike Huckabee, former governor, Arkansas The first step I will take is to invite Bono to the White House to meet with me about fulfilling the promise of the One Campaign. I intend to make the One Campaign a significant part of my presidential campaign so that more Americans will share my enthusiasm and excitement about it. I will explain to them why this is both a moral and a strategic imperative. I look forward to working with other world leaders to transform the lives and health and prospects of our African brothers and sisters.
Jim Gilmore, former governor, Virginia While the U.S. is doing much to help with the fight against H.I.V./aids in Africa, more must be done. Success can be obtained only if America is in full partnership with African nations to turn the tide against this devastating pandemic. As president, I will commit additional American financial support. I will push for advances in efforts to end mother-to-child transmission of H.I.V./aids and insist on full accountability, to ensure that funds are being received where they are most needed and that the latest medical supplies are safe and readily available.
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Africa
Young girls leave a camp for "internally displaced persons" to gather firewood, a necessary activity that leaves them vulnerable to rape or murder. Abu Shouk, North Darfur, Sudan, June 25, 2005. Photograph by Ron Haviv/VII.
Picturing Genocide
Inspired by images of suffering in Africa, a lone Chicago woman pulls together "Darfur/Darfur," an exhibit of haunting photos by important photographers. The show is now traveling the world—and making a difference.
by Evgenia Peretz VF.COM June 18, 2007
‘I think I'm a little stupid sometimes," says Leslie Thomas, the woman behind the traveling digital-projection exhibit "Darfur/Darfur," "but in a convenient fashion." To wit, this architect and new mother living in Chicago decided one night—despite zero contacts in the worlds of activism or politics—that she was going to do something significant to end the genocide in Darfur. Now, just over a year later, her project is hitting viewers in the gut, one city at a time. It's even helping to propel legislative action.
In March 2006, while surfing the Web after a middle-of-the-night feed with her infant son, Thomas came across a photograph of a one-year-old Sudanese girl with a bullet hole in her back. It was this image that inspired her to take action. "I harbor this fantasy that she survived," Thomas says. "The reality is that she just died, most likely, but now it's hard for me to just say that. I sat and cried for hours." The infant in her arms had something to do with it. "If my son died, and I was killed," she recalls thinking, "I would want someone to remember Niko, just for a moment to think of him." She knew from the very beginning that her project would involve photography: when she was young, her father showed her the famous photographs by Eugene Smith that revealed the crippling effects of mercury poisoning in Japan. Those photos had a huge political impact in the 1970s, and Thomas never forgot their power.
The "Darfur/Darfur" photography exhibit as projected on the exterior walls of the Jewish Museum in Berlin, March 15, 2007. Photograph by Helene Caux. Enlarge this photo.
After hundreds of cold calls, Thomas amassed a group of some of the most important photojournalists working today: Paolo Pellegrin, Lynsey Addario, Mark Brecke, Helene Caux, Ron Haviv, Ryan Spencer Reed, Brian Steidle, and Michal Ronnen Safdie, all of whom have been focusing on Darfur in their work. She then lined up a slew of impressive venues, from the Holocaust Museum in Washington, D.C., to the Hammer Museum in L.A., to the Jewish Museum in Berlin. The photographs collected in the exhibit reveal not just the effects of a genocide—with haunting images of corpses and burnt villages, children on their last breath, refugees headed to the unknown, child soldiers with vacant stares—but also Darfur's agrarian history, before men, women, and children began fearing for their lives every single day. A third group of photos consists of intimate portraits—poignant reminders that these victims are not statistics, they are people.
The exhibit is not intended to inspire quiet self-reflection. Accompanied by keening African music, the pictures are projected on walls (both interior and exterior), giving them a monumentality that is inescapable. "If you are a young mother in Darfur, and you have children and you are trying to protect them and save your own life, but most importantly, the life of your family, you are a hundred percent overwhelmed all the time," says Thomas. "I don't think it's possible for us to picture that [unless] we're overwhelmed."
African Union soldiers find the village of Tama, in South Darfur, still burning in June 2005, more than a week after it was first attacked by Arab nomads. Photograph by Lynsey Addario/Corbis. Enlarge this photo.
With current and upcoming shows at Milan's Centro Internazionale di Fotografia, Philadelphia's Constitution Center, Boston's Institute of Contemporary Art, and the New-York Historical Society, the exhibit has accomplished a major first step: shaking viewers into outrage and convincing them that standing by is no longer acceptable. The show has also had more concrete effects. Thanks in part to "Darfur/Darfur," the Texas state legislature has passed a Sudan divestment bill; a similar measure is on the docket in Rhode Island. And Senator Dick Durbin, Democrat of Illinois, may bring the exhibit to the halls of Congress as part of his Darfur efforts.
With such progress in just a year, Thomas is unfazed by the fact that she started it all herself. "I come from a family in which failing after a strong attempt was something to be proud of. Not trying was really an embarrassing state."
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Dr. Jim Yong Kim in Uganda.
Saving Malawi's Children
Madonna talks with Dr. Jim Yong Kim, a Harvard professor whose work has led to greatly improved aids treatment in Africa.
VF.COM June 5, 2007
Madonna first visited Malawi in April 2006. She's been there twice since, including a trip last October to adopt her son, David, who was then suffering from malaria and pneumonia. Through her Raising Malawi organization, Madonna is helping to foster sustainable solutions for the Malawian people, especially its most defenseless children. She's also working on a documentary about the orphans of Malawi.
Madonna and daughter Lourdes with 19-month-old David Banda, on a visit to the Malawian orphanage Home of Hope, April 2007. View a slide show of Malawi's children. AFP/Getty Images.
Below are excerpts from her conversation with Dr. Jim Yong Kim, a founder of Partners in Health, which provides medical care and social services to the world's poorest patients. Dr. Kim is currently based at Brigham and Women's Hospital and Harvard University. He works to bring good medicine to people without access; his campaigns have helped increase aids treatment in Africa eightfold.
For more about Madonna's work in Africa, see "Raising Malawi."
Madonna: A lot of people ask me, "Why did you choose Malawi?" I always say that Malawi chose me. Victoria Keelan, a businesswoman who was born and raised in Malawi, contacted me through a mutual friend and said, "Look, if you're in the business of helping children, we have over a million orphans here in Malawi, and the problem is insane. It's an emergency. They need your help." She reached out to me because I do a lot of fund-raising for an organization called Spirituality for Kids, which helps children in impoverished conditions everywhere in the world, whether it's Palestine, or East L.A., or New Orleans after Hurricane Katrina, or the Bronx, Miami, Mexico City—all over the place.
I must admit that I didn't really know where Malawi was when I first heard about the situation there. I had certainly heard about the aids pandemic in sub-Saharan Africa, and in more well-known countries like Ethiopia and Rwanda. But not Malawi. So I educated myself, and I couldn't say no, and it just seemed like a good idea. I sort of dove in.
Dr. Kim: When was your first trip?
Madonna: A year ago April. I've only been there three times, but so much has happened in a year. I'm thrilled because, as you know, it takes a lot of time and a lot of work to get things done. It was great to go back and see so many things manifested. But once you start turning over rocks and reaching out to help people, there's a whole avalanche coming right behind it. And it seems never-ending. But when you see the fruits of your labor, you feel like it's possible.
Dr. Kim: One of the things we've learned is that you've got to take lots of joy out of small victories. That's what keeps you going.
Madonna: Yes, and you have to stop fixating on things, too. I found myself getting really angry when I went into [the slums] and was visiting families or single people living with aids who we're supposed to be helping with home-based care. I would talk to people through translators and find out that they were getting all the wrong medication. That drove me bonkers, and I almost ripped my hair out. Those little things get me down, but then you realize there are all these other great things happening: the Millennium Villages have surplus crops, and orphan-care centers are being built. So you have to focus on the things that are getting done.
There are some kids you can help by building orphan-care centers they can visit during the day. It's a place to go, and there's food; they can have their health needs taken care of, and they can get an education. And then they can go home and sleep with their extended family. There are other orphans who are in such dire straits—they're living on the streets, and you need to find foster homes for them, or you need to send them to private schools. And some kids just need psychosocial support to deal with the fact that they're living with their extended family. But no one's addressing what it feels like to lose your parents, and what's going on in the heads and hearts of these kids. If they're the future of the country, then we need to do something about it.
I know that you're dealing with everything from alcoholism to orphans. There are just so many issues that need to be dealt with to raise up the level of someone's existence.
Dr. Kim: You mentioned alcoholism. We deal with that a lot in Russia—it happens to be one of the biggest complications in treating TB there. We're doing a lot of research on alcoholism and TB.
Madonna: I think there's very little difference between Moscow and Africa in some respects. Have you heard about the orphanages there?
Dr. Kim: Oh, God. They're just terrible.
Madonna: It's way more depressing in a way.
Dr. Kim: When I was at W.H.O. [the World Health Organization], the director general had been to every single depressing place in the world. And the one place that just ripped his heart out was an aids orphanage in Moscow. It was the most emotionally troubling place he'd ever been to. He started a fund-raising campaign—he sold all the gifts that had been given to him by all these different presidents. He put all the money into a Russian orphanage.
Madonna: Oh, well, God bless him.
Dr. Kim: Orphanages in general, Madonna, I have to tell you … I have a child. And it's just the most painful thing in the world even walking in there.
Madonna: I can't take it. I can't take it. It's difficult to watch people suffer, but it's so hard to watch children suffer. To see children lying on the ground in a daze, in a pool of urine with flies buzzing around their heads. It's unfathomable, and this is what the orphanage that David came from was like. I'm very happy to say it's not like that now, but it's just devastating. And there's another nursery we go to where a lot of the children are H.I.V.-positive, and they all weigh about three pounds, and they're all a year old. You hold these children and you think, How can I save them all, how can I make their lives better, what is their future. It's an unforgettable experience. I feel like everybody needs to take a sabbatical and go to Russia and Africa and work in orphanages and really witness true suffering. And then you'll just feel ridiculous for ever complaining about anything. Everybody needs that kind of reality check.
Dr. Kim: I think the second-worst thing I see on a regular basis is when parents can't feed their children.
Madonna: Yes, when they can't feed their kids—and then what they're pushed to do to feed their kids. Or just to sit and watch your child die of starvation. It's unthinkable when you consider how much we have.
Orphans are sort of my main focus—children are my main focus—so I have a question for you. From a health-care perspective, what is your approach for helping orphans?
Dr. Kim: Over time people have gone from just building orphanages around the aids epidemic. They're focusing more on preventing a generation of orphans. When people say, "What do orphans need the most?," I sometimes say, tongue in cheek, "Well, they need their parents more than anything else." So many children are being orphaned because of aids. That's why we push so hard for aids treatment.
Not too long ago, probably in 2000 or 2001, there were a lot of people who were still saying, "H.I.V. treatment is just not possible in Africa. All those 30 million people are just going to have to die." These are very nice, well-meaning people who sort of said, "It's not going to happen. Just forget about it and let them die." That's one of the things that we took on. We insist that people get treated. The other thing is that people need the whole range of services—not just basic health care, but help related to early childhood development, and whether they have a loving household. Those things are also really important.
The bad news is that there are a lot of orphans, and we have a lot of work to do. There isn't a single straightforward answer: "Well, if they just had orphanages …" No, it's going to be a little bit more complicated.
But the really, really good news is that there's plenty of money in the world to do these things. It just takes a small percentage of the money we spend on junk—and then we can invest it. There's more than enough money to do these things.
Madonna: If we would just stop spending money on killing people and start spending money on saving people?
Dr. Kim: Why not?
Madonna: [Laughs] It seems so simple.
Dr. Kim: I've looked at what you're doing with Raising Malawi. What would you like to see happen in the next five years? What do you want to see there as a result of the work of Raising Malawi?
Madonna: First of all, I'd like to know that we're getting a handle on the aids epidemic. Some people say that we've stabilized it, that the numbers are not increasing. I spoke to a woman who is the director of the ministry responsible for women and children's development, and she said that, according to studies, it's impossible to really know how many are sick, because there's such a stigma attached to being H.I.V.-positive. If people know they have it, they don't tell you. And the other thing is, it's so hard for a lot of people to get tested. If you go into most villages and orphanages and ask, "How many of the people in this village are infected?," they'll say, "Oh, 70 to 75 percent." Then you ask, "Well, how many people have actually been tested?," and they say, "Not even one!" So it's very hard to gauge, and there are a lot of elements that work against it.
It's not enough to just make ARVs [anti-retrovirals] more accessible; it's not enough to help diversify their crops; it's not enough to bring in the educational component, whether it's health education or just education in general. You still have to deal with traditional practices, which, especially in the more remote of Malawian places, have a huge stronghold. Some people still think that their illnesses are curses and spells that other people have put on them. Even if you give them a cure and they get better, they'll still insist it was a spell somebody put on them.
Dr. Kim: Paul [Farmer, the medical anthropologist who works to raise the standard of health care for the world's destitute] tells this great story about a woman he was treating for TB. She came every day, took all her medicines, and got better. Being an anthropologist, he was compelled to ask her, "What do you think caused your tuberculosis?" And she had this long explanation that had everything to do with sorcery. So Paul said, "But if you believe sorcery caused your TB, why did you take all your medicines?" And she put her hand on her hip and said, "My dear, are you incapable of complexity?" People think that if medicines are making them better, you should do that and talk to the voodoo priest. Cover all your bases.
Africa
Madonna: To me, the most important thing—aside from meeting people's physical needs, whether that's education, health care, clothing, food, a roof over their heads—is changing the mind-set and educating people. And most of all, most important, is empowering people and making them self-sustaining.
I want to continue to see that aspect changing and flourishing and growing. I want to see girls with educations. I think women are the future of Africa. I hate to sound like I'm being sexist, but I interviewed a lot of women, and found, while watching a rough cut of my documentary, which is very far from being finished, that the people who are really doing the most to effect change in Africa right now are all women. They're the future. So I want girls everywhere to get an education.
After the English came and went in Malawi, after three decades of dictatorship and several more years of corrupt government, I feel like everyone in Malawi is walking around with this feeling like, "How can I make a difference in my country? How can my point of view be heard? I'm a nobody, I don't have any say, I don't have a point of view." I want to get rid of this inferiority complex. I want to help them to believe in themselves, to empower them. That's really what I want to see in the next five years. I'd love to see growth in all areas. You can't just go into a place and say, "O.K., I'm going to fix it with this one solution." That's naïve and impossible.
Dr. Kim: What do you think it's going to take to get more Americans engaged with all these problems?
Madonna: That's part of the reason I'm making the documentary. I want people to be moved, to feel called to action. That's what I want to do.
Americans live in a bubble, for the most part. I say that from my house in London. [Laughs] But obviously I'm an American, and I've spent most of my life there. We're very privileged as Americans—it's easy to forget about the rest of the world and to think that your problems are the most important problems. Even poor people in America live better than poor people most everywhere else. I can remember being poor and living on the streets in New York back in the day. But you could still scrounge up a dollar and go to Kentucky Fried Chicken, you know what I mean?
Being poor in Africa is something people in America can't relate to. Part of the challenge is bringing that reality to people and moving them. You have to arouse compassion. But, like Al Gore's movie, An Inconvenient Truth, it's not enough to raise awareness. You have to give people solutions, and you have to invite them to get involved in whatever way they can, whether that's doing volunteer work or taking a portion of their salary and figuring out where they want that money to go. You have to find ways to inspire people to get involved.
Look, it happened with me. Obviously, I know what's going on in Africa, and I've contributed money to various funds over the years. But until you go there and you see it and experience it, it just feels like a problem that's somewhere in the distance, and it doesn't really affect you. So you're not moved to do anything about it.
Dr. Kim: How are you going to bring your art together with this? Do you see the two efforts coming together somehow?
Madonna: I'm making a documentary about the orphans in Malawi. And it's not really about just Malawi; it's about all of Africa, because Malawi shares a lot of the same problems with other countries. Making a film is an expression of my art, and I believe I'm going to connect to people that way, as a parent and a human being of this world. I want to appeal to people's sense of humanity and interconnectedness. I feel like I have the platform I'm standing on for a reason. It's not just to make people happy and get people to dance and sing, to feel an escape. It's also to get people to listen and to bring important issues to the forefront. With the success I've had and the position I've earned in the world, people are listening to me, so I'd better have something important to say.
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Hope
Silvia Ng'andwe, 28, in late March 2007, Zambia. Below, Silvia after just 40 days on anti-retroviral drugs. Photographs by Antonin Kratochvil.
The Lazarus Effect
Dedicated to providing lifesaving drugs to Africans with aids, through a partnership between the Global Fund and companies such as Apple, Armani, and Gap, (Product) Red could be a revolution in consumer-driven philanthropy. The author reports on both sides of the equation: the marketing of sunglasses, sneakers, and T-shirts, and the medicine's miraculous effects on dying patients in the poorest countries.
by Alex Shoumatoff July 2007
A Population on the Mend
I am not sure what I expected to find inside the aids ward at the Kinyinya Health Center, but it sure wasn't empty beds. This local government facility sits on a hilltop on the outskirts of Rwanda's capital, Kigali, where some 7 percent of the population is infected with H.I.V., the human retrovirus that causes aids. So what gives? Where are all the sick people? "All the beds used to be full," says Dr. Fred Mutabazi, who works at the center. "Now there are much fewer patients, because of the ARVs."
First introduced in 1987, anti-retroviral drugs—ARVs for short—block H.I.V.'s assault on the body's immune system. As the drugs have improved, becoming less toxic and easier to take, they have largely turned aids in the Western world from a death sentence into a manageable disease. But the drugs' high price—a year's supply can exceed $10,000 in the developed world—has kept them way out of reach for most Africans. In 2003, a coalition of activists led by former president Bill Clinton pulled off the heroic feat of persuading four manufacturers to make ARVs available to developing countries for $140 a year. They accomplished this not by appealing to the corporations' sense of compassion but by pointing out that, if you sell 1,000 times as many drugs at one-hundredth the price, you still increase your earnings tenfold. The drug companies were well aware that the African market for anti-retrovirals is huge and getting bigger all the time: roughly 28 million Africans are living with H.I.V., and roughly 15 percent of them are in dire need of ARV therapy.
But $140 for a year's worth of ARVs is still beyond the means of most H.I.V.-positive Africans. So the question then was: How can the medicine be made available to them for free? This time it was President George W. Bush who stepped up to the plate, pledging $15 billion through the President's Emergency Plan for aids Relief (pepfar). In addition, the Geneva-based Global Fund has raised $10.5 billion from 52 governments to distribute among 450 programs to combat aids, malaria, and tuberculosis. The results are impressive: in 2002, only 50,000 Africans—1 percent of those who needed ARVs—had them. Today, 28 percent—or 1.34 million people—are getting the treatment. And the rate of increase is getting faster. Between December 2005 and December 2006, the number of Africans receiving aids drugs rose by 530,000—or 1,450 per day.
Even so, 5,800 people who could be saved are dying of aids every day. In 2005 the consortium of rich nations known as the Group of Eight (G-8) promised "nearly universal access" to ARVs by 2010. That requires an annual increase of 655,000 treated patients in Africa alone.
'Judo Strategy'
There are only two patients in Kinyinya's eight-bed aids ward. Dr. Mutabazi introduces me to one of them, an emaciated man in his early 40s. "He was much thinner when he came in, three months ago, and so weak he was carried in by his brothers," the doctor says. "Now he can walk again. He is on the mend." Dr. Mutabazi explains that the man is a miller, "and women who bring grain to get milled sometimes slept with him to get served first. He doesn't know who infected him, but thinks there are three main possibilities, women he was sleeping with in 1995. He became sick in 2002. It started with some small disease."
One of the outpatients, a 35-year-old pregnant woman who is also on ARVs, is strong enough to lead us at a fast clip through banana and cassava shambas to her house, a few hundred yards from the health center. We sit on sisal mats in the front room. "She was infected by her husband, who died in 2004, leaving her with two children," Dr. Mutabazi says, translating as the woman tells her story. "She found out that she had H.I.V. during a routine pregnancy. She never suspected she had it. She is from Gikongoro [about 70 miles southwest of Kigali], but she came here for treatment, which is common: usually they come from far away, because they don't want the community to know. She made friends here and gets food from the center, so two years ago she moved here to be close to it. Later on, as you see, she became pregnant by a man, who also has H.I.V. He took off and is no longer in the picture. Her two children are with her mother, so there is social sharing of the burden. She has a support system, which many don't. Even if she dies, her brothers will take care of her children, but she doesn't think she will. Compared with the state she was in in 2004, she thinks she will survive. The ARVs have given her new life."
These two survivors are examples of what is being hailed as "the Lazarus effect." In the Gospel of John, Jesus raises a man named Lazarus from the dead, and in essence that's what these drugs are doing for people with aids. Antonin Kratochvil's photographs accompanying this article show the extraordinary transformation that can take place in critically ill patients after as little as 40 days of ARV treatment. While there is still no cure for aids, some patients have been restored to vibrant normalcy in just three months.
This medicinal miracle wouldn't be possible without the efforts of foundations such as the Global Fund, which began distributing free ARVs in Rwanda in 2004. The Global Fund gets most of its financing from world governments, but a growing proportion ($25 million by the end of 2006) comes from an altogether unlikely set of benefactors: Western retailers and the shoppers who can't resist them.
I admit to having been skeptical at first about the concept behind (Red). Buy a $170 pair of sunglasses and save the world? Give me a break. Not until I met Bono, the U2 singer, activist, and guest editor of this issue, did I understand what a fiendishly ingenious concept it is. "To change the world we need consumer power; idealists and activists alone will not get the job done," Bono told me. "(Red) is a gateway drug into a bigger movement."
The idea behind (Red) is simple: participating companies, which so far include American Express, Apple, Armani, Gap, Motorola, and Converse (a subsidiary of Nike), sell (Red)-branded products. Forty percent of the gross profits from those sales go to providing free ARVs to Africans with aids. As the Web site Joinred.com puts it in its bluntly worded manifesto:
(Red) is not a charity. It is simply a business model. You buy (Red) stuff. We get the money, buy the pills and distribute them. They take the pills, stay alive and continue to take care of their families and contribute socially and economically in their communities.
Hope
If they don't get the pills, they die. We don't want them to die. We want to give them the pills. And we can. And you can. And it's easy.
For the participating companies themselves, the appeal is strictly business. "What's in it for them is they get new customers, people who will buy your stuff if you do the following thing: give a percentage to the Global Fund," says Bobby Shriver, Bono's partner in (Red).
"It's judo strategy," adds Bono, "using the strength of your opponent to overthrow him." In this case the "opponent" is a criminally imbalanced world economy, where the residents of developed nations live in luxury while those of poor countries are lucky to scrape by. As Bono said at an N.A.A.C.P. event last year, "Where you live should not determine whether you live or die."
Shriver, a Los Angeles–based venture capitalist who happens to be a nephew of J.F.K. and the brother of California First Lady Maria Shriver, met Bono in 1987, when U2 contributed a song to the Special Olympics benefit album A Very Special Christmas. Shriver was a producer on the album (his mother, Eunice Kennedy Shriver, founded the Special Olympics in 1962), and it was probably inevitable that the Kennedy cousin and the socially conscious Irish rock star would hit it off.
As time went on, Bono began devoting more and more energy to the Jubilee 2000 movement to cancel debt for the world's poorest nations. (He says his music didn't suffer: "In fact, the opposite!") Jubilee was a coalition of religious, human-rights, and environmental groups, and its petition attracted millions of signatures in Europe but not nearly as many in the U.S. In 1998, Bono reached out to Shriver and asked him to help get America on board. "We thought we'd be at it for a few months, but it turned into seven, eight years," Shriver said. "The first thing that evolved was data, for Debt, aids, Trade, Africa, which lobbied Congress to increase its largesse. It also stands for Democracy, Accountability, Transparency—the things that the African countries have to do to make sure the money goes where it is supposed to. It was tough slogging. There were no votes in this one. We talked about having pig roasts, going to schools, and [appealing to] soccer moms. We started One: The Campaign to Make Poverty History, to get Americans to realize you could transform the future of the poorest people with only 1 percent more of the U.S. budget, directed at fair trade, debt relief, aids, education, clean water, care for orphans." Now comprising some 60 organizational members, One has recruited 2.5 million Americans to its campaign to fight aids and extreme poverty.
At the Gleneagles G-8 summit, in July 2005, Bono and Bob Geldof, another Irish rock star and activist, fronting a list of 31 million names from around the globe, persuaded the World Bank, the International Monetary Fund, and multilateral lenders including the African Development Bank to forgive $40 billion in debt owed by 18 of the world's poorest countries, all but 4 of which were African. The G-8 also promised to double their annual aid to Africa, from $25 to $50 billion, by 2015. "Getting the promises was one thing," Bono says. "Mobilizing public pressure to keep them was another."
One day in early 2004, Bono had a conversation with Robert Rubin, who had been secretary of the Treasury under Clinton, about the difficulty of engaging the American public on development issues. Rubin told him, "You'll never get this issue out there unless you market it like Nike." And with that, the idea was born for a new product line that would exploit the potential of a whole new sector of the U.S. economy.
Bono is the one who named it (Red), a color that brings to mind red alerts, the Red Cross, even the Red Army. The revolutionary undertone was appropriate, for this was a subversive new model in the staid world of cause marketing. By allowing partners to share in the profits, (Red) brought a whole new set of players into the aid game—and gave a scare to some in the nonprofit sector, who worried that "business … taking on the patina of philanthropy," as one academic put it, was going to cut into their action.
(Red) targeted the iconic brands: American Express was their first taker. Gap signed on for a (Red) line of clothing, Converse for (Red) sneakers, Motorola for (Red) cell phones, Apple for (Red) iPod Nanos, Armani for (Red) apparel, sunglasses, and wristwatches. "All of our relationships with these companies are with their marketing departments, not their public-relations, social-responsibility, or philanthropy divisions," says Shriver. "Good business is more sustainable than philanthropy, because next year there could be a tsunami and the support you were counting on could go there."
The companies agreed to divert tens of millions of dollars from their marketing budgets into a campaign publicizing (Red) and the African aids crisis. Christy Turlington, Steven Spielberg, and Chris Rock were photographed by Annie Leibovitz wearing (Red) clothes from the Gap, Gisele Bündchen posed with a Masai warrior and her (Red) AmEx card, and Kanye West and Penélope Cruz joined Bono on Oprah to unveil the line in time for Christmas 2006.
Some have criticized (Red) for spending more on marketing than the $25 million it has so far generated for the Global Fund. But, according to Shriver, this accusation is unfounded. In fact, he says, (Red) doesn't spend any money on advertising; the splashy campaigns are paid for with money diverted from its partners' existing marketing budgets. He also points out that $25 million is more than China, Australia, and Switzerland combined gave to the Global Fund last year.
So what do you call this?, I asked Bono when we met for dinner in Dublin this spring. Humanitarian self-indulgence? Bono borrowed my notebook and wrote the words "Fair Vanity." That's what he was hoping to talk V.F. editor Graydon Carter into letting him name this issue. (I told him not to get his hopes up. In 1997, I lobbied Graydon unsuccessfully on the idea of devoting a whole issue to global warming and calling it "Vanity Air." Guess I was a bit too far ahead of the curve on that one.)
Bono explained that unfair trade restrictions, enforced by the World Trade Organization, are giving African nations little chance of gaining economic traction. But the proliferation of fair-trade-certified products such as coffee, tea, chocolate, tropical fruit, rice, and sugar, which encourage sustainable farming methods and ensure that the farmers and workers receive fair compensation, proves that consumers can make a big difference simply by changing their buying habits. To quote the manifesto on Joinred.com, "As first-world consumers, we have tremendous power. What we collectively choose to buy, or not buy, can change the course of life and history on the planet."
'Post-Colonial Approach'
Most Westerners know Rwanda only as the site of the 1994 genocide, in which more than half a million Tutsi, together with thousands of insufficiently sectarian Hutu, were slaughtered in just a little more than three months. But much has happened in the past 13 years, and today Rwanda can claim a happier distinction, as one of Africa's leading success stories in the battle against aids.
Rwanda has managed to reduce the H.I.V.-positive proportion of its population from a high of 21 percent in the 1980s to around 3 percent today. Some of the decrease is actually attributable to the genocide, according to Dr. Étienne Karita, a virologist in Kigali, who has been tracking 500 H.I.V.-positive Rwandan women since 1986. Of those women, 200 were killed in the genocide and 200 have died of aids.
The bulk of the credit for Rwanda's decline in H.I.V. infection, however, goes to the post-genocide government of President Paul Kagame, which launched an ambitious campaign to educate the population on the ABCs of prevention, as they're called in neighboring Uganda: practice Abstinence, Be faithful, use a Condom. Thirty-nine percent of Rwandans are still illiterate, but, in the words of Dr. Innocent Nyaruhirira, Rwanda's minister of state in charge of H.I.V./aids and other epidemics, "We have a population that is responsive to guidance."
Of the 136 countries that receive aid from the Global Fund, Rwanda is one of the star performers. In 2004, it became one of the first countries to distribute ARVs with the Global Fund's help, and it launched another countrywide education campaign, urging people to come in and be tested. The Global Fund, which allocates the money raised by (Red), recommended Rwanda as the recipient of the campaign's first grant.
As in many African countries, there had been a terrible stigma attached to being H.I.V.-positive—especially for unmarried girls, since pre-marital sex is taboo for women. But by 2004 just about everyone in Rwanda had seen a family member succumb to aids. This destigmatized the disease, and the response to the new campaign was overwhelming. Since the program began, the 122 health facilities sponsored by the Global Fund have tested 635,300 people and provided 14,571 of them with free ARVs. (An additional 20,000 Rwandans receive the drugs from other foundations, including the Bill & Melinda Gates Foundation and pepfar.) The Global Fund soon launched a similar program in Zambia, where Antonin Kratochvil took the photographs to accompany this article.
"The programs are designed by the people in the country," says the Global Fund's outgoing executive director, Dr. Richard Feachem. "We treat our recipients as equals and grown-ups. This is not a patronizing relationship; it's the first truly post-neocolonial approach."
'There Is Hope'
Dr. Anita Asiimwe, the managing director of trac, the Rwandan Health Ministry's Treatment and Research aids Center, gives me a tour of its main clinic, in central Kigali. The waiting room—basically a roof providing shade and rain protection to benches filled with women and children—is divided into three areas: one for blood work, one for consultation, and one for dispensing the drugs. "Most of the people who come in for testing are presenting something chronic, like a cough and weaknesses, so they are questioning themselves why they are not feeling better," Asiimwe explains. "Others have had sexual behavior they think is risky, have lost a partner, or have been sent by doctors. If they are found positive, they are given counseling about their situation, and then a clinical exam to determine if they have any opportunistic diseases." Tuberculosis is the most prevalent and stubborn one, with new, multi-resistant strains arising all the time.
The doctors measure the aids virus's progress in attacking the immune system by testing each patient's level of CD4 immune cells. Patients with a count of more than 500 are released without further treatment. Those whose CD4 levels are between 500 and 350 are told to come back for more tests in three months. Those who score between 350 and 0 are eligible for ARVs.
The first-line regimen is usually a combination of three pills, taken twice a day. If side effects occur, the medication is adjusted. But if the virus is resistant to the first-line regimen, it is withdrawn and a completely different cocktail is prescribed. This second-line regimen is much more expensive, costing between $500 and $1,200 a year. The Clinton Foundation has just negotiated a deal with two India-based manufacturers of generic ARVs to provide the second-line regimen for a dollar a day to 1.5 million Africans by 2010.
I am introduced to a woman who developed lipodystrophy from taking her first trio of ARVs. A distortion of the body-fat distribution in the arms, legs, breasts, face, and buttocks, lipodystrophy is a common complication of stavudine, one of the medications that was in her first-line cocktail. When that was replaced with abacavir, the woman returned to normal. Still, she complains that the drugs are so strong she can't stand them without eating well, but since she isn't working, she can't afford food. The need for nutritional support was underforecast and underfunded, Asiimwe tells me. It will likely be written into the next grant proposals later this year.
Another patient, Angélique, 16, started on ARVs four years ago. "She used to be sickly, and now she can go on with her life," Asiimwe says. "She's a good student, fourth in a class of 40, and wants to be a doctor. Both her parents died—she doesn't know how—but she and her older sister were both probably infected perinatally by their mother when she was carrying them. Her neighbor, an old lady, became her guardian, but even the guardian died of aids. Her sister, who is also on ARVs, was taking care of her, but she now is in the hospital herself. We see many children with problems like this." I ask Angélique if she has anything to say to the Westerners who will be reading about her. Her message is "Thank you so much for these ARVs, because otherwise I'd be dead."
Among those in the waiting room are some of the 316,414 pregnant women who have volunteered for H.I.V. testing and counseling in Rwanda since 2004. There is a drug called nevirapine that helps prevent perinatal transmission, but a mother with the virus can still transmit it through her milk. A video about the danger of infecting your baby through breast-feeding is playing in the waiting room. Most women are unable to afford formula, and those who can afford it don't always have safe water to mix it with. The cheapest and most available alternative to infected breast milk is cow's milk, but the clinics don't have the money or infrastructure to distribute it. So here is another need that could be addressed with an influx of (Red) revenue.
"There is hope," says Florence Mukakabano, the principal nursing officer at the university hospital in Kigali. "The medicine is at least sustaining people." Mukakabano takes me through her hospital's pediatric ward, through the malnourishment room, the malaria room, the chest-problem room. "This cubicle is for very sick ones who need oxygen," she says, peering down at a tiny, nine-day-old girl with a mask strapped to her face. The girl is having difficulty breathing, for reasons not yet diagnosed.
As we enter the next room, a 13-year-old orphan named Toma appears from under a crumpled sheet. He is H.I.V.-positive, and very small for his age. "Toma has come in to be trained on how to take his ARVs," Mukakabano explains. "The drugs are very strong. He has to be taught how to eat. He has no family members. He came in very weak. Somebody brought him in. He does not know where he will go. When they are found to be positive, they are often abandoned by their families. He will go to an orphanage. We have many like this one." There are roughly 160,000 aids orphans in Rwanda.
"aids attacks Hutu, Tutsi, everybody, every background, and it will kill you unless you do A, B, C, and D," says Paul Kagame, the slender, austere 59-year-old Rwandan Patriotic Front leader who has been Rwanda's president since 2000. "We have no great reserves of minerals or timber, no oil. Our only asset is our people, so we are investing all of our resources in health and education. But our resources don't match our needs, so the fact that the private sector in the West is contributing to our well-being, to have thought of it and initiated it, is a wonderful thing. The brain behind that was brilliant."
Thanks to Kagame and foundations such as the Global Fund, ARVs have been distributed to a remarkable 67 percent of Rwandans who need them. Since 2004, the fund has disbursed $49 million in the country; of that amount, $14.3 million has come from (Red) since its launch last year. But, unlike government aid budgets, the private sector has the advantage of being a largely untapped resource. There is plenty of room for (Red) and programs like it to grow, and plenty of incentive to make them work.
"data members are walking the halls of Congress, One Campaigners are marching in the streets," says Bono. "And (Red) plays a key role in reaching parts that traditional activism cannot—raising more cash and adding mainstream appeal. It takes lobbyists, activists, and consumers to make a social movement of the kind we're trying to catalyze."
Back home in Montreal, I visit the Gap's flagship store, in the Eaton Mall. There, prominently displayed, is the full (Red) line: T-shirts, jeans, hoodies, raincoats, candles, journals, cosmetics. A stylish young African-Canadian saleswoman tells me they're selling pretty well. "The majority is bought by parents for their kids' Christmas or birthday presents," she says. "They figure, I'm giving my child a gift and also giving back. Clothes make you feel good. They make you stand tall, and these clothes make you feel great, because you know they're going to something."
Not all (Red) products are available universally, however. You need to be a U.K. resident to get the AmEx card, and Foot Locker—one of the largest shoe chains in the U.S.—won't carry (Red) Converse sneakers until this month. In the meantime, you can always buy them online or at the Gap. And with all the (Red) partners signed up for five years, and new ones expected to join this year, the plan is for (Red) to spread.
Naturally, the campaign still has its share of skeptics. I spoke to one woman from Montreal who works at Mother Teresa's orphanage in Kigali and is trying to set up housing for child-headed families orphaned by aids. "Isn't it pathetic," she reflected, "that to get money out of the rich you have to get them to buy something?" But then there's the view expressed by a Rwandan-exile friend of mine, who recently moved back to Kigali: "Whatever works."
Alex Shoumatoff is a frequent contributor to Vanity Fair and the author of the 1988 book African Madness. His writings can be found online at Dispatches from the Vanishing World.
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Out of Africa
Somewhere between 80,000 and 50,000 years ago, Africa saved Homo sapiens from extinction. Charting the DNA shared by more than six billion people, a population geneticist—and director of the Genographic Project—suggests what humanity "owes" its first home.
by Spencer Wells July 2007
For more about the Genographic Project, visit nationalgeographic.com.
Guest editor Bono as a toddler, circa 1961, with maps showing the migrations of his matrilineal (top) and patrilineal ancestors (middle), based on analysis of his DNA. His father's ancestors were among the first modern humans to enter Europe. Courtesy of the Hewson family.
Do you think you know who you are? Maybe Irish, Italian, Jewish, Chinese, or one of the dozens of other hyphenated Americans that make up the United States melting pot? Think deeper—beyond the past few hundred years. Back beyond genealogy, where everyone loses track of his or her ancestry—back in that dark, mysterious realm we call prehistory. What if I told you every single person in America—every single person on earth—is African? With a small scrape of cells from the inside of anyone's cheek, the science of genetics can even prove it.
Here's how it works. The human genome, the blueprint that describes how to make another version of you, is huge. It's composed of billions of sub-units called nucleotides, repeated in a long, linear code that contains all of your biological information. Skin color, hair type, the way you metabolize milk: it's all in there. You got your DNA from your parents, who got it from theirs, and so on, for millions of generations to the very beginning of life on earth. If you go far enough back, your genome connects you with bacteria, butterflies, and barracuda—the great chain of being linked together through DNA.
What about humanity, though? What about creatures you would recognize as being like you if they were peering over your shoulder right now? It turns out that every person alive today can trace his or her ancestry back to Africa. Everyone's DNA tells a story of a journey from an African homeland to wherever you live. You may be from Cambodia or County Cork, but you are carrying a map inside your genome that describes the wanderings of your ancestors as they moved from the savannas of Africa to wherever your family came from most recently. This is thanks to genetic markers—tiny changes that arise rarely and spontaneously as our DNA is copied and passed down through the generations—which serve to unite people on ever older branches of the human family tree. If you share a marker with someone, you share an ancestor with him or her at some point in the past: the person whose DNA first had the marker that defines your shared lineage. These markers can be traced to relatively specific times and places as humans moved across the globe. The farther back in time and the closer to Africa we get, the more markers we all share.
What set these migrations in motion? Climate change—today's big threat—seems to have had a long history of tormenting our species. Around 70,000 years ago it was getting very nippy in the northern part of the globe, with ice sheets bearing down on Seattle and New York; this was the last Ice Age. At that time, though, our species, Homo sapiens, was still limited to Africa; we were very much homebodies. But the encroaching Ice Age, perhaps coupled with the eruption of a super-volcano named Toba, in Sumatra, dried out the tropics and nearly decimated the early human population. While Homo sapiens can be traced to around 200,000 years ago in the fossil record, it is remarkably difficult to find an archaeological record of our species between 80,000 and 50,000 years ago, and genetic data suggest that the population eventually dwindled to as few as 2,000 individuals. Yes, 2,000—fewer than fit into many symphony halls. We were on the brink of extinction.
And then something happened. It began slowly, with only a few hints of the explosion to come: The first stirrings were art—tangible evidence of advanced, abstract thought—and a significant improvement in the types of tools humans made. Then, around 50,000 years ago, all hell broke loose. The human population began to expand, first in Africa, then leaving the homeland to spread into Eurasia. Within a couple of thousand years we had reached Australia, walking along the coast of South Asia. A slightly later wave of expansion into the Middle East, around 45,000 years ago, was aided by a brief damp period in the Sahara. Within 15,000 years of the exodus from Africa our species had entered Europe, defeating the Neanderthals in the process. (Neanderthals are distant cousins, not ancestors; our evolutionary lineages have been separate for more than 500,000 years.) We had also populated Asia, learning to live in frigid temperatures not unlike those on the Moon, and around 15,000 years ago we walked across a short-lived, icy land bridge to enter the Americas—the first hominids ever to set foot on the continents of the Western Hemisphere. Along the way we kept adapting to new climates, in some cases lost our dark tropical skin pigmentation, developed different languages, and generated the complex tapestry of human diversity we see around the world today, from Africa to Iceland to Tierra del Fuego. But the thing that set it all in motion, the thing that saved us from extinction, happened first in Africa. Some anthropologists call it the Great Leap Forward, and it marked the true origin of our species—the time when we started to behave like humans.
Africa gave us the tool we needed, in the form of a powerful, abstract mind, to take on the world (and eventually to decode the markers in our DNA that make it possible to track our amazing journeys). Perhaps just a few small genetic mutations that appeared around 50,000 years ago gave humans the amazing minds we use to make sense of the confusing and challenging world around us. Using our incredible capacity to put abstract musing into practice, we have managed to populate every continent on earth, in the process increasing the size of our population from a paltry few thousand to more than six billion. Now, 50 millennia after that first spark, times have changed. A huge number of things have contributed to Africa's relative decline on the world stage, perhaps most important geography. As Jared Diamond describes in his masterly book Guns, Germs, and Steel, Eurasia, with its East-West axis, allowed the rapid latitudinal diffusion of ideas and tools that would give its populations a huge advantage after the initial leap out of Africa. Couple that with the results of colonial exploitation over the past five centuries, and Africa, despite many strengths and resources, is once again in need, as it was 70,000 years ago. This time, though, things are different.
The world population that was spawned in Africa now has the power to save it. We are all alive today because of what happened to a small group of hungry Africans around 50,000 years ago. As their good sons and daughters, those of us who left, whether long ago or more recently, surely have a moral imperative to use our gifts to support our cousins who stayed. It's the least we can do for the continent that saved us all thousands of years ago.
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