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Bill & Melinda Gates Foundation

Melinda Gates and Nick Kristof Answer Your Questions, Part III

January 13, 2012

This is the final post in a series of three where Melinda Gates and the New York Times' Nick Kristof answer your questions about maternal, newborn, and child health. Check out the first post and read all of Melinda's and Nick's answers!

Q. ELAINE HARRIS: Presumably Melinda is visiting Bangladesh to ascertain the needs specifically related to women and children and ultimately providing assistance. What an amazing position to be in. How will the needs be evaluated? How will the women and children of Bangladesh be involved in the solution? Thank you both for engaging in these humanitarian efforts.

A. MELINDA: One of the best parts of my job is that I get to travel to places like Bangladesh to talk to women about their lives. I learn so much from them. Some of the most extraordinary innovations in health and development in recent decades have come from simple conversations that start with asking people what they need. I particularly like to ask mothers what they dream about for their children’s futures, and the answer is almost always the same wherever I go. They want their children to grow up healthy, and they want to be able to send them to school.

We know from experience that getting people to change their behavior is the single most important factor in determining whether innovations in health succeed or fail. If we don’t understand the traditional and cultural practices in a community, we won’t be able to work with them to discover and promote healthy changes in behavior. We have to listen. I’ve heard many people say that behavior adoption is a “last-mile” problem—if only we could get these communities to take up services! But at least one brilliant researcher from India sees it differently. He says that this isn’t the last mile at all. It’s actually the first mile and until we realize that everything starts with the community, we will never succeed.

Here in Bangladesh, women and children have long been part of the solution in a whole host of ways. Well-known movements like microfinance rely on the ingenuity of women. But women and their children are making other contributions too. Several times this week, I had the chance to visit the world-class research centers at the International Center for Diarrheal Disease Research, Bangladesh, or ICDDR,B for short (though it is still a mouthful!). ICDDR,B is a locally-based institute that has been working hand-in-hand with mothers from poor communities for several generations. Mothers enroll their children in scientific studies run by ICDDR,B to generate data used by decision makers in Dhaka and all over the world. These local partnerships ultimately impact the lives of millions of women and children.

Residents of the Mirpur locality in Bangladesh, which is part of an ongoing Cholera Vaccine Behavior Modification study being organized by the International Center for Diarrheal Disease Research, Bangladesh.

A. NICK: Let me just echo what Melinda said about the importance of listening. When development plans go awry, it’s often because they were cooked up by smart people sitting around a conference table in the West. When plans go right, it’s often because organizers listened to local people in the villages, got their buy-in and supported them. So if you want to make a difference, it helps to learn about economics and health and other fields, but above all: Learn to be a good listener.

Q. GARY HOWLETT: What are the top three things you are the most excited/optimistic about?

A. MELINDA: There is amazing progress happening all over the world. If I had to pick one metric to gauge that progress, it would be the number of children who die before their 5th birthday. In 1960, 20 million children died. In 1990, that number was just over 12 million. Today, it’s down to7.6 million. The decline is being driven by countries like Ethiopia, where a massive scale-up of health workers and health posts helped to bring down child deaths by nearly 30 percent over the past five years alone, according to a preliminary report from Demographic and Health Surveys. It’s also dropping here in Bangladesh, which is on track to meet and exceed the Millennium Development Goal related to reducing child mortality despite the fact that it is quite a poor country. Child deaths here have fallen by 65 percent since 1990!

Second, I am thrilled that we are starting to see a revival in support for family planning, which I believe is fundamental to global health and development. Back in November, we participated in the International Family Planning Conference in Dakar, Senegal, and it was exciting to see leaders from around the world come together to champion family planning. We can’t talk about the health of women and children without talking about family planning– access to contraceptives must remain front and center on the global health agenda.

Lastly, I am inspired by the innovation I see all the time in the developing world. Today in Mirpur, Bangladesh, I visited a study site that is evaluating whether giving a vaccine while improving hand washing rates and chlorinating water can help prevent cholera better than the vaccine alone. What struck me was how many small innovations were used in this campaign. I’ll give you two examples.

First, the team had to figure out how to encourage people to put chlorine in their water to disinfect it. They studied other models around the world and found an innovative approach from Kenya. The promoters of the Kenyan study were having a tough time getting people to treat their water with chlorine at home. They tested a variety of approaches and zeroed in on one that stood out—chlorinate water at its source instead of in the house. Putting chlorine dispensers at water sources visibly reminded people to chlorinate water at the exact moment when water was on the mind. Usage of chlorine skyrocketed.

Children stand beside a hand-washing station and a chlorine dispenser in a compound in the Mirpur locality of Bangladesh. The chlorination effort is part of the International Center for Diarrheal Disease Research, Bangladesh’s Cholera Vaccine Behavior Modification study.

Second, some community members in Mirpur were having trouble remembering how and when to properly use the dispenser. So the local community health workers came up with a solution—have community members draw out the process on a piece of paper and tape that near the water source too. Since community members had to describe the process on their own terms through drawing, they were better able to retain this information.

A. NICK: The three things that leave me most excited are these:

First, Africa is becoming economically more dynamic, with economic growth that has nothing to do with foreign aid. And ultimately it’s business, industry, agriculture and investment that transform countries, not handouts. Africa is now the fastest growing part of the world, and some countries are real standouts and serve as models for their neighbors. I think we’re close to a time when the world will envy Africa its economic dynamism, not pity its stagnation.

Second, Malaria has long been one of the world’s greatest scourges, not only killing vast numbers but also sickening 100 times as many. It’s also a huge burden on the economy and on education in poor countries. But over the last decade we’re registering enormous progress, and the number of people dying from it is tumbling fast. For any of us who have had malaria, and who have seen children dying of it so needlessly, that’s a huge reason to celebrate.

And third: When I first backpacked through Africa as a law student in 1982, the single sight that pained me the most was the blind beggars. Every city had them, men or women with a stick and led by their children or grandchildren – who of course had to be pulled out of school as a result. And vast tracts of Africa couldn’t be farmed because they were home to the parasite that causes river blindness. These days, there are many fewer such beggars, and there’s been tremendous progress against all kinds of blindness. Trachoma is easily prevented with cheap antibiotics. Vitamin A deficiency is prevented with Vitamin A drops that cost almost nothing (and that save lives as well). And thanks in part to the heroic efforts of Jimmy Carter, river blindness is on the decline and vast areas of farmland have been returned to production.

Natchimou Bagna, 47, who suffers from river blindness, at the entrance to his home, a thatched roof hut in Molii, a village in the Say district of Niger. Nick and his two 2011 Win A Trip winners, Saumya Dave and Noreen Connolly, visited with Mr. Bagna last summer. River Blindness will soon be a disease of the past thanks to efforts by The Carter Center.

Let me also just say that this was a great question. Journalists and humanitarians sometimes focus too much on all the things that are going wrong – because journalists always write about problems, and because humanitarians want money to solve problems. But a relentless focus on the negative leaves many Americans with a sense that global poverty efforts have been a failure, when in fact they have saved vast numbers of lives, improved the health of countless people, hugely increased the scale of education, cut back birth rates, and reduced the toll of wars (such as the Congo civil war, perhaps the bloodiest since World War II). The truth is that the struggle against global poverty is a successful campaign that we’re winning. We shouldn’t feel depressed about the trajectory of hunger and disease, but exhilarated. On our watch, we can wipe out the worst afflictions of poverty that have haunted humanity as long as there have been humans.

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