A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa
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A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa
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Overview
The complex relationships between altruists, beneficiaries, and brokers in the global effort to fight AIDS in Africa
In the wake of the AIDS pandemic, legions of organizations and compassionate individuals descended on Africa from faraway places to offer their help and save lives. A Fraught Embrace shows how the dreams of these altruists became entangled with complex institutional and human relationships. Ann Swidler and Susan Cotts Watkins vividly describe the often mismatched expectations and fantasies of those who seek to help, of the villagers who desperately seek help, and of the brokers on whom both Western altruists and impoverished villagers must rely.
Based on years of fieldwork in the heavily AIDS-affected country of Malawi, this powerful book digs into the sprawling AIDS enterprise and unravels the paradoxes of AIDS policy and practice. All who want to do good—from idealistic volunteers to world-weary development professionals—depend on brokers as guides, fixers, and cultural translators. These irreplaceable but frequently unseen local middlemen are the human connection between altruists' dreams and the realities of global philanthropy.
The mutual misunderstandings among donors, brokers, and villagers—each with their own desires and moral imaginations—create all the drama of a romance: longing, exhilaration, disappointment, heartache, and sometimes an enduring connection. Personal stories, public scandals, and intersecting, sometimes clashing fantasies bring the lofty intentions of AIDS altruism firmly down to earth.
Swidler and Watkins ultimately argue that altruists could accomplish more good, not by seeking to transform African lives but by helping Africans achieve their own goals. A Fraught Embrace unveils the tangled relations of those involved in the collective struggle to contain an epidemic.
Product Details
| ISBN-13: | 9781400884988 |
|---|---|
| Publisher: | Princeton University Press |
| Publication date: | 03/07/2017 |
| Series: | Princeton Studies in Cultural Sociology , #72 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 304 |
| File size: | 6 MB |
About the Author
Read an Excerpt
A Fraught Embrace
The Romance & Reality of AIDS Altruism in Africa
By Ann Swidler, Susan Cotts Watkins
PRINCETON UNIVERSITY PRESS
Copyright © 2017 Princeton University PressAll rights reserved.
ISBN: 978-1-4008-8498-8
CHAPTER 1
INTRODUCTION
Altruism from Afar
ALTRUISM FROM AFAR — THE FLOWS OF money and help from wealthy countries to poor ones — has become an enormous and enormously significant enterprise. We describe the efforts of altruists to turn the tide of new HIV infections in Malawi, to alleviate the suffering of the already infected, and to assist the orphans of those who have died. We focus on AIDS prevention rather than treatment, since preventing HIV transmission has been the ultimate goal of the AIDS enterprise. Some altruists are vast international organizations, such as USAID, Save the Children, and Britain's DFID, with offices in many countries. At the other end of the spectrum are freelance altruists who hope to mitigate the effects of the epidemic, such as church groups and compassionate individuals. These alight briefly in Malawi and then fly home.
Malawi is a small landlocked nation in southeast Africa that shares borders with Zambia, Zimbabwe, and Mozambique. The two largest cities are Lilongwe, the capital, and Blantyre, the commercial center. In 2016, it had an estimated population of almost 18 million of which approximately 85 percent live in rural areas and rely primarily on subsistence farming and small-scale trading. Formerly a protectorate of Great Britain, Malawi gained independence in 1964 and was then ruled for thirty years by President Hastings Banda. Although Banda made English the official language, he resisted Western influences. Male tourists with long hair were turned away, as were women wearing trousers; the Peace Corps was expelled for promoting family planning. Banda's reign was followed by a succession of democratically elected presidents who were eager for Western development aid and the arrival of streams of altruists.
Not all have come to respond to AIDS: Malawi is one of the poorest countries in Africa, which has perhaps brought disproportionate attention from altruists, including the pop star Madonna, who adopted two Malawian children. Malawi also has other, more practical features that make it attractive to altruists. Banda's legacy of reasonably good roads, built to control his population, permits altruists to travel with relative ease to the most distant rural districts. Unlike countries in the region that have been consumed by war, Malawi has historically been and remains very peaceful. It is not surprising then that altruists would come to Malawi rather than, say, the Congo.
In this book, we seek to explore the imaginations as well as the practical concerns of the actors in the drama of AIDS as it has played out in Malawi: altruists' visions of transforming the lives of those at risk of infection, brokers' visions of upward mobility through new careers in a multitude of AIDS organizations, and villagers' visions of what altruists from afar could do for them.
We undertook research unusual in its breadth and depth. Over more than fifteen years, we observed the organizations that sprang up in response to the epidemic, the altruists who arrived in Malawi, the brokers, and their struggles and successes. We also learned much about the lives of the villagers. We wanted not only to understand what altruists actually do, but also to understand the many other actors whose own aspirations inevitably shape — or frustrate — the altruistic projects imagined by those trying to do good at long distance.
A STORY OF COMPASSION
To explore what motivates altruists great and small, we turn to the testimony of a very successful one, Bill Rankin, who founded GAIA, the Global AIDS Interfaith Alliance, which works in Malawian villages:
Two years ago, when Bill Rankin visited Tiyamike School he had come away greatly disturbed by the 27 three- and four-year old orphans. Their nutritional status rendered them virtually inert and mute. All Mrs. Mpesi could afford was a half cup of maize porridge (nsima) for each child every other day, and sugared water or tea in between. But in May 2004 GAIA trustees Nancy Murray, Dr. Don Thomas, and International Programs Director Ellen Schell visited the little village in which the nursery school is operated, near Zomba, Malawi. They recorded a remarkable change that had taken place, owing to the generosity of many of you.
This year 75 orphans receive two meals each day: a breakfast of porridge, and a lunch of corn meal, vegetables, and sometimes dried fish. There is a new outdoor house in which the children gather and play. Though the number of orphans continues to grow, the kids are full of life, bouncing around the yard and eager to have their pictures taken.
Everywhere we went, we saw powerful evidence of hope in the face of HIV's ravages. For three days we visited our women's empowerment project funded by the Bill and Melinda Gates Foundation. Working in 25 villages in Malawi's famine-stricken south, the 125 community caregivers provide HIV prevention education, care for orphans, and care for people who are ill. All have energized their communities to mount a response to the epidemic. All caregivers have undergone voluntary counseling and HIV testing as a way of setting a personal example to others. The door-to-door strategy of encouraging testing has produced results to a degree for which none had dared to hope.
Such descriptions of the suffering wrought by AIDS in Africa and of the remarkable transformations that are possible inspire broad publics in far-off lands to believe that they too can make a difference. During our stays in rural Malawi, we saw the institutionalized altruism of citizens of rich countries made evident in the many 4×4s with NGO logos on local roads and in the wistful eagerness of those we met who asked whether we had a "project" to assist them. We were impressed by just how many freelance altruists came in person to do good; we chatted with them on our flights to Malawi, in visa lines at the airport, in the motels where we stayed, and at hotel breakfasts in Lilongwe, Malawi's capital.
Day-to-day, of course, most of the help poor Malawians get is from each other. In a very insecure world with no formal social safety net, support networks are largely comprised of family members. Malawians also draw on friends and the patron-client ties we described in the preface. Small loans go back and forth in local social networks, larger ones when someone has a medical emergency; relatives cook food for a funeral and help with farming when someone is too sick to work. Malawians have a long tradition of mutual help and a deep appreciation of the moral obligations of redistribution and reciprocity that are the bedrock of everyday life. Almost everyone is helping — and receiving help from — others. Members of the many religious congregations cook, clean, bathe, and pray for the bedridden, and wealthier relatives in the city take responsibility for the AIDS orphans of their extended families in the villages.
In this book, we distinguish between Malawian networks of mutual aid and the altruists from afar. Those within local networks know each other well. In contrast, the foreign altruists vividly and sympathetically imagine afflicted Malawians, but they do not — and usually cannot — know much about their daily lives. On the other hand, the foreign altruists have vastly greater resources than do members of local networks. The foreign altruists also differ from Malawians in that, while they redistribute resources, they do not expect reciprocity, except perhaps thanks.
The roots of contemporary AIDS altruism are deep, going back to the eighteenth- and nineteenth-century humanitarian movements that sought to end slavery and bring enlightenment to the African continent, Christian missionary work, and, more recently, efforts of Western governments, foundations, and other organizations to spread the modern gospels of family planning, gender equality, and universal human rights. In the era of AIDS, the goals of altruistic organizations are equally broad: to transform women and men into rational, self-reliant citizens of the modern world capable of preventing HIV infection, and for those infected, capable of adhering to strict regimens of medication. In this century, the preaching occurs not from the pulpit but through messages disseminated by the media and through ubiquitous trainings — a noun referring to small group sessions led by brokers.
It is inherent in the nature of altruism that the objects of the altruist's concern can neither get what they need on their own (otherwise they would not need the altruist's beneficence) nor choose what they are given. An important consequence is that hopeful beneficiaries must watch and wait to see what the altruist might feel moved to offer. Even — or especially — when the altruist wants to create not dependence but self-reliance, the potential recipients — as well as the brokers — must anticipate and interpret altruist wishes.
FRUSTRATED EMBRACES
While we are interested in what altruists imagine they are doing and in the aspirations they arouse, we pay special attention to brokers, whose lives have been transformed by the AIDS enterprise, often in ways the altruists did not expect. Many brokers work for NGOs on projects for HIV prevention and on orphan care (antiretroviral treatment is provided primarily by the Ministry of Health). NGO brokers range in status from cosmopolitan elites with graduate and post-graduate education who staff NGO offices in the cities, to district elites based in smaller towns, to young men and women with a secondary school education who desperately want a way out of the village through a job with an NGO. Malawians at all levels sometimes serve as impromptu brokers, such as a teacher or civil servant who comes across a foreigner and asks about the possibility of accessing funds to form his or her own NGO, or a taxi driver who offers to take a visitor to his village to see the orphans his mother is feeding.
All altruists, both institutional and freelance, are profoundly dependent on brokers to reach down into the grassroots. NGOs sell their proposals to potential donors by emphasizing that they have contacts with beneficiaries in the villages or urban slums: in this sense, knowing beneficiaries is part of the pitch. Freelance altruists need to find a broker who will guide them to a village where there is a grandmother who needs resources to care for orphans or a pastor who needs money for a new church roof. For all their importance, little attention is given to the brokers who provide the crucial channel — or, as it sometimes turns out, form the critical bottleneck — between the good deeds envisioned by the altruists and the village huts or slum dwellings where imagined recipients reside.
Freelance altruists eventually encounter hopeful and often enthusiastically grateful beneficiaries. Visiting staff of donor organizations usually deal with elite brokers, not villagers. The main exceptions are when brokers mount end-of-project celebrations in a village, treating visitors to songs, dances, and testimonials to the transformations that the organization has wrought. Mostly, institutional altruists make do with documents reporting statistics (the number of posters distributed, the number of dramas presented by youth groups to entertain and educate villagers) and the more compelling before-and-after testimonials, such as those of suffering widows and their return to health. Such stories then feature in the brochures of NGOs or in media stories about the success of an NGO project.
But the Malawians with whom the institutional donors actually interact — sometimes face to face, sometimes through directives and reports on paper — are the educated elites who staff the large urban NGOs that donors fund to implement their visions. Even an amateur altruist can reach the village and speak with villagers only through the help of a guide and translator. Like the biblical Jacob who worked for seven years to win Rachel but after his wedding night found that he had consummated the marriage with Leah instead, altruists large and small bond not with villagers but with brokers.
Behind the scenes, larger structures organize the relationships of donors, brokers, and villagers. In the specific case of AIDS, that structure is the global AIDS enterprise.
THE AIDS ENTERPRISE
The AIDS enterprise is in some ways like other development efforts — to contain malaria, boost crop yields, and so on — but in others it is distinct. It is distinct in scale: defined as an unprecedented emergency, AIDS stimulated a massive global effort to combat a single disease. Unlike earlier campaigns against smallpox and polio, and unlike the humanitarian relief organizations that rush into an area after an earthquake, for AIDS there is no short-term end in sight. Unlike development efforts focused on improving agriculture or building roads and bridges, preventing HIV transmission seems to require not only providing effective modern technologies, but also accomplishing diffuse and hard-to-achieve goals such as inducing millions of people to radically change their patterns of intimate behavior.
The AIDS enterprise is, however, structurally similar to other development projects in that it relies on a chain of intermediaries to reach its beneficiaries. Giant organizations with headquarters in Geneva, Washington, London, Tokyo, Oslo, and Seattle dominate the global AIDS enterprise. Precisely because of their global reach, the architecture of aid for AIDS — as well as that for development aid more generally — is similar in countries as different as Malawi, Nigeria, and Nepal. In Malawi, huge international NGOs (INGOs) like World Vision, CARE, PSI, and ActionAid have satellite offices in Lilongwe (the political capital) or Blantyre (the commercial capital) staffed by cosmopolitan brokers. The cities are a long journey from most of the 85 percent of Malawians who live in rural areas, however. Thus, national offices often subcontract the implementation of their projects to smaller organizations closer to the villages. Money and responsibilities pass down an aid chain. Not surprisingly, the activities of subcontractors play a major role in our book.
The AIDS enterprise has shaped Malawian society. Institutional altruists and brokers have collaborated to produce a riot of cultural creativity as brokers work to satisfy their own aspirations and to interpret the imported themes and practices of the AIDS industry for their countrymen. The AIDS enterprise has also transformed the landscape of aspirations not only of the brokers, but also of villagers who long to benefit from the altruists' largesse.
PRODUCING CULTURE
A striking feature of the AIDS enterprise is its lavish use of cultural symbols, emblems, and messages. The red AIDS ribbon can be found from Los Angeles to Lilongwe, decorating a church tower near Sunset Boulevard, or worn by members of village AIDS committees in Botswana and Malawi. There are cultural artifacts such as T-shirts, caps, bumper stickers, or radio and TV programs. But brokers and donors also work together to produce other sorts of culture, such as these specialized activities Malawi's National AIDS Commission (NAC) listed in an accounting of its donor-supported AIDS-prevention efforts:
320 HIV and AIDS corners established
5000 Copies of Life Skills manual printed and distributed
225 Community Dialogues (10 sessions/district)
In studying AIDS altruism, we sometimes felt like anthropologists exploring the exotic culture of some unknown tribe. We had to learn what "life skills" are and why they require manuals (for teaching youth about "gender roles" and "empowerment," with separate versions for primary and secondary students). But what is an "HIV and AIDS corner"? What would one expect to find happening at a "Community Dialogue"? Only insiders in the culture of the AIDS industry know.
Throughout the AIDS world, two cultural rituals are as ubiquitous as the mandatory cake at a child's birthday party. The brokers and donors who collectively create these rituals probably don't see them as culture at all, but they are works of art nonetheless. One is workshops and trainings, the other monitoring and evaluation.
Workshops and trainings work for everyone — donors, brokers, and village participants alike. Workshops are for brokers and trainings are for villagers. For example, the head of World Vision in Malawi might organize a workshop for selected members of the staff to discuss ways of implementing a new donor directive on financial tracking systems or a new approach to food security. Brokers like workshops; they are often held in fancy hotels with mid-morning and mid-afternoon rituals of tea and sandwiches, and brokers receive allowances for attending.
Trainings are for those who are considered to need education and enlightenment through exposure to donor messages. The aim is that after the training, participants from the village will serve as volunteers, educating and enlightening their neighbors. The rituals of a training are less costly and simpler than those at a workshop. Trainings take place in inexpensive motels or guest houses, the mid-morning snacks are a Fanta and a sweet bun rather than tea and sandwiches, and the teaching aids are usually flip charts rather than the PowerPoint presentations used in workshops. The allowances are much smaller, but they are still enough to attract participants.
(Continues...)
Excerpted from A Fraught Embrace by Ann Swidler, Susan Cotts Watkins. Copyright © 2017 Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS.
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Table of Contents
Preface vii1 Introduction: Altruism from Afar 1
2 Fevered Imaginations 19
3 Lumbering Behemoths and Fluttering Butterflies: Altruists in the Global AIDS Enterprise 36
4 Cultural Production: A Riot of Color 57
5 Getting to Know Brokers 78
6 Brokers’ Careers: Merit, Miracles, and Malice 106
7 Themes That Make Everyone Happy: Fighting Stigma and Helping Orphans 123
8 Themes That Make Everyone Anxious: Vulnerable Women and Harmful Cultural Practices 138
9 A Practice That Makes Everyone Happy: Training 166
10 Creating Success 183
11 Conclusions: Doing Good Better 198
Acknowledgments 215
Notes 219
References 247
Index 269
What People are Saying About This
“Ann Swidler and Susan Cotts Watkins provide a scathing, often funny, and always compassionate look at donor-sponsored AIDS prevention programs in Malawi.”—Kristin Harper, Interdisciplinary Association for Population Health Science“This splendid account of development aid explores how reality confronts donors’ dreams of effective altruism and recipients’ dreams of a better life. Swidler and Watkins show how a combination of ignorance, incomprehension, and conflicting aims brews the ‘working misunderstandings’ behind an enterprise that suits everyone yet fails to meet its nominal purpose.”—Angus Deaton, Nobel Laureate in Economics“[A]n extremely readable and deeply informative exploration of the international AIDS enterprise, essential reading for anyone interested in AIDS and the larger machinations of the international development system.”—Rachael Bonawitz, African Studies Review