President's Letter:
That's Us You Hear Applauding As the World of Aid Gets a Makeover

As one economist after another strafes the old approaches to foreign aid, we see again the folly of applying solutions hatched in the industrialized world to problems incubated in the developing world. We'll say it again: smaller is better.

It's the rage these days to point out that foreign aid doesn't work, certainly not as the driving force behind a nation's economy. And, for so long, that was the strategy. Pump in capital and watch the pie chart grow.

It wasn't just the corruption. Certainly, many a greenback went for Italian marble at the seaside palace of this general or that dictator-for-life. We could buy a semi-respectable country with the aid money that has been "diverted" to nefarious purposes in Africa alone. Still, there's more to the story.

Technology has made equipment more sophisticated and less user-friendly. The notion that shipping tons of stuff to a poor nation will set its economic engine humming has taken a beating lately. In perhaps the classic example, expensive medical equipment has sat rusting in warehouses for years.

Without people to train locals to operate it and people to repair it -- it contributes nothing to the health of either the people or their economy. Ordinary bandages and disposable syringes have far greater value in some places than fancy MRI rigs.

The world has learned as well that training alone is not the answer. Without a clear vision of how their lives can be improved coupled with an entrepreneurial spirit, people consistently turn their backs on educational opportunities. That vision can prove elusive for those who have never had, or allowed themselves to hope for, even what the industrialized world considers necessities.

Not everyone has received the message, of course. At every economic summit, anti-globalization protestors resume their cry for debt forgiveness. Maybe they aren't aware of research that demonstrates that welfare breeds slovenliness in personal finance and a lack of it prompts people to seek training and employment.

Maybe they don't see the global implications, the link between fiscal responsibility at the personal level and at the national. Debt forgiveness is simply international welfare. It hardly discourages the next satrap from importing gold bathroom fixtures of his own and it does nothing to spur participation in training programs among the poor.

Massive aid schemes don't work. With each passing day, we become more convinced of our commitment to a grass-roots approach to relief and development that emphasizes interaction at a human level tied to fiscal responsibility and strict accountability. Such initiatives will only be accomplished by workers who go for the long term and steep themselves in the culture and the language.

As long as economists are examining the old assumptions, they might next give the idea of drive-by development a good, hard look.

--Bill Koops

A Dad Who Won't Keep His Place Demands a Better One for His Son

Hicham Fatmi's gentle eyes didn't set him apart, nor did his tender manner toward his little boy. The first thing one noticed was simply that he was not a woman. Every other adult in the dim main room of the Cheshire Center for Handicapped Children in Meknes was.

Most of them wore the traditional neck-to-ankle djellaba. On blue mats on the floor, mothers exercised their children by simply raising and lowering their arms. Others worked with youngsters strapped to a padded, vertical board that held them erect.

Fatmi gave his son, Yassine, almost 3, easy pushes in a toddler's swing. For 2 1/2 years, they have visited the center three times a week. The father loves his son too much to yield to his culture's attitude toward the handicapped or to starkly defined gender roles.

Hicham Fatmi has plans for his son, Yassinne, that don't include diapers.

In Morocco as in most of Islam, the physically and mentally impaired are considered the cursed of God, under punishment for something either their parents or they did.

Most are shoved aside and given nothing beyond the most minimal care. The fortunate child who receives a higher level gets it from his mother in almost every case.

Fatmi's wife is a secretary, confined to an office all day. He is a 36-year-old high school English teacher, able to leave for a half-day when he has no classes scheduled. So it is that he brings Yassine to the center, and on the rare occasions that he isn't available a relative fills in.

"I'm the only father who comes here regularly," he said in a soft, firm voice. "I'm not embarrassed about it. I'm even proud. It's something rare, and when something is rare, you're proud of it."

Fatimazorha Elmcherfi, the director of the center, can take pride in the 168 children the facility has served at no charge since the current tracking system was inaugurated in January, 1998. More than two-thirds of those have attended three half-days a week, the others one day every two to three months when their parents can bring them from distant towns. Of the total, 52 have been classified as making above-average progress.

Mother and daughter work on puzzles.

Some have gone on to standard schools. Mike Cloud, formerly head groundskeeper for the Texas Rangers baseball club and a seminary graduate, serves the center as administrator. The care provided, he said, ranks a notch below that available in the U.S. due to less advanced equipment and a shortage of trained therapists. In compensating for these shortcomings, however, the center has devised a system with one major advantage.

Elsewhere, a handicapped child might attend a rehabilitation program for five full days each week. Because limited resources, including small staffs, do not allow Moroccan centers to make such expensive treatment available, they demand parental involvement.

No child is merely dropped off and picked up. The benefit of that approach glowed from Fatmi as he pushed Yassine, who suffers from cerebral palsy, in his swing. "The progress may be slow," he said, "but I can see it. It is there.

"He'll never go to school, but I can deal with that. My goal is to see him independent, to feed and dress himself. It doesn't matter if he doesn't go to school or have a good job. What matters to me is that he can do these things other people do.

"I have friends who have an 18-year-old daughter who has cerebral palsy. They must change her diapers. My goal is to see my son do the things other people do."

--Ed Fowler

Officially, the Rose of the South Center in Agadir serves handicapped children aged 5 to18. In the developing world, however, a great deal happens unofficially.

The oldest patient is 45. Until he arrived earlier this year, he had never been outside his home. Learning of his case, the center agreed to take him on a 15-day experimental basis. He made so much progress so quickly that, three months later, he remains.

A man of 20 had lived his life in a house next door to the souk, or market, but had never seen it until he went on an outing organized by the center.

In Morocco, few are aware that excursions facilitate development for the handicapped. Many believe that they are shamed if they are seen in public with impaired family members. Some who do send their children to the center insist that its bus stop precisely at their door so that neighbors do not see the youngster on his way out.

Most of the clients are indeed children. The center, founded in 1995 by a Frenchwoman whose husband practiced medicine in the area, is the only facility of its sort between Marrakech to the northeast and the southern border with Mauritania.

Since 1999, it has been administered and staffed entirely by Moroccans. A staff of 14, including 10 teachers, serves 54, but there is no full-time physical or speech therapist. Most of the clients arrive on the bus and remain all day, five days a week.

The government contributes nothing toward the annual budget of $52,540.

A door remains open in Marrakech.

Director M'bark Essamadi said the center tries to collect about half of the capital required from parents who are able to pay. Most are not, however, and the center has never turned anyone away for financial reasons. Support from a foundation in France takes up some of the slack and a few thousand dollars comes in annually through sponsorships of children from needy families.

The waiting list currently stands at 30, but Essamadi said countless others in the southern reaches of the nation are in need but have not come forth.

The 7-month-old on the examining table was screaming. At the video monitor, Dr. Said Ejjennane was pointing to the hole in the boy's heart. On an average day in Morocco, the cardiologist said, six to eight children like this one die of treatable heart conditions for lack of money. The question, as always: How much?

Dr. Ejjennane in Casablanca; So many kids, so little time.

If performed in Morocco, the procedure this infant requires to close the hole would cost $2,000 and take three to four hours. About 85 percent of the life-saving procedures needed are relatively simple for skilled hands, Dr. Ejjennane said, but there are no skilled hands.

The nation of 30 million has only six practicing heart surgeons, and not one that specializes in pediatric cases.

Most infants and toddlers never get the surgery. About 25 per year make it to France for the operations they require.

In Morocco, about 800 are performed annually on adults; 15 or more of whom die daily for lack of treatment -- and children. About 8,000 to 10,000 are needed.  

To meet that need, Dr. Ejjennane and nine colleagues are founding the

 Good Works of the Heart clinic, expected to open in the summer of 2002

with a staff of 80. They have secured donated land and raised $2.5 million, a staggering sum, for construction through a national telethon.

Still needed are equipment and supplies as well as pediatric heart surgeons who would visit on a short-term basis. Another desperate need is for surgeons abroad who would accept charity cases and for funding to transport the patients.

Dr. Ejjennane, who spent 10 years in Paris before returning to his native country, has donated half his time to charity cases for the last six years. He and his colleagues anticipate treating more patients more effectively when the new clinic is completed.

In government hospitals, treatment is free but results are unimpressive and the patient must pay for supplies. A typical heart operation thus costs about $6,000 in a country in which 92 percent of the population earns $90 a month or less and unemployment tops 23 percent.

The crying infant on the examining table, underdeveloped for his age and distended in his chest, made a case in point. He is one of five children and his father, a chauffeur, earns $94 a month. Without the surgery he needs, the cardiologist said, he will live two to four years; with it, he could live a normal life.

The examination concluded, the boy's mother grabbed for the doctor's hand to kiss it, but he pulled it away. His waiting room was full.

--Ed Fowler