I was encouraged to read Paul Theroux’s Dark Star Safari by a co-worker in back in Texas when I mentioned that I was interested in a career in international health. “You should definitely read this book. It tells the truth about the corruption of aid agencies and how they’re actually hurting Africa.”
She was at least partially right. Over the course of Theroux’s “safari” across the continent, he lapses into several ranting session about selfishness and self-importance of aid workers (“they were, in general, oafish self-dramatizing prigs, and often complete bastards,” p. 146), the futility of various aid projects, and the corrupting influence that foreign aid has on African governments and people. He takes it upon himself to diagnose the problem. “Where are the Africans in all this? In my view, aid is a failure if in forty years of charity the only people still dishing up the food and doling out the money are foreigners. No Africans are involved – there is not even a concept of African volunteerism or labor-intensive projects.” (p. 272) Unfortunately, Theroux never bothers to actually visit an aid agency at all during his trip. If he had, he might have learned the majority of employees of aid agencies in Africa are Africans.1
Despite this lack of research, there is some truth to Theroux’s perceptions of and rants about the damage that foreign aid does to African countries. It creates a culture of dependence, stifles sustainable growth, discourages investment, and burdens poor countries with massive debt. Real per-capita income on the continent is lower now than in the 1970s, and the number of people who live on less than a dollar a day has doubled in the last two decades.2 Corruption siphons off huge amounts of donor funds, and the continuous flow of aid keeps inefficient and abusive governments in power.
Fortunately, there are organizations that seek to promote education and economic programs that will have lasting effects in the region. For example, Tostan works with villages in Sénégal and neighboring countries by training local people to lead education modules that focus on hygiene, literacy, and human rights; through their program, they’ve gotten over 4,500 villages to collectively abandon FGM.3 The Acumen Fund provides mid-size loans to early-stage enterprises providing healthcare, water, housing, or agriculture; one of their loans financed the Kenyan Company Advanced Bio-Extracts, the first African company to produce artemisinin for antimalarial drugs.4 These groups bring a fresh approach to the decades-old problem of the stagnation of African communities and economies.
I was not discouraged by Theroux’s tirades; as a field, I feel, or at least I hope, that public health is less prone to “throwing money” at problems and seeks to implement long-lasting behavior changes. However, despite the author’s vitriol and lack of knowledge on his chosen tirade, his observations are still a powerful reminder that public health professionals can fail people by not giving them the tools to continuously implement the changes we try to effect.