Focus should be on lives, not dollars

RIVERCESS COUNTY,

Liberia e’s a 2-year-old boy named Sunday Dahn, lying in a coma in a rural health center with cerebral malaria. Even if Sunday survives, he may suffer permanent brain damage.

In Washington, we’ll see debates about President Donald Trump’s proposal to slash humanitarian aid, and politicians will emerge as winners or losers depending on the outcome. But the real winners and losers are kids like Sunday.

I’m on my annual win-a-trip journey with a university student — this year it’s Aneri Pattani of Northeastern University — and Aneri and I find that most people in rural Liberia have never even heard of Donald Trump. Yet he will profoundly shape their lives, and deaths, for American health assistance benefits half the Liberian population.

It’s not, of course, that Trump is responsible for Sunday’s coma. And our Liberia journey underscores that saving lives is often complicated, and harder than we think.

Pregnant women in Liberia

Hreceive free mosquito nets to prevent malaria, and almost every household has received one — including Sunday’s. The problem is that families often don’t use the nets. “Sleeping under the net makes one hot,” Sayee Dahn, Sunday’s father, explained as he stood anxiously by the boy’s bedside. He loves his son and didn’t intend to risk his life any more than an American who sends a text while driving is deliberately risking the life of the child in the back seat. In each case, we get lulled by routines and do stupid things.

When mosquito nets are handed out free, they are sometimes misused; I’ve seen them turned into wedding dresses, fishing nets, sponges and chicken fencing. Yet there’s overwhelming evidence that net distributions do save lives; they’re one reason the number of people dying globally from malaria has dropped 60 percent since 2000.

When Sunday developed a fever, his father spent $8 — a considerable sum for him — for medicine from a street vendor. Unfortunately, the medicine was apparently counterfeit or was ineffective.

This is a huge problem: One large study found that 32 percent of antimalarial drugs sold in poor countries were fake. Predatory Chinese companies export these counterfeit drugs to poor countries with weak regulation.

So Sunday’s malaria worsened. By the time his father brought him to the clinic, he was at the edge of death.

There is no doctor for many miles around, and no lab or blood bank, but the clinic has a physician assistant, the Rev. Carl Hanson, who immediately gave the boy an antimalarial suppository. “He’s still in danger,” Hanson told me hours later, looking at the tiny figure.

Yet if humanitarian aid is complex and imperfect, the evidence is overwhelming that it helps; indeed, it has helped save more than 100 million children’s lives around the world since 1990. With American financial support, Liberia is experimenting with rural health workers who encourage families to use bed nets, administer rapid malaria tests, hand out reliable medicine and refer problem cases to a clinic.

Rural health workers also promote contraception, which is free in Liberia through support from American aid and from the U.N. Population Fund. Trump proposes to cut off both family planning assistance and money for the Population Fund.

Dr. Ami Waters, co-medical director of Last Mile Health, which established the network of rural health workers, offered a glimpse of the consequences if contraception becomes less available. She described treating a 14-year-old girl who lost a baby and suffered gynecological complications, and a 19-year-old student who, in trying to self-abort with a stick, perforated her uterus and suffered sepsis.

“A lot happens when you don’t have family planning,” Waters noted dryly.

She treated those patients here in Rivercess County, where the hospital has no working X-ray machine, the operating theater lacks running water and oxygen and the pharmacy has mostly bare shelves. There is no aspirin, no gauze, no anesthetic and, most seriously, no antimalarials. Aneri noted on my blog that she had a better supply of medicine in her bag than this entire county hospital did.

Why should we care? Shouldn’t we solve Americans’ problems first, before worrying about West Africans’?

One response is that we have bonds of common humanity that should impel us to help. Another is that we have a self-interest in preventing the next Ebola outbreak or other epidemic. (At a different hospital Aneri and I visited, a woman had died the day before our arrival of suspected Lassa fever, a hemorrhagic disease similar to Ebola.)

Some people say: Let Africans look after African problems. And, indeed, they do. In the Rivercess hospital, we met Betty Tarr, who had four children of her own but adopted her nephew, God Power, after the boy’s mother died. Her husband was furious and abandoned her when she took in God Power.

Now God Power is severely malnourished and fighting for his life, but it’s not because Tarr is neglecting him: When we met her, she hadn’t eaten for three days.

We can’t save every child, whether it’s God Power or Sunday. But America and other wealthy countries have always tried to provide modest sums — less than one-half of 1 percent of GDP — to fight disease and illiteracy, as a sign of global leadership and of our common humanity.

Trump proposes that we turn our back on that bipartisan tradition, and on children like Sunday and God Power. I hope Congress and the American people understand that what’s at stake isn’t numbers in a budget, but children’s lives.

Nicholas Kristof is a columnist for The New York Times.