Theory Teacher's Blog

Nairobi Diaries 9: the Ethics of Aid and the Catholic Church

Two obvious understatements: (1) Kenya has been seriously affected by HIV, and the Catholic Church does quite a lot of AIDS relief work there; (2) the Catholic church is officially against the use of condoms and many of the other things that social workers in Africa think need to be done to address HIV properly. Contradiction? Problem? A valid disagreement about what works best? Or maybe just an effective division of labor?

I ask this question (and don’t expect me to answer it) in light of Kenyan writer Binyavanga Wainaina’s provocative statement on a segment of NPR’s Speaking of Faith in December 2008 entitled “The Ethics of Aid.” His host Krista Tippet was surprised and baffled that he’d rather white people in Europe and the United States stop giving aid to Africa — that no aid was better than misguided aid. He compares the 21st-century desire to help Africa to the 19th-century desire to colonize it. His biggest criticism is directed at those Westerners who seem to want to save their own souls and alleviate their guilt by donating something — something that ends up being temporary and soon forgotten by the donor. Such ineffective programs help the Westerner imagine themselves as saviors of the poor Africans who — in this imagination — can’t save themselves. However, as far as I know, Wainaina hasn’t said anything specifically about the Catholic Church or any of the programs I witnessed, and I am curious about what he would say. CRS’s programs aren’t temporary fly-by-night, feel-good charities, and the staff of CRS are mostly Africans themselves working with local organizations and culture. After all, about 33% of Kenyans are Catholics.

As several of my earlier Nairobi Diaries mentioned before, much of my trip was about this situation. Whether in the background or in the foreground, both HIV and the Catholic church were very much present. Catholic Relief Services (CRS) is one of the largest non-governmental organizations doing AIDS relief there. Most of CRS’s budget for AIDS relief comes not from the church itself but from the President’s Emergency Plan for Aids Relief (PEPFAR) set up by President George Bush in 2003 — which is to say, it comes from the United States Agency for International Development (USAID). PEPFAR has been much praised for the widespread distribution of antiretroviral therapy (ART) medications free of charge to the poor and needy around the world. Many non-governmental organizations, both religious such as CRS and non-religious, have collaborated effectively with international agencies and national governments all over the world to make this happen. However, what has been controversial for a long time about both PEPFAR and the Catholic Church’s involvement in AIDS relief  is the conservative “family values” agenda that severely hampers aid workers in their efforts to do what they think they should to address the real roots of the problem. See [here], for just one example of this criticism. Some worry that such efforts may just prolong the problem. I personally wonder whether PEPFAR creates a dependency in Africa on ART so that the corporations that manufacture it can continue to rake in money from the American taxpayer (though admittedly I have no idea if these companies are making a profit off it or not.) I also couldn’t help but wonder if the evangelical presence of the Catholic and protestant churches in Kenya were not being deliberately strengthened by PEPFAR dollars, and I wondered what would happen if the U.S. government allowed such aid to support HIV programs organized by socialist or Muslim organizations. (And I think I need to emphasize something about USAID, because a friend of mine doubted me — I saw USAID signs all over rural Kenya,  including at the Day of the African Child events that I attended.)

In any case, the biggest criticism of PEPFAR and USAID is that the money comes with strings attached. In the case of CRS, the money seems to be tied to identity politics; for example, when I asked one CRS worker about the difficulty of fighting AIDS within the limits of U.S. government and papal policy, she implied that their identity as a Catholic institution was part of what made them effective and ought not be compromised.

In particular, Pope Benedict XVI is somewhat notorious for stating during his first visit to Africa that (against all evidence to the contrary) “the problem [of AIDS] cannot be overcome by the distribution of prophylactics: on the contrary, they increase it.” For the full text of that statement see [here], and for just a couple of reactions, see [here] and [here]. Naturally, the African Bishops fully endorse the Pope’s position as you can see [here]; what else could they do? While I was in Kenya, I wondered whether this policy was adhered to by those who had to work with HIV cases everyday. And I wondered this several times out loud. Do the CRS social workers strictly follow papal decrees? It’s impossible to know for sure what the answer to that question is… but… when we were interviewing a poor farmer with HIV who received assistance from CRS, and he proudly told both us and his case worker that he now used condoms. (I was afraid to ask how he was able to afford them, considering that he couldn’t even afford a tin roof for his mud home without CRS assistance.)

Interestingly, the Pope’s comment about condoms was said in passing during an interview, not during an official speech. His speeches given in Africa never made any recommendations about sexual practice. Catholic TV’s coverage of the Pope’s visit focused entirely on the ethics of reconciliation in the context of violent civil conflict.

I think liberal media such as the Huffington Post  have made too much of the condom comment and done so in a rather unsophisticated way, when you consider the issue in the context of regional violence, systemic poverty, government corruption, human trafficking, child labor, etc.  And of course, this is exactly the context that the Pope was addressing, so if we are to evauate the Pope’s overall mission, we need to think more broadly about the his emphasis on personal and religious ethics as a solution to the various problems in Africa — problems that everyone living in Africa recognizes to be extremely complex, in part because Africa is far, far, far more diverse than the average politician in America or Europe seems to realize.

So, for instance, in his first speech ever delivered in Africa, after detailing the horrors of regional violence and human trafficking, the Pope said,

At a time of global food shortages, financial turmoil, and disturbing patterns of climate change, Africa suffers disproportionately: more and more of her people are falling prey to hunger, poverty, and disease. They cry out for reconciliation, justice and peace, and that is what the Church offers them. Not new forms of economic or political oppression, but the glorious freedom of the children of God (cf. Rom 8:21). Not the imposition of cultural models that ignore the rights of the unborn, but the pure healing water of the Gospel of life. Not bitter interethnic or interreligious rivalry, but the righteousness, peace and joy of God’s kingdom, so aptly described by Pope Paul VI as the civilization of love.

Obviously he is not giving technocratic solutions but searching for guiding principles… but hold on a second…. Am I reading this incorrectly or is the Pope’s solution to child slavery and ethnic violence really that we ban abortions? And exactly how are “righteousness” and the “Gospel of life” going to address the global problems he lists? My knee-jerk reaction is to critique the Pope via another theologian, Reinhold Neihbur, whose famous book Moral Man and Immoral Society argues in a Marxist sort of way that individual morality (such as the Pope seems to be speaking of) cannot solve systemic, social problems.

But the Pope’s thinking might be a bit more complex. Later, right after I came back from Kenya a little over a month ago, he delivered his third Encyclical “Charity in Truth” that focuses on the ethics of global capitalism and suggests that the logic of the market only works if there is a moral consensus guiding it, and of course there isn’t any such consensus, and in a “fallen world” such as ours, there never will be, implying that regulations and global governance is perhaps necessary. I would agree with him there, except that he also seems to me to be implying that the Vatican might be a good candidate for governing the globe. [Here] is a somewhat incoherent response to that encyclical by People for Peace in Africa whom we met on my trip and whom I mentioned in Nairbi Dairies 2. And [here] and [here] are a couple other summaries because I definitely don’t have time to read the whole thing — yo, it’s 144 pages!

One of the theoretically interesting upshots seems to be his notion that capitalism may be moving into a new phase beyond the simple profit motive, beyond simple commercial value, and towards a realization that social welfare and ethical human relations are increasingly a part of the way the economic system measures value. This almost sounds like Negri and Hardt’s Marxist manifesto for the 21st century in their books Empire and Multitude, except without the many social antagonisms (race, class, gender, sexuality, etc.) that Hardt and Negri and countless other theorists of globalization recognize as basic to the capitalist world system. Their books argue that an economy increasingly based on information systems, human services, and social capital (and not just financial capital and commodities) will transform itself — a sort of “democracy from below” — almost (but not quite) the way the Pope seems to imagine because of the ethical relations immanent in social capital. So, maybe the Pope and Bush are right that, when thinking of aid (i.e., charity) and solutions to HIV, ethics should come first…. But then that begs the question of what kind of ethics are we talking about here?

Kenya 564

At the end of the day, however, what concerns me can be summed up in these two photographs that I took. The first photograph on the left is of a Bishop’s house in a small diocese. We had lunch with the Bishop in the house. It was the largest and most opulent structure I saw my entire three days driving all around that diocese. Kenya 398The second photograph is a street corner of a nearby town. The motorcycles are basically taxis, which have become popular all over Africa because they are fuel efficient and oil is too expensive. It’s clear that the Catholic church is powerful in Kenya, since it owns a lot of the most expensive land…. And so I repeat, what are the ethics of aid here?

In addition to that kind of disparity, I can’t help but remain sceptical of a church that requires Africans to adopt European names in order to be baptised and that still officially and adamantly promotes an image of Jesus as a white man — yes, I asked about that while I was there, and no, Jesus obviously wasn’t a white European — and still seems to be waging an ideological battle against protestantism, Islam, and secularism not only at the level of the Vatican but also precisely at the grassroots level of CRS itself.

In conclusion, I have no conclusion, only questions, but for a really good novel about ethical ambiguity, family, and the Catholic Church in Nigeria that I just finished yesterday, check out Chimananda Ngozi Adichie’s novel Purple Hibiscus.

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August 12, 2009 - Posted by | global, international aid, Kenya

4 Comments »

  1. […] View­ o­­r­igina­l h­er­e: N­a­irobi Dia­rie­s 9: the­ E­thics of A­id a­n­d the&#… […]

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  2. It says: ‘In particular, Pope Benedict XVI is somewhat notorious for stating during his first visit to Africa that (against all evidence to the contrary) “the problem [of AIDS] cannot be overcome by the distribution of prophylactics: on the contrary, they increase it.”’

    And this isn’t true. There is evidence to the contrary, for example: http://www.stwr.org/health-education-shelter/dialogue-on-aids-prevention.html

    “How has the Western risk-reduction model fared in Africa? Most efforts have focused on condoms. There is no evidence to date that mass promotion of condoms has paid off in decline of HIV infec-tion rates at the population level. The UNAIDS multi-center study, published in a special edition of AIDS in 2001, found that condom user levels made no significant difference in determining HIV prevalence levels. And a 2003 UNAIDS review of condom effectiveness, by Hearst and Chen
    concludes, “There are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on condom promotion.””

    It says: ‘Obviously he is not giving technocratic solutions but searching for guiding principles… but hold on a second…. Am I reading this incorrectly or is the Pope’s solution to child slavery and ethnic violence really that we ban abortions? And exactly how are “righteousness” and the “Gospel of life” going to address the global problems he lists? My knee-jerk reaction is to critique the Pope via another theologian, Reinhold Neihbur, whose famous book Moral Man and Immoral Society argues in a Marxist sort of way that individual morality (such as the Pope seems to be speaking of) cannot solve systemic, social problems.’

    The gospel of life is one that recognizes the fundamental rights of all human beings (both born and unborn) and the pope is further claiming that killing off the unborn through abortion is not the solution to social problems. Neihbur is mistaken; individual morality is at the root of all systemic social problems. If people loved each other as they ought, there would be no poverty, war, exploitation, etc. Trying to change the system certainly isn’t going to solve social problems without changing the hearts of the people who make up the system.

    It says, ‘Later, right after I came back from Kenya a little over a month ago, he delivered his third Encyclical “Charity in Truth” that focuses on the ethics of global capitalism and suggests that the logic of the market only works if there is a moral consensus guiding it, and of course there isn’t any such consensus, and in a “fallen world” such as ours, there never will be, implying that regulations and global governance is perhaps necessary. I would agree with him there, except that he also seems to me to be implying that the Vatican might be a good candidate for governing the globe.’

    I have read it, and it doesn’t say this. It reaffirms the role of governments to regulate commerce but notes that it is no longer possible in the contemporary globalizing world for there to be simple a state + market approach, and that commercial ventures themselves need to guide themselves to work ethically in addition to state regulation. In no place does he claim that the vatican should govern the globe, except as an authority on morals.

    The catholic church does not require people to adopt european names in order to be baptized; it is simply a tradition among catholics to name their children after someone who was canonized (who may not be european) to get the saint’s intercession.

    It seems strange that the writer would hold the church in a critical light for ‘waging an ideological battle’ against others, when the writer appears to be waging his own ideological battle himself against the church.

    It may be surprising for me to state this, but CRS has actually been criticized by many in the church for supposedly having violated church teaching by assisting the spread of condoms.

    Very interesting post though.

    God Bless,

    Comment by David Murdoch | August 13, 2009 | Reply

  3. In response to David Murdoch’s reply, I’d like to first thank him for posting that link that features an excellent dialogue between two leading experts in HIV/AIDS in the Global South, Drs. Edward Green and Paul Farmer. In the dialogue, the two doctors discuss many of the points brought up in the original blog post, specifically the effectiveness of condoms in the prevention of HIV and AIDS. Unfortunately in David’s reply, it doesn’t appear that David Murdoch read the entire page of debate, but rather only a portion of the dialogue from Dr. Green that supports his own assertion about the use of condoms in the prevention of HIV in Africa.

    In Dr. Green’s section, he argues that risk-reduction efforts including the promotion of use of condoms and needle exchange may be more effective in societies where there are small populations that are at great risk for HIV (re: San Francisco and Bankok — his examples), but such efforts are inapplicable in most of Africa. Rather a “behavioral” approach to HIV is needed in the case of Africa, or “primary behavior changes” (PBCs) such as promotion of the ABC model (Abstinence, Be faithful, use Condoms). To highlight this, he cites the evidence that David posted. Dr. Green goes on to bring up Uganda’s success in quelling the spread of HIV, but when speaking about it he says:

    “Uganda’s largely home-grown approach to AIDS led to a delayed age of first sex, less casual sex, and relatively high condom user rates among the few who still engage in casual sex. Uganda also pioneered approaches in reducing stigma, bringing discussion of sexual behavior out into the open, involving HIV-infected people in public education, persuading individuals and couples to be tested and counseled, and improving the status of women.”

    Dr. Green does, in the context of other things, recognize the use of condoms in the prevention of HIV and AIDS.

    In his response to Dr. Green, Dr. Farmer first agrees that yes, risk reduction measures alone are grossly inappropriate, but we may be missing the forest for the trees if we focus on individuals’ behavior. Instead, we need to recognize who is being infected by HIV in Africa: the world’s poorest.

    Dr. Farmer insists that Dr. Green “push further,” and ask the following: “Why is HIV concentrated so heavily in the poorest parts of the world? Why do social inequalities, including gender inequality and racism, seem to fuel the AIDS pandemic whether in Africa or in the cities of the US? Why do economic policies foisted on poor countries tend to heighten HIV risk?” He, like the original poster, challenges Dr. Green and those who look at only one part of the HIV mess to really examine the larger context of the spread of the disease, and then consider solutions that are based this complexity of “biosocial” reality on the ground.

    Farmer is also worried about Green’s use of Uganda as a success story based solely on behavioral changes of the population. “There are skeptics out there—I am one— who think that what has happened in Uganda is complex and has as much to do with war, dying off, migration, and many other events and processes (including, in Kampala and beyond, increased access to better HIV care) not readily classed under the rubric ‘ABC campaign.’”

    Essentially, Dr. Farmer argues HIV in Africa is one that is tied to a host of different social problems (as he says: “gender inequality and racism,” poverty, etc) and a “one size fits all” remedy cannot be assessed. It can be argued that the ABC can be modified to fit different situations, but if applied, it must be done in the context of all the issues mentioned above, which need to be addressed comprehensively. The belief that Africa is monolithic is what plagues a lot of these ineffective policies from all sides – the church, “donor nations,” risk-reduction advocates with no sense of the political context of each African nation that they are addressing, etc.

    In other relevant news, Dr. Paul Farmer was on the short list for the position the head of USAID in the Obama administration, but instead became the United Nations Deputy Special Envoy to Haiti under former President Clinton, who is now the current lead UN Special Envoy to Haiti:

    http://kristof.blogs.nytimes.com/2009/08/10/update-on-paul-farmer-and-usaid/

    http://www.un.org/apps/news/story.asp?NewsID=31740&Cr=Haiti&Cr1=

    Comment by M--- | August 16, 2009 | Reply

  4. I really appreciate David Murdoch and M–‘s informed and engaged response to my blog, and I especially appreciate David’s correction of me for misunderstanding the Pope’s Encyclical (which I admitted I hadn’t actually read) and also M—‘s correction of David for misunderstanding the very evidence he cites against me.

    I’d like to start where all of us agree instead of where all of us disagree. I think all of us agree that condoms are not THE solution to the HIV/AIDS problem, and those who overemphasize them as such are doing a disservice. The issue is very complex, and the Pope was certainly right to focus on the larger issues of poverty and violence. I hope, David, you noticed that I was just as critical of the liberal media for overemphasizing the condom comment without any attention to the context as I was of the Pople for making it. And I was also just as critical of old-school Marxists for focusing entirely on the systemic problem and refusing to acknowlege the essential role of morality. As a theorists, my job is to critique, not to criticise or “wage ideological battles” — in other words, to raise questions and open up new ways of thinking. And any Jesuit or Benedictine will tell you exactly the same thing.

    But of course, the problem with all this back and forth on the condom issue (and the problem both with the Pope’s statment and with David’s argument as well as with the Huffington Post’s response to the Pope) is that no health agency is actually advocating condoms as THE primary solution to the problem, so arguing for or against condoms in such a way is arguing against a straw man. In the same way, I don’t think individual morality and righteousness can be THE solution to the problem. As the website David nicely provided indicates, everyone (including the Pope, including CRS) recognizes that the issue is very complex and in need of a nuanced, multifaceted approach. In my view, condoms should be included in that approach, because there is lots of evidence that they are effective so long as they are promoted and distributed in a culturally appropriate way, but regardless of whether they are or not, they are much less important than other things such as the empowerment of women. The complexity of the issue and the central importance of gender empowerment has recently been argued excellently by Mehret Mandefro in the documentary movie _All of Us_, and by Ibrahim Elemo in a just published book _Reproductive Health, HIV/AIDS and Gender Perspectives in East Africa: Understanding the Oromo Culture_, and by several authors in the book _AIDS Sutra: Untold Stories from India_. All three of these are discussed in a wonderful essay by Maya Tessema in the latest issue of the on-line magazine _Ogina_, which I blogged about last May.

    I’d like to first respond to David’s statment against Neihbur, and also reveal that David’s argument in defence of the Pope is surprisingly un-Catholic. Before I begin my response, I want to say that I hope, David, that you noticed I didn’t simply affirm Neighbur’s statement. I said that was my knee-jerk response, and then I went on to appreciate the nuances of the Pope’s argument and compared them to points made by Negri and Hardt (who, by the way, though Marxist, find some affinity with the Catholic monk, Francis of Assisi.) I mention this to you because you seem to have trouble reading whole arguments and instead just pick out the bits and pieces you want to use or react against.

    But here is what is un-Catholic about your argument. You seem to suggest that the solution to the problem is everyone becoming moral and life affirming in that American “right to life” sort of way. I agree that everyone being moral would be wonderful, but as I’m sure you know well, according to Catholic doctrine, we live in a fallen world. As St. Augustine suggested long ago, and which countless theologians both Catholic and Protestant have rearticulated since, it is impossible to be perfectly moral in an imperfect world.

    Therefore, as Augustine, as well as Neibuhr, suggest, we must look beyond simple moral dogmatism and law to something else. For Christians, that something else is faith — the community of the faithful which will have transformative effects. I suspect that is what the Pope was really getting at, which is a little more nuanced than your simplistic sense of righteousness and the affirmation of life. And note, the important thing in the phrase “community of faith” is not just faith, but the community — i.e., not just individual ethics, but the ethics of and over the community.

    What I wanted to suggest is that there is something in common with the religious notion of a community of faith and the postmodern Marxist approach of Negri and Hardt, who stress the value of “affective labor” in the global economy. Affective labor would include things such as bearing and raising children, but it includes the emotional and ethical bonds created between two business people. There is something wonderful about that, but there is also something a little anarchist about it too. Such an approach tends to dismiss the role of government in favor of the ethics of affective labor — which is a really surprising argument for either a Catholic or a Marxist to make.

    And this is what I find really disturbing about your synopsis of the Pope’s argument (and I’m sorry, but I still haven’t read the Pope’s Encyclical, so I can’t judge it, and I can’t really judge whether your synposis is accurate or not.) It is a false consciousness to argue that righteous individuals rather than government is the solution for several reasons. First, it should be obvious that most of the money for all the programs we have been talking about come from the government — i.e., CRS gets money from USAID, and that money indirectly supports the Catholic church’s evangelical mission.

    Second, most Christian philosophers have acknowledged the important role that a worldly government and worldly laws play even though at the same time they stressed the higher, transcendent law of the church. It has never been an either/or. It has always been a both/and.

    But the issue has gotten more complex recently. Until now, the wordly governments theologians (and Jesus) were talking about, were small-scale kingdoms or nation states. But since the fall of the Berlin Wall in 1989 and the commencement of the World Trade Organization in 1995, national governments seem to have lost their primacy if not their control. In other words, Adam Smith’s famous “wealth of nations” has given way to global capital.

    So, the question on everyone’s minds has been what the new form of governance should be. Your interpretation of the Pope’s answer is shockingly anarchistic, since it suggests that secular governments are not the answer, righteousness is. (Interestingly, some have accused Negri and Hardt of being ridiculously anarchistic as well.) Most would suggest that both governments and ethics are necessary, not just one or the other. And your interpretation seems to ideologically support those who believe the market should be unregulated — or rather, should be regulated by individual morality rather than by governments. My fear is that the Pope (and his Opus Dei supporters) are more servants of free-market capital than they are servants of God, because of course, in the real world — i.e., in the fallen world in which we live — we know that that will never happen, as we have seen from the recent financial crisis. As most theologians have agreed, the worldly laws (and secular governments) are unfortunately (if perhaps temporarily) necessary.

    But why would a theologian posit the necessity of secular governments? Well, first, it comes from the admission that we are human, not God. (That is the lesson of the story of Babel in the Bible.) And second, it comes from the obvious truth that we live in a diverse world. (That is the lesson of Babel, the movie.) And that was what I was getting at in my final three paragraphs when I re-asked the question “what are the ethics of aid here?” A genuine ethics (rather than the falsely self-righteous morality that David advocates) has to begin with that recognition of personal fallibility and worldly difference. It doesn’t seem to me that the Pope is recognizing either of those enough. (In contrast to the Pope, the CRS social workers that I met really do recognize both of those things. Perhaps it’s because they actually do the real work and don’t just give speeches… or write blogs.)

    Comment by steventhomas | August 18, 2009 | Reply


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