My job, pt. I: Moldova’s Health Profile

I’ve been getting more questions recently about what the work side of my life actually entails.  It’s a huge topic, so I’m tackling it in three parts.  The series will move from the broad to the specific.  This is Part I, a general introduction to the public health situation in Moldova.  This article is by far the lengthiest, and if the background is boring, I won’t begrudge you for skipping it.  But it also contains the roots of the problems I struggle with daily, so it’s an important part of my work here.  Part II will look at my specific projects, and Part III will focus on what I do on a daily basis.

Moldova has what’s known as a “dual health profile,” meaning that it has elements of a health care system of a fully developed nation, but simultaneously struggles with problems typically associated with less developed countries. As an example, while Moldova has high vaccination rates and one of the highest doctor and nurse to patient ratios in the world, it also faces a high prevalence of TB, and access to safe drinking water and sanitation standards remain a pressing problem in rural areas.

Moldova is often summed up as “Europe’s poorest country.”  Obviously, this depends on a lot of definitions, but based on GDP per capita and given the broadest possible conception of Europe, only Kyrgyzstan and Tajikistan are poorer, so the general point is well taken.  Despite this fact, however, at Moldova has a higher life expectancy (by 2 to 5 years) than other significantly richer post-Soviet states.

• Life Expectancy: 68.5 years (WHO, 2007), 70.8 years (CIA World Fact Book, 2010)

On other key indicators of health such as infant and maternal mortality, Moldova is also outperforming the rest of the Eastern European WHO region (WHO 2005).

• Infant Mortality: 13.13 deaths/1000 live births (CIA World Fact Book, 2010)

Arguably, then, Moldova is doing pretty well given the context – it’s significantly below the global economic average, but nevertheless can boast health outcomes somewhat above the global average.  This fact is impressive, because wealth is a key predictor of health outcomes – though not by any stretch the only important indicator, remember the U.S. has a lower life expectancy than Bosnia and Herzegovina.  The point is, clearly systems and public policy matter too.  And “doing well given the context” isn’t much consolation to those people dying at young ages from preventable causes.

Response to Alms Dealer

Just finished Philip Gourevitch’s “Alms Dealer,” in October’s The New Yorker.  One part review of Linda Polman’s “The Crisis Caravan: What’s Wrong with Humanitarian Aid?”, it’s a very powerful and thought provoking article its own right.  The article was posted to my Facebook wall by Lindsay Toler, one of the brightest fellow volunteers I have the pleasure to serve with here in Moldova (and a healthy, which clearly speaks to her good character).  I’ve been thinking a lot lately about international aid – its ethics, its effectiveness, and its unintended consequences.  Until now, my thoughts have been mostly focused on development aid, so this article struck a chord and made me think about development’s humanitarian cousin.  What follows are some unorganized thoughts that originally began as a FB comment but grew too long for that medium.  Not the update friends and family back home were probably hoping for, but it’s the one that got written.  Preemptive forgiveness given if you decide to skip it.

The article starts on the familiar terrain of the greed v. grievance debate within conflict studies.  The whole argument is premised heavily on the greed side of this debate, within the academic camp of liberal rationality.  In short, people are rational, including warlords.

The initial problem then that this article forces is that constructivist bane of all rationalist attempts to remake the world into a better place (realism and liberalism alike): rules are not stable, and as soon as the rules of the game are known, rational actors adjust to manipulate the rules in their favor.  The result is a constantly shifting arms race of changing rules.  Unfortunately, as the tomes of failed humanitarian interventions show, the “bad guys” seem to figure out how to work the old rules in their favor much quicker than the “good guys” can come with new rules to prevent them from doing so.

Very quickly, however, the article leaves behind technical questions of why intervention might fuel conflict, and goes for the moral jugular of humanitarianism, whether there can truly be any neutral or unambiguously good intervention.  The single most prescient sentence: "The scenes of suffering that we tend to call humanitarian crises are almost always symptoms of political circumstances, and there’s no apolitical way of responding to them—no way to act without having a political effect."