A Century Behind

Placide Tapsoba, a 53-year-old physician, was born at home in the village of Satte outside of Ouagadougou, the capital of Burkina Faso, the landlocked West African country that until 1960 was the French protectorate of Upper Volta. He received his medical education at the University of Padua in Italy and a graduate degree from U.C.L.A.’s School of Public Health. Ask Doctor Tapsoba why he became a physician, and he will tell you that as a young man he wanted to be both a priest and a physician. He had been inspired by the medical missionaries of the Order of Saint Camillus. The Camillians had come to Burkina Faso in 1966 and immediately built a medical center that provided high quality services to the poor. When the Camillians opened a seminary in 1968, Placide was among the first group of seminarians to take the vows of poverty, chastity, obedience and devotion to the sick.

But as Doctor Tapsoba recounts it, he was a young seminarian when, in one of the Camillians’ periodic general assemblies held at their headquarters in Rome, a policy was issued that said, absent extraordinary circumstances, the roles of priest and physician were not compatible. According to the directive, each required such a level of commitment and daily involvement that in ordinary circumstances it was impossible to be true to both callings. The decision to study for both needed authorization from Rome. When Placide found out that at the time Burkina Faso had over 650 priests but only 67 physicians, he decided to leave the seminary and concentrate on medicine.

I cannot speak about the spiritual needs of Burkina Faso’s citizens, but there are clear measures of Burkina Faso’s health situation. It is appalling. Mortality rates in Burkina are higher than they were in the United States in 1900. A baby born in Burkina can expect to live about 30 years less than a child born in the United States45 versus 77 years. Sadly, recent reports indicate that child health is getting even worse. The high mortality is not caused by H.I.V./AIDS, the prevalence of which is less than 5 percent, but by diseases long ago controlled in most other places: malaria, respiratory infections, diarrhea and, in bad years, measles and meningitis.

One reason for the poor health conditions is poverty. The nation’s 13.6 million people are among the world’s poorest. Per capita income is about $250 per year. In the United States, by contrast, it is $35,000. Burkina’s situation may not be typical, but its problems epitomize those of Africa’s poorest countries.

The tragedy of Burkina Faso is not only its pervasive poverty and its people’s poor health, but also the very limited resources available to overcome these circumstances. Transportation and communication infrastructure is nonexistent. Burkina has fewer phone lines per 1,000 people than almost any other country. Only 25 percent of the adult population are literate, so the labor force lacks an essential ingredient for getting ahead. The culture and development strategies of the now prosperous countries of East Asia emphasized education. As a consequence, they were able to purchase weaving equipment from Britain, translate the operating manuals into Korean, Chinese or Thai, give them to literate factory employees and set them to work at lower costs and higher levels of productivity than Manchester factory workers using the same equipment. That is not possible in Burkinatoo few people are able to read.

Burkina’s principal export is cotton, but here too Burkinabes operate at a significant disadvantage. They must compete against heavily subsidized American and European cotton. The subsidies lower the price that Burkina’s cotton commands on the world market. The subsidy that the U.S. government gives to its small number of cotton farmers exceeds the yearly economic output of Burkina Faso. Two years ago in an op-ed piece in The New York Times, Blaise Compaoré, the Burkinabe president, pleaded for reduced subsidies, which would increase the price of cotton and improve Burkina’s prospects. Compaoré noted that payments to about 2,500 relatively well-off farmers has the unintended but nevertheless real effect of impoverishing some 10 million rural poor people in West and Central Africa. The cotton subsidies are another chapter in the sorry story of Africa’s exploitation. Outsiders have long set the terms of trade, whether by harsh colonial arrangements or in contemporary cotton trading.

Placide and I recently visited the World Bank and the American embassy in Ouagadougou. At both places, senior officials agreed that the cotton subsidies were hurting Burkinabe farmers and those who depend on them. We were also told that Burkina’s government is doing what it can to promote economic development. At the U.S. embassy, a senior official said, They are doing everything they can do, but they are starting from such a low base that it is difficult to accomplish anything.

One morning, we drove two-and-a-half hours from Ouagadougou to Navrongo in northern Ghana. We left Ouaga at 7:00 a.m. As people went to work, the streets became crowded with bicycles and bicyclettes (motorized bicycles with small, two-cycle engines that spew smoke). I found the activity encouraging. Until that morning Ouagadougou had seemed so sleepy it was almost dead. But once we left the capital, there was very little traffic and almost no trucks on the road. Commerce declined, in fact disappeared, until we reached small towns, one after another.

Along the way, the difficulty of rural life was evident. Farming was done in small plots, often with only a small hand hoe or a simple plow pulled by a donkey. Women worked in the field, fetched water and washed clothes at communal wells. Children everywhere helped in the fields. There were schools only in the towns. I could not imagine how children in the countryside could get to school, even if there were one for them to attend.

Fewer than 10 percent of the children from Burkina’s poorest households attend school. Even among the richest 20 percent of the population, fewer than two-thirds of the children attend school. How can a society be transformed without education? And how is it possible to educate a rural population of over four million children with so few resources?

The United States is doing very little to help Franco-phone West Africa. The U.S. Agency for International Development closed its mission in Burkina in 1995. A new aid program, the Millennium Challenge Account, had yet to disperse any funds in Burkina when I visited. During our visit to the American Embassy, we were told that Ambassador J. Anthony Holmes, who recently left Burkina, was unhappy because promised funding for a program to promote girls’ education had been slow in coming. But this was only one $12 million grant. Much more help will be needed to transform Burkina Faso’s education system. The increases in funding recently promised by the G8 leaders will likely be slow to reach Burkina.

During a briefing on the H.I.V./AIDS epidemic in Burkina, I asked about the impact of malaria. One of the physicians in the group, a man with a shaved head, round glasses and a deep voice, scolded me, saying, Of course malaria is a much more important problem than H.I.V., but since it doesn’t exist in the United States, you don’t provide funds to deal with it.

Two days later, as I was about to go to my room to sleep under a treated bed net to protect me from the mosquitoes that carry malaria, I asked the same physician why malaria is still a problem in West Africa when so many other places have eradicated or greatly reduced the incidence of the disease. Apathy, he said. He seemed to blame his countrymen, not me or the West.

Both of this doctor’s perspectives on Africa’s problems seem correct. Much that is wrong is the result of colonial rule, international neglect and unfair practices, like U.S. cotton subsidies. But corrupt African leaders, terribly ineffective government bureaucracies and debilitating tribal rivalries have added at least as many problems. The result for Burkina and other very poor African countriessuch as Angola, Chad, Ethiopia, Mali and Nigerare conditions that the United States has not seen in 100 years. Simply put, many people in Burkina are living a century behind us.

Social development specialists in Burkina and elsewhere in Africa are delighted with the G8’s debt forgiveness program and with the promised increases in foreign assistance. They hope that additional resources will be used to increase the quality and coverage of health and education services and improve inadequate infrastructure. Many plans have already been prepared. The additional resources will help if they strengthen human capitalthat is, increase health and promote literacyand improve agricultural infrastructure, but these will be challenging tasks.

Aid alone will not be sufficient to move Burkina Faso from poverty to prosperity. Even under the best conditions, development is a long, complicated and uneven process that depends not only on social sector investments in health and education but also on people’s ability to find work. That requires private sector investment, which, given Burkina’s poverty, must come mainly from outside the country. It will be difficult to attract investment until conditions improve. In the meantime, the low-end manufacturing jobs that could help set Burkina on a road to a better economy will continue to go to China and other more developed regions.

I asked Placide about his view of Burkina’s development prospects. Things are improving, but very slowly, he told me. His older brother had not been able to go to school, but by the time he himself came of age, a gift from the parents of a White Father missionary in Burkina had paid for the construction of a primary school five miles from Placide’s village close to Ouagadougou. There were 98 children in the first year of primary school, only 25 of whom went on to secondary school in Ouagadougou. Only two of the 98 went to university. One needed brains, access to resources and good luck to stay in school. Placide did not know how many of those starting out in school get to the university these days. But there is now a high school in his village, so students do not have to leave home, with all the associated inconvenience and expense, to continue their education.

Placide noted that another important issue shaped Burkina’s economy: rain. If it doesn’t rain, people are in trouble, he said. This is the same point made by specialists, who note the high correlation between rainfall and agricultural yields. But for Placide, water is also a sign of how things have changed for the better. When he was a boy in the early 1960’s, there was no piped water in his village; now clean water is available at several boreholes.

Life in Burkina Faso, which looks so harsh to a visiting Westerner, has a bright side for Placide and perhaps for others who share his positive spirit. He told me: There is no wealth, so there is nothing to fight for. We live in harmony. I hope the harmony does not disappear, if and when development comes.