Geek Heresy (23 page)

I-TECH operates at various levels of a health system, but all of its work comes down to training and organizational development. It teaches frontline health-care providers, instructs lab workers in quality control, offers leadership training to health ministry officials, develops standardized curricula for health-care education programs, and trains local instructors to do all of these things on their own. “We do less with frontline health workers than we used to,” Downer said. “But whether frontline or up the chain of command, our goal is always to help health systems become more effective and self-sustaining for the ultimate benefit of patients.”

There’s little glitter in I-TECH’s work. Downer was matter of fact when I asked her about the specifics of teaching in Tanzania. “Here in the United States, I think we take a lot for granted,” she told me. “We undervalue the powerful effect of a good teacher using basic, low-tech, and replicable teaching methods – things like discussion and case studies to help learners develop a body of knowledge and critical thinking skills. These same methods can have a profound impact on learning when applied in countries struggling to provide basic education in an era of high-tech temptation. It gives new meaning to ‘back to basics.’”

Basic efforts, though, can have lasting impact. In the decade since its founding, I-TECH has provided training to over 180,000 health-care professionals, contributing to an estimated 1.2 million lives saved during PEPFAR’s first four years.
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Every life saved, of course, has ongoing impact through families and economic productivity. But these numbers still underestimate the eventual impact of a stronger health-care system beyond HIV/AIDS treatment.
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Researchers cite improvements in general health care where PEPFAR works, including more reliable blood supply and more households treating their drinking water.
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And the training lasts throughout a health-care worker’s professional life. Much of it will be passed on to those they manage and mentor.

It’s impossible to tally all of the downstream benefit. Who knows how many great-grandchildren will have better health because an ancestor started boiling water at home at the suggestion of a nurse who learned from an I-TECH curriculum? And it’s important to acknowledge that it’s impossible. By doing so, we shift from mere cost-benefit analysis to a judgment involving less measurable desiderata: Should we simply provide as many packaged interventions as we can, or should we nurture institutions that can fund, maintain, and implement packaged interventions on their own?

What organizations such as I-TECH do amounts to building the heart, mind, and will of national health-care systems.
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The concept of intrinsic growth applies not just to individuals but to groups and societies as well. Of course, how these traits are formed and expressed differs for groups as compared to individuals. Group heart, mind, and will are the result of many individuals combining their intentions, discernments, and self-control through organizational structures and messy but unavoidable politics. Social qualities such as trust, which have no real meaning for a single person, suddenly take on great importance as they mediate group interactions. Nevertheless, groups have intentions, groups discern among options, and groups act with varying degrees of self-control. Group intrinsic growth is a complex aggregation of individual intrinsic growth with complicated social factors mixed in.
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Downer noted, however, that their work was dependent on a preexisting foundation: “For I-TECH’s work to be effective in the public health arena, the public education system must also be functional,” she explained. “When all systems work together, you are then left with the most important elements – individuals’ commitment to their jobs and their nation and their ability to set goals and get things done.” While these were traits that I-TECH could strengthen to some degree, it is difficult to foster them from scratch.

The same could be said about Ashesi University. Despite its accomplishments, the school can’t take full credit for the achievements of its alumni. Like other good universities, Ashesi is selective about whom it admits. That means many students arrive with strong heart, mind, and will to begin with.

So both I-TECH and Ashesi force us to ask another set of questions: How do you establish the foundation required for people to benefit from an I-TECH or an Ashesi? And is it possible to establish that foundation in the starkest of circumstances? These questions are answered by the miracle that is Shanti Bhavan.

A Haven of Peace and Learning

When she was in the eleventh grade, Tara Sreenivasa wrote that she liked math and computers. Thanks to a terrific teacher, she especially enjoyed accounting. She also took guitar lessons, and in the afternoons she could be found playing badminton or basketball with her friends. She explained her future plans confidently: “I want to get into . . . business and earn lots of money. Someday, I would like to start a company of my own and open an old age home in remembrance of my grandmother . . . because she has taught me to be independent.”
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In 2009, Sreenivasa passed her state’s standardized secondary-school examinations and went to college. Upon graduation, she became an accountant.

Sreenivasa might not seem too out of the ordinary, but she’s extraordinary when you consider her background. She comes from Kundhukotte, an extremely poor agrarian village in South India. The Indian government designates her family “Backward Class,” a label applied to castes that are formally considered “socially and educationally backward.”
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Sreenivasa’s mother had no formal schooling and cannot read or write. She used to work as a cook in a government school, where she earned $120 a year. Sreenivasa’s father is unemployed and mostly absent. As for her grandmother, Sreenivasa thinks of her as independent because, until recently taking ill, she provided for herself by doing menial farm labor on other people’s land for wages of 40 cents a day.

Meanwhile, in a village a couple of hours away from Kundhukotte, a woman roughly Sreenivasa’s age illustrates what life could have been for Sreenivasa. Kavitha’s life began much like Sreenivasa’s, but Kavitha stopped going to school in the eighth grade. She had chores to do, and the four-kilometer trek to her secondary school took too much time. In any case, she was learning little by the end of primary school. Her
school system stuck to a rigid curriculum regardless of student comprehension; by fifth grade, she and most of her classmates had fallen hopelessly behind. At the age of fourteen, Kavitha was married to her uncle, fifteen years her senior, to whom she had been promised since childhood. He is the groundskeeper for some local government offices. It’s a steady job that pays a couple of hundred dollars a year, but it offers no prospects. He doesn’t believe Kavitha should leave the house except to buy food. When I met her in 2009, she was eighteen and pregnant with her second child.

Sreenivasa has a brighter future thanks to Shanti Bhavan, a boarding school where children of low-income, low-caste Indian families are provided a first-class, donor-funded education. With her parents’ consent and encouragement, the school adopted Sreenivasa in all but name at the age of four.
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Shanti Bhavan occupies forty acres in the middle of a stretch of agricultural land in the South Indian state of Tamil Nadu. For miles around, there is little else but small, partitioned fields in various states of cultivation. Baliganapalli, the nearest village, comprises perhaps a hundred mud, brick, and concrete homes. Its roads are unpaved, and the biggest building is a small government primary school.

In contrast to Baliganapalli, Shanti Bhavan is a lush oasis. Abraham George, the school’s visionary founder and main benefactor, translates Shanti Bhavan as “Haven of Peace.” He felt that his students should have facilities equal to those enjoyed by their upper-middle-class counterparts.
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Instead of the hard, dry dirt surface of so many Indian schoolyards, well-trimmed grass covers the grounds at Shanti Bhavan. Carefully tended bushes and flowers line the walkways. In May, the bright orange flowers of “flame of the forest”
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trees light up the driveway like fireworks. The school building is a pastel pink two-story structure with a large courtyard that all the classrooms face.

Lalitha Law was Shanti Bhavan’s headmaster for its first twelve years. “We have to start with basics that middle-class schools can take for granted,” she told me. Few of the students have seen a book before entering the school. No one comes in knowing the alphabet in any language. But there are even more basic challenges. “When they arrive,
few of the children have modern health practices,” Law said. “Some are not used to regular bathing. Most do not have a habit of brushing their teeth.” She hinted that many of them go to the bathroom right on the school lawn.

Shanti Bhavan thus has a staff of “aunties,” who raise new entrants as they would their own children. Sreenivasa remembers her first few days: “I learnt how to hold a spoon and how to polish my shoes. I saw a toilet for the first time in my life. I was taught how to brush my teeth, wear my shoes, to eat with a spoon, to hold a pencil and a book, and many other things.” By the time Shanti Bhavan children formally enter the first grade at age five or six, they are not quite at the level of their middle-class peers, but they’re closer.

The remaining gaps, however, are closed over the next twelve years as the students receive an education on par with that provided by first-rate Indian private schools. The dedicated faculty are supplemented by a stream of volunteers, mostly from abroad, who focus on extracurricular activities. Students play the piano, put on plays, and compete in soccer tournaments. (Incidentally, the school is not particularly high-tech. It has one classroom for an elective computer class outfitted with PCs, none of which are connected to the Internet.)

By secondary school, Shanti Bhavan students are indistinguishable from children of well-educated, upper-middle-class Indian households. Every one of their graduates so far has gone on to a good university. In 2012, the first batch of Shanti Bhavan students finished college. They now work at various multinational companies, such as Goldman Sachs, iGate, and Mercedes Benz. Sreenivasa herself works at Ernst & Young. Without Shanti Bhavan, these same children would have been lucky to be literate. They would have likely ended up in wage labor, marginal farming, or other work below the poverty line.

I have visited many other alternative schools in India, but none of them were anything like Shanti Bhavan. Schools that spend two or three times the government budget per student can increase learning here and there, but only the occasional student will see a radical change in his or her future. At Shanti Bhavan, the transformation is total. The school’s eleventh-grade students once challenged my colleagues and me – PhDs
with years of public-speaking experience – to a debate. They trounced us with their poise and their well-constructed logic, all while regaling us with quotations from Shakespeare. And though sending every tot to boarding school may not be a viable public policy, Shanti Bhavan still stands as a beacon that demonstrates the dramatic effect of a good all-around education – one that stresses academics, extracurriculars, character, and cultural capital. In one generation, Shanti Bhavan ejects its students from poverty.

The Real Value of Formal Education

Focusing on financial poverty, however, encourages a narrowly technocratic view. It’s tempting to see Ashesi University and Shanti Bhavan as producers of economically productive human capital. Much of their success is visible in the job placements of graduates. As World Bank economist Harry A. Patrinos and his colleague George Psacharopoulos noted, “it is established beyond any reasonable doubt that there are tangible and measurable returns to investment in education.” Based on data from a range of countries, they estimated the economic rate of return to nationwide education programs to be roughly 10 percent.
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But Nelson Mandela once said that “education is the most powerful weapon we can use to change the world,” and he was certainly not just talking about economic change.
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In fact, education’s benefits go well beyond economic productivity. Here, for example, is Patrinos’s own catalog of the benefits of girls’ education:

A year of schooling for girls reduces infant mortality by 5 to 10 percent. Children of mothers with five years of primary education are 40 percent more likely to live beyond age 5. When the proportion of women with secondary schooling doubles, the fertility rate is reduced from 5.3 to 3.9 children per woman. Providing girls with an extra year of schooling increases their wages by 10 to 20 percent. There is evidence of more productive farming methods attributable to increased female schooling and a 43 percent decline in malnutrition. It has also
been shown that educating women has a greater impact on children’s schooling than educating men. In Brazil women’s resources have 20 times more impact than men’s resources on child health. Young rural Ugandans with secondary schooling are three times less likely to be HIV positive. In India women with formal schooling are more likely to resist violence. In Bangladesh educated women are three times more likely to participate in political meetings.
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Statistics such as these lead some development specialists to think of girls’ education as the closest thing to a silver bullet in the fight against global poverty.
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What’s not evident in these figures is why education has such a wide-ranging impact. Patrinos links education to productive farming, but what does formal schooling have to do with agriculture? Modern curriculums don’t teach it. Why does a girl’s primary schooling affect the survival rate of her children? She’s not learning about neonatal care in third grade.