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  • good morning tickets Tuesday so later this month will be making a big announcement about working with partners in health, Sierra Leone.

  • But before that, I thought it might be helpful to consider why Sierra Leone is so poor now.

  • Poverty is complex, and we're not going to get to the bottom of it in a YouTube video.

  • But I do think this could be some helpful context.

  • Okay, so Sierra Leone, located here, is a nation of around 7.5 1,000,000 people.

  • It's ethnically and religiously diverse, most Sierra Leoneans or descendants of people who have long lived in West Africa.

  • But many former slaves in the British Empire were resettled here.

  • And so there are Sierra Leoneans who trace their descent to Canada or to England, to Nigeria and many other places.

  • And while it was in Sierra Leone earlier this year, someone told me that to understand its impoverishment, I should look at a map showing all the railroad tracks that were built in Sierra Leone while it was a British colony.

  • As you can see, the train tracks didn't really connect cities to each other.

  • They connected the mineral rich areas of Sierra Leone to the coast of Sierra Leone, so those minerals could be exported.

  • And this is a very important thing to understand about colonization.

  • It was in the business of resource extraction, and so the systems that were built in colonies were resource extraction systems.

  • There was not much colonial investment in, say, health systems or education systems, and sincerely own achieved independence in 1961.

  • It has struggled to transition away from resource extraction and to build the kinds of systems infrastructure, healthcare, even mail delivery that would lead to a more balanced economy and a healthier population.

  • Now it's easy to blame these failures on a single cause, like, say, corruption.

  • But while corruption is a serious problem in poor countries around the world, the bigger problem by far is that it's very hard to build health and education and infrastructure systems in communities that have been built around resource extraction.

  • That's true all over the world, but also a community just cannot spend what it does not have.

  • Like if Sierra Leone spent the same percentage of its economy on health care and education as, say, the United Kingdom does, Sierra Leone would have about $45 per person per year to spend on healthcare and a similar amount per child per year to spend on education.

  • That's just obviously inadequate.

  • Like in the U.

  • S.

  • We spend over $10,000 per person per year on healthcare and over $12,000 per child per year on education.

  • OK, so all these challenges were compounded in Sierra Leone by a long and extremely violent civil war, which lasted from 1991 to 2002.

  • Tens of thousands of people died.

  • Millions were displaced.

  • The health care system with devastated HIV infections, increased deaths from every cause increased and education and professional development were interrupted as schools closed or students had to flee violence.

  • Like Dr Byler Barry, who founded the widely respected Well Body clinic in Sierra Leone, had to leave his studies for a time to escape to a refugee camp.

  • And I heard similar stories from several health care workers because the civil war was on all sides, partly funded by trade in diamonds and other valuable minerals.

  • The war was especially devastating to Sierra Leone's diamond mining district, Cho No and as we traveled through CO know, I kept thinking about that old Faulkner line about how the past is never dead.

  • It's not even past.

  • In the end, the government paid for a mercenary army and weaponry, in part by selling the rights to the country's largest diamond concession.

  • And so today, almost none of the wealth generated by Kono's diamond mines ends up in co.

  • No.

  • And this is that to a paradox that is common in poor countries.

  • While Cano is one of the richest parts of West Africa, by some measures in terms of poverty rates, malnutrition, disease burden and child and maternal mortality it is one of the poorest and least healthy places in the world.

  • Because while diamond mining produces a lot of money, there aren't actually that many jobs for Sierra Leoneans in the mines.

  • Meanwhile, all around the mine, just outside the fence, you will see many people working at breaking stone to eventually be sold as gravel.

  • This is how you end up with a country where $100 million in diamonds gets exported annually and 6% of all women die in childbirth, and this poverty can become a vicious cycle.

  • I think the Ebola outbreak really epitomizes how impoverished and fragile health care systems can lead to emergencies.

  • When a bullet first appeared in Sierra Leone in 2014 the entire country had about 150 doctors for Context.

  • My home state of Indiana has a similar population and over 16,000 doctors.

  • Lack of running water made sterilization difficult.

  • There weren't enough gloves or surgical masks, and this systemic weakness is the reason that Ebola could ravage a country like Sierra Leone, but not, say, the United States or Spain.

  • We met in a bowl of survivor who now works for partners in health and who shared a bed with his son at an Ebola treatment facility.

  • Both he and his son survived, but his wife died just a few beds over.

  • So base we kill for So I told them, No, my someone, not groups.

  • I'm going to share the same bed with my son more.

  • I know I have no problem.

  • Sony's was line struggling for nineties.

  • You brought my wife when I asked Dr Bury his memory of treating patients there, he told me, waning and seeing like next.

  • Theo Ebola crisis was caused by a fragile health care system, and it led to a more fragile health care system, and that vicious cycle is often the story of poverty.

  • So I understand that these problems can feel far away and like they aren't our problems.

  • But first, you can't separate the wealth of nations like the United States in the United Kingdom, from the poverty of Sierra Leone.

  • You just can't.

  • We industrialized with their natural resource is and we built lucrative systems of trade by trading in West African slaves, but also, secondly, if these problems aren't our problems, I'm troubled by how word defining us like I don't want to be part of an US that makes them of the world's most vulnerable people.

  • And I think the idea that Sierra Leone can somehow solve its own problems in isolation wrongly imagines that its problems exist in isolation.

  • Now, of course, one of the risks of philanthropic work is that it's possible to make things worse or to create new problems while trying to solve old ones.

  • And I think it's important to be aware of those risks and to try to minimize them by grounding your work in listening and deep partnership.

  • But I just think it's inaccurate to say that nothing can be done or that investment is pointless.

  • I have seen the difference that partners in health and the Sierra Leonean Ministry of Health have made in the Cone Oh district, even with extremely limited resource is I mean, five years ago, the hospital and CO.

  • No had no electricity and very few supplies and as a result, almost no patients.

  • Today it is well staffed and well supplied and widely utilized.

  • There's a blood bank and a functioning operating room for C sections and other procedures.

  • Now it's still totally inadequate.

  • There are only 40 maternal beds for a population of 550,000 people.

  • But the progress Israel and I believe that progress will continue if the Ministry of Health, in partnership with organizations like Ph, is able to make the kinds of long term investments that address long term problems.

  • So why is Sierra Leone poor?

  • Because its systems have for centuries been structured around resource extraction because of war because of disease burden and because of colonialism and it's legacies.

  • But I am hopeful not because I think these problems are easy to solve, but because I have seen the extraordinary commitment of Sierra Leonean health care workers to their patients.

  • And because those patients have helped me to understand that despair is not the right response to big problems, even existential problems, there is nothing natural or inevitable about Sierra Leone's poverty.

  • And so I don't think it's permanent.

  • We have much evidence from around the world that overtime systems can get stronger, more moms can survive childbirth and more Children can survive.

  • Childhood educational opportunities can improve, and infrastructure can begin to connect people to each other and not just minerals to ports.

  • Hank, I'll see you on Friday.

good morning tickets Tuesday so later this month will be making a big announcement about working with partners in health, Sierra Leone.

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窮國為什麼窮? (Why Are Poor Countries Poor?)

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    林宜悉 發佈於 2021 年 01 月 14 日
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