When you hear what you expect to hear. Cooperation for development lost in translation

Henry Alexander Henrysson
Jan 1, 2018
8 min read

The scene is etched in my mind. A medical doctor standing in his spotless, off-white coat in a room one immediately conjectures must be in a typical hospital. He has a slight smile on his face, looking thoughtful and straight in the camera like a character in countless hospital dramas. When one takes the eyes of the doctor and looks at the surroundings one immediately realises that this is not an ordinary hospital. This is a small clinic in a remote African village. The ceiling is mouldy and crumbling down in places. A few patients are scattered in the clinic’s beds but apart from the beds there seems hardly to be anything around that a hospital – or even a small clinic – needs. The room is conspicuously empty apart from the doctor, the beds and the patients, most of whom are probably battling tropical diseases such as malaria or typhoid.

The scene comes from a recent documentary which was made about my family’s life in Freetown, the capital of Sierra Leone. My wife runs an Icelandic privately funded foundation called Aurora Foundation, which has been active in the country for many years. The foundation has a close working relationship with the basket weaving community of the village and facilitated that the clinic would receive hospital beds donated from an Icelandic hospital. European hospitals now have beds with electric motors and older manually controlled beds are now stored without serving any purpose. To see them being put into good use in this particular clinic – the patients are now comfortable despite the scarcity of everything else needed to alleviate their ills – is really reassuring. The considerable complications of getting the beds from Iceland and to the village were worth it.

It is hard to imagine a country that needs more development assistance in the health sector than Sierra Leone. Obviously, there are other countries in a similar position, but every index tells the same story of Sierra Leone being constantly languishing close to the bottom. For Sierra Leone the challenges appear to be insurmountable. It is not only the constant battles with neglected tropical diseases and a horrible Ebola outbreak which have shaped the deficiencies of the country’s health system. The problems are to be found at every level. Perhaps one of the worst health-related situations is the mental one. A visitor does not have to be a long time in the country to realise the mental scars and disorders following the long and brutal civil war around the turn of the century. More recently, an epidemic of Kush-use, a cheap, readily available, synthetic drug, is blasting through the streets of Freetown. Rehab options are few and far between. One cannot really see what options there are to fight addiction in this country.

The above-mentioned problems persist despite good intentions and substantial work from many agencies for decades. To be sure, one can see examples around Freetown and neighbouring municipalities where aid has delivered much needed results. Some of the aid, for example the donations which ensure access to life-saving medicine, are perhaps invisible to most people. At the same time, one is also frustrated with the limited progress and the persistent challenges. Projects failing to achieve desired results are in front of everyone’s eyes. Some started well before fizzling out, while others never took off. The problems are always unintentional. Often one feels as if opportunities were missed due to lack of communication, which in the case of former English colonies are not caused by language barriers. The needs and realities on the ground were not sufficiently accounted for. In the health sector a well-known problem, which often does not receive necessary attention in the beginning, is the human resource status. Trained professionals tend to move to greener pastures, while sometimes there are no trained professionals to fill the necessary positions to begin with.

What happens when what we set out to achieve does not materialise? Is it due to lack of planning or is it because our aims are unrealistic? Or is it a bit of both? Sometimes we are so fixated on targets that we forget to ask ourselves why we set things in motion; what is the purpose? When the target – the measurable results – is the only thing that directs decisions, we tend to miss the target. As every good marksman knows, it is the whole process – which sometimes includes ignoring the target for a moment – that yields the best results. If there is something one can take from the flawed but ever interesting book of Eugen Herrigel Zen and the Art of Archery, it is how communication and understanding of custom together with limiting the focus on the target, leads to the best results.

I have mostly been an observer to my wife’s work here in Sierra Leone. My observations have convinced me of a few things which have been on my mind recently. One of the projects she planned to work on when moving to Freetown was to build a maternity hospital. The need most certainly existed and there was available funding to finish the construction. However, early in the process warning lights started to come up. If she had been absolutely fixated on the target itself, the hospital (the structure, not necessarily the operation) would be a reality by now. It would probably be among a handful of institutions with unsustainable budgets waiting to be handed over to the government of Sierra Leone (as is usually the plan). Unfortunately, the government has no means of running such institutions, and they continue with limited operations as long as funding from abroad can be secured. In the end, the foundation decided to step out of this project diversifying its portfolio and working on smaller projects with local stakeholders. If the target of constructing a hospital would have been something no one was ready to take his or her eyes off we would, unfortunately, be stuck with yet another White Elephant, as such expensive yet underutilised constructions are widely known as in the developing world.

Obviously, one must be careful in criticising development work in times like these. The developing world may be facing the end of aid, at least an aid on the scale of recent decades. Funding for essential projects is being slashed on a level never seen before. And it is not only the new government in the United States which is at fault, although their decisions are by far the worst in pushing health care and necessary services to the brink today. Many other countries had already started cutting aid in the name of budget austerity back home. The result is that developing countries have no chance of coming up with ways to absorb the outcome in such a short time and millions of people effectively will soon be without necessary medicine and health services, if they are not without it already. It is completely unrealistic that countries with unimaginable fiscal burden can come up with solutions on their own. But at the same time, we should perhaps now use the opportunity to openly discuss lessons learnt in the field of development cooperation while being strongly committed to aid for health-related responses, such as securing drug accessibility.

Let us now revisit the phrase which is the catalyst for this article. ‘Lost in translation’ refers to different things, everything from a poor translation to a complicated mix up of profound cultural connotations. The translation does not have to be between languages, sometimes something is lost in communication even though the working language is one and the same. A certain translation takes place when we get assistance in figuring out what a person meant when stating a wish or a desire.

‘Cooperation’ is built on communication. It refers to shared decision-making and understanding. It relies on meaning not being lost. To me it seems that the perennial problem with development cooperation is what was mentioned earlier about the targets and aims being decided from afar and followed meticulously through without much willingness to modify the course. Often the instructions are what people should do rather than what they can do – or what can be realistically expected of them. The most common complaint one hears in a city like Freetown is that local people find that their comments and input have got lost when projects are being designed, decided, and ultimately implemented. When projects fail to deliver the expected results those responsible tend to state the obvious that the problems were unintended – but perhaps they could have been foreseen. Taking a relatively large budget and dividing it up into smaller portions for more limited projects can be time consuming but no less fruitful and perhaps ultimately more cost effective. Our experience from Freetown is that positive things tend to add up if one makes sure enough projects take off. Some ventures may not seem to be that glorious project one imagines when setting up a development cooperation, but in the end the result can be more fruitful when all the projects come together. The most important task is to set up an environment where culture (in all its various forms) can develop on the terms of those who are receiving the support.

The most common complaint one hears in a city like Freetown is that local people find that their comments and input have got lost when projects are being designed, decided, and ultimately implemented.

It is not easy to explain how this approach should be applied to the health sector. The foundation my family has been associated with for a decade in Freetown is now working with young entrepreneurs and local artisans. Importing and distributing Icelandic hospital beds was an extracurricular project. Someone could ask what our experiences have to say for development cooperation in the health sector which surely follows its own needs and standards. The honest answer is that I don’t know, apart from being rather sure that stepping away from building the maternity hospital was the correct decision at the time. Obviously, one cannot reasonably claim that no projects that include maternity hospitals should take off. Many such projects will hopefully be realised in the future. These projects need to be sustainable, however. They cannot put strain on society, the existing health sector, or governmental entities. Bringing an impressive project into a country like Sierra Leone can have counterproductive effects.

I hope that my thoughts in this article have not only expressed the negative message of how often development cooperation ends up as White Elephants. What I have learned from my observations in Freetown is more about how much effect the smallest projects can have. My personal worry has been for many years that people think that their efforts in the “Global South” will not have any effect on anything. Although such sentiments can potentially be accurate – sometimes people think they are bringing in solutions when they are only bringing in their own anxieties and lust for adventure – I think such stories get too much coverage. They can discourage people from participating and offering much needed assistance to the cooperation between the global north and south. When choosing and designing projects, some of which can be rather limited in terms of funding and manpower, give yourself time to really listen to the perspectives of those you want to cooperate with. And you should not be too preoccupied with the targets you think you must achieve. Not every project must be on a grand scale, and every project may have to be fundamentally modified as it progresses. What often is lost in translation comes from preconceived ideas of what your counterpart is going to say on the one hand, and what you expect (or even hope) to hear on the other. It is too easy to interpret what people have to say as something which confirms your great plan. Often, one does the greatest good by being humble enough to admit that one’s own ideas of the needs of others are limited. □