Saturday, May 31, 2014

BODHI at 25

BODHI (Benevolent Organisation for Development, Health and Insight) is the NGO (non-governmental organisation) development charity, that I co-founded with the late Susan Woldenberg Butler in July 1989. When I wrote the first draft of this in May 2014 we were almost 25 years old (we then knew of Susan's diagnosis with stage IV pancreatic cancer but it was Susan's wish to not make that public during her life). We currently have autonomous branches in the US (California) and Australia (originally based in Tasmania, now in Canberra).
BODHI has a Buddhist influence – it may even be the second oldest strongly Buddhist influenced development NGO based in the West; certainly in Australia. Tzu Chi, based in Taiwan, is about two decades older and about 3 orders of magnitude bigger (branches in numerous countries, they have wonderful hospitals in Taiwan and perhaps  other countries, such as one planned in Indonesia.) The Karuna Trust, in the UK, is also older.

The Dalai Lama has been BODHI’s patron since 1989, the year he was awarded the Nobel Peace Prize, perhaps because it was also the year of the Tiananmen Square atrocities. I have met the Dalai Lama several times, the first in 1985 when I spent 10 months mostly studying the health problems of developing countries, including medical student electives in Nigeria and Nepal; I also that year met the Minister of Health of the Tibetan government in exile (in Dharamsala, India) – at that time my ambition was to specialise in infectious diseases of poverty, and to do a PhD looking at TB treatment of Tibetan refugees in India (of whom there were over 100,000, even then.) (I last met His Holiness in Sankissa, Uttar Pradesh, in February 2015.)

Prior to 1985 I had searched for a Buddhist–influenced NGO to volunteer for, but could not find one, instead studying general medicine and public health,with Christian missions in Nigeria in both hospital and community settings and later with the Britain Nepal Medical Trust, who work on TB control and reduction. I met Susan in Delhi, by chance, that year, and later we corresponded. I did have the idea of BODHI (though not the name) in 1985 but it seemed beyond reach – but not to Susan with whom I discussed it when we next met (for Buddhist teachings by the Dalai Lama) in Los Angeles in 1989.

So we started it in July 1989, first in the US, then in Australia. Susan and I eventually married in 1991, a few months after our first newsletter, BODHI Times. There are now 48 such newsletters, Susan had started number 47 before she got too sick to complete it.

BODHI's first project was to try to prevent rabies among Tibetan exiles in south India. Then we expanded to supporting Tibetan promotors of education. In the late 1990s we started the “revolving sheep bank” in Tibet. That's a long story - the Dalai Lama had recommended we work in Tibet when we met him in 1990 - and eventually we were able to do this via Professor Melvyn Goldstein, who is a leading Tibetologist. Susan and I met Mel (and his partner Dr Cynthia Beale) at Case Western University, Ohio, USA in 1996.

For many years the income BODHI received was tiny ($4k, then $6k, eventually $10k pa then $25k, then $50k, now $80k in 2013, but falling to $50K in 2014), but we always had some support and encouragement, eg the late Swiss industrialist Baron von Thyssen-Bornemisza
gave us US$1,000 for six consecutive bi-annual newsletters in our very early years. Gradually, income has increased but we are still small (average development NGO income in Australia is, coincidentally, about $70K per annum). (I can't find the evidence for this but here are some facts - Australians seem quite generous to charities, but our official foreign aid budget is lamentably mean, and has just been cut further.) BODHI US, so far, is less successful.

BODHI's current projects are mainly in India (especially in Pune and the Changlang district of Arunachal Pradesh) and Bangladesh, in the Chittagong Hill Tracts. We also used to provide some scholarships for poor Muslim girls, in Dhaka. Since Susan died this has not been possible, but might be in the future.
Our main target communities in South Asia are dalits and Chakmas (did you see the news coverage re two 14 year old dalit girls who were hanged in early 2014 in Uttar Pradesh?) They were Buddhist. 

There are between 10 and 30 million dalits in India who have converted to Buddhism. We no longer do any projects with Tibetans; we can't do everything, and in general, Tibetans in exile are not so disadvantaged any more, though they sure have a hard time in Tibet. (There is a short version of a chapter I wrote about Tibetan self-immolation here.)

Since the start, BODHI has been very strict in not providing any funds for religious or overtly political purposes. Religion is fine, but it's far more important to get adequate nutrition as a child, and to learn to read, write and count. (I nearly became a Buddhist monk in 1976; instead I decided to study medicine, now I work entirely in public health). 

It's also important to receive kindness, to not be exploited and to grow up and learn in an ethical environment; but no religion or philosophy has a monopoly on those characteristics.

BODHI's money goes mainly for education (it's the easiest - though you still need to find honest and effective school administrators) livelihood training (also a kind of education) and health. We work exclusively with NGOs based in developing countries, with whom we have a relationship and trust. Us trying to directly administer a school or clinic etc would just be too hard, too expensive, and probably could not be sustained for long - we have never tried that route. 

Health is actually very hard to fund on a shoestring, though we do sometimes fund community health clinics, both in villages and in a slum in Pune. But their effectiveness is probably limited. Instead we have chosen to focus more on trying to improve the determinants of health, especially education and human rights.

Donations are entirely from the public, though BODHI US did get a very small grant a few years back, and we almost got another from Buddhist Global Relief (to provide eggs at school for very poor children in Uttar Pradesh at some of the schools I visited in 2009) ... but that failed as the eating of eggs turned out to be tabooed by some of the parents and it got too complicated to administer.

Our third Australian director, Dr Denis Wright (a Bangladeshi specialist at the University of New England) died in December 2013, following 4 years suffering from a GBM (a malignant brain tumour). In those 4 years we hinted to a few people we thought might be suitable to become a replacement director, and we directly asked 2 people (both Chakmas – the Chakma community in Australia has no tax deductible charity of its own; BODHI is probably the largest NGO in Australia supporting Chakmas.) (Chakmas are a non-Muslim ethnic minority, mainly in SE Bangladesh, NE India and parts of Arakan, Myanmar. They face a lot of discrimination in Bangladesh and some parts of India.) Neither could find the time, but they continue to assist in other ways.

However, in 2014, Dr Indira Samarawickrema, who has a strong background in community medicine, and who is originally from Sri Lanka, agreed to be BODHI Australia's third director. That was wonderful news. Since then Dr Marty Rubin, a founding director of BODHI US has agreed to be a board member of BODHI Australia, so too had Dr Julie Adamson, a paediatrician in Newcastle, Australia, with whom I started medical school (also in Newcastle) in 1980. 

Mind you, in 2015 we realised that out constitution has no specific roles for directors (only committee members) so the directors are now "local advisers". (We also have a committee: a president, a secretary, a treasurer and a public officer.)

There are many critics of aid (eg William Easterly), and there are some strong supporters, eg Jeffrey Sachs. An awful lot of aid is wasted, and there are many reasons for that. A big problem is that the social and governance structures of most big countries have no genuine interest in lifting the living standards of the poor, but instead use aid to buy political influence (eg so a poor country votes for a rich country in the UN).

There is also phantom aid and there is boomerang aid

Another really big problem is that corrupt government aid recipients in many poor countries (eg Chad) have minimal if any interest in the general welfare of their own people, instead favouring one tribe, ethnic group, religion, gender, or perhaps the military.  Paul Collier's book "The Bottom Billion"  has a pretty good discussion of aid, and is far less dismissive than Easterly. However Collier has some big blind spots, especially to environmental determinants of well-being, and also to the harmful effects of rapid population growth, which contribute to entrapment in poverty.

After 25 years of experience I know aid is very hard to do well. But there is definitely a niche for groups of our size (though we'd like to get a bit bigger). Australian government aid scarcely goes to India anymore, though that does not mean there is any shortage of misery and exploitation there. But even if it did go to the Indian government, the chance of anything trickling down to the marginalised groups BODHI works with is minimal. 

For example, the morale and accountability among Indian teachers, especially those who work in poor or remote areas, is abysmal. There are numerous factors in Indian society which limit its own capacity to lift itself up. I personally think teachers in under-privileged parts of India should be paid more (than in richer parts), but that won't work unless it's properly enforced. And, it's very hard for illiterate, under-nourished parents of children whose education is being neglected, to effectively complain to some official; in fact it's virtually impossible.

There are benefits from involvement in BODHI which greatly exceed the monetary value of the projects. These take the form of learning (including in my case, learning about how to improve world health), they also, I believe, serve as a model, a prompt, for others, Buddhist or not. Perhaps BODHI and other NGOs give others hope. However, getting funds to the poorest of the poor is almost impossible. Such groups need champions, and their champions rarely if ever have the means and skill to even communicate with us, let alone account for money that we might send. 

But, not far above the really really poor there are (in India and elsewhere) millions of people who are still extremely poor and with whom progress can be made. I guess you could say that BODHI's work is mainly with that group. We can hope that, gradually, some of them - who are locally based - will in turn work with even poorer people. In 2014 I was interviewed by an Indian journalist, working for Down to Earth. We discussed poverty in India. She expressed concern about the poor but mentioned how her own parents were not very sympathetic to them. But perhaps the journalist's parents had grown up in relative hardship (or maybe the grandparents had). There seems to be an early stage of wealth accumulation where concern to reduce the poverty of others is really limited, but after a while, at least some people start to feel more secure, and start to share a bit, not to resent paying taxes (especially if they can see tax money being used for the benefit of poor), agitate for public health, education or the fair application of laws.

Though there are also some people who seem intent on just getting richer and richer, though there are exceptions: both Bill Gates and Warren Buffet have pledged to give lots of it away; and in Gates' case he has.

Involvement in aid can also help us value what we have here and be more sensitive to outrages like the plight of (as mentioned) those two hanged cousins in Uttar Pradesh, and a host of other atrocities, whether in India or South Sudan (etc).
We always have the choice – we can look the other way, or try to do something. We don’t need to be saints to do something.

Saturday, May 17, 2014

Energy transition, the Royal Society of Medicine, and DEEPA

I attended a conference yesterday called "Prosperity challenged: Energy transition & public health (there is a blog of it here, posted by Medsin-UK), hosted by the Royal Society of Medicine, founded in the 18th century, in London. I attended it electronically, using software called Jabber.

I was the first invited speaker, and had intended to travel in person. Circumstances stopped that; it's a shame I couldn't interact more with the people at the meeting, including Prof Kevin Anderson, but at least I didn't have to spend days on a plane, and my carbon generation is a bit less. Instead, I recorded my slides a few day ago. My slides (with recorded voice) are now posted on slideshare; maybe also on You-Tube if I can figure it out. Note, that to hear the voice you need to download the file, which is almost 80 megabytes.
We need a transition to clean energy urgently, in order to (a) prevent dangerous climate change; (b) improve air pollution, especially in Asia, and (c) because, pretty soon, fossil fuel is going to be generally unaffordable. If we factored in the negative "externalities" of fossil fuel we'd already find them too expensive, as Christine Legarde, of the IMF has pointed out. 

Optimists think ingenuity will solve scarcity. It may (largely) – including by recognizing limits. Triumphalists don’t seem to admit that reduced energy use, solar, education for girls, wider human rights, indeed environmental rights etc etc are forms of applied ingenuity. But market forces, even though rigged by an increasingly desperate fossil fuel industry (as pointed out by Prof Sharon Beder), are now working in favour of renewables.

Later I had an interesting "conversation" with Dr David McCoy, current president of MedAct, UK, who also attended the conference. In that correspondence, I was reminded of my proposal, made in 1988, for a global coalition of doctors and their friends, which I suggested, perhaps romantically, be called "DEEPA", an acronym for “Doctors for Earth, Environment, Peace and Action”. DEEPA in English, is of course a pun on "deeper" .. but it also means “light” (or "lamp") in Sanskrit. Deepawali, usually shortened to Diwali, is the Hindu Festival of Light. It's probably an ancient harvest festival, held in October or November.

DEEPA remains an idea, but soon after Susan and I did found the NGO BODHI (Benevolent Organisation for Development, Health and Insight). BODHI is also a Sanskrit word, meaning "enlightenment", or "awakening." "Bodhicitta" can be translated as the mind of enlightenment, and also of compassion. BODHI, whose patron is His Holiness the Dalai Lama, marks its 25th anniversary in July 2014.

Susan and I first met during Diwali in Delhi, in 1985. On the next night I left Delhi to travel by train for three days to West Bengal. I still vividly recall my emotion as I passed through what seemed miles lit by thousands of candles, with no electric light anywhere.

In November, 1990, the International Society of Doctors for the Environment (ISDE) was founded, a sister organisation to the International Physicians for the Prevention of Nuclear War, which was awarded the Nobel Peace Prize in 1985. One of ISDE's affiliates is Doctors for the Environment Australia (of which I am a founding board member). Since 2011 I have been DEA's representative to ISDE.

Perhaps doctors can develop even more coalitions trying to protect planetary health in order to protect human health. There is a chapter on the general topic of health and medical activism, co-authored with Dr Sue Wareham, in my forthcoming edited book Climate Change and Global Health (CABI). Both the Lancet and BMJ have recently had relevant articles (in the Lancet's case a manifesto that anyone can sign) on the need for health workers to also think about planetary well-being. In fact, the author of the BMJ piece is Dr Eric Chivian, who co-founded IPPNW in 1980. Dr Chivian also founded the Center for Health and the Global Environment, later associated with Dr Paul Epstein, to whom my book is dedicated.