Why Are Poor Countries Poor?

good morning Hank it's Tuesday so later this month we'll 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 are not going to get to the bottom of it in a YouTube video but I do think this can be some helpful context okay so Sierra Leone located here is a nation of around seven and a half million people it's ethnically and religiously diverse most Sierra Leoneans are descendants of people who've 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 I 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 since Sierra Leone achieved independence in 1961 it has struggled to transition away from resource extraction and to build the kinds of systems infrastructure health care 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 forty five dollars per person per year to spend on health care 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 ten thousand dollars per person per year on health care and over 12,000 dollars per child per year on education okay 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 was 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. Beeler berry 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 kono and as we traveled through kono 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 kono and this has led to a paradox that is common in poor countries while kono 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 a hundred million dollars in diamonds gets exported annually and six percent 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 bola 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 sixteen thousand 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 bulwa survivor who now works for Partners in Health and who shared a bed with his son at Ana bola treatment facility both he and his son survived but his wife died just a few beds over so about one in three days how he killed fall so I told them no my son not groups I'm going to share the same bed with my son so nice comfort I have no problem so was the online struggling for 90s you brought my wife Corso she died that's what when I asked dr. berry his memory of treating patients there he told me waning and seeing my patients the 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 and the United Kingdom from the poverty of Sierra Leone you just can't we industrialized with their natural resources 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 we're defining us like I don't want to be part of an us that makes of 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 kono district even with extremely limited resources I mean five years ago the hospital in kono 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 is real and I believe that progress will continue if the Ministry of Health in partnership with organizations like PIH is able to make the kinds of long-term investments that address long-term problems so why is Sierra Leone poor because it's systems have for centuries been structured around resource extraction because of war because of disease burden and because of colonialism and its 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 over time 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

Channel: vlogbrothers

Views: 439,986

Rating: 4.9282484 out of 5

Keywords: global health, ebola, health, health care, vlogbrothers, nerdfighters, partners in health, sierra leone

Id: snj6W9c8VIo

Length: 8min 17sec (497 seconds)

Published: Tue Oct 01 2019

Reddit Comments

[u/barravian]

“I don’t want to be part of an ‘us’ that makes a ‘them’ of the worlds most vulnerable people.”

Oof what a line. Stopped me dead in my tracks.

[u/CaptainDyslexia]

this video had so many gut punching facts, found it hard to watch but grateful it was created . thank you john

[u/wild-cows]

If he says anything other than colonialism, capitalism, and continued exploitation from western powers, imma be disappointed.