Scenes from the Rally to Restore Sanity

I suppose it is indicative of the current movements in American political thought that in a year that the Tea Party’s Rally to Restore Honor and the organized left’s One Nation Rally drew crowds of no more than tens of thousands, a decidedly postmodern demonstration could usher a crowd as great as 6 billion people. Okay... in reality it was more like 250,000 – but the point is that the largest demonstration to march upon Washington in recent memory was not pushing for Congress to pass a certain piece of legislation or for the White House to end a certain war, it did not seem to have any tangible agenda in the proper sense of the word beyond the civilization of our nation’s political discourse.

To be honest, I was never able to get close enough to the stage to see exactly what was going on. But that didn’t matter – like at a Phish festival, the multitude of the audience was just as much if not more of an attraction as Jon Stewart and Stephen Colbert's three-ring circus on center stage. It was an interesting bunch of mostly urban hipsters but also yuppies, hippies and bourgeois squares of all shades and hues and faiths and sexual orientations united by the fact that we are all so appalled by the lack of quality news programming on mainstream television that we have to resort to Comedy Central for our information on current events.

The Rally to Restore Sanity served as a celebration of blue state values; namely, respect for Science and Objective Reality, skepticism of Dogma and Ideology, and faith in mankind’s ability to evaluate arguments with the power of Reason. When the culture of college-educated professionals who develop their opinions from newspapers, policy journals and non-fiction books is withstanding an onslaught of philistinism and bigotry masquerading as a coherent political theory, eventually push comes to shove and someone has to hold the world's greatest flash mob of participatory absurdist theater.

To the barricades!!!

Do You Cause More Harm than Good by Giving TOMS Shoes to the Poor?

After returning from a two-year tour with the Peace Corps I have only been home in New York for three weeks, and over the course of these three weeks at least a dozen people have told me to check out this new brand of TOMS Shoes and their “One for One” campaign – leading me to believe that this is the new trendy thing in humanitarianism. If you haven’t heard the pitch already;

In 2006, American traveler Blake Mycoskie befriended children in Argentina and found they had no shoes to protect their feet. Wanting to help, he created TOMS Shoes, a company that would match every pair of shoes purchased with a pair of new shoes given to a child in need… Blake returned to Argentina with a group of family, friends and staff later that year with 10,000 pairs of shoes made possible by TOMS customers.

Now in its fifth year of operations, TOMS has given away more than 1 million alpargata shoes to children and adults in Argentina and more impoverished, even more trendy Third World societies where the poor go shoeless such as Haiti, South Africa, Rwanda, Ethiopia, Guatemala, Kentucky, Louisiana and Mississippi. Blake does not consider himself to be just another businessman selling a product to make a profit, but as the CEO of a “movement”.
After all, an Argentinean alpargata shoe is not just a fashion choice to impress your Williamsburg hipster friends with your awareness of the oppressed indigenous peoples of the world. So their Birkenstocks were made by high-paid union workers and their Chacos were manufactured with limited carbon footprints – that’s so bourgeois! But if you buy a pair of TOMS Shoes for yourself, you’re directly helping the poor because Blake is going to give another pair to a child running barefoot through the rubble-strewn streets of Port-au-Prince!



The way the TOMS system works is very straightforwardly the way that it is advertised. Similar alpargatas of comparable quality sell for a retail price of $20 to $25, so when TOMS sells their shoes for $38, $44 or $54 the consumer is essentially buying one for the price of two. So yes, TOMS is giving half of their shoes away to the poor, but its not like those donations are coming out of corporate profits - all of the charity is paid for by the Western consumer. TOMS Shoes is profiting from both the shoe the wealthy Western consumer buys for his- or herself and TOMS Shoes is profiting from the second shoe the wealthy Western consumer buys for the person in need.

All through the promotional materials, Blake Myscoskie lays out the case that his shoes are not mere fashion items but humanitarian supplies necessary to promote health and education;

A leading cause of disease in developing countries is soil-transmitted diseases, which can penetrate the skin through bare feet. Wearing shoes can help prevent these diseases, and the long-term physical and cognitive harm they cause.

For those Westerners who have never stubbed their toe, Blake explains how the shoeless suffer from mundane ailments;

Wearing shoes also prevents feet from getting cuts and sores. Not only are these injuries painful, they also are dangerous when wounds become infected.

Furthermore, the lack of children wearing adequate footwear impedes education;

Many times children can’t attend school barefoot because shoes are a required part of their uniform. If they don’t have shoes, they don’t go to school.

Blake seems to have an adequate understanding of the importance of wearing shoes in the developing world. Though I feel the need to elaborate upon one particular “soil-transmitted disease” to which the One for One media implicitly refers: hookworm. If you talk to any doctor familiar with tropical diseases, they will tell you that there are many reasons why one should always wear shoes outdoors; ants, snakes, scorpions, ascariasis, schistosomiasis, rusty nails, broken glass, splinters, etc. But if there is one danger that a doctor is going to cite as a reason to wear shoes in the tropics, it is probably going to be hookworm.


The hookworm is a parasitic nematode which lives in the bodies of carriers and the soil, or to be more precise, in soil soiled with fecal matter. There are many species of hookworm which inhabit different kinds of mammals. People who walk barefoot around places where pigs and humans shit freely are prone to stepping in dirt teeming with larvae of the hookworm species Ancylostoma duodenale or Necator americanus which prefer to reside in our digestive tracts. The larvae need a host in order to feed so they penetrate the skin – usually the underside of the foot. Hookworm larvae then migrate under the skin through the vascular system and into the lungs, and from there they crawl all the way up to the trachea where they are eventually swallowed. The larvae then travel down through the esophagus and the digestive system until they finally reach the intestine where they mature into adult hookworms and grow to a size of 5 to 13 millimeters. Once female hookworms have reached reproductive maturity they can lay as many as 30,000 eggs a day – or 15 to 54 million eggs over the course of a single worm’s lifetime. Hookworm eggs pass through the host’s feces, and once they hatch a pig will eventually lay in the muck or a barefoot child in Nigeria will walk through a schoolyard without adequate latrines… and the life cycle of the hookworm continues…

Hookworm causes a host of physical symptoms among its human hosts, including nausea, fevers, painful diarrhea and anemia. Children born to mothers who were also incubating hookworm eggs in their intestine tend to suffer from low birth weight and prematurity. And I am inclined to assume that Blake Mycoskie’s One for One campaign is referring to hookworm when it invokes the “long-term physical and cognitive harm” caused by diseases incurred by barefoot-walking poor people; after all, hookworm is by far the most widespread ailment which causes cognitive harm which could be prevented by wearing shoes. Especially if contracted at a young age, unwitting hookworm hosts become increasingly more unwitting as the natural development of their brain is retarded and their cognitive abilities either level off at early childhood or they pointedly regress. This is among the many reasons why adequate sanitation and hygiene is so vital for improving education in the developing world, because when children are shitting all over the schoolyard and walking barefoot across the contaminated soils at least a quarter of the student body will probably contract hookworm and become neurologically incapable of learning.

Accordingly, one must understand that the combination of people walking barefoot, inadequate sanitation infrastructre and open defecation is one of the primary reasons why all of the above symptoms are so pervasive in the developing societies of Africa, South Asia, Latin America and Oceania. It is estimated that 576 to 740 million people are afflicted with hookworm worldwide; a stunning majority of 198 million are estimated to reside in sub-Saharan Africa (about a quarter of the total population of 800 million). If you haven't digested that statistic thoroughly enough, that means that - in addition to Down Syndrome and Klinefelter's Syndrome and general malnutrition - as much as a quarter of sub-Saharan Africans might be suffering from some degree of mental disability because they have been walking barefoot in fecal matter.

However, after a thorough reading of all of TOMS Shoes’ literature, I could only find indirect allusions to and one single fleeting mention of what is perhaps the gravest reason why anyone who walks around in the tropics should not walk barefoot. The sole explicit mention of hookworm I can find in the entire plethora of One for One materials is presented in such a way – buried in a misleading post titled “Let’s Talk About Podoconiosis” – that the symptoms of hookworm can be easily confused with this very completely different disease that is only related in that it can also be prevented by wearing shoes.

The One for One campaign explains the relevance of shoes to public health by focusing on podoconiosis – an illness which causes the grotesque swelling and deformity in the feet and legs properly known as elephantiasis.

Not to be confused with lymphatic filariasis – the elephantiasis-causing disease caused by parasitic worms transmitted via mosquito bite – podoconiosis is the significantly more obscure elephantiasis-causing disease found almost exclusively in certain populations of people who walk around barefoot over red clayish soils associated with volcanic activity and thereby rich with the alkali silicon dioxide. Repeated absorption of alkalis into the skin causes the lymphatics to form fibrous tissue and block and for the femoral nodes to enlarge; eventually the skin of the infected area swells with fluid, and it becomes thicker, nodular and rough like the skin of an elephant (hence “elephantiasis”). Podoconiosis disables its victims to such an extent that they cannot work and it disfigures them in a way that they are usually shunned as social outcasts.

Since the environment for this disease exists only in remote mountainous areas, podoconiosis is found almost exclusively amongst isolated subsistence agriculturalist and pastoralist societies in places like Sudan, Kenya, Uganda and especially Ethiopia. In certain pockets of the Ethiopian Highlands where the soils are particularly rich with volcanic alkalis and the traditional farmers and herders walk around their fields barefoot, as much as 6 percent of the population is thought to suffer from podoconiosis. It is very difficult to conduct an accurate census in these parts of the world where such a significant part of the population migrates with the seasons or is properly nomadic, so compiling reliable statistics on this particular disease is a rather arduous task; nonetheless, epidemiologists estimate that anywhere from 500,000 to 1 million people worldwide currently suffer from podoconiosis.



Let’s say that you were looking for a way to reduce the spread of disease in Ethiopia. If you buy a pair of TOMS Shoes it will cost you anywhere from $38 for a pair of Youth Canvas Classics to $79 for a pair of Highlands Botas - plus shipping and handling. Equivalent products cost $20 to $25, so the cost of manufacturing a cheap shoe like this cannot possibly be more than $10 - it's probably closer to $5. The average markup from American shoe retailer to the consumer price is around 40 percent, the average markup from a shoe company to a retailer is around 50 percent. What that means is that even if you're buying two of these shoes, TOMS is making oodles of money on both the shoes you buy for yourself as well as the shoes you buy for charity. Yes, a single pair of these shoes per se is really only worth about $5 - but that figure is only applicable if Blake Mycoskie is manufacturing these shoes and sending them to the Third World himself; but if you buy a pair of Pink Murray Organic Cotton Men's Vegans online for $54 the cost which you pay to give a pair of shoes to Ndugu the Amhara cattle herder is more or less half that - or $27.

If there are 1,000 children at a school in an Ethiopian village, for you to provide TOMS alpargatas for the entire student body should cost about $27,000. I will be generous and assume that these foam-and-rubber-soled, twill and suede-topped shoes will last their wearer an average of 2 years before they inevitably rip, degrade and fall apart to the point that they either no longer serve any protective function or they cannot be worn at all – seeing that these kids will be walking over rough terrain and doing heavy labor in the fields, 2 years is an extremely generous estimate. And I’ll be even more generous and assume that 100 percent of the recipients of these free shoes will be protected from contaminated soil as long as their shoes remain intact and wearable. So by handing out 1,000 pairs of free shoes to the sum total of $27,000, you could theoretically protect 1,000 children from hookworm, ascariasis, podoconiosis and stubbed toes for about 2 years.

Another way to improve public health would be for you to donate to a reputable non-profit on the ground in Ethiopia to build latrines at a public schoolyard so the students wouldn’t have to walk through each other’s feces in the first place. I’ve built a row of latrines at a school in Mali for a total price of $1,969, and I've built latrines in private homes for an individual price of $41 per latrine. Though I have never built a latrine in Ethiopia, my understanding of cement prices gives me no reason to think that the cost of latrine construction there should be all that much more expensive than in Mali. Even if no one ever conducts any repairs beyond superficial maintenance, a decently-built concrete latrine should last for about 25 years. Though it would not protect them from disease transmission outside the schoolyard, a disproportionate amount of disease transmission is concentrated around schoolyards without adequate sanitation - so these $1,969 latrines could thoroughly reduce the chances tens of thousands of children contracting hookworm, ascariasis, giardia, dysentery, cholera and schistosomiasis over the course of a quarter century.

For $1,969 you could give 72 kids in Ethiopia a pair of shoes which will inevitably rip and degrade into rags within a few years – or you could send your money to a Peace Corps Volunteer or Oxfam or Water Aid to build one row of concrete latrines at a school which should last for decades. For the price of sending TOMS Shoes to a school of 1,000 kids for 2 years, you could build 13 latrines at 13 schools to benefit the health of tens of thousands if not a hundred thousand kids over the course of 25 years.

Giving a child in Ethiopia a pair of shoes might very well be a moral thing to do, but when a development agency or NGO is pursuing some sort of public health agenda they have to do these kinds of calculations to determine which of many policy options available to them are worth the expenditure of finite financial resources. If you are going to donate your money to some sort of humanitarian cause, you should do the same kind of math to determine which charity you feel best deserves your money.

Even if cement prices fluctuate and building latrines becomes relatively more expensive, it’s fair to say that – dollar-for-dollar – you could reduce the incidence of disease incredibly more cost-efficiently if you were to stop giving away free shoes and use that money to contribute to the construction of latrines at public schools. Or you could contribute to the construction of a water pump so people don't have to drink unpotable water contaminated with guinea worm. Or you can pay to build a hangar at the clinic so that parents don't have to stand in the blistering sun for hours at a time during polio vaccinations and more kids will get vaccinated. Or you could pay for a village community health organization to get their hands on visual educational materials so they can train illiterate people to recognize the warning signs of tuberculosis. Or you could pay for the training of midwives in a rural village. No matter how expensive constuction materials might become in Ethiopia, the fundamental issue is that money spent on public sanitation infrastructure or education programs is going to be inherently more cost-effective than money spent on personal hygiene products because they last much longer for the direct benefit of a much greater number of people.

If Blake Mycoskie were running a non-profit charity mandated to reduce disease as effectively and as efficiently as he could on a dollar-for-dollar basis, then he would be spending money on sustainable water and sanitation infrastructure or rural health clinics or AIDS education materials in public schools. But he’s not – he’s a shoe salesman. As much as TOMS Shoes considers itself to be a “movement” rather than a mere profit-based firm, let us not forget that they are a shoe company first and a humanitarian aid agency second. And their niche in the galaxy of non-profits and quasi-non-profits-that-are-actually-for-profits is that if you buy a pair of TOMS Shoes, they give a pair to a poor person in Haiti or South Africa. Epidemiological or economic data be damned, their policy is to give away shoes.

But unless you yourself own stock in the TOMS Shoes company, you don't have any vested interest in sending a Tutsi girl a pair of shoes. You can donate to one of infinite charitable causes. Why not pay for her to have clean water? Or a mosquito net? Or a year's worth of antiretroviral treatment?

So what if we assume that podoconiosis is the only disease that you care about, that you are dead-set on contributing to that one particular cause - and the only way to prevent podoconisis is to get more Ethiopian Highlanders to wear shoes? Or let’s even forget about disease transmission and assume that you want to decrease the number of people without shoes as an end unto itself. Does that mean that giving away shoes is the best way to clothe the naked? Not necessarily.

To shed some light on my own point of view, as of late I have developed a strong sense of skepticism towards rich people who aim to improve the lot of the poor by simply giving things away because I have seen firsthand how such acts of well-intended charity can all-too-often result in painful belly flops of failure and can even be counterproductive to its stated goals.

While I was a Peace Corps Volunteer in Mali from 2008 to 2010 I lived in a concrete home built by the Christian NGO World Vision to house its own development extension agents (missionaries with secular humanitarian agendas) who lived there from 1988 to 1998. Though World Vision’s personnel had never returned since they closed down operations in Sanadougou in 1998, 10 years later the legacy of their actions remained tangibly apparent. Not only had they built the house I lived in, but they had built a clinic across the street from my house which was full of patients and decently staffed every day. They built a kindergarten which was still used despite the fact that it was falling to pieces. They built a solar pump system which could provide the town with potable water, but it was never managed, never maintained, in need of serious repairs and was for all practical purposes non-functional. They built a library that no one ever borrowed books from. They built a dance hall that was used a total of 4 times in 2 years. And even more durable than their legacy of steel and concrete structures, the well-intentioned NGO had completely distorted the incentive for perfectly rational economic actors to spend their own money to buy shoes for their children.

Every Christmas countless churches throughout the affluent West decide that they should spread their love for all of God’s children by putting together boxes of gifts to send to poor kids in Africa. By May or June hundreds of these boxes of gifts would have arrived in World Vision’s Bamako bureau and eventually a portion of them would make it to Sanadougou and the World Vision agents who lived in my house would go out and distribute these gifts to Christian children in villages around the area. As I have been told by my neighbors in Sanadougou, these gift boxes contained soccer balls for boys, baby dolls for girls, and every gift box contained an age- and gender-appropriate pair of shoes. Depending who was telling the story, I was told that “the White People gave us cadeaux” on various years with occasional differentiations in the contents of the box – my understanding is that the Christian NGO personnel distributed shoes to kids around the village to celebrate a number of Christmases in June.

None of these shoes from Christmases past still existed for me to see in 2008 – even the most professionally child-sewn Nikes could never last a decade’s worth of wear in Africa. The enduring legacy of these well-meaning Christian philanthropists was rather the dog that did not bark; at least part of the multitude of bare feet. In Sanadougou all but the poorest adults would walk around in a pair of shoes, so did most kids 12 or older – those old enough to work in the fields. But the majority of kids younger than that – young enough that they are most susceptible to serious complications of hookworm, ascariasis, etc. – always walked barefoot. Of course, part of this is because many a farmer did not have all that much monetary income to spend on shoes for every single one of his 9, 12, 15, 20 children. But there were also a lot of people who did have enough income from cash-cropping, livestock sales, blacksmithing, carpentry and assorted other trades, people who could most certainly afford to pay for shoes for their kids but decided to spend their money elsewhere.

In Sanadougou’s market a pair of the cheapest, lowest-quality Chinese-manufactured plastic shoe costs 800 francs CFA (~$1.60). The equivalent pair of flip-flops costs 500 francs (~$1). A packet of tea costs 200 francs, a kilogram of sugar costs 450 francs, a cigarette costs 100 francs, and a full motorcycle gas tank costs 2,000 francs – 3,000 if it’s a Yamaha. In a small town like this, phone cards are sold for denominations of 1,000 or 2,000 francs. 500 francs for a pair of flip-flops is not so unaffordable to explain why so many kids in my village walked around barefoot.

Some adults in Sanadougou were very, very poor and could not afford shoes even for themselves – but they could afford to brew three rounds of tea and sugar every night. I’d go to the butigi to buy some matches and there would be Nouhoume sitting in his place as usual enjoying his afternoon cigarette and he’d point at his cracked, broken feet,

“Madu, you have so much money! Why don’t you buy me a pair of shoes?”

“Y’know, Nouhoume, if you forego cigarettes from today until Thursday, on Thursday you will have saved enough money to buy a pair of shoes yourself!”

What really infuriated me was when people would show off to me their conspicuous consumption of top-of-the-line Western electronics that they absolutely could not afford – because it was always shamelessly juxtaposed with the abject want of necessity. In particular I remember this one guy Sori Sogoba; Sori is a 22-year-old who farms millet and peanuts and goes to Bamako every cold season to sell phone cards, and he has a wife and three kids who walk around town barefoot. And he has an iPhone. Just about every time I saw him he would always steer the conversation to “My iPhone is better than your dinky Nokia. Your telephone can’t even play music videos!”

“Yeah, but everyone in my family has a pair of shoes.”

I would try to make the connection between the abundance of unaffordable luxuries and paucity of necessities like shoes and mosquito nets whenever granted the opportunity. And I pissed off a good many people in the process – especially Sori.

He would respond, “Yeah, well, I don’t have to buy them shoes because one day The White People are going to come back and give shoes to the children. My kids don’t have shoes because The White People haven’t come yet!”

In so many inversions, dozens of Malian parents have told me this same sorry excuse on even more numerous occasions. They would always cite the fact that once upon a time the World Vision gift-givers drove around the village in their big SUV and handed out shoes to a couple dozen children every other year or so from 1988 to 1998. The Time That the White People Came and Gave Shoes to the Children is one of the few legends of Sanadougou lore that is recounted over the teapot on a fairly regular basis, and in accordance with their Messianic creed they had every reason to have faith that one day The White People shall return – with shoes, of course. Back in 1997 many of today’s fathers were then among the recipients of the White People’s Christmas gift drive, so it seems only natural that this formative experience has made a lasting impression on their parenting now that they have kids of their own.

Of course this is a completely unscientific survey, but from my casual conversations with dozens and dozens of poor Minianka farmers in Mali, I only have reason to think that a significant number of people were telling me the truth when they told me that they had decided upon the inaction of not splurging 500 francs on a pair of shoes for their child at least partly because of the expectation that The White People would take care of this expenditure for them – and therefore they consider that to spend their own money on shoes would be a waste of 500 francs that could otherwise be spent on… say, five cigarettes. Likewise, I don’t think I’m going out on too far of a limb when I conclude that there exists a significant population of children running around Sanadougou barefoot and contracting hookworm, ascariasis, etc. who are lacking shoes precisely because once upon a time between 10 and 20 years ago World Vision decided to give away shoes for free.

Indeed, it is also quite likely that a number of men who told me that they didn’t need to buy their children shoes because in the past a Christian charity gave away free shoes were just making sorry excuses and that they would have never bought their kids shoes even if this precedent of Western intervention in the local shoe market had never been set. Even so, these men were still able to abdicate personal responsibility for the welfare of their children by citing the (in their minds reasonable) expectation that someone else would do their job for them – because this one time they did.

The incentive problem caused by the free distribution of shoes in Sanadougou seems quite similar to the problem with the free distribution of mosquito nets. As I have written in prior musings, every year the Sanadougou clinic gets a shipment of a few hundred mosquito nets from UNICEF which they give for free to every pregnant mother whom they admit to the maternity. Even though the overwhelming majority of the population is never going to be eligible for one of these free mosquito nets, the fact that some people are getting free mosquito nets allows for an economy in which no one – not even the wealthy and educated who do understand the value of this product and have more than enough money to obtain one by their own means – will ever feel obligated to buy mosquito nets for themselves and for their children. Even though sleeping under a mosquito net is the simplest, cheapest, most cost-effective way of preventing malaria, the knowledge that foreign charities are intervening to help some people obtain a mosquito net for free allows everyone else to completely relinquish any self-determination of their own health and well-being. Once a precedent like this has been established in the collective mind of the tribe, it’s really difficult to undo.

Philanthropic Westerners must understand that even though their intentions in giving might be perfectly benevolent, in practice just giving things away to people can have destructive implications. Before you give to a certain charity or purchase a pair of TOMS Shoes, it is imperative to comprehend that in these parts of the world where people have next to nothing, incentives can work in such ways that the recipients of your aid might adopt behaviors that Western do-gooders simply cannot conceive. I’m not saying that you should not give to charity – all I’m saying is that before you give whimsically to just any humanitarian-sounding cause, first take into consideration that it is possible that your unconditional generosity might just distort incentives to such a perverse extreme that any good that they might have achieve in the short run might be negated by the greater harm that they might cause in the long run.

So should Blake Mycoskie get out of the business of distributing shoes to poor people? Not at all. I do think, however, that he should consider getting out of the business of giving away shoes for free. Blake Mycoskie is a shoe salesman – he should be selling shoes to poor people.

In a study by Population Services International, a campaign to distribute free mosquito nets in Zambia resulted in only 30 percent of all recipients ever actually using their free mosquito net. However, as economist William Easterly describes the effort in culturally-similar Malawi:

PSI sells bed nets for fifty cents to mothers through antenatal clinics in the countryside, which means it gets the nets to those who both value and need them… The nurse who distributes the nets gets nine cents per net to keep for herself, so the nets are always in stock. PSI also sells nets to richer urban Malawians through private-sector channels for five dollars a net. The profits from this are used to pay for the subsidized nets sold at the clinics, so the program pays for itself. PSI’s bed net program increased the nationwide average of children under five sleeping under nets from 8 percent in 2000 to 55 percent in 2004, with a similar increase for pregnant women. A follow-up survey found nearly universal use of the nets by those who paid for them.

If people are still going to buy their $20 shoes for $54, TOMS Shoes should consider tinkering with the current “One for One Movement” and replacing it with some sort of distribution method that aims to decrease the number of people who are shoeless and nevertheless abstain from doing anything that might create a perverse incentive for people to not buy shoes with their own money. Why not try to emulate PSI’s successful Malawi Model? Step up efforts to sell alpargatas directly to Guatemalan and Rwandan and Haitian elites at a price that they can most likely afford – and only after the style catches on amongst the trend-setting upper class reach out to potential middle class and working class and subsistence agricultural class customers and set prices accordingly at levels that each respective class can most likely afford. Sell a pair of alpargatas to the poor for one dollar or fifty cents – a price that is low enough that it is within their price range and yet somewhat more expensive than free.

If TOMS is making profits giving away a free pair of shoes for every pair they sell, I find it difficult to believe that they could run into financial trouble by charging a nominal price for the shoes they now distribute pro bono. The only way that selling shoes to the poor could possibly be detrimental to the company’s bottom line is that a significant number of wealthy Westerners are buying alpargatas solely because of the premise that they are giving a pair to a barefoot kid in Ethiopia. But TOMS Shoes doesn’t even have to abandon the “One for One Movement” – only now, their slogan should be “For every pair you buy, we will sell a pair of shoes to someone in need for only fifty cents.” I find it hard to believe that the class of customers who will buy a pair of shoes because they want to make a political statement with their wallet is going to abandon the TOMS line if they're only selling shoes to the poor at 95 percent off.

Selling a quality product for a profit in places like Ethiopia and Rwanda is nothing to sneeze at. There are already shoes for sale there – the problem is that the only shoes that most people can afford are cheaply-made Chinese shoes that are of poor quality and they do not last through the rigors of farm work and they break too easily. Some people can afford decent shoes, but too many cannot. That is why the world needs entrepreneurs like Blake Mycoskie to devise a successful business model to sell durable shoes to the poor at prices that they can afford.

Nevertheless, as the company’s policies now stand, at the moment I remain a skeptic of TOMS Shoes and the “One for One Movement” because I think that its goals are misdirected and that its model does not seem to be cost-effective compared to viable and proven alternatives for reducing disease. I believe that at best this company is selling its customers a bunch of overpriced earth shoes whose expense can only be justified because they come with the satisfaction of thinking that one has made a difference, and at worst they might actually be increasing the likelihood that more children will walk around barefoot. But I also believe that this basic premise of TOMS Shoes is not without hope, and with some structural changes to the way that they do business in the developing world this firm can make a much better long-term, sustainable change in the clothing market which allows for more of the world’s poor to afford a decent pair of shoes.

In the meantime, I think that anyone who is buying one pair of mediocre shoes for the price of two is just wasting their money. If you want to spend your money in a way that helps the world's poor, you might as well just buy another brand of alpargatas for $20 and take that other $34 you would have spent had you bought a pair of TOMS and donate it to Oxfam, Habitat for Humanity, Doctors Without Borders or some other genuine non-profit that is more likely going to spend it on more worthwhile projects that will make a much greater impact.

Eating With My Hands

To preclude accusations of “cultural imperialism” the educational philosophy of the Peace Corps is all but one of cultural relativism. We are supposed to teach the people of developing countries about which new varieties of sorghum offer the highest yields, how to start a business and manage their accounts, sometimes we work in the classroom as math and science teachers – but we’re supposed to teach only objective truths and we’re explicitly not supposed to tender criticism of our host country’s indigenous culture. Understandably, few self-respecting nations which have lived through the humiliation of Colonialism – particularly those nations which have suffered under the yoke of French overlords who appointed themselves mission civilatrice and sought to discredit and dismantle the beliefs of tribal heritage – would now petition the United States to come and tell them that their culture is wrong.

However, maintaining a position of absolute political correctness is impossible when the prevailing practices in a given field are in fact objectively wrong. When Malians greet me “bo swa” at 8 in the morning, when bus drivers have filled their car beyond the legal maximum capacity and tell me to cough up more cash so they can bribe the police, when people ask for leaves from my lemon tree so they don’t feel guilty about not buying real medicine for their child in a malarial coma, it would be a disservice for me to just go along with the prevailing practices of this culture and not criticize the way people live in this country to their faces. Of course a liberal would argue that all of the above are the muddling of Western modernity, so all of this present-day African nonsense can be attributed to the corrupting influence of French colonial rule. But some of the most self-defeating customs which people follow here were established long before there even was such thing as a France, it would be obtuse for thinking people to subscribe to the absolutely non-judgmental broadmindedness of mushy-headed liberalism and tell themselves “it’s not wrong, it’s just different.”


Perhaps the most difficult custom for a mushy-headed liberal to digest is the way that Malians eat – because it is an objective truth that the traditional way of eating is one of the most significant vectors of disease transmission in this society. Malians by and large eat their food with their hands, and so long as they are eating with family or friends they eat with their hands from a single communal food bowl. Most Malian men tend to livestock and spread their manure over the fields, almost everyone wipes their butt all women wipe their children’s with their left hand; somehow or another over the course of the day their hands are likely to come into contact with fecal matter. Hardly anyone ever washes their hands with soap, so when Malians eat with their hands from the communal food bowl they share and consume each other’s fecal germs. Hence the primary reason why giardia, dysentery and all other forms of severe diarrhea are endemic in this culture is the purely cultural factor of how one brings food to one’s mouth.

When I arrived in Mali for Peace Corps Training, the language and cultural teachers collected me and my fellow trainees into groups of six, sat us around big aluminum bowls of zamé: fried rice with chunks of beef, cabbage, hot peppers and onions. The object of our lesson that day was to learn to eat our lunch with our hands. This task was not so daunting for a dedicated multiculturalist such as myself; I had spent a month in Sri Lanka where I learned the Indian subcontinent’s method of folding one’s four fingers into a V-shape to scoop up a mouthful of rice and sauce and pushing it towards one’s mouth with the thumb – the Sri Lankan finger scoop method could be so refined that at the end of a meal an apt practitioner should have their palm perfectly clean. In my prior experience, eating with my hands was something exotic and worldly.

“Exotic” – yes, but “worldly” is not the first word that usually comes to mind as a Westerner watches Malians eating with their hands. Unlike the Sri Lankans and their graceful finger scoop, a Malian is wont to grab a heaping handful of rice with their right hand, squeeze it in their palm, open their mouth as wide as they can and place their palm to their bottom lip as they shove the handful of rice into their gaping gullet, then thrust the entirety of their four fingers deep into their mouth so they can suck off every last drop of sauce. If they are the staple dish of grayish-green millet goop called toh, Malians will cup their hand a little more as they dip the millet goop balls into a separate bowl of sticky sauce made from baobab leaves, dried fish and peanut oil – the sucking of the fingers remains the same. All of this is done as quickly as possible with no conversation between wolfing down handfuls of food, because the faster one eats the more they can consume. After they have eaten their fill, a Malian licks his or her saucy hand clean in a manner not unlike that of a cat preening the fur on their head.

I went with the flow as I tried to integrate into the family of Karitie Sanogo and Durcas Dembele and their Minianka subgroup of the Bambara tribe. I found eating with my hand sloppy, and it was quite impractical if I was eating lunch alone and trying to read a book. But when I sat down with a group of men around the communal food bowl, I thought “When in Rome…” and shoveled away. I feared that eating with a fork or a spoon would set this hairy, light-skinned Jewish boy apart as an even more distinct Other.

Cheap aluminum forks and spoons are widely available at any sizeable market for no more than the price of a small box of tea, so there were some times though when I wondered how Malians had never developed the custom of eating with utensils by their own initiative. On special occasions Durcas would cook spaghetti seasoned with a bit of tomato paste and a heaping volume of peanut oil, and since food here is served directly from the kitchen with no time to cool off people would begin to dig in while the oil on the spaghetti was still scalding hot. The oil would be so hot that even the old men with their thickly-calloused hands would be wincing at the touch. And long strands of spaghetti are not designed to be eaten manually; every time the men around me would reach down for another painful handful they struggled to shove eight inches of floppy, steaming noodles into their mouths – at least half of the spaghetti strands would be dangling out of their mouths as they chewed, splattering hot burning oil all over their faces and all over their clothing. All of the men seemed to be in such pain and discomfort that it was hard to believe that any of them really enjoyed eating this impractical delicacy.

After a few experiences with this nonsense, the third time that Durcas prepared spaghetti I came equipped with a fork and showed them a much more efficient way of twirling it into practical, bite-sized portions. “You see, not long after the Italians learned how to make spaghetti they invented these things called forks so that they could it without burning their hands and making a mess with the sauce.”

“Maybe they eat with forks in Italy” I was reprimanded, “but here in Mali we eat with our hands.”

“Suite yourself” I thought, and twirled my spaghetti with a fork as all the other men in the family continued scalding their hands.

So long as we weren’t eating spaghetti covered in scalding-hot oil, I thought that eating manually from the communal food bowl didn’t have to be a bad thing, for I could use every meal as a forum to inculcate proper hygiene by washing my hands with soap and water and insisting that every man I ate with do the same. This should be no minor formality in a society of people who wash after defecating by sticking their left hand up their asshole, scrape their rectum with an extra-long pinky nail, and then flush their asshole clean with water from a plastic teapot. Malian culture stresses that anal cleansing is to be conducted exclusively with the left hand – “the good hand”, and that one eats with only the hand on the right – “the rice hand”. But all of this business about separating the right hand from the left comes to naught only a few seconds after anal cleansing when Malians “wash” both hands with only water from that same plastic teapot which was up their asshole only moments ago. Before eating from the communal food bowl, they will pass a calabash or tin can full of water around in a circle starting with the eldest so that everyone can mush their left and right hands together in the increasingly-filthy water. In this culture where just about everyone is completely ignorant of modern germ theory, people think this is actually a hygienic practice.

The fact of the matter is that the prevalent Malian “hand-washing” practices is one of the primary reasons why the population of Mali suffers from more giardia and dysentery than almost any other culture in the world, it goes a long way in explaining why 2 out of 5 children in this country die before the age of 5 and why life expectancy is only 45 years for men, 48 for women. If a circle of men are mushing their shitty hands together in the same calabash of water then after the calabash has gone around everyone has the fecal matter of other men on his hands. And if these men are then eating with their hands from the same bowl of rice or toh, over the course of a meal they are most likely consuming each other’s fecal matter. The Minianka village in which I have lived for two years is an unwittingly coprophagic culture, for a person to eat with their hands from a communal food bowl without having adequately washed their hands is to directly subject other people to the consumption of human feces.

I don’t think that it is going too far out on a limb to say that traditional Minianka eating habits are not just distasteful to the cultural norms to which I am accustomed but objectively wrong. Let’s say that I had in my possession a syringe containing Ebola – wouldn’t it be immoral for me to inject it into an innocent bystander and infect them with the deadly virus? Or if someone knew that they were infected with HIV, wouldn’t it be immoral for them to exchange bodily fluids with another person and subject them to that deadly disease? Knowing that the consumption of human feces is a surefire way to make someone sick, wouldn’t it be wrong to furtively slip a fresh stool from a cholera patient into someone else’s milkshake? How about if someone with dysentery wipes their ass with their hand and then puts his hand in someone else’s rice bowl? Even if someone has yet to be diagnosed with a particular malady, in this day and age when (at least in the Western world) people understand how diseases are transmitted it is unambiguously wrong to engage in practices known to spread serious illness. Ignorance might obviate moral culpability, but it does not change the fundamental wrongness of a practice which inflicts harm upon others.

Where the Peace Corps Volunteer comes into the equation to break the cycle of disease and poverty is to simply eat with the people and still live up to our own standards of cleanliness. Accepting the fact that the Minianka villagers of Sanadougou crouch around a communal food bowl to eat with their hands, I made my point of washing my hands with soap before eating and insisting that all the other men eating with me do the same. I even bought this nifty plastic contraption to replace the calabash so that everyone could wash their hands with a clean, non-toilet plastic teapot over a receptacle without dirtying their hands in other people’s filth. I was eating with the Director of the elementary school Karitie Sanogo and two bachelor teachers Lazar Balo and Boubacar Coulibaly – if there was anyone in this society who could understand proper hygiene it should be this literate elite – and even if they preferred to not wash their hands with soap they grudgingly obliged to accommodate this foreigner’s eccentric ways.


That is not to say that I didn’t have any trouble getting my eating partners to wash their hands. Karitie and the teachers were generally cooperative, but they would have guests come to eat from the food bowl on a regular basis. When we passed the soap and water around the circle, guests would usually just rinse their hands with the water and mush them together like usual. I would nag them about the soap, and they would usually retort, “In our country, we don’t wash our hands with soap – we wash our hands with water.”

“I know – and that’s why so many people in your country die from dysentery. In my country, no one ever gets sick with dysentery – it just doesn’t happen because we wash our hands with water and soap.”

Some men simply refused. “SHUBAGAW!!!” they hollered – “evil sorcerers”. Though they publicly identify themselves as Muslims or Christians, the people in Sanadougou cling tenaciously to their animist superstitions; not knowing anything about germs or viruses, they believe that illness and disease come from these evil sorcerers' black magic spells. And according to ancient lore, washing your hands with water protects oneself from such malevolent witchcraft – soap, however, negates water’s protective powers and renders one vulnerable to sorcerers and their evil ways. Grown adults seriously believe in this twaddle, to such an extent that they would raise the tone of the conversation into a shouting match.

“NO!!! I REFUSE to use soap!!! EVIL SORCERERS!!!”

“Evil sorcerers ARE NOT REAL!!! THEY DON’T EXIST!!!

At this point in the conversation, Karitie would look his guest sternly in the eye and lash them in Minianka “If you’re going to eat with the American, you have to wash your hands with soap. Just do it.”

In a society where old men are considered to be a depository of all knowledge and wisdom, people thought it was downright subversive for 24-year-old me to tell a 50-year-old cekoroba how to wash his hands. This went for anyone. Even on the occasion when the chief of the village or the Mayor of the entire Commune would come to eat with Karitie and me, without batting an eyelash I directed the upper crust of society to scrub their hands with soap. And they were duly offended. No one likes to be told that they’ve been eating shit their entire life – let alone by a foreigner half their age.

I ate like this for about a year, getting in fights with Karitie’s houseguests and winning so long as Karitie was there himself to provide the moral support. But on some occasions he would be gone on business and I would be eating alone with the teachers Lazar and Boubacar – neither of which had any desire to be cursed by evil wizards any more than the next guy, they were only washing their hands to humor their boss. One night Lazar looked me defiantly in the eye, mushed his hands in a pot of water and plunged them into the bowl full of rice, “You can’t make me wash my hands with soap.”

“You’re right. And I can’t eat with you, because I don’t want to eat rice with your shit all over it.” I got up and walked home to cook dinner by myself. Durcas was so thoroughly insulted that I had walked away from her afternoon’s work that she gave Lazar an earful; from then on before eating he would dip his hands into the soap dish while casting me the stink eye.

I put up with this shit for quite a while, but after a year of struggling to convince my eating partners about the merits of soap from time to time I would still find myself running to the nyegen with giardia. I was filtering and treating every drop of water that went into my body, so the only way I could possibly be getting giardia was from the food I was eating. I began to watch the other men eating from the food bowl more closely, and I realized that that a lot of them were merely feigning to apply soap; most dinner guests – and Lazar of course – were meekly touching the bar of soap with the tip of their forefinger and calling it a day. Apparently they thought that hand-washing with soap was just some sort of Tubab eating ritual (though it isn’t – we don’t eat with our hands from any sort of communal anything). No matter how many times I tried to explain how soap actually has chemical properties which detach particulate matter from one’s skin and kill the microorganisms which cause diarrhea, they thought that I was just spouting off American mythology equivalent to their own folklore about witches and wizards. No matter how hard I tried, it seemed that science, reason and the moral power of example had no use on these people – and that for me to eat with my hands from a food bowl meant that I would inevitably be eating other people’s feces.

I thought long and hard about this. Eating from the communal food bowl was more than just a ritual in Minianka society. Even though conversation has nothing to do with it, eating together with another person is the most basic social activity which I could partake with another Minianka man as a sign of friendship and camaraderie. To be a part of this society meant eating with the same food as them, to eat from a food bowl with another is to treat them as one’s equal. To eat alone would be interpreted as a strong demonstration that I truly wished to set myself apart from this society.

I called to seek the wisdom and sagacity of my elders, and my dad recounted a conversation we had had when I was a senior in high school driving around New England looking at colleges. I had made a point of checking out schools where Greek life was small to nonexistent, because I didn’t want to be faced with the choice of either joining a fraternity or having no social life.

“Don’t worry about it, Zac, even if you go to Dartmouth or Cornell that doesn’t mean you have to join the Deltas. There are better ways of creating lasting bonds with friends than running some dehumanizing hazing gauntlet.”

“If I did want to join a fraternity, what would I have to do in order to pledge?”

“Let’s put it this way: if you’re invited to join a secret society and you’re told you have to eat a brother’s feces, just say nothing more and walk away. If you have to eat someone’s shit in order to be a member of a society, there can’t be any compelling reason for you to be a part of it.”

Thus I concluded that I could no longer eat from the communal food bowl.

I came to Karitie and Durcas’ house one day with my own plastic bowl and explained that from that day onwards I could only eat alone. They really didn’t know what to make of it – no one had ever done or said anything like this before. I didn’t have the heart to explain to them the real reason why I couldn’t eat from the men’s bowl, I feared they would interpret it as a grave insult and they would disregard anything else I had to say. So I offered a little white lie that my doctor told me I needed to lose weight and that I should start exercising portion control: “It’s not that I don’t like eating your rice and peanut butter sauce, it’s that I love it so much that if you put the whole bowl in front of me I’m going to eat the whole thing!”

But Karitie and Durcas are intelligent people. Eventually they figured it out.

For the rest of the year, guests to their food bowl would make a stink about me eating alone. People would accuse me of being an elitist or a racist; they would ask “You think you’re better than us?” I didn’t want to make a big deal of it, but in regards to the very significant matter of hygiene I certainly did think so – I knew so, it was a fact.

And eventually I realized that since I was eating by myself, and conversation has nothing to do with the Malian eating ritual anyway, I might as well bring a book or magazine with me to read while I ate from my private food bowl. But it was difficult to turn the pages when I had peanut butter sauce all over my right hand, so I started bringing a spoon with me to all of my meals. Eventually I dropped the eating with my hands business altogether, because I had discovered a much cleaner, more efficient and hygienic manner of bringing food to my mouth.

The more I thought about it, there is really no compelling reason for me or for anyone else to eat with their hands, that it’s simply a primitive practice employed by those cultures who have yet to embrace modern sanitation. Hand-washing with soap is a harm-reduction practice which can reduce the spread of disease among cultures that eat with their hands much like if heroin addicts were to shoot up with clean needles instead of sharing them – but the harm can be eliminated if people would stop shooting heroin altogether. I resolved to never eat with my hands again.

Once I started eating with utensils again, Durcas remarked that I was “eating like a Tubab.”

“No matter how long you look at it, a tree stump will never turn into a crocodile”, I replied. The one and only proverb in the Bambara language means that some things just don’t change.

And eventually I noticed that Karitie, Lazar and Boubacar had given up on washing their hands with soap. It was plainly obvious that they had been going through that charade the whole time to humor me – not because they were actually serious about adopting this practice. Despite a whole year of my lectures about the giardia, the fecal-oral cycle and disease prevention, the most educated men in the entire community were still content to be ingesting each other’s fecal matter.

“No matter how long you look at it, a tree stump will never turn into a crocodile”, Karitie said.

I was really disappointed with this outcome, both with my host family and with myself. I interpreted it as my greatest failure in two years of Peace Corps service.

The people of this village requested a Peace Corps Volunteer to help them build the capacity to improve their water and sanitation, so the United States government decided to take this former lifeguard with three years experience testing and chlorinating the pool water, they trained me to build concrete wells, latrines and wastewater receptacles, and sent me to Sanadougou. With the help of the Water Committee and my expert mason counterpart, we secured roughly $6,000 in USAID , NGO and private donor grants to build 112 latrines, 96 soak pits, 3 infiltration trenches and 6 top-well platforms in families’ homes, we built a row of latrines at the secondary school, we built a row of latrines at le Bureau de la Mairie, we even repaired and reorganized a broken solar water pump-to-tap system so that the people of Sanadougou could enjoy clean, potable drinking water. After all the work that we did, Sanadougou is now a visibly cleaner place. Though I have no way of compiling exact statistics, our work to improve this community’s infrastructure should lead to a significant decrease in the transmission of diarrheal diseases.

Though as I prepare ready to leave for America, I fear that all my work has come to naught because I wasn’t able to make a dent in Sanadougou’s eating habits. The World Health Organization estimates that if people would only wash their hands with soap it would reduce the incidence of diarrheal disease by 43 percent. Even if Engineers Without Borders were to expand the solar pump-to-tap system and bring running water directly to every family’s kitchen, even if some charity were to give the people of Sanadougou a lifetime supply of bottled Evian so long as people keep on eating the way that they do now they are still going to be consuming each other’s shit. Until people in Mali are willing to change their habits, giardia and dysentery are going to forever remain facts of life and children in this town are still going to die from simple bouts of diarrhea.

The fact of the matter is that sometimes tree stumps do, in fact, turn into crocodiles. There’s a word for this phenomenon: “progress”. Hundreds of years ago, the disparate Slavic tribes from which I am descended, the Franks, Teutons, Angles and Celts all lived in earthen huts, they farmed the little food they had with simple hand tools made of iron and wood, they lived in poverty not unlike that of the present-day Miniankas. They didn’t have toilets, they didn’t have toilet paper, and they ate their potatoes with their hands, so the tribes of Europe suffered from endemic giardia and dysentery and they had a life expectancy about as low as that of the Miniankas today. But sometime around the 10th century the French and Italian nobility popularized a simple technology which made eating all the more cleaner: the fork. It took a few more centuries for the peasants and lowly serfs to follow in kind, but eventually all the people of Europe adopted this new custom which not only made eating easier and more pleasurable but also reduced the incidence of disease.

There was also a time in the not-so-distant past when Europeans didn’t quite understand disease transmission either; they thought that sickness was spread by the Devil, the cold and the wind. There was a time when angry mobs massacred Jews by the hundreds because they could think of no other explanation for why the plague had come to their city, they burned so-called witches at the stake for causing outbreaks of cholera – very few Westerners took the time to question whether the spread of disease had anything to do with the complete and utter lack of sanitation in the cities where people lived amongst and ate and drank their own filth.

Now America, Europe, Japan, Australia and all the countries of the developed West have established a culture in which it is absolutely unacceptable for people to eat most foods with our hands, we all eat from our own separate bowls and separate plates with our own separate sets of utensils. And even though a surprising number of Westerners are not conscientious about washing their hands on their way out of the bathroom, we have developed our cultural habits to the point where even if you invite someone over for dinner and they did have microscopic pathogens crawling all over their hands, it wouldn’t really matter because at no point over the course of the meal is your guest ever going to put their hands in your food. As a result, giardia, dysentery and cholera are all but nonexistent in Western societies, it would be a freak occurrence if a child were to die from diarrhea, and we can expect to live to a ripe old age in our late 70s. It is only a rare occasion when someone falls so sick that they cannot work, and since we are so much healthier and more productive we have so much more wealth and a superior standard of living.

When I try to explain this to Malians, they typically respond along the lines of “Well, you Americans are healthy because you have so much money and you can buy so much more medicine” – they think that every time we contract dysentery we just pop some expensive pills and that’s the end of it. I insist that Americans don’t ever contract dysentery to begin with and few will believe me – gastrointestinal disease is simply accepted as a fact of life in these parts. More worldly Malians might understand that everyone in America has flush toilets and tap water in their home, but they can still attribute that to our superior wealth – it seems that no one is willing to be critical enough of their own culture to realize that maybe our superior health has more to do with our superior hygiene and superior methods of disease prevention, and that they could improve their own health if only they adopt new methods of eating.

The people of Mali have a choice; either they can overcome the pagan superstitions about evil sorcerers and start washing their hands with soap, or they can start eating from separate food bowls, or they can start eating with forks or spoons or chopsticks or spatulas or flat-nosed screwdrivers - anything besides the hands; even better, they can adopt some combination of all of the above. Or they can continue what they’re doing and forever remain mired in this endless cycle of disease. This kind of change is not something that white-skinned NGO workers can do for them – changing the habits and customs of Malian culture is something that only Malians can do for themselves. And when they do take this great leap forward, the people of Mali will finally understand that development is not just about building roads and factories but that it is also about changing behavior, that positive change doesn’t require massive foreign aid and that it can be done on the cheap or for free, and that the future of their society truly rests in their own hands.

This is Why UNICEF and NGOs Should Stop Giving People Free Mosquito Nets

Madu Bigmeat: What are you doing?

Gajuma: I am cutting up a mosquito net.

M: I can see that. But why?

G: I am making rope.

M: You can make rope out of old rice bags, you can make rope out of cotton or grass or even old rope. Why - of all things - are you making rope out of a precious mosquito net?

G: This mosquito net was free.

M: Do you have another mosquito net?

G: No.

M: Are you going to buy another mosquito net?

G: Of course not! The doctor gives them to pregnant women for free!

M: Is your wife pregnant?

G: Of course not! She is 70 years old! She is too old to have another child.

M: Then you're never going to get another free mosquito net! Why on Earth are you destoying this one?!?!?!

G: It doesn't matter - my sons have wives. And soon they will have more children. And the doctor will give them another mosquito net.

M: Yeah, that new mosquito net - if they ever get it - would be for the mother and her infant child to protect themselves from malaria. No doctor is ever going to give you a new mosquito net!

G: Yes, but when my sons' daughters get new mosquito nets, they will give them to me because I am an old man.

M: And are you going to sleep under them?

G: No, I will use them to make more rope.