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The Aid Lab and Its Ethics

Visitors to Matlab in Chandpur, southern Bangladesh—the 'world's longest running health project' (source: Wikipedia)—are said to be surprised when they learn the name is a real place-name, and not a contraction of MATernal and Child Health LABoratory. They are surprised because Matlab has been at the heart of advancements in our understanding of, precisely, maternal and child health, and is internationally renowned as a large human laboratory. Appropriately enough, Matlab actually means 'plan' or 'idea' in Bangla; it therefore refers not to the science of the foreigners but to a clever scheme in the vernacular.

It is as the international experiment in aid, the aid lab, that Bangladesh has fulfilled its side of the development contract with the international community. The idea of the aid lab helps keep in focus some of the defining features of Bangladesh's development journey, but it is a troubling label. It prioritizes an outsider's view of Bangladesh, from the not-always-pleasant gaze of the development industry. It suggests a treatment of human beings as scientific subjects—as means and not as ends. And it seems to negate the point made above—that politics and the state have mattered in these achievements, suggesting instead the insulation of the clever scientist, toiling away at her experiments under 'lab conditions' without hindrance from the real world.

As we have already seen, Bangladesh's status as the Aid Lab reflects its lack of alternative geostrategic significance and the terms of its incorporation in a developmental social contract. This deliberately problematic metaphor makes us keep in mind that the country's geostrategic and ideological role in the world is as the 'test case' for global capitalist development (Faaland and Parkinson 1976). A flat, small space with an accessible and homogenous population, the country has many qualities suited to social experimentation. Many experiments with poverty reduction have been tested on its soil. Bangladesh's status as aid lab has several implications for its place in the world, and is a reminder that comparatively small, less developed, aid-dependent countries are shaped by their place in a larger whole in a way that a Brazil, China, or India never could be. For Bangladesh, global connections and global perceptions matter a great deal. This is true whether you stitch jeans for America, build stadiums in Qatar, buy banks or telecoms, or send your kids to the Ivy League or the LSE.[1] [2]

When aid officials and diplomats come to Bangladesh they seek not minerals or land or geopolitical advantage, but to demonstrate that the social, economic, and political model they promote works. The country's greatest product is ideational, an idea of Bangladesh. The key point here is that external intervention in this misbegotten Malthusia has been motivated by something close to altruism. It is the gift of the scientist who wants to learn the truth, the visionary that desires to share her vision—not of the colonialist grabbing your wealth. If aid is about making the world safe for capitalism to enter, it is not clear that anyone has been particularly desperate to get into Bangladesh. Because it lacks any obvious material benefit to the donor, the contract endows its donors with a particular kind of power: the gift that is not returned, leaving the recipient in permanent debt.11

As an aid lab, the inner workings of Bangladesh's policies and projects are exposed—global public property for researchers and aid missionaries and media. The bell jar hothouses some ideas; others, less easily marketable in a policy and intellectual space crowded with free market doctrine, have withered. But the experimentation has produced many justly celebrated successes that Bangladesh has gifted back to the world. Among the pioneering development

NGOs that eventually grew so large, the most successful had actual laboratories: research centres that tested emerging ideas about what worked. A famous example is BRAC's Research and Evaluation Division, which works in close partnership with the International Center for Diarrhoeal Diseases Research Bangladesh (ICDDR,B), one of the world's largest applied public health research institutions. Together they pioneered major innovations in oral rehydration therapies, maternal and child healthcare delivery, and tuberculosis treatments that have saved unknown millions of lives.[3]

The experiments in the aid lab have been real as well as metaphorical, and the ethical standards of the science have often been low. In its large numbers, densely situated and affordable to reach, the Bangladeshi population has often been an inviting prospect for testing risky initiatives, and the pressure to take interventions 'to scale' has resulted in disasters where a more cautious respect for human life and rights would have put a stop to matters. A UNICEF/World Bank project celebrated for delivering 'safe' water to 80 per cent of the population by promoting shallow tubewells in the 1970s turned into 'the largest mass poisoning of a population in history', having failed to test the groundwater for arsenic (Smith, Lingas, and Rahman 2000, 1093). An estimated seventy-seven million Bangladeshis have had heightened risk factors for cancers and other diseases as a direct result (Argos et al. 2010). To date, there has been no accountability for the ongoing disaster, and a 2003 lawsuit against the British Geological Society for not testing for arsenic in the preparation of the project failed.[4]

Another notorious instance was the testing of the fertility control implant Norplant during the 1980s. In the 1995 BBC Horizon series documentary 'The Human Laboratory', the activist director of UBINIG, Farida Akhter, described how the implants were being marketed to uneducated slum women to control their fertility without informing them that the drugs were unapproved and experimental. Potential side effects were not explained to the women, nor, once they were experienced, recorded in the data. Women reported having been coerced and threatened to keep the implants in. The United States Agency for International Development, USAID, defended the ethical standards of these drug trials it had sponsored in the slums of Dhaka and in conflict- ridden, deeply poor Haiti, denying all wrongdoing. The dark side of the aid lab comes into focus. Women's health rights activist Nasreen Huq said:

When you conduct a trial in this sort of setting, you are simply taking advantage of

them being poor. You've access, cheap access, to subjects, and you can write it up

as a successful trial. You're not in any way advancing science, you're taking advantage of a situation in which women are poor and they don't want to have more children, and by providing this method, or conducting this trial, you are not in any way letting them out of their desperate situation. I mean, I have been trained in science and I'm sorry, this is not science. (BBC 1995)

For Farida Akhter, Bangladeshi women were preferred because they were cheaper and more easily controlled than guinea pigs. Betsy Hartmann, another researcher familiar with the aid discourse in Bangladesh, argued that 'the population bomb' was seen as the biggest threat in Washington: 'now we're fearing these Third World peoples. Does this mean that you promote Norplant like a weapon in the war against population growth?' (BBC 1995).

The militant Malthusianism that drove American attitudes in the 1970s and 1980s has faded, at least in respect of the bodies of Bangladeshi women. But there is a residual utilitarianism in development-think in this context that makes interventions like the Norplant 'weapon' and poisonous groundwater sources likely. Utilitarianism is a pragmatic response to the fear of large numbers, the logical implication of the knowledge of quite how many people are crowded onto a sinking, eroding piece of land. F. H. Abed, the founder of BRAC—an organization famous worldwide for its ability 'to scale'—has as his mantra 'small is beautiful, but big is necessary', a gentle mockery of the alternative economics popularized by E. F. Schumacher at precisely the same time he was founding BRAC. Abed believes in the need for small-scale innovation, but only if it can be blown up to reach millions: there can be no laurels for tiny perfection in a place where tens of millions have desperate need now. The failure to treat each human as an end in her own right is justified thus: when fifty million have been pulled out of poverty, what does it matter if two or three or ninety have had their rights and dignity trampled on to achieve this end?

People who know Bangladesh know why this makes sense as a rough-and- ready moral philosophy of development. But it is a crude utilitarianism that justifies the trampling of human rights and permits fascistic tendencies, the suppression of dissent and competition included. Under emergency conditions of 'triage', such errors are understandable. One of the conclusions of this book is that a utilitarian calculus that neglects human rights no longer suits a country at the stage to which Bangladesh has advanced. It is time—long overdue, some would argue—to negotiate a new social contract for development.

  • [1] Hickey warns us off of 'methodological nationalism' in thinking about the politics ofdevelopment, reminding us that global influences may be particularly important for developingcountry elites (Hickey 2013). Global influences and networks matter in particular to the elites ofsmall, open countries like Bangladesh.
  • [2] As we know from the economic anthropology of gift exchange (Mauss 2002;Parry 1986). Onthe specific and considerable problem of altruism and reciprocity in aid exchanges, see Stirrat andHenkel (1997).
  • [3] The author's first job was on a joint BRAC-ICDDR,B project on women's empowerment, inthe very centre of the Aid Lab.
  • [4] See Hossain (2006);Buncombe (2010).
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