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snarky volunteer gets pwned on Twitter; or why you should learn something before you do something

28 March 2011

As usual every morning, today I woke up and checked my Twitter feed. I was particularly interested in an exchange between a person I follow and some NGO tweep I hadn’t come across before. It all started with this:

To make such a claim, it would have to be true that the prevalence rate in Malawi hovered somewhere in the 70% range (or was at least projected to be 70% some time in the not-so-distant future). In actuality, the last population-based estimate of HIV prevalence in Malawi was 12% (source). Certainly, rates are higher in different regions (i.e., in the South, it’s estimated to be as high as 16.5%). In no subsection of the population, however, have I ever seen an estimate anywhere in the range of 70% in Malawi.

When I responded to the NGO tweep (@3LeftHands), he seemed genuinely interested in learning more:

Still, @3LeftHands is skeptical:

Especially, considering the one nurse he talked to in whatever clinic he was in:

Then, the ugly came out. A Malawian abroad, @kumwendafrank (who actually works in the public health field), got annoyed that @3LeftHands couldn’t accept that the Malawian stats weren’t “made up”, calls @3LeftHands ignorant (which, let’s be honest — is fair), asks that he leave the Warm Heart of Africa alone.

Then, @3LeftHands hits where it hurts:

So, a volunteer gets three experienced public health informants that have spent a great deal of time in Malawi trying to point him in the direction of data and truth, and instead tells us we are all wrong because he’s been in the country for less than a month and talked to one nurse.

What’s the lesson learned here? (That is, beyond the one I should have learned that some strangers in the world aren’t worth the energy.) For all of you good-intentioned folks out there who “who want to make Africa a notch better,” I recommend you not make up statistics out of thin air — even if to provoke a response. And, when you’re presented with evidence, consider it. Having a passion to do something meaningful is a gift; cherish and nurture it — and most of all, give it the respect it deserves. What good is a passion for creating positive change in the world if you don’t even know what you’re talking about?

Given the exchange, I’d recommend not making donations to Three Left Hands. Just my free advice.

24 Comments leave one →
  1. 28 March 2011 11:36 pm

    Only one caution on your thoughts. Point prevalence rates and lifetime infection rates are not equal. Supposing the 12% is correct has only partial bearing on how many people currently living in a society would ultimately contract the virus. Even if the 12% remained constant, depending on demographic shifts, the lifetime estimates for those alive today could still be considerably higher OR lower than the 12%.

    • 29 March 2011 7:41 am

      jimi – Do you know what the lifetime risk of infection is for a Malawian? I can’t seem to find that statistic.

      • 30 March 2011 2:55 am

        i do not. It’s actually a statistic i’ve been interested in for a while, but haven’t ever spent the time to dig up.

  2. 28 March 2011 11:37 pm

    That’s not to say that i don’t agree with the underlying premise of your post. That’s a separate issue entirely, and i think you already know i’m with you there.

  3. frank kumwenda permalink
    29 March 2011 1:28 am

    I love this true and amazing writing.

  4. 29 March 2011 7:37 am

    Nice writing, thanks for including us in your daily thoughts. But ehm, I’m making up stats? Been here for six months in total, not one. And I did more than talk to one nurse. And, if a head nurse that works here for over seven (7) years tells me it’s at least 60% in this region, I believe that. Further more, I’m not even surprised by that figure. If you talk to people, the locals, you know, who live here, most of them don’t even know how to use a condom, or have weird superstition about it. Also, most cases of HIV/AIDS here are not recorded, for no-one dies of AIDS, they die from TB, or whatever that has been induced by the virus. I really believe that denying those stories is the real ignorance. I like to provoke indeed, but I was there yesterday, in that classroom. And they were singing and dancing and suddenly it struck me; most of them WILL die of AIDS or a related disease. However, I’m still interested in that report of yours.

    • 29 March 2011 7:46 am

      From your website, I gathered you were just recently in Moz, not in Malawi (and that you had traveled through a number of other countries before that). 6 months in Africa does not equal 6 months in Malawi.

      The problem with health personnel making up statistics is that they only see sick people. In social science, we call that selection bias (all the healthy people stay at home, away from the hospital, and thus aren’t seen by clinicians/nurses, and thus aren’t included in an estimate derived by clinic-based workers).

      I would be surprised if “locals” don’t know how to use condoms. I suspect they don’t like to use condoms (I can’t blame them — I prefer “plain” sex as well). There’s a paper on that, too.

      The report I referred to is linked in the blog post.

      • 29 March 2011 8:08 am

        See, now thats a comment I can do something with; also you looked in to our travels. Before mozam, we were back at NL for a bit, to prepare the 2nd part of the trip. Before that, we were in Malawi. This time, but then a year ago. So yes, six months. Thanks for that paper!

    • Lynn Hancock permalink
      31 March 2011 6:42 pm

      To pipe in on dadakim’s side here, “selection bias” is a real concern in social science. If I had a dollar for every time that an undergrad submitted a paper to me that was based on an “n=1″/personal experience/observation, I would be one rich TA.

      I am stunned that you met someone who reported HIV infections at 60%, even for a small portion of the population. I would be surprised to find that 60% of people at the clinic or hospital were infected with the virus. For what it is worth, I spent 2 months coding and double-checking HIV testing results for a darn large (random, multi-year, nation-wide) survey and our findings were not over 12% for any area (and well under this in many regions). Results were not falsified.

      The take home point might be that there is a huge difference between personal observation and scientific findings. Also, attacking researchers without empirical support makes one appear a wee bit foolish (unless said person chooses to be belligerent and closed minded). I would have thought that finding that 3/4 of the so-called “doomed” will not contract AIDS would be a cause for celebration, not accusatory whistle-blowing.

  5. 29 March 2011 7:41 am

    The last comment is a bit snide…

  6. Graeme Bell permalink
    29 March 2011 10:53 am

    Met Henk in Malawi in April 2010 and he had already been there for a few months – fact! Keep up the good work Henk.

    • 29 March 2011 10:56 am

      and that is exactly the kind of evidence-bearing endorsement that one needs, I’m sure.

      • Graeme Bell permalink
        29 March 2011 12:09 pm

        Hey dadakim! I think i met you in Tanzania. You were wearing the gorgeous native threads carrying the water on your head. How you Doing?

  7. 29 March 2011 12:14 pm

    I don’t believe we’ve met. I’m not sure what “native” threads are. And I never carried water on my head in TZ (we were fortunate to have piped water).

    • Graeme Bell permalink
      29 March 2011 12:23 pm

      Threads (clothing) native to TZ. Must have been the other dadakim. My apologies.

  8. Steven Kompier permalink
    29 March 2011 8:19 pm

    Hi there, just say a few words. 3 left hands isn’t an NGO, they try to get a few pennies by donation but it’s not worth talking about. They all have a university degree, are critical and above all cynical towards a lot off things. Where ever they come they like to help in the most positive way possible! The way this discussion is going especially by Frank (he is contacting immigration) I find unnecessary. Relax they mean well!! About the figures:
    Thanks and I wish you the best.

    • 29 March 2011 8:35 pm

      Steven – since you know the guys, you might suggest that same link to them. What a few of us have been trying to say is that they shouldn’t make up figures out of thin air (even if “they mean well!!”). I uploaded a copy of the most recent report from the Ministry of Health that used population-based testing, which is the best way of measuring HIV that we have available. Still, 3LeftHands is convinced that a figure of 60% quoted to them by a nurse in a clinic is better than any of the documents we have shared. Apparently, their choice on what to be critical and cynical about is limited to whatever we say (despite the fact that many of us have also lived in Malawi and conducted research firsthand specifically on HIV). I find that disappointing.

      I can’t speak for Frank’s actions in contacting Immigration, but if 3LeftHands is in the country legally, they shouldn’t have any concern. Even if they’re not, maybe it wasn’t the best idea to trash-talk a Malawian about whether he knows his own country and saying a variety of childish taunts I won’t repeat here (you can see their Twitter feed yourself).

      • 8 April 2011 2:35 am

        Steve, being critical and cynical, although being ‘cool’ in some aid circles, is not a qualification for working in development. Just a quick look at their blog/Twitter shows their more derogative and patronizing to Malawi than critical.
        You say they have degrees – are they in anything useful?

        Regardless of statistics, you can’t hold that amount of contempt for a place and still ‘make it a notch better’. How many people who hate their jobs do it well?

        I would say, ‘Good intentions are not enough’, but I can’t even see any good intentions here…

      • 8 April 2011 2:37 am

        “they’re more derogative”…..pardon my English.

  9. 7 April 2011 5:53 am

    The plural of anecdote isn’t evidence. But if it comes from multiple, independent key informants, you might call it anecdata. If your anecdata is different by a factor of 500% to other sources, you might be tempted to see if there was any real reason for a local clustering (eg: your clinic serves only sex workers!), otherwise one might be tempted to politely call it “highly questionable anecdata.”

  10. ineyo permalink
    3 June 2011 12:56 am

    frank, did u really contact the immigration? I can help u with that if u dnt.


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