http://www.economist.com/world/displaystory.cfm?story_id=5323888&no_jw_tran=1&no_na_tran=1
The mountain man and the surgeon
Dec 20th 2005 | HAZARD, KENTUCKY AND KINSHASA, DEMOCRATIC REPUBLIC OF CONGO
From The Economist print edition
Reflections on relative poverty in North America and Africa
ENOS BANKS tells a cracking yarn about ketchup. One day, he spilled a
splurge of it on his shirt. For fun, he persuaded his brother in law to
shout angrily and shoot through the window. When their two wives came
rushing in, they saw Mr Banks lying there covered in what looked like
blood. “My wife passed out,” chuckles Mr Banks, “and my brother-in-law's
wife shook him till his [false] teeth rattled.”
Mr Banks lives in a trailer in eastern Kentucky, amid the majestically
forested Appalachian mountains. He is in his early 60s and has no job—he
used to work as a driver for a coal-mining firm, but left after a heart
attack 25 years ago. He wears a cowboy hat and talks with an accent that
outsiders find nearly impenetrable. He is clever with his hands. When
the price of petrol soared this year, he grafted a chainsaw engine onto
a bicycle to make a moped.
He is a loud, jovial man, but suspicious of the young folk who live
nearby. There is a drug problem in the mountains, and Mr Banks was
recently burgled for the painkillers he takes for a bad back, hip and
ankle. But he is ready for any mugger. He walks with a
walking-stick-cum-rifle, with a plastic cap on the end of the barrel to
keep out the dirt. If someone attacks him, he is ready to “shoot them
plumb between the eyes.” And if he runs out of bullets, he has a big
knife strapped to the contraption with duct tape.
When Americans hear the words “poor” and “white”, they think of someone
like Mr Banks. He has half a dozen cars in varying states of disrepair
parked outside his trailer, car-parts everywhere and a pile of crushed
Pepsi cans below his porch.
He “draws” $521 a month in supplemental security income (a form of cash
assistance for the elderly, poor and disabled). He laments that the
authorities deduct $67 a month because he won $3,600 on the slot
machines. Why, he asks, won't they take account of all the money he has
lost gambling? It is a fair question. If middle-class America had this
problem, accountants would surely find a way round it. Mr Banks also
complains that he cannot draw food stamps. In order to qualify, he would
have to sell his truck, which he cannot bear to part with. Mr Banks
would probably be surprised to hear that, thousands of miles away in
central Africa, there lives a prominent surgeon whose monthly income is
roughly the same as his. Mbwebwe Kabamba is the head of the emergency
department at the main public hospital in Kinshasa, the capital of the
Democratic Republic of Congo. After 28 years as a doctor, his salary is
only $250 a month, but by operating on private patients after hours, he
ekes it out to $600 or $700.
Given the lower cost of living in Congo, one might guess that Dr Kabamba
is better off than Mr Banks. But the doctor has to support an extended
family of 12, whereas Mr Banks's ex-wife and three sons claim public
assistance. Indeed, the reason Mr Banks split up from his wife, he says,
is because they can draw more benefits separately. She still lives in
the trailer next door.
Why juxtapose the lives of a poor man in a rich country and a relatively
well-off man in a poor one? The exercise is useful for two reasons.
First, it puts the rich world's wealth into context. A Congolese doctor,
a man most other Congolese would consider wealthy, is worse off
materially than most poor people in America. That, in itself, is striking.
The second purpose of the exercise is to shed light on some ticklish
questions. What is the relationship between wealth and happiness? And
what is the significance of relative poverty? Mr Banks makes $521 a
month in a country where median male earnings are $3,400 a month. Dr
Kabamba earns $600 a month in a country where most people grow their own
food and hardly ever see a bank note. The two men's experiences could
hardly be less similar. But which of the two would one expect to be happier?
Before trying to grapple with these questions, take a look at the places
where the two men live. Eastern Kentucky was where President Lyndon
Johnson stood by a shack in 1964 to launch a “national war on poverty”.
Since then, Appalachia has had tons of government cash and seen real
improvements in living standards, but it retains large and stubborn
pockets of distress. Mr Banks lives in one. His trailer stands in a
hollow near a disused coal mine in Perry county, where the official
poverty rate is 24.5%.
The region is poor partly because it is remote. Steep slopes and heavy
rain can make it hard to get around. Julie Zimmerman, a professor of
sociology at the University of Kentucky, notes that Appalachian folk
sometimes make appointments with the proviso that “I'll be there, God
willing and the creek don't rise.”
Another problem is that the region's mineral wealth has corrupted local
politics. For decades, argues Mil Duncan, another of the many
sociologists to have pondered Appalachian poverty, coal bosses exerted
an unhealthy influence, and politicians won support through patronage.
The 13 coal-producing counties of eastern Kentucky have consistently
worse poverty than the others, notes Justin Maxson, director of the
Mountain Association for Community Economic Development, a local
microfinance group. “Corruption by public officials has been a
significant contributor to poverty in the region,” he adds.
Congo is also remote, and its politics have also been corrupted by
mineral wealth. But corruption in Kentucky consists of mining firms
leaning on local officials to go easy on environmental regulations, or
school boards appointing their members' relatives to sinecures. In
Congo, it means half a dozen armies and dozens of militia groups
fighting over the country's gold and diamond mines between 1998 and
2003, leaving perhaps 3m dead.
Sporadic fighting continues in the east of the country, but this does
not directly affect Dr Kabamba, who lives in the west. Still, the
soldiers in Kinshasa, where he works, are a menace, because they rob
civilians to supplement their wages. Dr Kabamba is shaken down about
twice a month by men in uniform.
Dr Kabamba's hospital is healthier than it was during the war, or under
Mobutu Sese Seko, the leopardskin-hatted crook who ruled Congo until his
overthrow in 1997. There are no medicines unless patients can pay for
them, and many of the sick lie huddled on the ground. But it used to be
worse. In the early 1990s, patients who could not pay were sometimes
held hostage for weeks until their families found cash to free them.
Dr Kabamba's income fluctuates with his country's fortunes. His
$250-a-month salary is a fivefold increase from last year, and the fact
that it is paid only two months in arrears is an improvement too. The
cause of his good fortune is that Congo was given a huge debt write-off
when the civil war ended in 2003, so there is more money around. What do
Dr Kabamba's wages buy? He has a four-bedroom house with a kitchen and
living room, which would be ample if there weren't 12 people under his
roof. His home would be deemed unacceptably overcrowded in America. Even
among the 37m Americans officially classed as poor, only 6% live in
homes with more occupants than rooms.
Having seen how doctors live elsewhere, Dr Kabamba would quite like
running water and a regular power supply. His family fetches water in
jars and the electricity comes on maybe twice a week. Air-conditioning
would be nice, but “that's only for VIPs,” says Dr Kabamba. In America,
three-quarters of poor households have air-conditioning.
Dr Kabamba earns enough to feed his children, but not as well as he
would like. The family eats meat about twice a month; Dr Kabamba calls
it “a great luxury”. In America, poor children eat more meat than the
well-to-do. In fact, they get twice as much protein as their government
says is good for them, which is why the Wal-Mart near Mr Banks sells
such enormous jeans.
“Poverty” describes two quite different phenomena: utter penury, of the
sort experienced by the billion or so souls who subsist on $1 a day or
less; and the situation of people in rich countries who are less well
off than their compatriots.
For the first group, finding enough to eat is a daily struggle, and a
$2-a-day job hand-washing mineral ore in a river is a lucky break.
Shortly before meeting Dr Kabamba, your correspondent interviewed a
group of Congolese ore-washers who were delighted to have found such
lucrative work.
European countries tend to use relative measures of poverty. A household
with an income less than 50% or 60% of the national median counts as
poor. This has the perverse result that if the country gets richer, the
poverty rate can still rise, as long as incomes at the top and in the
middle rise faster than those at the bottom.
America, more sensibly, uses an absolute standard. The “poverty
threshold”, created in the mid-1960s, was based on an estimate of how
much an adequate diet might cost, multiplied by three. This figure is
adjusted for inflation each year, but is otherwise unchanged. So the
fact that, according to the Census Bureau, the share of Americans in
poverty rose between 1974 and 2004, from 11.2% to 12.7%, ought to be a
cause for shame.
But it is not, because American poverty statistics are misleading. For
one thing, the poor rarely stay that way. In 1996-99, only 2% of
Americans were poor every month over the full four-year period. And life
appears, by most measures, to have improved. Poor people today live
longer, spend longer in education and are more likely to have jobs.
Fewer live in substandard houses, more have cars, fridges, boomboxes and
other necessities that were luxuries a couple of generations ago.
How, then, to account for the apparent rise in poverty? It is partly a
matter of definition. Some non-cash benefits, such as food stamps,
housing assistance and Medicaid, are excluded from the calculation. And
the raw data must be wrong. Nicholas Eberstadt of the American
Enterprise Institute, a conservative think-tank, notes that while
reported annual income for the poorest fifth of households in 2003 was
$8,201, their reported expenditure was $18,492. Nobody can explain this
vast discrepancy.
All one can say is that whereas the poor in Kinshasa complain about the
price of bread, the poor in Kentucky complain about the price of motor
insurance. Fair enough—they need to drive to work.
Granted, the poor in America do not starve. But their relative poverty
can hurt in other ways. To be poor in a meritocracy implies failure.
Eastern Kentucky is one of America's least meritocratic enclaves, but
failure still carries a stigma. Though few Americans say that the poor
have only themselves to blame, many believe it. Many of the poor believe
it, too.
For a Congolese peasant, there is no shame in living in a hut made of
sticks. Everyone you know does too. In America, by contrast, the term
“trailer” denotes more than a mobile home, and the people who live in
one know it. They are also acutely aware of how richer folk live,
because they watch so much television. A typical poor household in
America has two televisions, cable or satellite reception and a VCR or a
DVD player.
Dr Kabamba, though hard up, enjoys the respect that doctors receive in
all societies. Perhaps more, for people can see that he does an
essential job under the toughest of conditions. That his hospital still
functions despite years of war, corruption, economic decline and the
occasional “grand pillage” by unpaid soldiers is, he sighs, “almost a
miracle”. His compatriots might add that it is almost a miracle that Dr
Kabamba, whose skills would allow him to emigrate, has chosen not to.
Those who know Dr Kabamba treat him with deference. When your
correspondent was detained by the police outside his hospital, for the
crime of appearing to possess a wallet, one telephone call to the doctor
was enough to fix the problem. The officers even apologised.
Mr Banks, by contrast, though outwardly cheery, has no illusions about
how other Americans see people like himself. Of the officials who hand
him his monthly cheque, he says: “Some are okay, but some act like the
money's coming out of their own pockets.” His great-niece, Rosie Woolum,
tells a story about growing up in the hollows. She was the girl on the
school cheerleading team who could not afford shoes. A teacher who lived
nearby could have offered her a lift home after practice, she says, but
never did. So she had to wait a couple of hours for her mother. At the
time, she did not understand why her better-off neighbours shunned her.
Now that she has a good job (running a project that provides health care
for the homeless), she finds they no longer do.
It is hard to gauge the pain of relative poverty because no one knows
how to measure happiness. Simply asking people “Are you happy?” only
gets you so far. The answers people give depend in part on cultural
factors. Few English or Japanese will offer anything more ecstatic than
a “mustn't grumble”, but that does not necessarily mean they are glummer
than say, Americans, 86% of whom told Gallup this year that they were
“completely” or “somewhat satisfied” with their jobs.
Indirect evidence of unhappiness is equally hard to gather, since so
many potential proxies, such as drug abuse and wife-beating, are hushed
up. Nonetheless, for what it is worth, when your correspondent asked Ms
Woolum and three of her local social-worker colleagues to share their
life stories, those stories shared a common thread.
All four women had been beaten by husbands or boyfriends, most of whom
had problems with drink or drugs. One recalls being knelt on so that her
arms were pinned to the floor and punched repeatedly in the face.
Another says she was stabbed. Without excusing the abuse, the women
assume that it had something to do with their menfolk's sense of
frustration at the poor hand life had dealt them. As the last of the
quartet puts it: “He wasn't happy. We got hit.”
Happily, all four have escaped their abusers. Ms Woolum reckons that the
welfare reforms of the 1990s have, indirectly, made local women more
assertive. “Welfare is more demanding. [To receive it], women have to
get out and work, so we're getting out into a different environment.”
This, she argues, fosters self-reliance and self-respect, so “Women
don't take it as much now.”
The personal is political
Both Dr Kabamba and Mr Banks feel bitter about the state of politics in
their respective countries. Dr Kabamba resents the fact that Congo is
run by a mob of unelected thieves and warlords, who for the most part
only pretend to care about good governance so they can continue milking
western donors. The country was promised an election by June this year,
but the ruling class somehow never got around to organising it. They now
promise to have one next year—they held a constitutional referendum this
month—but Dr Kabamba is not holding his breath. He takes such a dim view
of the probity of Congolese politicians that he once turned down a job
in the cabinet. In his spare time, he is the leader of one of Congo's
many opposition parties, but no one is tipping him to be the next
president. He is neither rich nor ruthless enough.
Mr Banks, for his part, expresses an intense dislike of President George
Bush. “If someone shoots that sonofabitch, I'll celebrate,” he says.
Some of his complaints echo those of the coastal intelligentsia—he
thinks the president should create more manufacturing jobs, for example.
But some of his gripes are of the sort rarely aired in the New York Times.
For example, he berates Mr Bush for allowing too many foreign doctors
into the country. In eastern Kentucky, as in Congo, those with
marketable skills often leave as soon as they graduate. Unlike Congo,
however, Kentucky can attract doctors from poorer parts of the world,
such as South Asia. Mr Banks does not think much of these immigrant
medics. He fears they may give him the wrong medicine, perhaps
deliberately, and threatens to “shoot them plumb between the eyes” if
they try. He is not serious about this threat, one assumes, but his
sense of grievance is no less real for being incoherent.
The point of this article is neither to mock Mr Banks nor to praise Dr
Kabamba. Both have their virtues and flaws, and your correspondent
cannot reliably judge which is the happier. But here are two concluding
observations. First, if poor Americans were to compare their standard of
living with what is normal elsewhere in the world, let alone in Congo,
they would see they have little cause for discontent. Then again, were
Americans not so incurably discontented with their lot, their great
country would not be half as dynamic as it is.
