A Mighty Purpose (7 page)

“Now look, I’ve read this thing,” Grant said, referring to Rohde’s paper. “You say that the science is there.”

“Yes,” Rohde replied.

“The epidemiology is there,” Grant continued. “This is what they’re dying of?”

“Yes.”

“The science is there and the interventions are there.”

“Yes.”

Grant went on: “The organizational structure is there. We’ve got enough health workers who can do this. We don’t need doctors to do this. We don’t need ambulances. We could just do a mass campaign.”

Rohde agreed.

“In other words, we have all these things and no political will?”

“That’s right,” Rohde said. “That’s the problem.”

“Well,” Grant said. “I’m here to make the political will.”

Rohde knew such a colossal task was not so facile. “How and where are we going to get that?”

Grant replied simply, “That’s my job.”

But before winning over prime ministers and presidents and generals and donors and journalists and UN bureaucrats, he had to win over his own staff.

It would be the most important meeting of his life. On the weekend of September 25 and 26, 1982, Grant asked a group of UNICEF staff and outside experts to join him for two days at UNICEF headquarters on Forty-eighth Street and First Avenue in Manhattan. It was an informal gathering and does not appear on an official list of his meetings and trips for 1982. There may have been a reason for that—he might not have wanted the meeting to attract the attention of too many people. It could have alarmed them. More importantly, he did not want to go through proper channels if he didn’t have to. That would only invite interagency jealousy and a tussle for control.

What he needed to do was generate enough of a consensus to give him the legitimacy—or the appearance of legitimacy—to move forward. He also wanted to stoke a discussion about what worked and what didn’t, what his next steps might be—though he was already probably fairly certain.

There were twenty-five people—ten from UNICEF and fifteen from outside organizations—who met in a stuffy, windowless conference room on the sixth floor, not far from
Grant’s office. Everyone crammed around a large, oblong table. The space was not designed to hold this many people; some had to squeeze between the wall and the chair backs to get to their seats.

The stated theme of the meeting was nutrition, but the discussions veered from poverty reduction to primary health care to the need for community participation to curative versus preventive health care. Grant brought up the Green Revolution of the 1960s, when American plant scientist Norman Borlaug developed high-yield wheat seeds that averted starvation for up to one billion people. Borlaug is estimated to have saved more lives than any other person in history, and he was a big hero of Grant’s. Grant wanted to do for child health what Borlaug had done for agriculture. He told attendees that a “global movement” was needed to spur a “revolution in child health.”

Sometime that afternoon, Rohde gave a presentation based on his child mortality lecture. He used a flip chart and felt-tip markers and scrawled out big numbers. One was six million: the number of kids who died from diarrhea every year. “We can save six million lives from diarrhea alone,” Rohde told the attendees. “And we’re not doing it.” He went through the interventions he believed would save the most lives.

The response was muted. Not everyone reacted the way Grant had.

As Dave Haxton listened to Rohde’s presentation, an old Harry James tune ran through his head:
It seems to me I’ve heard that song before
. Haxton and Rohde had, in fact, both helped
create a UNICEF-supported community health program in the 1970s in Indonesia, where much of what Rohde proposed was already taking place. (Rohde had worked for the Rockefeller Foundation at the time.)

Still, while the science was not new—Rohde never said it was—it was simply not in use in most of the rest of the world. Haxton eventually appreciated that that was what Rohde and Grant wanted to change, and he supported it.

Debate thumped around the room. Doubts and disagreements were lobbed across the table. Several people complained that Rohde’s ideas were too narrow, too top-down—and they didn’t place enough emphasis on family planning. Despite the discord, many participants did agree that four basic health interventions, if bundled together, could strike a convincing blow against child mortality. They were oral rehydration salts, immunization, the promotion of breast-feeding, and the use of growth charts to combat malnutrition.

As objections continued to flicker, Grant leaned forward and calmly listened. As he did in many similar settings, he may have folded his hands together and placed an index finger against his lips, just under his nose. This gesture seemed to signify intense attention. At one point, according to Rohde, he cocked his head and reiterated that Rohde’s approach was “doable” and “yesable.”

A turning point came during a particularly soporific lull, recalls Grant’s former Overseas Development Council colleague Dave Gwatkin. Many people were slumped in their chairs, “brain dead” and “drowsing off.” Then John Evans, a
measured, sharp-featured Canadian doctor who ran the World Bank’s health section, piped up. He had been scribbling notes and had scratched out a possible acronym for Grant’s new program.

“What you’ve got here,” he said, “is something you might call GOBI.”

GOBI, he explained, stood for growth monitoring, oral rehydration, breast-feeding, and immunization.

Grant’s eyes fixed on Evans, who passed him a scrap of paper. The UNICEF chief rose out of his chair, according to Gwatkin, visibly excited. “I could see Jim’s eyes light up,” he says. “I knew we were off and running.”

Not everyone was so enthused.

“GOBI went over like a fart in church,” recalls Haxton. “Only two or three or four of us were interested.”

Haxton was one of them. “That’s a terrific idea,” he said. “Let’s run with it.”

Then came a loud, sardonic retort: “GOBI Shmoby!”

The source was Carl Taylor, a Johns Hopkins professor of international health. Taylor’s background was similar to Grant’s—he had been born in the Indian Himalayas to medical missionaries and had spent much of his life in developing countries. The two men were, in fact, longtime friends, who each shared a crusading spirit for improving the well-being of the world’s most marginalized people. But Taylor was also a staunch proponent of the “community-based” approach to health care and had been a key contributor to the “health for all” declaration
issued in Alma Ata. In the late 1960s, he had taught a husband-and-wife team of Indian doctors, Rajanikant and Mabelle Arole, who would go on to found a pioneering project in Jamkhed, India, that is widely regarded as a sterling example of effective, locally sustainable health care. Now Taylor was irate.

“GOBI is Hindi for cabbage!” he scoffed. (The Hindi word
gobi
can also refer to cauliflower.) The professor went on: “You can’t codify all of health care, all of what people need, into these four things!”

Then, according to Rohde, Taylor stood up. He either angrily stomped out of the room or threatened to. “He was so pissed off,” Rohde says.

The meeting resumed the next morning, and Jolly recalls that Taylor immediately begged Grant not to move forward with GOBI—at least not right away.

“Jim, I haven’t been able to sleep,” Taylor said. “I can see it in your eyes, Jim, you will take GOBI and run with it.”

Then he added, “I warned you, Jim.”

Taylor likely knew his plea was futile. UNICEF staff would soon discover that once Grant had chosen to do something, once he had “taken off,” it was virtually impossible to change his mind. It was like trying to dissuade a charging bull. Either you got behind him or you got out of his way.

The GOBI meeting had not produced a uniform consensus, but it had given Grant the pretense of one. That was all he needed. The next step, quite literally, was to start a revolution.

Peter Adamson was one of the first people Grant went to see. The tall, methodical British communications expert had been at the GOBI meeting and knew what was coming. But that did nothing to soften the jolt of what Grant told him. It was the kind of comment that could knock a writer clear out of his chair.

“We need to redo
The State of the World’s Children
,” Grant said matter-of-factly.

The State of the World’s Children
was UNICEF’s annual flagship report, created in 1980 by Adamson and Grant. It was a forceful advocacy tool to convey the plight of impoverished children and describe what could be done to help them. Also a superb promotional device, it chronicled UNICEF’s recent accomplishments. Adamson had already written a draft of the
SOWC
for 1982. Heavily influenced by Rohde’s paper, it focused on child mortality and invisible malnutrition—the first sentence estimated that if world leaders were walking through a village in a developing country, they would only be able to “recognize about 2 percent of the malnutrition around them.”

But now, Grant wanted something bolder. He told Adamson he wanted the upcoming report to launch a “child survival revolution.”

Adamson had about a week, maybe ten days, to sharpen his existing draft into Grant’s manifesto, to fashion a document that would chart a wholly new course for a global agency. It would be translated into numerous languages and released to newspapers and radio and TV stations all over the globe. “I seem to remember that it was the only occasion when I ever worked through the night two nights running,” Adamson recalls.

What vexed him most at the time was the “revolution” itself. Like Taylor and many others, Adamson had misgivings about a course that seemed to collide rudely with the predominant school of thought on international development at the time. A concept hatched by industrialized nations following World War II, “international development” was intended to spur economic growth and improve the well-being of people in former colonies and protectorates and other places considered to be badly lagging behind. But as the Cold War polarized the world, development also became an instrument for enhancing the political, economic, and strategic interests of donor countries on both sides of the divide. The first two “development decades” (from 1960 through 1979) had produced growth in some countries. But it would become increasingly clear that “development” was not all positive; in some ways it exacerbated poverty instead of lessening it. Part of this had to do with the stinginess of the industrialized countries, which gave far less than expected. It also stemmed from agendas that had been set by people who knew little about the realities on the ground, which differed greatly from one community to the next. The yardstick of success was usually a decent gross national product, and this did not take into account the actual health and well-being of people, especially the very poor.

Jim Grant had long been a proponent of “human development.” Before coming to UNICEF, he had helped devise an alternate way of gauging success called the “physical quality of life index,” which assessed infant mortality, literacy, and life expectancy of children at age one; these were more accurate measures of progress than gross national products. In the
early 1970s, while at the Overseas Development Council, he had been an influential advocate of a major shift in US foreign aid policy away from economic growth and large infrastructure projects and toward “meeting the basic needs” of the world’s poorest people.

As the third development decade began in the 1980s (one that would become known as the “lost development decade” because of the crippling burdens of debt and structural adjustment), a new line of thinking had already taken root: development should be driven not by the donors, but by the recipients, who knew best what their own needs were. This spawned the “bottom-up” approach, which emphasized community participation and was thought to be an antidote to Western arrogance and paternalism. The Alma Ata declaration on “health for all” had grown out of this vision.

Peter Adamson was a fervent believer in the “bottom-up” philosophy. The founding editor of a progressive, UK-based magazine called the
New Internationalist
, which chronicles issues of poverty and inequality, he was committed to social and economic justice. He felt that development was a long-term and nuanced process. It was not something you could tackle with a handful of health interventions prescribed from an office in New York.

“I was very doubtful that this was a viable or right thing to do,” he says. “It faced everyone with a choice, and I was no exception. I found it very distressing.”

At the very least, Adamson thought he would be able to persuade Grant to delay his revolution. Grant had not even
reviewed the plan with the board. Except for the few people at the GOBI meeting, he had not run it by UNICEF staff. He had not officially vetted the idea with any other UN agencies, as would have been the custom. Why not take a few months and get some additional feedback? UNICEF’s director of communications, John Williams, shared Adamson’s concerns. Together, they asked to see Grant.

They met in Williams’s office on the first floor, which was known as the “Chinese restaurant” (that’s what had previously occupied the space). The three men started talking midmorning and did not finish until four or five hours later. Adamson and Williams tried to persuade Grant that he would have a very hard time pulling the organization behind him; it would be smoother and easier if he slowed down and built more support before going ahead with GOBI.

But Grant was impatient. “There was a sense of urgency and not brooking delay,” Adamson says.

According to Williams, Grant eventually relented and “said something like, ‘You’ve convinced me … We’ll do this for next year.’ ” He adds, “Peter and I were so relieved, we met downstairs and had a few drinks.”

The relief was short-lived. The next morning, Grant called Adamson and Williams. He had changed his mind. He was going ahead with GOBI and the child survival revolution after all.

Adamson kept trying to dissuade him. He remembers pleading with Grant late one night. They were sitting in the UNICEF chief’s apartment, in his breakfast nook or living room. Grant
was genial but unmoved. Desperate, Adamson deployed a big, blunt metaphor.