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NickLaing

Country Director @ OneDay Health
5094 karmaJoined Oct 2018Working (6-15 years)Gulu, Ugandaonedayhealth.org

Bio

Participation
1

I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 35 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 

Comments
693

I understand posting this here, but for following up specific cases like this, especially second hand I think it's better to first contact OpenPhil before airing it publicly. Like you mentioned there is likely to be much context here we don't have, and it's hard to have a public discussion without most of the context.

"There is probably some more delicate way I could have handled this, but anything more complicated than writing this comment, would probably have ended up with me not taking action at all"

That's a fair comment I understand the importance of overcoming the bent toward inaction, but I feel like even sending this exact message you posted here to OpenPhil first might have been a better start to the conversation.

And even if it was to be posted, I think it may be better to come from the people directly involved Even if pseudo anonymously (open Phil would know who it was probably) rather than a third party.

I say this with fairly low confidence. I appreciate the benefits of transparency as well and I appreciate overcoming the inertia of doing nothing as well, which I agree is probably worse.

I really appreciated this report, it seemed one of the most honest and open communications to come out of Open Philanthropy, and it helped me connect with your priorities and vision. A couple of specific things I liked.

I appreciated the comment about the Wytham Abby purchase, recognising the flow on effects Open Phil decisions can have on the wider community, and even just acknowledging a mistake - something which is both difficult and uncommon in leadership.

"But I still think I personally made a mistake in not objecting to this grant back when the initial decision was made and I was co-CEO. My assessment then was that this wasn’t a major risk to Open Philanthropy institutionally, so it wasn’t my place to try to stop it. I missed how something that could be parodied as an “effective altruist castle” would become a symbol of EA hypocrisy and self-servingness, causing reputational harm to many people and organizations who had nothing to do with the decision or the building."

I also liked the admission on slow movement on lead exposure. I had wondered why I hadn't been hearing more on that front given the huge opportunities there and the potential for something like the equivalent of a disease "elimination" with a huge effect on future generations. From what I've seen, my instinct is that it had potential to perhaps be a more clear/urgent/cost-effective focus than other Open Phil areas like air quality.

All the best for this year!

Looks amazing! I'm 37 but can I go back to high school and apply? ;)

A LOT of global health orgs, both big and small. I'm global health there's a decent amount of focus on cost effectiveness as is. Many orgs Givewell funds (miraclefeet a great example) scale cost effective solutions, but aren't part of the EA community at all.

I would say though EA is aware of many of those global health orgs, although I'm sure there are some that aren't so much on the radar.

Thanks that makes sense. I was actually trying to ask what proportion of the households reported using ORS, not what percent of sachets were used. I think I get most of it it now nice one, still one thing I'm not clear on is...

Of the 2400 Households surveyed, how many of them reported using any ORS at all after 6 weeks? That's a crucial number for me both as a sanity check and uptake check. I'm not sure if that's in this report here or not

Just my 2 cents, but I think its helpful to start a report with the really basic design stuff, ie We gave out xxxx ORS sachets to XXXX Families while doing XXXXX education, then followed them up after XXXX weeks - I struggled a little bit to follow the process here. Not a big deal

Nice one great reply! 

Just to double check (still not completely clear) did you distribute to about 1000 households and about 930 of those used the ORS over a 6 week follow up period? Or did you distribute to more than that, but about 1000 households said their kid had diarrhoea in that time? 

A bit confused whether 93% - ish of all families given ORS used it over 6 weeks or something different? Obviously it would be impossible for that higher proportion of the families to have kids with Diarrhoea in only a 6 week period - still trying to get my head around this.

Nick.

As a side note, I think content split is important, but the quality of presentation / group discussion and people that are leading those is more important. Obviously there needs to be a decent content split, but if you have the opportunity to get many really great people presenting great things in one area, I wouldn't necessarily cut some because it exceeds your "content percent budget" or whatever.

I haven't organised these kinds of events though, so this comment might not be relevent/helpful.

This point about altering the questioning is brilliant. Personally (many disagree with me) I think that social desirability and "future hope," bias are so overwhelming when free stuff has been given out that there's almost no point in asking someone if they used the ors correctly.

I like the "do you still have the products" as a betterquestion to partly mitigate that or you could take that further and ask "can you show me the ORS".

I also find the drop in "2 week prevalence" suspicious pre and post, as is the pre prevalence of 38 percent in the slum. This high rate seems implausible, unless there's a cholera epidemic going on or similar (and even then it's probably still almost impossible).

I also had a question about what percent of the ORS given was actually used during the 4 week period. Not what percent of diarrhea was treated with ORS, but what percent of what was overall given out was reportedly used. This is an important figure to help you check potential reporting bias as well. I might be missing it but I couldn't see it there.

Interested to hear your thoughts on this. Thanks for all the amazing work

"If boosting economic growth is the best proxy" to future welfare...

I feel like this is a real crux here, because to me it seems counterintuitive to the point of absurd when applied to high income countries, but I'm always trying to keep an open mind. I can understand how economic growth could be a proxy in a low income country as welfare is likely to increase as a poor country gets richer.

It doesn't seem to me likely that high economic growth in an already rich country would increase welfare very much at all. Can you point me to a resource which steelman's this idea?

I would contend they are not "suffering" in poverty overall, because most of their lives are net positive. There may be many struggles and their lives are a lot harder than ours, but still better than not being alive at all.

I agree with you on the animals in torture factories, because their lives are probably net negative unlike the 700 million in poverty. 

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