December 19, 2010


[The big question was whether the suggestion would fall foul of the zero sum game thinking which has bedevilled relations between India, Pakistan and China for nearly 50 years.  India was defeated by China in a border war in 1962 and since then has regarded it as its main military threat.]

Just over a year ago, President Barack Obama suggested during a visit to Beijing that China and the United States could cooperate on bringing stability to Afghanistan and Pakistan.  As I wrote at the time, China — Islamabad’s most loyal partner — was an obvious country to turn to for help in working out how to deal with Pakistan.  Its economy would be the first to gain from greater regional stability which opened up trade routes and improved its access to energy supplies. And it also shared some of Washington’s concerns about Islamist militancy, particularly if this were to spread unrest in its Muslim Xinjiang region.

The big question was whether the suggestion would fall foul of the zero sum game thinking which has bedevilled relations between India, Pakistan and China for nearly 50 years.  India was defeated by China in a border war in 1962 and since then has regarded it as its main military threat. 

Pakistan has built close ties with China to offset what it sees as its own main military threat from its much larger neighbour India. China in turn has been able to use its relationship with Pakistan to clip India’s wings and curb any ambitions it has at regional hegemony.

So where does Obama’s suggestion stand now that Chinese Prime Minister Wen Jiabao has just completed a visit to both India and Pakistan?  The answer to that probably depends on how far economics and how far politics determine the behaviour of India and Pakistan in the coming years. China itself is seen as putting its economic interests first, or in the words of the People’s Daily, a search for “win-win results consistently dominate China’s diplomacy”.

In India, Wen offered expanded trade and greater cooperation between two countries which increasingly have reason to align their positions in negotiations within the G-20 economies. That is positive for those whose world view is seen through the lens of economic development –among them Prime Minister Manmohan Singh. In an editorial in The Hindu, Siddharth Varadarajan argues that India needs to stop focusing so much on China as a strategic threat and take advantage of the gains it can reap from Chinese economic growth.  And while expanding trade left India with a $16 billion trade deficit with China in 2007-2008, you can argue that India could still be a long-term beneficiary if rising Chinese wages open up space for cheaper Indian manufacturing.

However, at the same time the two countries apparently failed to make any progress on the political and strategic issues which divide them, among them their disputed border and Chinese support for Pakistan.  That is a worry for those who focus primarily on the strategic, rather than the economic, environment in South Asia — particularly given that both Beijing and Delhi have become much scratchier about their political disputes in the last few years. 

“During the first visit of a major Chinese leader to India in more than four years, some easing of political tensions should have been accomplished. Instead the two sides decided to kick all contentious issues down the road and expand bilateral trade by two-thirds over the next five years. However, increased trade is no panacea for the sharpening geopolitical rivalry,”  Brahma Chellaney wrote in an op-ed in the Wall Street Journal.

In short, there is no real consensus on what to make of Wen’s visit as India grapples with growing Chinese power and tries to decide whether to hitch a ride on the coat tails of China’s economic growth or stand up to it.

In Pakistan, the picture was no less complicated.

Wen praised Pakistan’s efforts to tackle Islamist militants at a time when the United States is pushing Islamabad to “do more”.  But China has also been leaning on Pakistan to crack down on militants.  It broke ranks with Islamabad when it supported a U.N. Security Council ban on the Jamaat-ud-Dawa, the humanitarian wing of the Lashkar-e-Taiba (LeT) after the November 2008 attack on Mumbai.  In Pakistan, the JuD continues to operate openly, albeit under a different name.

Wen also promoted trade and investment with Pakistan.  During his visit, the two countries signed commercial and trade deals worth at least $25 billion. By comparison, Wen signed $16 billion in deals in India. But for all its reputation as an all-weather friend, China refused to bail out the Pakistani economy in 2008, forcing it to turn instead to the International Monetary Fund. That decision, amongst others, prompted a rethink about whether relations with China were quite as cosy as Pakistan thinks – though those questions appeared to have been forgotten during Wen’s visit.

No doubt much energy will be expended trying to work out the signals from Wen’s tour of South Asia. Did he, or did he not rebuke the United States over its pressure to “do more” - a guaranteed winner in Pakistan where Washington is deeply unpopular? Or is China’s position actually nearer to that of the United States, which also presents itself as an ally struggling to balance, in Admiral Mike Mullen’s rather curious choice of words, strategic impatience with strategic patience? And has China stepped up its support for old ally Pakistan at India’s expense, or is it trying to keep Delhi on board given India’s growing economy?

It is going to be awfully hard to tell for sure. Everyone is talking from a different perspective, depending on whether you prioritise economic issues or political and strategic disputes. And we are speaking in different languages.  Since partition in 1947, relations between India and Pakistan have been dominated by zero sum game thinking. China officially is talking about ”win-win”.


[Patients provide the crops they grow and the animals they raise — food that feeds the thousands of patients who use the hospital — and the hospital tends to their wounds, treats their illnesses and delivers their babies. Its two doctors and 15 nurses see about 6,000 patients a month and have put 2,000 people with AIDS on life-saving antiretroviral medicines. ]
People seeking health care in Chidamoyo, Zimbabwe,
 arrive with goods to barter for treatment.
The hospital’s cavernous chapel is now filled with what looks like a giant sand dune of unshelled nuts. The hospital makes them into peanut butter that is mixed into patients’ breakfast porridge, spread on teatime snacks and melted into vegetables at dinnertime. 

“We literally are providing medical services for peanuts!” exclaimed Kathy McCarty, a nurse from California who has run this rural hospital, 35 miles from the nearest tarred road, since 1981. 

The hospital, along with countless Zimbabweans, turned to barter in earnest in 2008 when inflation peaked at what the International Monetary Fund estimates was an astonishing 500 billion percent, wiping out life savings, making even trillion-dollar notes worthless and propelling the health and education systems into a vertiginous collapse

Since then, a power-sharing government has formed after years of decline under President Robert Mugabe, and the economy has stabilized. Zimbabwe abandoned its currency last year, replacing it with the American dollar, and inflation has fallen to a demure 3.6 percent. Teachers are back in their classrooms and nurses are back on their wards. 

But a recent United Nations report suggests how far Zimbabwe has to go. It is still poorer than any of the 183 countries the United Nations has income data for. It is also one of only three countries in the world to be worse off now on combined measures of health, education and income than it was 40 years ago, the United Nations found. 

For many rural Zimbabweans, cash remains so scarce that the 85-bed Chidamoyo Christian Hospital has continued to allow its patients to barter. Studies have found that fees are a major barrier to medical care in rural areas, where most Zimbabweans live. 

“It’s very difficult to get this famous dollar that people are talking about,” said Esther Chirasasa, 30, who hiked eight miles through the bush to the hospital for treatment of debilitating arthritis. Her son, Cain, 13, walked at her side carrying a sack of peanuts to pay for her care. 

Mrs. Chirasasa said her family of seven was nearly out of the food they grew on their small plot, so she needed to get her pain under control to work in other farmers’ fields to feed her children. 

Bartering helps plug some of the holes. A May survey of more than 4,000 rural households found that each of them, typically a family of six, spent an average of only $8 for all their needs in April, the cost of a couple of cappuccinos in New York. To help them get by, more than a third of households surveyed in September 2009 had used bartering. 

Still, United Nations agencies estimate that 1.7 million of Zimbabwe’s 11 million people will need food aid in the coming months. And Mr. Mugabe’s continued domination of political life, along with persistent violations of the rule of law and human rights, have deterred foreign aid and investment needed to rebuild the nation’s shattered economy, analysts say. 

Here in this rustic outpost with no phone service and often no electricity, the Chidamoyo hospital and the people who rely on it have entered an unwritten pact to resist the tide of death that has carried away so many. Life expectancy in Zimbabwe, plagued by AIDS and poverty, has fallen to 47 years from 61 years over the past quarter century. 

With the economy in ruins, 
the hospital in Chidamoyo 
turned to barter in 2008.
Patients provide the crops they grow and the animals they raise — food that feeds the thousands of patients who use the hospital — and the hospital tends to their wounds, treats their illnesses and delivers their babies. Its two doctors and 15 nurses see about 6,000 patients a month and have put 2,000 people with AIDS on life-saving antiretroviral medicines. 

Even during the hyperinflation of 2008, when government hospitals ceased to function as the salaries of their workers shriveled, the Chidamoyo hospital stayed open by giving its staff members food that patients had bartered. 

“People are helped very well and the staff cares about the patients,” said Monica Mbizo, 22, who arrived with stomach pains and traded three skinny, black-feathered chickens for treatment. 

The hospital, founded over four decades ago by American missionaries, from the Christian Church and Churches of Christ, receives limited support from a government that is itself hurting for revenue.

The hospital also gets up to $10,000 a month from American and British churches, enabling it to charge patients far less in cash or goods than the fees at most government facilities. The hospital charges $1 to see the doctor — or a quarter bucket of peanuts — while a government hospital typically charges $4, in cash only. 

Short of cash like the people it serves, the hospital practices a level of thrift unheard of in the United States. Workers and volunteers steam latex gloves to sterilize them for reuse, filling the fingers with water to ensure against leaks. They remove the cotton balls from thousands of pill bottles to swab patients’ arms before injections. And they collect the tissue-thin pages of instructions from the same bottles for use as toilet paper. 

But there are limits to what even stringent economies can achieve. For most of the past year, the hospital did not have enough money to stock blood. Ms. McCarty said women who hemorrhaged after giving birth or experiencing ruptured ectopic pregnancies were referred to bigger hospitals, but often they had no blood either. Eight women died, she said. Just recently, the United Nations has begun paying for blood at the hospital to improve women’s odds of surviving. 

Standing over an anesthetized woman before a Caesarean section, Dr. Vernon Murenje recalled how frightening it was to operate without blood in stock. “You’re operating,” he said, “but then at the back of your mind, you’ll be thinking, ‘What if we have significant blood loss?’ ” 

As he prepared to make the incision, the hospital was in the midst of almost two weeks without power. Its old generator, already used when the hospital bought it 20 years ago, lacked enough juice to run the X-ray machine or to keep the florescent lights from flickering. It was turned on just before the Caesarean section. The air-conditioner coughed weakly to life in the stifling room. 

When a boy emerged, Ms. McCarty cried, “Welcome to Zimbabwe!” But the newborn made no sound. She pounded his back and suctioned his nose until he let out a cry like a quavering baby bird. 

“Oh, you finally realized you were born in Zimbabwe,” she said. “He thought he was born in South Africa, and he was happy.” 

Postscript: The Community Presbyterian Church of Ringwood, N.J., has raised $24,000, and the Rotary Club of Sebastopol, Calif., contributed $7,000 to buy the hospital a generator.

@ The New York Times