The GiveWell Blog

Thank God I don’t have HDTV

Corrective surgery organizations love to make generalizations: $250 can save a child’s smile, $10000 makes children smile for miles, smiles are magical, frowns are a leading cause of death, etc. I asked the organizations I was looking at for more details, because there are all kinds of ways that numbers like that can be ambiguous … when I’m quoted $250 to fix a child’s cleft, does that include overhead? Donated supplies? Is it an average, or is it what I would actually be funding with a donation? Is it just for the initial surgery, and is that initial surgery enough to make the child smile/be functional for life?

My questions got a variety of responses, from actual information (more detailed budgets, information on followup surgery, etc.) to hostile accusations (I’ll talk about that one later) to … a movie (“In response to your request for added info, I wish to mail you a DVD”). Well, I’m a sucker for movies, so I was pretty pumped about this, and even talked myself into how a movie can capture what you can’t put into words etc. When the DVD arrived, I insisted to my GiveWell buddies that we get out some pretzels and watch it together.

Within seconds, the room was filled with moans: “Holden, what the !@#$?” “You’re going to give me nightmares, you !@#$!” “What are you making us watch?” I should have seen it coming, really. There has often been a disconnect between what I want to see and what nonprofits want me to see, but this is as big as it’s gotten, because I most definitely do not want to see this, and that movie was nothing but slide after slide of it. I went easy on you with that link, too–we were looking at closeups, surgeries in progress, the whole deal.

“Look, the guy told me to watch this video, he saw the questions I was asking, there must be something useful here,” I pleaded. “Just let me fast forward.” I fast-forwarded through more horrifying pictures, and more, and more … and we realized that we were basically looking at, and there was no end in sight. Finally, with about 2 minutes left in the 10-minute video, we started seeing post-surgery pictures: smiling children with little scars on their lips. Great. I shut off the video and took out the DVD, which we voted to destroy.

Having a cleft sucks. I get it. Worse than not looking good is a host of other problems: feeding difficulties leading to malnutrition, speech defects, and societies that are often superstitious and ostracize deformed people in ways that the developed world doesn’t. I’ve been told that Chinese children with clefts are commonly left by the side of the road; on other regions, they’re believed to be supernaturally evil and are feared and shunned; in most places, they don’t go to school at all. I don’t need to spend 10 minutes trying not to puke up my dinner to understand this. I’ve moved on from “Can you have a reasonable life despite a cleft?” (you can’t) to a host of other questions about cost-effectiveness of methods, needs for followup surgeries, and most importantly: what ultimately happens to a person who gets his/her cleft fixed? What kinds of lives are made possible by these nonprofits’ activities?

With some exceptions, cleft nonprofits don’t market around these questions; they market around before-and-after pictures. It’s what I call Guilt Marketing: making someone feel bad, and reach for their wallet to ease the pain. It’s the wrong reason to give to charity. If you think of giving as something you have to do, you’ll treat it the same way you treat other things you have to do, like homework or taxes: you’ll wait until someone asks you to do it, and then you’ll basically do what you’re told.

I don’t think of charity as an obligation—none of this stuff is my fault, or yours—but as an opportunity, a chance to buy a better life for someone for about the same cost as a PlayStation. And just like buying a PlayStation, this is a decision I can’t make based on a picture.


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