There’s a scarcity of $250,000 Ferrari 599 GTB Fioranos, and that’s ruining Christmas for 49 investment bankers who can’t buy the Christmas gift they want. I have an idea of what they can do with their money instead: Save 250 lives. How, you ask?

I recently learned about the problem of Obstetric Fistula. Briefly, childbirth is often more than a young, teenage girl’s body can bear, and it leads to, essentially, a hole in her body that does not close. Because of the hole, the young girl cannot control her wastes, and is often sent to live alone, far from other people. While these women don’t die, it’s hard to see the lives they end up living as anything much better than death.

Currently, approximately 2 million women have the condition, and the UN estimates that there are approximately 100,000 new cases each year. The Fistula Foundation and the UN claim that it costs $300 to perform one operation. (I’ve also seen estimates of $450.) We’ve found that a per-person cost estimates are often understated (ignoring necessary overhead, for example), so let’s be conservative and estimate the cost of curing one Fistula at $1,000. Assuming that there are currently 2 million afflicted women and that it costs $1000 to cure each, the total cost of curing everyone with Fistula is $2 billion. Assuming that 100,000 women are newly affected each year, it would cost $100 million/year going forward.

OK, not pocket change. On the other hand, this is the season of the Wall Street Christmas bonus, and stories abound with what the newly minted bonus babies will buy. The New York Times reported that Goldman Sachs will pay about $16.5 billion in employee compensation this year, much of it coming in year-end bonuses. Yes, that’s right. $16.5 billion. If each Goldman Sachs employee contributed 1/8th of their bonus, Goldman Sachs alone could essentially eradicate the problem of Obstetric Fistula. And that’s only Goldman Sachs. Well, that’s just Goldman Sachs – why put all the onus on them? CNN estimates that bonuses paid to the people working in the securities industrey will come to approximately $24 billion in 2006.

So, I’d like to offer a different perspective on bonus season. For each $5,200 hour you choose not to ride on a Gulfstream IV chartered jet, you can save 5 women. And, if you just can’t believe that there’s a dearth of Manhattan properties being offered in the $20 million range, don’t worry. You can spend $10 million on a starter apartment, and use the savings to save 10,000 lives.

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 rotten.com, 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.