A Mighty Purpose Page 6

  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.

  “This organization is a two-hundred-thousand-ton vessel,” he said fervently. “It’s an oil tanker, and you’re driving it like a speed boat.”

  As soon as he said it, he realized he shouldn’t have. The nautical image elicited a charge from Grant, a glint in his eyes. Grant “saw himself at the helm of an oil tanker, throwing the throttle, changing up a gear, watching the prow rise up in the water, taking off across the high seas,” Adamson later wrote in an essay that was included in Jim Grant: UNICEF Visionary, published by UNICEF.

  “I had pressed entirely the wrong button,” Adamson says now.

  Adamson and Williams lost their argument. Adamson set about rewriting the report. Grant quickly made preparations. It was as if, Williams offers, Grant was running a hurdle race by his own rules. “He would arrive at the end first,” he says. “He might have knocked over most of the hurdles, but he could go back and put them up later, whereas everybody else was running a normal race.”

  Had Grant taken the advice to hold off and solicit more feedback, the child survival revolution might never have gotten off the ground, suggests Stephen Joseph. “Jim wasn’t so stupid,” he says. “Here, he was dealing with the UN bureaucracy … Imagine if he had called all UNICEF together, with representatives from the UNDP and [other agencies] and said, ‘We’re going to do this.’ … He might never have gotten it done.” Joseph adds: “There are people who achieve things that could not be achieved by the traditional manner, because the traditional manner is part of the reason why they ain’t being achieved. And that was Jim Grant.”

  As the word spread of Grant’s designs, fears and confusion uncoiled. What was this revolution? How could such a preposterous plan possibly go anywhere? Would UNICEF survive Grant’s reign? He soon earned a new nickname: the Mad American.

  Adamson knew he had to take sides. Finally, he made his choice. No matter how ill-advised the timing, no matter how much it slashed against the grain, Grant’s reasoning could not be dismissed. Some critics had charged that the eager new head of UNICEF was focusing only on the “symptoms”—mass child deaths, malnutrition, and pervasive ill health—and was therefore neglecting the fundamental causes of poverty and the complex, long-term, “bottom-up” solutions that were necessary to effecti
vely combat it. But as Adamson came to appreciate, and would later write in a speech for his boss, these “symptoms of poverty help to crush the potential of the poor, to reduce their control over circumstance, to narrow choices available to them, and to undermine the long-term process of development.”

  He realized that, ultimately, what Grant was trying to do was “take up the slack.”

  That “slack” was an appalling daily toll of death and misery that didn’t have to happen. At the time, an estimated fourteen million children were dying every year of causes that had long ago been banished to the medical history books in the industrialized world. The means to save these children existed; they were cheap, readily accessible—yet they were not being used. “It was as if a cure for cancer had been found, and no one was doing anything about it,” Adamson says. “Because they were poor and had no voice.”

  Jim Grant had decided he would do something about it.

  Adamson resolved that he would join the Mad American. “I decided this is worth a go,” he says. “I threw myself in.”

  Chapter 3

  TURNING OFF THE TAP

  It was on his way to school on frigid winter mornings, peddling his bicycle through the kinetic, imperial labyrinth of Peking, that he would see the bodies. They lay in the street. What surprised him most was that passersby did not seem at all alarmed. They did not stop. They just stepped over the corpses or around them, as if they were heaps of snow or garbage. Whether these people had starved or frozen to death the night before, their bodies had simply become yet another part of the teeming, motley urban landscape. Peking (now Beijing) in the late 1920s and early 1930s was a city of opium dens and prostitution and commerce of all kinds, a dense metropolis surrounded by ancient walls and living under the crumbling legacy of two thousand years of dynastic rule (the last dynasty, the Qing, had fallen in 1912). The threat of invasion from Japan hung menacingly in the air. It was also a place where awesome grandeur mixed with pernicious poverty.

  Commenting on the frozen bodies in the street years later, Grant would say that “it was virtually unthought of at that time that all these people would ultimately read and write and have access to health services.” They were dispensable, insignificant—acceptable casualties for a society, not unlike many societies at the time, where the benefits of life and health and education were organized disproportionately for the few, and not the many. The visual imprint of these lifeless souls, and the morally vexing questions that came with them, would flicker in Grant’s mind, on a continual loop, for the rest of his life.

  But Peking was also a wondrous place for a young boy, a great domain to explore, which is something his parents apparently liberally allowed. “It was a boyhood of freedom,” he would say years later. He bicycled everywhere, weaving between the rickshaws and street merchants. With his friends, he built tree houses and clambered aboard rooftops. Many of the roofs were connected, and the boys could roam above the city, from block to block, for up to half a mile, as occupants cursed them from below. Grant knew that, as a foreigner, he was not subject to the same laws as the Chinese, “so there was the additional element of freedom.”

  Curious and adventurous, he played tennis and basketball, collected stamps, and joined the local Boy Scout troop. He got into skirmishes. During one fight, a boy grabbed his arm and hoisted it roughly behind his back, until his elbow snapped. It was the third time he had broken it in the same place; the first was after rolling down a hill. He fell a lot, and, by his own estimation, his forehead was stitched up twenty times.

  By far his favorite activity was reading. He read the entire World Book Encyclopedia, from A to Z. He claimed to have checked out War and Peace from the school library and to have read it in a few days. He liked The Hardy Boys series and The Swiss Family Robinson. The book that seems to have made the biggest impression on him as a young reader was The Forty Days of Musa Dagh, Franz Werfel’s 1933 novel about the 1915 Armenian genocide. Based on real events, the book “powerfully affected” Grant.

  He lived with his parents and sister, Betty, who was two years older, in a large, enclosed compound in the middle of the city that included the hospital and medical college where his father worked. His mother, Charlotte Hill Grant, was a “true homemaker” who looked after Jim and Betty attentively, with the help of a Chinese nanny. Her hobby was buying and collecting broad robes and pieces of art from the imperial court, which was selling off the items, and the Grant household became filled with elegant artifacts from ancient China. A perfectionist who “loved beautiful things,” she also liked to sew and was often heard humming. Grant remembered “a light and happy atmosphere” permeating the home, seemingly due to his mother’s warmth and positive aura; he credited her with largely forming his own upbeat and optimistic outlook. The family took weekend excursions together, venturing into the countryside to visit temples; over the summer, they sometimes spent several months at a resort. In one photo taken when he was six, he and his sister are standing with their nanny, who is holding their hands. They are both wearing shorts and long boots and are standing rigidly straight. Jim is staring into the camera, his eyes wide, looking surprised or perhaps bewildered. His ears protrude underneath neatly combed hair.

  Like his son many years later, Grant’s father worked long hours, traveled frequently, and “was gone half the time.” When Grant was eleven, his parents divorced, and he and his sister lived with his mother.

  He went to a school in the medical college compound, where he estimated that about half of the two hundred students were Chinese, a quarter were American, and a quarter were European and Japanese. Several of his closest friends were Chinese, and his first girlfriend was Scottish-Chinese. “I always grew up feeling that China was one of the greatest civilizations in the world,” he recalled, “and that the disorder they were in was a temporary phenomena …, that the Chinese would regain their status as one of the world’s leading civilizations during this century.”

  Growing up in China and regularly associating with Chinese, he later claimed, had spawned in him a “complete lack of race consciousness.” Whether or not this was true or a rare burst of braggadocio, Grant’s ability later in life to quickly establish a rapport with people from other cultures was undoubtedly influenced by spending his formative years as a minority resident in a developing country.

  Grant’s China roots began with his grandfather, a Baptist medical missionary from St. Stephen, New Brunswick, Canada, named James Skiffington Grant. After graduating from medical school at the University of Michigan, James S. Grant joined a university-sponsored volunteer program to open a health clinic in China. He was supported by the Baptist Foreign Mission Society. Dr. Grant went to the seaport town of Ningpo in 1889, and his son John Black Grant was born there on August 31, 1890. The clinic Jim Grant’s grandfather helped found would become a major hospital. Dr. Grant was known for his deep personal commitment. He made house calls and skipped summer vacations to tend to patients. When hospital beds were filled up, he would sometimes invite patients into his home and reportedly even once offered one his own bed. He remained in China during the violent Boxer Rebellion in 1900, when foreigners and Christians were targeted and many fled. He knew the horror of disease intimately—he lost a brother to appendicitis and a son, John Grant’s younger brother, apparently to dysentery.

  Jim Grant was five or six years old the last time he saw his paternal grandfather. He recalled in his oral history that the elder Grant “had a stubbie”—he had lost part of his middle finger somehow.

  John Black Grant left China to attend Acadia College in Nova Scotia. As World War I enveloped Europe, he tried to volunteer for the Canadian Army but was turned down because of poor vision. “One of his great regrets was that he didn’t participate in the war at that time,” Jim Grant remarked. His father chose Jim’s middle name, Pineo, to honor one of his friends who died in the Great War.

  After graduating from medical school at the University of Michigan in 1917, John Grant joined the Rockef
eller Foundation’s International Health Division. He briefly worked in North Carolina on a rural health project and was then sent back to China to take part in a Rockefeller-funded program to combat hookworm disease. With some real-world experience under his fingernails, he enrolled at the Johns Hopkins School of Public Health in Baltimore before returning to China in 1921. He was sent again by the Rockefeller Foundation, this time to become the first-ever professor of public health at the medical educational facility Rockefeller had funded and built in Peking. The sprawling, state-of-the-art, twenty-five-acre Peking Union Medical College was intended to be China’s answer to Johns Hopkins. It comprised a hospital, classrooms, laboratories, residences, and a school.

  As a young man, John Grant found himself in a position of immense responsibility and influence. Thin and bespectacled, he eschewed small talk and projected an air of self-confidence “that could border on brashness,” according to a 2005 profile in Johns Hopkins Public Health magazine. Though he aroused idealism in his students and inspired many to devote themselves to public service, he was not demonstratively warm or effusive. As Jim put it, “he was not a man to talk a lot.” Several decades after his service in China, John Grant’s then graduate student Conrad Seipp would characterize the legendary doctor in the preface of a book of Grant’s collected writings: “Singleness of purpose is one of the outstanding characteristics of the man … There is in him a tenacity and a constancy, even an obsessive quality in the advocacy of his views on health care, but most of all there is a profound integrity.”

  John Grant’s father had been wary of his son becoming a doctor. Practicing medicine in an impoverished community in a developing country with limited resources placed you at the mouth of an unceasing torrent of disease and death. It was overwhelming, dispiriting, crushing. The Canadian Baptist had imparted his reservations to his son with this metaphor: treating patients in this sort of environment is like “trying to mop the water overflowing the sink while the tap is still on.”