Support by another means

"The girls need your support! Literally," wrote Rebecca Snavely on The Huffington Post last year. The former web producer and staff writer for the Los Angeles Times entertainment site said she had received an email from a friend who works in Uganda: "Do you have any bras lying around that you're not going to wear anymore?" it read. "Would you be willing to donate them to women in Uganda who desperately need them?"

Snavely wrote, "Imagine spending every day without a bra. Ouch. Now imagine that your day involves walking miles to the water pump, walking even more miles to the market, and your free time is spent working in the fields . . . without a bra. . . . My own highly scientific guesstimation is that 99.82% of women in rural Uganda do not own a bra." The pitch: An associate traveling to Uganda was "willing to bring a duffle bag of bras. The only problem? WE NEED YOUR USED BRAS IMMEDIATELY!!"

That's typical of how some international aid projects get started. Someone with a big heart sees a problem and sets out to fix it by sending stuff-known as "gifts-in-kind" or "in-kind" donations. An anonymous aid worker who goes by "J" and blogs at Tales from the Hood coined a more acid term: #SWEDOW, or "Stuff We Don't Want" with a Twitter hashtag suggesting a trend and a term that's caught on among aid bloggers.

In-kind project founders may have good intentions but their efforts are often misguided. Maybe the women in Uganda don't want to wear bras, say critics. Maybe they aren't culturally accepted. Maybe it is more cost effective to send money. Maybe dumping duffle bags full of foreign bras in the marketplace lowers the price and drives local producers out of business. In other words, every problem is more complicated than it first appears, and good-hearted donors can make things worse if they don't understand the culture or the economic effects of their efforts.

Tales from the Hood's "Best in #SWEDOW" 2010 Grand Prize winner was the International Breast Milk Project (IBMP), which claims to be "the only international milk bank in the world." According to its website, "Moms like you have donated over 67,000 bottles of safe donor milk to help orphaned, sick and hungry infants in South Africa and around the world."

I emailed J, who says he has "worked in the field of international aid, relief and development since 1991" and was in a remote area of the Philippines, to find out what makes a project a winner. He defines #SWEDOW as stuff "foisted off onto a recipient community" and says planning happens "far from that community, usually without meaningful input from those the implementers say they want to help." Whether the stuff is new, used, or technologically sophisticated is unimportant to J: The process "is almost always about the donor-and the benefit to beneficiaries is a serendipitous side effect."

J argued that the Breast Milk Project was "dreamed up by someone" without "input from those she meant to help" and said he doubted that imported breast milk would deal with chronic malnutrition "better or more effectively than another intervention or technology." He also cited the project's "'ick' factor" as another qualification for grand prize: "My head is swimming at the possibility for misunderstanding, rumor, gossip, perhaps even intentional misinformation about what 'The Americans' are trying to do by sending their breast milk over for 'our babies' in some remote zone."

I called the International Breast Milk Project executive director Amanda Nickerson, who admitted that the project came about in 2006 when founder Jill Youse looked in her freezer and saw more breast milk than her baby needed. She didn't want to dump it out, so she used Google to figure out where to donate it.

Youse found an orphanage in South Africa that was actively seeking donated breast milk for HIV-infected infants in its care. Youse asked her grandmother to pay the shipping costs to send the milk, kept frozen with dry ice, to South Africa. The project grew, especially after Oprah featured it on her show. IBMP has now sent almost 268,000 ounces of breast milk to a neonatal intensive care unit in Cape Town where babies weigh less than three pounds and are orphaned or their mothers for health reasons can't breastfeed.

Nickerson says for these babies it is a "life or death medical supply"-given by prescription, three weeks at a time, with amounts adjusted according to the baby's size, health, and age. IBMP also has raised and donated more than $186,000 to fund health projects and develop local milk banks in Kenya, Tanzania, and South Africa. It makes two shipments of milk a year, 50,000 ounces at a time.

What about J's objections? It is true that Jill Youse had the desire to donate her excess breast milk, and that she and the other donors feel good about what they do. But it's also true that she responded to a plea from an organization on the ground in South Africa. As to safety, milk banks are similar to blood banks: Donors are screened, their blood is tested, and the milk pasteurized to kill any bacteria or disease. The milk goes to sick and low-weight babies, and doctors say breast milk is the best thing. One neonatalist recently wrote to Nickerson, "Breast milk makes all the difference. Please send more." And since the milk is going to institutional users, the "ick factor" isn't really an issue.

So, while J's general concerns seem valid, he may have jumped too fast to criticize the International Breast Milk Project. Let's look at another of his winners, Soles 4 Souls.

Wayne Elsey, a shoe executive, founded Soles 4 Souls after he "felt compelled to do something" following the 2004 Asian tsunami. He didn't know what to do, but as he watched TV he saw "a picture of a single shoe washing up on the beach . . . it triggered a few calls to some other executives in the footwear industry and the subsequent donation of a quarter of a million shoes to victims in the devastated countries."

Soles 4 Souls has sent shoes elsewhere-and it drives the aid bloggers crazy. They don't question Mr. Elsey's good intentions-although Slate reported that he makes $500,000 a year, a salary he justifies by saying, "I've given up my prime earning years to do this. I made four times that as a business executive."

The aid bloggers do question his premise. Saundra Schimmelpfennig, who blogs at Good Intentions Are Not Enough, writes, "I challenge anyone to find a single country in the world where there are not shoes for sale in the market­place. There are many better and cheaper ways to get shoes on the feet of the poor."

Schimmelpfennig adds, "Sending donated goods oversees is an appealing idea because it makes you feel like you're really helping while at the same time recycling things that are no longer of any use to you." But since people don't wear shoes for many reasons, both cultural and economic, she says it can be a bad solution, especially if donors don't consult with the people they're trying to help.

Elizabeth Kirk, director of communications at Soles 4 Souls, has a different view. She says her organization listens to criticism and is "always collecting data from partners . . . consistently keeping our ear to the ground. That has led to changes, including working more with non-governmental organizations that are "already on the ground. We trust their instincts and networks." She says the group sometimes buys shoes in-country rather than shipping in used shoes collected in America.

But on the big criticism, that giving shoes or other stuff is more about the donor and the donor's needs than about the recipient, Kirk doesn't back down: "We are trying to meet an issue-lack of footwear-with footwear." Maybe better sanitation is the long-term goal, but Kirk says her organization is focused on the 300 million children worldwide who go without shoes: "You can quickly improve the quality of life and lifespan of a child by giving a pair of shoes." She's impatient with people who "stand against a fence with their hands in their pockets, saying there's a better way to do that."

For now, the aid bloggers and the givers are talking past each other. Schimmelpfennig is concerned about "the impact that the aid project could have on the local economy, that inappropriate donations can do more harm than good." Those concerns don't dissuade organizations like Soles 4 Souls.

But back to underwear: Don't even think of sending your old skivvies or bras to Rwanda. The Rwanda Bureau of Standards (RBS) recently banned both the importation and sales of used nightgowns, men and women's underwear, bras, and undershirts. Inspectors will be guarding the six main border points and the Kigali International Airport to keep out such #SWEDOW. The Rwandan newspaper New Times said of the used underwear, they are "old and cannot serve their purpose."

Saundra Schimmelpfennig says donors should ask six questions before donating goods abroad: 1. Is the donation appropriate for the local climate, culture, and religion? 2. After a disaster, will an influx of donated goods clog the ports? 3. Do the recipients actually need the donation? 4. Are the goods available locally? 5. Will the people receiving the goods be able to afford to fix or replace the donated items? 6. Will donating this item do more harm than good?

She also poses an empathy test: If the roles were reversed, and your town was the one suffering from poverty, famine, or disaster, would you welcome foreign aid workers offering the type of aid you are handing out?