Well, today is no better than yesterday. Turkish airlines lost my reservation to go home on the 19th. “Body blow, body blow.” Kir is going to call and yell at them and see if that helps. We’re also having trouble buying airline tickets for our planned weekend on the Caspian Sea. The policy used to be that you could only buy tickets in the seven days before departure. Now the rule is that you have to buy 2 weeks in advance.

I am, most of the time, extraordinarily grateful to have found the job I do. I have work that is meaningful. When I work extra hours, or get up early to check for an important email, or bring my own pens to save the office money, I am doing it for a cause that matters to me. I know why I am here in Turkmenistan. I know why I am sitting behind this desk. There are hundreds of thousands, millions of people, in America who do jobs they hate or are indifferent to, just to feed their families. Kir’s dad is one of them; Edith is another. For me to have this job I love and make good salary doing it is glorious. I know that. I remember to appreciate it.

But. (there’s always a but, isn’t there?) Then there are days like today. Today I’m not so sure. I mean, how do I really know my project is doing good? And even if it is, how can be sure it’s doing more good, or even as much, as some other project receiving the same funding would do?

Development is a weird idea. It’s an entire field of study and still nobody really knows what works. I placed my bets in one direction – on health. I have chosen to ignore grand unifying theories of development in favor of looking at individual activities that will help. Theories cannot be proven or disproved without several hundred years of development to test them. Activities, on the other hand, you can test. Will improving emergency obstetric care save women’s lives? Yes, and we can give you the numbers on much it costs per life saved or per year of life. Will free trade lead to development? I have no idea. Neither does anyone else, no matter what economists claim.

I stick to what I know. Small-scale, properly tested interventions that we can evaluate and see f they’re working. But am I attempting to bail the Titanic? Patch small holes in a sinking ship? More developed countries already have emergency obstetric care. They don’t need me or my project to help them establish a system. Educational attainment has more impact on health status than any kind of medical intervention.

It could well be that economic restructuring and other large, theory-based endeavors are exactly what we need. And here I am, drafting pamphlets on nutrition for pregnant women who can barely afford food.

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USAID is one of many donors for the project I work for. The views expressed herein are the author’s own views and do not necessarily reflect those of the author’s employer or especially those of the United States Agency for International Development or the United States Government. And I mean it. I probably give the US government heart attacks.