Introduction

In 2001, in Mascarenha, Mozambique, only one ambulance served a population of more than 500,000. In the district’s medical center, while one nurse assisted over eighty-five patients a day, another risked HIV contamination daily while washing their limited supply of used syringes. As for medication, the local pharmacist hadn’t even stocked a vitamin since 1999. To increase the level of these services was simply impossible; it was too expensive. Things weren’t much better in the rest of the country. Overall, three out of four people in this impoverished sub-Saharan African state lived on less than forty cents a day. Yet the central state could do little to help. Designated a “Heavily Indebted Poor Country” by the World Bank and the International Monetary Fund (IMF), Mozambique paid over $70 million annually in debt service. And Mozambique wasn’t alone. In all, forty nations shared that unenviable qualifier at the dawn of the twenty-first century; together, these states owed over $212 billion! Added to the debts of those poor nations fortunate enough to escape the IMF’s criteria for this classification, the total external debt of developing countries rose to over $2 trillion. As the village of Mascarenha demonstrates all too clearly, crippled by the high cost of debt service, these indebted states could offer few social programs, leaving many of their people to suffer from extreme want.