The poor | The mountain man and the surgeon | Economist.com

The poor | The mountain man and the surgeon | Economist.com: "When Americans hear the words “poor” and “white”, they think of someone like Mr Banks. He has half a dozen cars in varying states of disrepair parked outside his trailer, car-parts everywhere and a pile of crushed Pepsi cans below his porch.

He “draws” $521 a month in supplemental security income (a form of cash assistance for the elderly, poor and disabled). He laments that the authorities deduct $67 a month because he won $3,600 on the slot machines. Why, he asks, won't they take account of all the money he has lost gambling?"...

Mr Banks would probably be surprised to hear that, thousands of miles away in central Africa, there lives a prominent surgeon whose monthly income is roughly the same as his. Mbwebwe Kabamba is the head of the emergency department at the main public hospital in Kinshasa, the capital of the Democratic Republic of Congo. After 28 years as a doctor, his salary is only $250 a month, but by operating on private patients after hours, he ekes it out to $600 or $700.

Given the lower cost of living in Congo, one might guess that Dr Kabamba is better off than Mr Banks. But the doctor has to support an extended family of 12, whereas Mr Banks's ex-wife and three sons claim public assistance. Indeed, the reason Mr Banks split up from his wife, he says, is because they can draw more benefits separately. She still lives in the trailer next door.

Why juxtapose the lives of a poor man in a rich country and a relatively well-off man in a poor one? The exercise is useful for two reasons. First, it puts the rich world's wealth into context. A Congolese doctor, a man most other Congolese would consider wealthy, is worse off materially than most poor people in America. That, in itself, is striking.

The second purpose of the exercise is to shed light on some ticklish questions. What is the relationship between wealth and happiness? And what is the significance of relative poverty? Mr Banks makes $521 a month in a country where median male earnings are $3,400 a month. Dr Kabamba earns $600 a month in a country where most people grow their own food and hardly ever see a bank note. The two men's experiences could hardly be less similar. But which of the two would one expect to be happier?...

r Kabamba's hospital is healthier than it was during the war, or under Mobutu Sese Seko, the leopardskin-hatted crook who ruled Congo until his overthrow in 1997. There are no medicines unless patients can pay for them, and many of the sick lie huddled on the ground. But it used to be worse. In the early 1990s, patients who could not pay were sometimes held hostage for weeks until their families found cash to free them.

Dr Kabamba's income fluctuates with his country's fortunes. His $250-a-month salary is a fivefold increase from last year, and the fact that it is paid only two months in arrears is an improvement too. The cause of his good fortune is that Congo was given a huge debt write-off when the civil war ended in 2003, so there is more money around. What do Dr Kabamba's wages buy? He has a four-bedroom house with a kitchen and living room, which would be ample if there weren't 12 people under his roof. His home would be deemed unacceptably overcrowded in America. Even among the 37m Americans officially classed as poor, only 6% live in homes with more occupants than rooms.

Having seen how doctors live elsewhere, Dr Kabamba would quite like running water and a regular power supply. His family fetches water in jars and the electricity comes on maybe twice a week. Air-conditioning would be nice, but “that's only for VIPs,” says Dr Kabamba. In America, three-quarters of poor households have air-conditioning.

Dr Kabamba earns enough to feed his children, but not as well as he would like. The family eats meat about twice a month; Dr Kabamba calls it “a great luxury”. In America, poor children eat more meat than the well-to-do. In fact, they get twice as much protein as their government says is good for them, which is why the Wal-Mart near Mr Banks sells such enormous jeans.

“Poverty” describes two quite different phenomena: utter penury, of the sort experienced by the billion or so souls who subsist on $1 a day or less; and the situation of people in rich countries who are less well off than their compatriots.

For the first group, finding enough to eat is a daily struggle, and a $2-a-day job hand-washing mineral ore in a river is a lucky break. Shortly before meeting Dr Kabamba, your correspondent interviewed a group of Congolese ore-washers who were delighted to have found such lucrative work....

bread, the poor in Kentucky complain about the price of motor insurance. Fair enough—they need to drive to work.

Granted, the poor in America do not starve. But their relative poverty can hurt in other ways. To be poor in a meritocracy implies failure. Eastern Kentucky is one of America's least meritocratic enclaves, but failure still carries a stigma. Though few Americans say that the poor have only themselves to blame, many believe it. Many of the poor believe it, too.

For a Congolese peasant, there is no shame in living in a hut made of sticks. Everyone you know does too. In America, by contrast, the term “trailer” denotes more than a mobile home, and the people who live in one know it. They are also acutely aware of how richer folk live, because they watch so much television. A typical poor household in America has two televisions, cable or satellite reception and a VCR or a DVD player.

Dr Kabamba, though hard up, enjoys the respect that doctors receive in all societies. Perhaps more, for people can see that he does an essential job under the toughest of conditions. That his hospital still functions despite years of war, corruption, economic decline and the occasional “grand pillage” by unpaid soldiers is, he sighs, “almost a miracle”. His compatriots might add that it is almost a miracle that Dr Kabamba, whose skills would allow him to emigrate, has chosen not to.

Those who know Dr Kabamba treat him with deference. When your correspondent was detained by the police outside his hospital, for the crime of appearing to possess a wallet, one telephone call to the doctor was enough to fix the problem. The officers even apologised.

Mr Banks, by contrast, though outwardly cheery, has no illusions about how other Americans see people like himself. Of the officials who hand him his monthly cheque, he says: “Some are okay, but some act like the money's coming out of their own pockets.” His great-niece, Rosie Woolum, tells a story about growing up in the hollows. She was the girl on the school cheerleading team who could not afford shoes. A teacher who lived nearby could have offered her a lift home after practice, she says, but never did. So she had to wait a couple of hours for her mother. At the time, she did not understand why her better-off neighbours shunned her. Now that she has a good job (running a project that provides health care for the homeless), she finds they no longer do.

It is hard to guage the pain of relative poverty because no one knows how to measure happiness. Simply asking people “Are you happy?” only gets you so far. The answers people give depend in part on cultural factors. Few English or Japanese will offer anything more ecstatic than a “mustn't grumble”, but that does not necessarily mean they are glummer than say, Americans, 86% of whom told Gallup this year that they were “completely” or “somewhat satisfied” with their jobs.

Indirect evidence of unhappiness is equally hard to gather, since so many potential proxies, such as drug abuse and wife-beating, are hushed up. Nonetheless, for what it is worth, when your correspondent asked Ms Woolum and three of her local social-worker colleagues to share their life stories, those stories shared a common thread.