In the spirit of random

I’m having one of those mornings when I’m not quite sure what to write about. After all the hustle and bustle of the last couple of weeks the last few days have felt very still, and somewhat empty. So, today, I’m going to do a brief summary of what’s going on in life at present and wrap up with a question for you all.

In no particular order, here’s the big and small of what has been going on this week:

• I am super excited about our puppy coming home in about two weeks, but somewhat sobered by all the people who are telling me (with the sort of passion and graphic detail usually reserved for stories about labor and delivery) how much hard work puppies are. Most people who’ve weighed in seem dead-set against getting two puppies. One friend laughed out loud when I wondered if our little puppy would be house-trained by the time Mike leaves for Australia on Dec 10. The vehemence of all the facebook comments prompted yet another facebook friend to fear that I’d be dissuaded from puppies entirely and write me a long and lovely email reassuring me that it would be worth it.

• As a PS to the puppy commentary, is it seriously messed up that I’m already dreading possibly having to leave this puppy here if and when we leave Laos and the puppy hasn’t even come home yet?   

• Mike’s down south in Vientiane for a couple of days. He gets back tonight, yay!

• I re-read on old friend of a book this week that I remember loving when I was twenty. It was one of my top twenty most incandescent reading experiences ever. So I was rather disappointed to return to it and find it still engaging but no longer incandescent. On the other hand I read a new book I loved – A Girl Named Zippy – which was just a treat of a memoir about a relatively happy childhood in a town of 300 in Indiana. The author’s voice is wonderful – a study in childhood resilience.

• And, speaking of resilience, I have started interviewing people this week for the consulting project on resilience in humanitarian managers that I am aiming to have wrapped up by Nov 28^th. It’s a fun topic to be pondering, and a real treat to have a good reason to chat to some of the many acquaintances and friends I’ve made over the years in the humanitarian field and make some new ones. Three more interviews today – Kenya, Australia, and Central African Republic. Once again I think of the pure genius of skype with shivers of awed gratitude.

So now, the question. I’ve been reading a lot of articles and blog posts lately about themes in blogging, and offering your readers useful content, and the strategic use of twitter, and how to time your comments on facebook so that you get the most traffic… and it’s all leaving me a bit baffled.

This is a level of strategic thinking I just haven’t reached with social media (and am not entirely sure I want to, either). My usual blogging process is to get up in the morning on Monday, Wednesday, and Friday, grab some coffee, and then figure out what I feel like writing about that day. Sometimes that is snakes, or toilets. Sometimes it’s sick kids.

So I’m really grateful that so many of you come here regularly to check out what Mike and I are up to, and I’ve been wondering this week what constitutes “useful content” for you all? What do you enjoy about this blog? What would you like to see me writing more of? What topics would you be interested in?

And, have a great weekend, all.

PS. In the spirit of random, here’s a photo I took from the back of the elephant the other day, because Laos is beautiful.

A tale of two puppies

Mike should have known better, really.

I was so happy at the prospect of finally getting a puppy that the thought of two puppies had never entered my mind. Honestly.

Then, while we were on the way to the airport last Monday to be medivaced to Bangkok, Mike mentioned that he’d called the puppy lady and told her we wouldn’t be able to make our scheduled appointment at lunchtime that day, after all.

It has turned out to be more difficult to find a puppy in Laos than we’d bargained for. Once we’d settled the fact that we definitely not getting the imported Samoyed (a question that was only really resolved in my mind when we went back to the little store and she was gone) we started scouting around.

Then Mike’s colleagues got wind of the fact that we were looking for a puppy and, hospitality being what it is here, decided to take care of this for us.

“What do you mean Makan has found us a puppy?” I asked, when Mike told me what was going on.

“Well, I’m not exactly sure,” Mike said. “You know how indirect everything is here. The word on the street is that Makan has ‘ordered one’ but I can’t get anyone to tell me when we might expect this puppy to show up at our house, or whether these puppies have even been born yet.”

“But what if we don’t like this puppy?” I asked.

Mike shrugged. “Unless we find another puppy quickly we will have exactly zero choice in the matter.”

We really didn’t want Makan spending his hard-earned money to buy us a puppy, so we set to hunting down puppies with new will. We asked the owner of the little grocery store we go to, and the people in the hardware store. But we didn’t strike gold until we asked the German guy who sells the only decent ice cream in town.

Ice cream man was very confused to be asked about “mah noy” (little dogs) while we were paying our bill, but when he finally realized what we were after he obligingly dug out the phone number of the German butcher. The German butcher, he told us, had little dogs.

The German butcher and his wife, Soumontha, did indeed have little dogs. We told Soumontha that we’d come round on Monday lunchtime to see them.

Except, last Monday at lunchtime found us in a car on the way to the airport to catch a flight that would ferry us to hospital in Thailand. Damn staph.

“Maybe we should get a puppy in Bangkok,” I suggested, trying to think of ways to redeem this trip and get my puppy fix. “A yellow lab, maybe. Or a husky.”

“Soumontha said she’d keep one for us,” Mike said. “Or two. She asked how many we wanted.”

Have you ever had one of those moments when your perspective and vision for life shifts with all the brilliant immediacy of a lightening strike? That was how the possibility of two puppies arrived in my mind – in a single, mesmerizing, instant.

“What did you tell her?” I asked, pretending casual.

“I told her that it depended on how cute my wife thought they were,” Mike said.

“Really?” I said.

“Stop!” Mike said, with all the sudden fear of someone who’s just realized that they have handled a Pandora’s box far too casually. “I was joking. We do not need two dogs.”

“How do you feel?” I asked, glancing down at the swollen legs that were jammed into his shoes.

“Stop!” Mike said, ignoring my solicitous diversion.

“What???” I asked.

“I can see you thinking.”

“Once upon a time you loved it when I thought,” I said.

“Yes,” Mike parried. “And then we got married.”

I didn’t pester him too much about two puppies last week. It’s hard to muster up the steely willpower necessary to press an argument with someone dressed in green pajamas who has an IV decorating the back of their hand. So I bought him chocolate covered ice cream bars from the gift shop downstairs and bided my time.

That time came yesterday, when we finally got to go see Soumontha’s puppies. There are fifteen of them, five weeks old now, and they are a squirming tangle of adorable. I sat down on the ground and let them crawl all over me and wondered how we were ever going to be able to pick one in ten minutes flat.

As it turned out, there were only two left unallocated from the litter that we wanted – a little girl and a little boy – tiny, tawny, balls of fluff with black noses.

We were leaning towards the little boy, but then we noticed that he whimpered a lot and started to wonder whether he was chronically noisy, or anxious… or brain damaged. Then we started leaning towards the little girl.

“Perhaps we could take them both,” I suggested, smiling up at Mike and Soumontha.

“I told you,” Mike said to Soumontha.

Mike and I talked this over again last night as we walked down to an outdoor restaurant overlooking the Mekong.

“They could be buddies for each other,” I said. “When we have to go out they won’t be lonely – they can play nicely with each other while we’re gone. And during the day when I am busy they can curl up together like tiny, contented, bundles of love. They will be happier with a friend.”

“That is a beautiful vision indeed,” Mike said. “But I don’t think it works like that, exactly. When puppies are together all they want to do is play, and I think it’s far more likely that they’ll wind each other up and get into all sorts of mischief. Do you really want to be trying to write in the same room as two bored puppies and all sorts of things they should not be chewing on?”

“Huh,” I said, my beautiful vision dying a small death.

After we got home from dinner I put this to an informal poll and it seems that, as usual, the global facebook audience agrees with Mike.

“Uh oh!” warned a good friend from California, Danielle. “I know it’s tempting, but don’t get two that are siblings! They maintain a pack mentality and it makes them unbearably hard to housetrain and domesticate! They act like little wild wolves when you have two from same litter together.”

“Little wild wolves” piques my curiosity, I must admit – after all, how much trouble can two puppies be? But I suspect that my curiosity will be trumped by pragmatism-plus-spouse, and I am slowly resigning myself to being a one-puppy household.

Of course, we are going again on Sunday to visit the whole furry mob of them – a visit that is likely to take a pair of bellows to the dying embers of that beautiful vision of canine comradeship…

I’ll keep you posted.

We, the beneficiaries of admin costs, thank you

I am sitting in Bangkok airport in a recliner. Yes, recliner – Bangkok airport has a bank of them right near gate C2, surrounded by pots of orchids.

Mike is stretched out next to me, dozing. It’s 10:30 in the morning and we’re both yawning our heads off. We’ve done an awful lot of sitting around this week, so I feel a bit silly about being quite so tired. But, then again, even the best hospitals are not entirely relaxing places to hang out.

We may not have gotten quite as much sleep as we’d like this week, but we did get good medical care. Mike has another week’s worth of antibiotic tablets to take three times daily, but so far everything points to him being well mended – for which we are very grateful.

I read an article this week by Nicholas Kristof called The D.I.Y Foreign Aid Revolution. It was an interesting, challenging piece primarily focused on the stories of three women who are passionately committed to making a difference in the lives of the poor.

“It’s not only presidents and United Nations officials who chip away at global challenges,” Kristof writes. “Passionate individuals with great ideas can do the same, especially in the age of the Internet and social media.”

Driven by “some combustible mix of indignation and vision” these women have accomplished extraordinary things.

They have also sacrificed greatly. One has depleted her life savings and is now close to homeless. Another one of these young women in rural Nepal recently had an infected tooth extracted by pliers…with no anesthetic.

This last story stands in stark contrast to our experience this week. For me, it’s enormously reassuring to have seen our emergency medical insurance company in action.

When Mike rang them in Singapore last Monday to talk to the on-call doctor, they could easily have told us to monitor the situation and wait it out for another 24 to 48 hours, but they didn’t.

Within hours they had transferred Mike’s case to their Bangkok branch and organized flights for both of us. On the other end they had pre-arranged someone to meet us at the gate, shepherd us through customs, and lead us straight to a waiting taxi. They had also contacted the hospital in advance, lined up a doctor to see us upon admission, and put us in a single room with a couch. They will cover the tab for this week’s little adventure completely. The only thing they won’t pay for is my air ticket and on-ground expenses.

This is one of the hidden benefits of working for a large NGO rather than on your own. Yes, the bureaucracy of large organizations can be frustrating at times. But the flip side of that coin, in this case, was that when something went wrong there was a safety net in place – a safety net paid for by funds that would normally be labeled “admin”.

“Administrative costs” is a bit of a hot-button topic for humanitarian organizations. NGOs love to be able to tell people they keep admin costs low. However, a hell-for-leather drive to keep admin costs low can mean more than just the vast majority of your dollar is going straight to building wells (or whatever you’ve donated to). It can mean that the organization is not investing in their staff and building their skills. It can mean that they’re not providing staff with emergency medical coverage, or resources (such as laptops in decent working order) that they need to do their work well and efficiently. It can mean that they’re not paying their staff well enough to stay long – which means high turnover and all that costs in terms of organizational knowledge, program continuity, and the recruitment and training of new staff.

So by all means look at the portion of a charity’s money that goes to admin costs when you donate, but don’t let it be your only yardstick. It is not a yardstick that does a complex situation justice. Mike’s office, for example, has a relatively high ratio of admin costs associated with it. This is partly due to the fact that (in accordance with government policy) program staff are not allowed to visit the project sites without being accompanied by government officials. Also according to government policy, the organization must pay these government officials a per diem for their time.

The relatively higher admin costs of this office are also partly due to Mike himself being here. In many other countries, a local would fill Mike’s position. But in this “strong state” it can be virtually impossible for the local staff to stand up to the demands of their government counterparts – demands that local staff hand over the money for the projects to the government, or work in non-target communities, or focus only on building infrastructure (such as schools) and neglect commensurate capacity building (such as teacher training). Part of Mike’s role here is to help shield these local staff by saying no to government when no needs to be said – to buffer local nationals enough to enable them to get on and do their vital work.

Here in Bangkok we must quit these recliners now – they are calling boarding. On the other end of this flight, Mike will head straight to the office from the airport and they will drop me at the house along the way. After a week on the couch with a small blanket I’m particularly looking forward to our bed, and I’m glad we’re going “home” to Laos today. But I must admit that I’m also very glad to know that we have good medical insurance (and, failing that, some savings of our own) and that I will not necessarily have to face a local dentist with a pair of pliers anytime soon.

A three year “anniversary” in Bumrungrad

We are still in Bangkok in Bumrungrad hospital. Mike is still in those sexy green PJ’s with an IV line sticking out of the back of his hand and plastic bags full of Dalacin and Ceftriaxone hanging off a metal stand above his head. Periodically air bubbles get in the line and the machine emits a loud and obnoxious beeping that doesn’t stop until a nurse comes and sorts it out. Yesterday’s last course finished dripping into his veins at 11:20pm, and nurses came in this morning to take his blood pressure at 5:15am – which I think is a ridiculous practice. Why would you wake someone out of a restorative sleep every morning in the five’s just to take their blood pressure when they’re clearly in no imminent danger?

Yes, three days into this and our serene gratitude has started to disappear at odd moments. It’s like my good mood just takes off and wanders downstairs to the Starbucks to get a cup of coffee, then saunters back in some time later and acts all surprised to find that pissiness has taken up residence in its absence.

“What’s your problem?” my sensible and cheerful self asks in these moments, genuinely bewildered. “You’ve really got it very good. Mike’s getting much better, there’s a McDonalds downstairs, they sell Haagen Dazs in the gift shop, and the shower here is awesome.”

“Just shut up,” my pissy self answers. “You’re annoying.”

Sometimes my sensible and cheerful self gives pissiness the middle finger and reclaims the throne. Sometimes my sensible and cheerful self goes and sulks in the corner.

So here’s the update: Mike is getting much better – the infection seems to be disappearing rapidly, though we both had an expectations readjustment yesterday when the smiling doctor suggested we may not get discharged until Monday.

“We trust your judgment,” we told him yesterday. “If that’s what it takes we’ll stay until Monday.”

(Of course, we’ve spent much of the last day speculating as to whether we could possibly get released on Sunday, or maybe even Saturday.)

In the meantime we’re both trying to stay focused and working off our laptops (Mike is typing one-handed as I write this while the other is soaking up all those antibiotics). I’m really enjoying the French fries down in the food court. I had a crème brule latte this morning and wasn’t that impressed. I ventured out of the hospital last night for the first time to find a local spa – where I decided to get the traditional Thai massage because it was significantly cheaper than the Swedish oil massage. I won’t make that mistake again. She twisted my body into positions I hadn’t known I could achieve, and she yanked me into some of these positions while standing on me. It was like being mugged by yoga.

Today is an anniversary of sorts for us – three years ago today Mike emailed me for the third time. It was a lovely long letter that basically inquired as to whether I might like to embark upon a long distance relationship with a virtual stranger. We all know how that story ended. Or, rather, how it started.

So, tonight, if they let Mike off his plastic tubes at some stage, I’m going to take him on a surprise field trip date to the rooftop garden on the sixth floor to mark our “anniversary”. Then we might stop at the nursery and look at the babies. I spied a dozen babies yesterday through a giant glass window – all these impossibly tiny bundles neatly lined up, fast asleep. I stood for a couple of seconds and watched them. It was like visiting a pet store and watching the puppies, only much less entertaining. But, hey, good entertainment is a bit in short supply around here at the moment so wandering past the nursery will just have to do. That and Haagen Dazs ice cream bars.

Thank you all for your messages of support and apologies that I haven’t been able to get back to you all yet. We’ve been really touched by all the blog comments and facebook comments and emails that have flooded in. When you’re clothed in green PJs and far from home it’s really nice to know people are thinking of you. I sure hope you’re all having a good week and that your sensible and cheerful selves are reigning supreme in your own internal kingdom.

Greetings from Bangkok

About two hours after I posted A Tale of Two Right Legs I got a call from Mike at the office. Our emergency evacuation medical insurance company had gotten involved. Given Mike’s history with this particular set of bugs, they wanted him to go to Bangkok.

It all happened very quickly after that. We made the decision that I would come with him, and the insurance company made the reservations for both of us on the 2:20 flight to Bangkok. We packed in less than an hour, got to the airport, finished paying for my ticket with a credit card forty minutes before scheduled take-off, and we were on our way.

The hospital here is, well, lovely. We have a private room, there’s a couch in here I can sleep on, and if it weren’t for the fact that neatly dressed nurses keep coming in every couple of hours to take Mike’s blood pressure or hook up another bag of antibiotics to his IV, I might forget we were in a hospital – this place looks more like a particularly sterile hotel.

It’ll take a couple of days to get last night’s test results back, but Mike’s already on a cocktail of IV antibiotics that the doctors seem fairly confident will kill the staph.

I’ve found the last couple of days a little bit overwhelming. Not overwhelming in a bad sense, thankfully. But I have been overwhelmed by all the reminders inherent in this whole experience of how much Mike and I have to be grateful for in this life – how ridiculously blessed we are. We were talking in the taxi to the hospital about Sommai. He had the same problem Mike does now. He did not, however, have our options. We are profoundly grateful for our options.

We are also thankful for good medical insurance, and for co-workers and supervisors who prioritized caring for staff and strongly recommended we come straight to Thailand. Emails and comments on facebook and comments on the blog have poured in from all over the world to remind us that people are thinking about us and praying for us. We feel cared for in more ways than one.

Thanks all, I’ll keep you posted when I can.

A tale of two right legs

Something happened this weekend that I’ve been dreading for almost a year – ever since we decided to move to Laos.

I have lymphedema. For those of you lucky enough not to know what that is – it’s what happens when your lymphatic vessels are either missing or impaired. This causes your lymph fluid to accumulate in the area (in my case, my legs, especially my right one). Lymph is full of white blood cells and protein, and when it hangs out in tissue instead of filtering back into your tiny lymph vessels and on up to lymph nodes, it’s not good…

Things swell. They stay swollen. The whole area become the perfect breeding ground for any bacteria that finds its way into the limb – putting you at high risk of infections that come on quickly and sometimes require hospitalization so that antibiotics can be administered intravenously. Protein starts to accumulate in the tissues. This causes them to harden, further damaging joints and the delicate network of lymph vessels. Things swell more. Etc.

It sucks.

There’s no cure. That sucks too.

I’ve struggled with my right foot ever since I picked up a nasty infection in the Philippines in 2003. At the time I put the infection down to bad luck – I’d been volunteering in a slum area in Manila, wandering around in sandals, and these things happen, I thought. Eighteen straight days of penicillin killed the awful red streaks that had started to climb up my leg, but my foot was never same.

After that, I always struggled with swelling in that foot when it got hot. I started wearing compression stockings whenever I flew. I oscillated between realizing that I may have a serious problem and ignoring the situation.

Until, last May, two months after Mike and I returned from honeymoon, it became impossible to ignore.

For no apparent reason this time, my right foot swelled up dramatically, and so did my calf. When I gave in and went to find a physical therapist specialized in manual lymphatic drainage massage she measured my legs. My right one was bigger than my left all the way through my thigh.

Six weeks of therapy every couple of days reduced the swelling somewhat, but my therapist and a specialist in LA confirmed what I suspected – this wasn’t going to go away. I needed to start wearing compression stockings every day, do therapy regularly, and avoid risk factors.

What are those risk factors for exacerbating lymphedema worse? Well, flying is one. Heat is another.

When we told my doctor that we were considering moving to Laos she looked appalled.

“Why would you do that?” she asked in her typically abrupt, East European, fashion. “Better you move to Alaska than Laos. If you were my sister I would tell you not to go.”

Mike and I agonized over the decision to come here – my health was our single biggest concern about this move. We knew I’d struggle with the heat in the tropics, and we were worried about the implications of being a two-hour plane flight away from a decent hospital should I pick up another terrible infection. When, we wondered, exactly does risk cross that invisible border between sensible and stupid? But in the end we stocked up on compression stockings, invested in an expensive piece of medical equipment to help me with at-home therapy, and decided to give it a try.

And so far, so good.

I mean, not great. Compression stockings are uncomfortable at the best of times, and particularly frustrating when you’re bathed in sweat. My right foot is permanently swollen, and I sometimes mourn the fact that it will never be pretty again. I was never really a foot-person before, but now I catch myself checking out other women’s feet with a mixture of wonder and envy – the agile play of bone and vessel visible under skin, the beautiful curve of an arch, and their perfectly matched, delicate, naked, ankles. I am perpetually amazed (and occasionally resentful) that people prance around on these works of art, heedless of their good fortune.

But, overall, things have gone pretty well since we arrived here in Laos. I stay cool when possible. I keep my feet up when possible. I wear my stocking. I do my therapy with the pump machine. I treat every break in skin with antiseptic – I’m well aware that one infected mosquito bite on my right leg is all it could take to land me in hospital in Thailand.

Then, this weekend, what I’ve been fearing came to pass. An infection that started with a single nasty-looking nodule blew out in the course of twelve hours into a large, dangerous, angry, swamp of staph.

But the irony is that it’s not my right leg that could well land us on that plane to Bangkok in the next couple of days – it’s Mike’s.

Mike has battled staph before. Four years ago staph infections in his legs resulted in one medical evacuation from Sri Lanka to Singapore, four surgeries, and six months of antibiotics. Now, it looks as if the couple of hours perched on an elephant’s head last Thursday rubbed his shins raw and the opportunistic bacteria has struck again.

As soon as dark purple patches started to spread over his shins and it became apparent what was happening, we pulled up his test results from four years ago to check which antibiotics the staph was resistant to last time and which might have a hope of heading this off at the pass. Then we went looking for a pharmacy. We might not have a decent hospital up here, or many English speaking doctors, but you can buy all sorts of antibiotics over the counter.

So, dear doctor friends across the oceans have chimed in with helpful advice, and Mike’s on six tablets of cloxacillin a day. It’s been 36 hours since he started popping those orange and brown tablets, and he woke up this morning with his whole right leg swollen – his ankle’s so big it was hard to get a shoe on. We lined our feet up this morning and took a photo and laughed a little at our matched pair of mismatched legs, and sighed a little, too.

Now we’re crossing our fingers and watching for the next day or two to see whether cloxacillin is going to win this particular battle or whether we’re off to spend some unscheduled time in Thailand. I’ll keep you posted.

World’s Worst Elephant Mahout

Mike and I went on an elephant mahout training course yesterday.

Yes, seriously.

Here’s how it happened.

Last week we came back two days early from our time in Cambodia so that Mike could attend some important meetings in Vientiane – so he took those two days of leave this weekend instead. Given that we’d be in Luang Prabang, Mike decided it would be a good idea to pre-schedule some interesting things to do out of the house on these two days so that he would not be tempted out of habit to, as he put it, “fall into bed with my second wife, Madame Toshiba, when it is not her turn.”

(Madame Toshiba is Mike’s work computer and, for the record, she already gets more than her fair share of his attention.)

So that is how we ended up out at Elephant Village for the day, and when the owners asked us if we wanted to do the special package where you learn how to be a mahout and you get to swim with your elephant we said, “that sounds cool, why not?”

Perhaps if I had stopped to think about it for more than a nano-second I might have come up with a couple of potentially valid reasons why not.

Here’s one, for example: Mahouts ride elephants bareback.

Here’s another: Before they ride the elephants bareback they somehow climb up on them unassisted.

Here’s a third: There is no such thing as an elephant bridle.

And here’s the kicker: Elephants are very big.

But no – as in so many other situations in life I didn’t stop to think. Or perhaps more accurately, I knew that thinking might be wise, but I took one look at Mike’s hopeful, excited, face at the prospect of mahout training (he looked exactly like a Labrador Retriever who’s just spied someone with a tennis ball in hand) and knew I wouldn’t have the heart to say no, so I chose not to think. I can never figure out in those moments whether I’m being a great wife or an idiot.

They say you learn something every day, and here’s one of the things I learned yesterday: I’d be the world’s worst mahout.

It took two people to shovel me up onto our training elephant and things only went downhill from there.

 

 

 

 

 

 

 

I mastered exactly none of the commands designed to tell the elephant where to go and almost fell off the elephant’s head while it was merely walking in a gentle circle. Then I nearly lost my shirt over my head sliding down its neck.

Here’s another thing I learned yesterday: Sometimes I need to repeat an experience before I really learn my lesson, because later in the day I got back up bareback on an elephant – this time I wearing nothing but a bathing suit – and almost fell off again.

But here’s the third thing I learned: I might not particularly like riding the elephants without the aid of a howdah, but I sure do like swimming with them.

When Helping is Hard (Part 4): Money, It’s Complicated

It was about a month after we returned from Viengkham that Mike received his first phone call about the case of Lahela, little orphan girl. You can read the start of this story in the post titled: What price a child’s life?

After eight days in the hospital in Vientiane, no one seemed to be all that much closer to figuring out for sure what might be wrong with eleven-year-old Lahela. All the tests had come back negative, but the doctors had now circled back around to thinking that she might have Japanese encephalitis, after all.

All that the medication she’d been given in Luang Prabang before being flown south may have clouded the test results. Either that, they said, or she had a chronic neurological condition and would continue to suffer from acute episodes of paralysis in the future.

The good news was that Lahela no longer appeared to be in imminent danger. She was eating again, although she still needed help even to sit up in bed.

Mindful of the fact that the medical emergency fund was set up to assist families with emergencies, not chronic medical conditions, Mike and the child sponsorship staff judged that Lahela needed to be transported back to her village so that she could continue to recover there.

Mike instructed the staff in Vientiane to make sure that Lahela knew she would be leaving the hospital in a couple of days and to encourage her fourteen year old sister (who the organization had arranged to accompany Lahela to Vientiane) to continue to learn the rehabilitation exercises so that she could help her sister complete them back in the village. The staff were to put together instructions for rehabilitation in Khmu, pay the hospital bills, organize bus tickets and paperwork, and (as Lahela could not yet walk) accompany Lahela and her sister on the ten-hour bus trip back to Luang Prabang.

With the exception of the bus breaking down in the middle of the night during their long journey home, all of this went fairly smoothly and Lahela and her sister were returned to the care of their elderly grandmother in their village. National staff up here were tasked with checking in on them regularly and doing what they could to help Lahela in her rehabilitation.

Two weeks ago, a month after Lahela arrived home, Mike had to visit a village nearby to conduct a construction inspection for a half-completed school. While he was in the area, he decided he would drop in and see Lahela.

“It was depressing,” Mike told me later, after he’d gotten home tired and dirty from his three-day field trip. “The child sponsorship guy was there, helping her, and he says she’s getting better. But she’s very thin, and still can’t move her right arm or leg much without help. It’s a tough situation.”

“What’s happened with the paperwork for this case?” I asked, sitting on the bed while Mike unpacked.

“All the bills have been paid for the organization,” Mike said, “Everything is taken care of except for one hundred thousand kip ($12) they owe as family contribution and three hundred thousand ($36) they borrowed from the village development bank when she first got sick.”

“How are they planning on paying that back?” I asked.

“Iokina says they’ll sell rice from this harvest,” Mike said. “But that’ll leave them short during the hungry months.”

“Can we pay it using Matt’s and Hilary’s money?” I asked.

“I’ve already asked the national staff to look into that possibility,” Mike said. “They’re a bit wary. They say that if word gets around that the organization paid back someone’s loan from the village development bank, then no one else will pay back their loans.”

“But the money’s not coming from the organization,” I said.

“We know that,” Mike said. “It won’t look that way to the people in the village. Let’s see what the staff suggest.”

When Mike came home a week later he was grinning and shaking his head.

“OK,” he said, as we were walking into town for dinner. “Here’s the plan the staff have made. They’re going to take the money for the village development loan from me in cash and give it to a local government official they trust, and the government official is going to give it to the family, and then the family can give it to the village development bank. That way no one will know it came from us.”

“OK,” I said, a bit dubious. “That’s fine. I don’t know how they’re planning on explaining why the government had decided to help out, but as long as the loan gets repaid, that’s fine.”

“I printed out a picture of Hilary and Matt from Facebook and gave it to the team so that if the plan unravels and people start asking questions they can show them who gave the money and reiterate that it wasn’t the organization.”

I laughed. “Nice touch. So, score one for the Matt and Hilary fund?”

“Yeah,” Mike said. “Score one for the Matt and Hilary fund. Now Lahela’s family won’t have to sell any rice this season. So if their harvest is good this year, they’ll have enough rice to make it through three or four of the hungry months instead of being hungry for all six.”

“That’s good,” I said uncertainly.

“Yeah,” Mike said, and sighed.

We walked along the Khan River in silence. I presume Mike was contemplating the difference between our lives and Lahela’s. I sure was.

“OK,” I said after we’d been quiet for a while, when we were only a minute or two from the main road lined with market stalls, and tourists, and restaurants.

“Where you want to eat dinner tonight?”

1. When Helping is Hard (Part 1): That sort of decision
2. When Helping is Hard (Part 2): In the village
3. When Helping is Hard (Part 3): Score one for policy
4. When Helping is Hard (Part 4): Money, it’s complicated

To learn or not to learn?

I have one more installment of the When Helping is Hard series to write, but it ain’t gonna happen today. Because today I am sick, and feel utterly pathetic, and in no mood to try to write a well-crafted post highlighting how absurdly difficult it can be to spend money to help others in ways that “do no harm.”

So I have sent Mike off to the office for a full day of meetings and said a little prayer that he doesn’t get whatever it is that I’ve been battling for the last couple of days. I’ve googled  “dengue fever”. I have determined that I probably just have a plan old cold, albeit one that comes with a nasty headache, and that I am most likely in no mortal danger. And I have cancelled my Lao language lesson for the day – which gave me a brief burst of that feeling I used to get as a kid when I woke up and found that school had been canceled because of snow or military lockdown (depending on which country we lived in at the time).

After three months here, my Lao remains decidedly crap. Mike had a significant head start on me and he has been making some good progress. I love listening to him trying to make himself understood and he looks downright sexy when he’s trying to ask people what type of laundry detergent is the best one to buy. He is fearless – he just puts himself out there with his big smile and animated hands and even when people don’t have a clue what he is saying they love him for trying.

It’s taken me a couple of months to decide that I even want to try.

I feel a bit defensive and embarrassed about this, but the truth of the matter is that I don’t like learning new languages.

We moved around a lot while I was growing up and I spent too much time learning bits and pieces of languages – Bengali, Spanish, Shona – that I never gained any sort of proficiency in. After five years of high school study, with a brief revival during my time at Notre Dame, I am somewhat functional in French, but it’s never really done much for me. Certainly not enough, in my mind, to justify the many hours of study I invested to get to that point.

I know that really throwing myself into learning Lao could unlock a wealth of experiences here that I will never have otherwise, and part of me really wants to be that person who’s genuinely excited by the novel puzzle presented by a brand new language – one with six tones and an abugida script. But another part of me shrugs my shoulders and says, “Lao will be virtually useless outside this country and you are better off taking that time and energy and investing it elsewhere – reading, writing, and perhaps even setting your mind to learning the English grammar that somehow also got missed in childhood during all that country hopping.”

So for the time being I’m taking the middle road and having lessons twice a week. Perhaps this is the worst of both worlds – enough study to feel like hard work, but not enough to get me very far. My aims are modest though. I’m just hoping that it will help me learn how to say more than “good morning” and “you did a great job today” to our maebaan, Un, and perhaps make some basic conversation during long lunches and official dinners.

If this past weekend is anything to go by it won’t take too much to make some small progress on that front. On Saturday, Mike and I spent several hours out at his deputy’s farm. A couple of months ago one of Kampono’s buffalos was stolen and during a similar long lunch around that time we all drank many toasts to the productivity of the remaining herd. So I was delighted to see some baby buffalos in amongst the bigger ones that came wandering out of the trees to check out the music and the smoky scent of meat grilling over an open fire.

“Kwai noy,” (“buffalo small”) I said, pointing and smiling.

There was a sweet-looking older man to my left. He spoke not a word of English but he had been watching out for me all day, refilling my juice and putting food on my plate every time I turned my attention elsewhere. When I said this you might have been forgiven for thinking that I was his favorite child who’d just said her first words.

”Kwai noy! Kwai noy!” He said, nodding vigorously and correcting my pronunciation. Then he turned to everyone at the table and told them my Lao was “keng heng” (very strong).

Then he reached over, picked up a long skewer of grilled pineapple, chilies, and beef liver, and placed it on my plate.

[PS, I’m curious. What do the rest of you – particularly those that move often – do about language? Do you try to learn? Why or why not? Have you ever put time into learning a language and then felt that it wasn’t worth it?]

When Helping is Hard (Part 3): Score One For Policy

[Follow these links for Part 1 and Part 2 of this story]

After we left Sommai’s village it was a long and bumpy car ride back to Luang Prabang. As I braced myself against the potholes I stared at the dozens of white cotton strings swathing my wrists – remnants of the blessings that had been bestowed upon all of us earlier in the day. The national staff who had traveled out with us all had strings around their wrists too, I noticed, but not nearly as many as I did, or Mike. It seemed a fitting metaphor for the day, for our entire life here: Upon those who are already well blessed will be bestowed the lion’s share of any blessings that are going around.

“You know,” Mike said suddenly sometime around hour four, long after I’d been jostled into an dazed and aching sort of exhausted. “I think they have the policy wrong.”

“Who?” I asked. “What policy?”

“Edena and the child sponsorship team,” Mike said. “The policy about how much Sommai’s family should be paying. They told me the family was responsible for a quarter of the medical expenses, but I don’t think that’s right. I think this family falls into the extremely poor category, which I think means they should be responsible for a hundred thousand kip (about $13) and the organization should pay the rest.”

“If that’s true,” I said, “then forget about us trying to figure out ways to save the water buffalo. The most important thing you can do is to go into the office on Monday, find that policy, and make sure it’s followed.”

When Mike came home on Monday night he had good news and bad news.

The bad news was that Sommai’s family had already sold their buffalo. They’d sold it almost three months earlier when Sommai first got sick.

“But I thought Edena said they were going to sell it,” I said, confused.

Mike was well used to these sorts of misunderstandings. He just shrugged.

“English,” he said. “It’s a slippery language.”

The good news though, was very good. Mike had been right about the policy. It turned out that Sommai’s family was only responsible for $13. The organization would pay the rest of Sommai’s medical expenses.

“Yay for good policy!” I said.

Mike laughed, for he knows how ambivalent I am about some of the policies and practices of many NGOs (non-governmental organizations).

Some of the policies that I am most conflicted about have to do with financial accountability.

Donors who give to NGOs understandably wish to know that their money is not ending up in the pockets of those in power and is being put to good use in ways that help people.

This puts pressure on NGOs to be able to demonstrate exactly how donated money is being used.

Up to a certain point, I think that this pressure to be financially transparent is a good thing. It opens international NGOs up to some scrutiny of their decision-making. It gives rise to anti-corruption policies and safeguards. It forces organizations to pay attention to how much of their money is utilized in target communities in demonstrable ways.

However, donor expectations related to financial transparency and accountability have also helped create an environment where the merest hint of scandal (or even heated debate) about how an NGO has used funds can spark a significant drop in public giving – and most NGOs rely on public giving to stay in business.

This feeds into the drive to keep overhead costs as low as humanely possible (and often lower than is sensible to adequately equip and care for the staff of the organization). It can also lead the managers, auditors, and finance people of humanitarian organizations to be hyper-vigilant about the merest possibility of bad press related to corruption, theft, or the misappropriation of donor money. This, in turn, can lead NGOs to go to extreme lengths to document every detail of every expenditure – in essence spending ten dollars to account for five.

About a month after we arrived in Laos, Mike came home with a form detailing the bottles of water (each worth about fifty cents) that were given out to volunteer development workers during a meeting in a village.

Everyone from the village who received a bottle of water at this meeting had to fill in a variety of information – date, time, village, and name (twice, for some reason). Right after the space for the 2^nd printed name was a space for a signature.

Here was the problem with that, though: the Lao script has no cursive. There is no such thing as a signature in Lao.

So how had some auditor, somewhere, decided to deal with this problem of missing signatures?

Thumbprint everyone who received a bottle of water.

 

“No!” I said, horrified, when I saw this.

“Lisa, Lisa,” Mike said, playing devil’s advocate and trying unsuccessfully not to laugh. “How else are we to make sure people are who they say they are, and that no bottles of water go missing? How else are we to explain to the donors that we are using every single cent of their money in field activities and exactly where it went?”

“How are you supposed to explain to the donors that you are spending a significant amount in staff time, paper, and ink pads, to account for 50 cent bottles of water?” I asked. “Or why you’re thumb-printing beneficiaries like criminals?”

“Yes, well,” Mike said, sighing. “Those are good questions, too. But they don’t get asked nearly as often or as loudly, you see.”

No, I am not always a fan of the policies and practices that result from that fertile tension between donor expectations and desires, and the specific needs, opportunities, and contextual realities on the ground. I do not think it serves anyone well to prioritize financial accountability at the significant expense of operational achievement.

In Sommai’s case, however, policy has helped save the day. It has taken Mike several hours of discussions and coaching to straighten out the teams’ understanding of how to apply the policies related to emergency medical care for sponsored children, but Sommai’s story has a relatively happy ending.

The family might be minus one water buffalo, but they are now also minus a significant debt to the village that they would have found virtually impossible to repay. And they are plus one Sommai.

[Next time, in Part IV of this story, Money, it’s complicated, we revisit little orphan girl]

1. When Helping is Hard (Part 1): That sort of decision
2. When Helping is Hard (Part 2): In the village
3. When Helping is Hard (Part 3): Score one for policy
4. When Helping is Hard (Part 4): Money, it’s complicated