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.