Category Archives: Humanitarian work

Journalism and trauma in Bangkok

I’m in steamy Bangkok this week, working with the Dart Center for Journalism and Trauma. I’m here primarily to talk about resilience with the 14 journalists gathered from Bangladesh, Indonesia, Kashmir, Korea, Pakistan, the Philippines, Samoa, Sri Lanka, and Thailand for the 2011 Dart Asia Fellowship.

They’re an inspiring bunch, and as psychology is my training and writing is my passion this is a neat opportunity to learn from people who write for a living. I’m having a great time hearing about their stories and how telling these stories have impacted them over time.

In addition to resilience we’ve being talking about topics such as:

  • Mechanisms and signs of trauma and vicarious trauma
  • The role of the media in kidnapping situations and other unfolding crises situations – how they can help and when they can make things worse
  • How to stay safe as journalists when in high threat environments
  • Tensions between local and “parachute” journalists (international journalists who fly in for stories)
  • Skills for interviewing traumatized sources

One story I’ve heard so far, in particular, has made me both laugh and cringe.

A couple of months after a tsunami hit Samoa in 2009, a New Zealand journalist flew in to report on the recovery efforts. This journalist put together a story alleging that aid destined for recovery efforts was being mismanaged and misappropriated. As part of his story he placed himself in front of a well-constructed middle-class traditional Samoan house, pointed to it on camera and said with every appearance of outrage, “Look at this house, recently built with recovery money. It doesn’t even have any walls!!!”

I laughed at this because traditional houses in Samoa never have walls – something that this journalist should have either already have known (presuming he had working eyes) or asked about.

I cringed when the Samoan journalist presenting described the impact of this story on the local tsunami recovery effort.

“This article demoralized people,” she said. “The vast majority of aid money was not being mismanaged, and it struck a sour note in a context where people were just starting to refocus on stories of hope and rebuilding after all the stories of tragedy. It also reduced the amount of aid coming in to help the Samoan’s get back on their feet.”

I feel I should have something more to say about this right now – something deep and meaningful, or even just coherent. But I’m very tired tonight after two and a half long days of new people and new stories and images from some of the most incendiary frontlines on earth (and I’m sure the fact that it’s 9:15pm and I’ve just now finished consuming a large plate of stir fried noodles and duck – yum – isn’t helping funnel more blood towards my brain). All I’m good for at this point apart from brushing my teeth and taking my kindle to bed is sharing the simple thought that stories matter. They’re powerful. And whether we’re telling them through the vehicle of fiction or otherwise, it is both a privilege and a responsibility to be a storyteller.

More from Bangkok later this week.

Resilience Research Report – The Executive Summary

Here is the Executive Summary of the Report I introduced yesterday: Building resilient managers in humanitarian organizations (plus some photos from Cambodia, just because). The research report is available for purchase from the People In Aid website.


Background, and purpose of the research

In the last decade there has been increasing interest in the level of stress, trauma, or violence experienced by humanitarian workers, but relatively little focus on the other side of the coin – qualities that promote resilience and thriving in these challenging environments. People In Aid, through this report, undertakes an initial exploration of the personal skills and strengths, and organizational structures and practices, which can promote resilience in managers working for international humanitarian organizations.


What we did

During October and November 2010, interviews were carried out with fifteen individuals humanitarian workers, staff support specialists, and psychologists who well placed to comment on these issues in relation to middle managers with humanitarian organizations. These discussions, author experience, and published research, informed the content of this thought/research paper and allowed us to:

  • Suggest a useful working definition of resilience;
  • Identify some key indicators of resilience for managers in humanitarian organizations;
  • Identify some key points of influence – organizational structures and practices that can strengthen resilience in managers in humanitarian organizations;
  • Offer some practical suggestions for ways that humanitarian organizations can help increase the resilience of their middle managers.

Summary of the discussion topics

There is no universally accepted definition of resilience. The definition we propose here is: The ability to successfully navigate high levels of challenge and change, and to bounce back after stressful or traumatic events.

Key personal skills and strengths of resilient humanitarian workers include:

1. Adaptability. Adaptability is the result of a number of skills and abilities working in tandem to help us deal well with challenge, change, and setbacks. Two related themes particularly pertinent to humanitarian workers are pragmatic idealism and the ability to cope with ambiguity.

2. Problem solving ability. Humanitarian workers who are naturally challenge-oriented, employ problem-focused coping, are able to accept imperfect solutions and partial victories, and independently learn as they go, fare better. 

3. Sense of meaning and purpose. A sense that what they are doing is meaningful and purposeful is very important to most international humanitarian workers – and those with strong values and a clear belief system rooted outside themselves fare better. However, the ability to be flexible in adapting these beliefs over time is also very important. 

4. Good relationships/social support. There is no single factor that will make you resilient, but good relationships may be about as close as we can come to a silver bullet. Supportive relationships that extend well beyond mere acquaintance are vital, yet can be challenging for international humanitarian workers to maintain over time. 

5. Optimism and the regular experience of positive emotions. Having a generally positive outlook (realistic optimism) and a sense of humour/fun are common attributes of resilient humanitarian workers.

6. Emotional regulation. The ability to regulate and manage intense and negative emotions when appropriate is an important part of resilience. Humanitarian workers who are able to strategically use strategies related to attention control, cognitive reappraisal, and emotional expression, are more resilient. 

7. Self-awareness. Resilient humanitarian workers know themselves well – their strengths and relative weaknesses, their limits, and their needs. This self-awareness underlies their awareness of their limits.

8. Balance, and the ability to pace oneself and disconnect. Many resilient humanitarian workers appear to live by the matra, “this is a marathon, not a sprint.” They find ways to pace themselves and disconnect from their work both in the short-term and the long term.

9. Physical health. The basic building blocks of physical health – eating well, getting enough sleep, and exercising – are often neglected by humanitarian workers, but without some basic level of physical health to draw upon, resilient actions and reactions become less likely.

Some of the most challenging demands that managers in humanitarian organizations face were identified as:

  • Managing others: Frequently mentioned issues included a lack of management experience to do the job required and having a lot of responsibility without the commensurate authority.
  • Being managed by others: The stress caused by constant organizational change topped this list, followed by mismatches between headquarter-office expectations and field capabilities and having a poor direct manager.
  • Workload: Too much work to do and not enough people to do it.
  • The structure of their role: Many humanitarian workers seem to relish the variety inherent in their jobs but also find it stressful to have to be wear many different hats and be adept in so many different ways.
  • Personal coping and self-care: Environmental hardships are not unexpected although still stressful, and the “place” and “pace” of the work makes it challenging to achieve a balanced lifestyle.

Some key points of influence in organizational structures and practices that can help strengthen resilience in managers in humanitarian organizations can be found in the following areas:

  1. Management practices: Frequently mentioned during interviews was the need for this topic to be a strategic priority for upper management, part of the organizational conversation in the context of a culture of affirmation, and basic good-management practices such as regular professional supervision meetings. 
  2. Role structure: More commonly than not, in this field, the scope of the role and the position expectations are such that the job is literally impossible for one person to accomplish. Realistic and clearly defined expectations, and more assistance identifying strategic priorities when needed, could go a long way to increasing the resilience of humanitarian managers. 
  3. Training and skill building: Most humanitarian workers are hungry for training and skill building opportunities, including coaching, mentoring, and career planning. Of particular importance is the need to assist people who are promoted to management positions with little or no background in management learn how to better manage others.
  4. Support services: Making psychological support services available – particularly by providers outside the organization or completely removed from a person’s line manager – was repeatedly identified as helpful.   
  5. Policies and benefits: Adequate vacation and R&R leave, and the provision of amenities in situations of shared accommodation, were identified as particularly crucial to helping humanitarian workers maintain resilience.
  6. The recruitment and handover periods: It is hard to over-estimate the importance of good recruitment and information transfer to an organization. An organization that manages to consistently identify and hire people who are already naturally resilient are going to be way ahead of the curve. In addition, good information transfer during an adequate handover period provides new staff with a critical running start in their position.

Critical questions for further discussion

A PhD (or several) could be written about each of the major topics addressed in this report. As such, the paper raises many questions that could benefit from further research and thought. The following a few of the key questions that we hope will catalyze further discussion and exploration:

  1. Is there a difference between the qualities that help make humanitarian workers resilient in the short term versus the long term?
  2. Do humanitarian workers who are highly resilient actually perform better in their role or are they mostly, rather, less stressed and/or damaged by the demands of their work?
  3. To what extent can organizational structures and practices really help build individual resilience? To what extent is it the organization’s responsibility to attempt to do so?

Resilience Research Report – The Introduction

Resilience is a defining theme of my life at present – last week’s chapter for the distance learning course I’m writing was on personal resilience and this week’s is on organizational resilience.

In April, I’ll travel to Bangkok to spend a week working with the DART Center for Journalism and Trauma as they bring together journalists from around Asia for a week. Guess what I’ll be speaking on… Yup, resilience.

And back in November I completed a research report for a very cool organization in London, People In Aid, on Building Resilient Managers in Humanitarian Organizations. That project has recently been published and is available for purchase on People In Aid’s website. Over the next two days, however, I’m going to share the introduction and the executive summary of that report on my blog.

I’ll be back later in the week with more stories to share. Perhaps they will be stories of how my mother demonstrated resilience this morning when she realized – apparently for the first time – that I was going to be home for five whole months later this year around the time the baby is due (there was only a slight gulp and a couple of seconds delay before she smiled brightly and said that it would be absolutely lovely to have me). Perhaps they will be stories of whether or not our poor pup, Zulu, demonstrates resilience when he wakes up from the anesthetic this afternoon and realizes that his testicles have vanished. Perhaps they will be speculations as to whether my bladder will ever demonstrate resilience once there’s no longer a baby in there to squish it down to the size of a lima bean (please, anyone who has been pregnant, tell me this is so).

But that is all still to come. For now, here’s the introduction I penned to the report Building resilient managers in humanitarian organizations: Strengthening key organizational structures and personal skills that promote resilience in challenging environments.

Mike doing a handstand atop Jebel Rock in South Sudan

Introduction

International humanitarian and development work has been a part of my life for almost as long as I can remember. As the child of a development worker I grew up in Bangladesh, Zimbabwe, the US, and Australia – flipping regularly between worlds of poverty and plenty. As a young forensic psychologist with a background in stress and trauma I left Australia to seek humanitarian jobs of my own in The Philippines and Croatia, and then worked for seven years as the Director of Training for a non-profit that provides psychological support services to humanitarian workers around the world. Recently I married someone who was working with a humanitarian organization in Papua New Guinea when we met. Even more recently we moved to Laos to undertake development work.

During the last twenty-five years I have met many humanitarian workers in many countries. They are, for the most part, an amazing bunch doing fascinating work.

They are people who help provide water, food, shelter, and sanitation after disasters to help reduce the shocking number of people who die during these periods from exposure, starvation, diarrhea, or disease.

They are people who advocate for change in chronic emergency situations, or who document the stories of refugees in camps who are desperate for a chance at another life. Persecution histories, these stories are called, and they are largely tales of horror and fear.

On the development end of the spectrum – they are people who work in remote communities to help develop sanitation infrastructure, or build and equip schools, or establish rice and animal banks or small businesses. All of these initiatives can raise the standard of living in poor communities and help buffer the families within those communities from the impact of unexpected challenges such as illness or drought.

Humanitarian workers do not have easy jobs, nor are they particularly safe. During the last 15 years intentional violence has become the leading cause of death for humanitarian relief and development workers in complex humanitarian emergency situations, and kidnapping is on the rise. Humanitarian workers already confronted with the realities of poverty, conflict, starvation, and disease must also face the reality that their work is dangerous. Being shot at or bombed; being assaulted, kidnapped or carjacked; being threatened at a checkpoint by a child totting a gun – in many parts of the world these are not infrequent occurrences.

Most of the humanitarian workers I know, however, don’t pinpoint this sort of danger as the most stressful aspect of their work. Most humanitarian workers who leave the developed world and head for the developing world expect (on some level, anyway) to run certain risks. Fewer expect to find environmental hassle factors such as unreliable communications and shared accommodations, or organizational challenges related to bureaucracy, management, and communication quite so frustrating and wearisome. Perhaps even fewer expect to have their fundamental ideals and beliefs about meaning and purpose challenged, reshaped, and sometimes shattered during the course of their work.

Some of those who decide to pursue humanitarian work don’t make it past two years before burning out – spent, disillusioned, or traumatized. Some people survive for much longer than that, but do it at cost to their closest relationships and while flirting (or worse) with alcoholism or other addictions. But some people genuinely seem to thrive in this line of work. They seem able to bounce relatively quickly from traumatic events that come their way, and remain passionate and committed to the work. Some even seem able to do this without sacrificing their relationships, their health, or their sanity in the process.

After years of focusing on the impact of stress and trauma, of seeing people who were not coping, I started to wonder about those who were. What, I wondered, were the qualities that helped humanitarian workers thrive? What sets apart the resilient?

Tomorrow: What were some of the key findings of this report? I’ll post the Executive Summary.

Resilience – what does it even mean?

Today I’m going to do some thinking out loud on the blog. Sorry guys, but Mike’s been in Vientiane for the last three days, so you’re it.

You see, I’m doing a consultancy project at the moment focused on resilience as it’s related to managers in humanitarian organizations.

I’m loving this project. It’s given me the perfect excuse to call up some really smart people the world over and ask them all sorts of questions that I haven’t yet decided how I would answer. This morning I talked to a friend and colleague in New Zealand. Last night I was chatting to a new acquaintance in Bali – she and her husband are starting a program to provide retreats for international aid workers (Satori Worldwide). On Friday night it was someone in the Central African Republic.

Among many other things during this last discussion, I learned that skype does have immutable limitations. To whit… it will not work for longer than one minute and sixteen seconds when you are trying to connect Laos and the Central African Republic.

(Thank you to the person I was interviewing for ringing me after the fourth time the line was dropped. I do not even want to think about how much the mobile-mobile call cost her, but she had some awesome insights to share and I’m grateful.)

Of course, at some point (like next week) I’m going to have to start weaving all of these insightful commentaries together, figure out what I think, and write a big thought/research paper. That sound suspiciously like hard work to me. But in the meantime, good times!

You might think that by this stage of the process I would have figured out exactly what I mean when I say the word resilience.

Yeah, well, you’d be wrong.

Apologies for perhaps sounding like a professor here, but the definitional waters around this concept of resilience are incredibly, frustratingly, muddy.

The Latin root of the word resilient is resilire – meaning to spring back, to recoil, to return to the original form after being bent back or stretched.

When it was first grafted into the psychology domain, resilience was used in precisely this manner – to denote someone’s ability to “bounce back” or recover quickly from traumatic events and other types of adversity.

Over time, however, resilience has also come to be used in at least two other ways.

Some researchers argue that resilience goes beyond the ability to bounce back from trauma. Rather, they claim, it is an ability to cope well with fast-paced and continuously changing environments – to cope well with high levels of pressure rather than simply being able to recover quickly when you’ve been knocked for six.

Another group of thinkers and researchers have been even more ambitious in trying to broaden the scope of the term. Steve Wolin, for example, defines resilience as, “the capacity to rise above adversity—sometimes the terrible adversity of outright violence, molestation or war—and forge lasting strengths in the struggle.” This takes the concept well beyond merely bouncing back to the status quo and burdens it with the expectation of positive post-traumatic growth.

What to do with all of this? I can’t very well write a thought paper if I don’t settle on a definition now, can I.

This is still a work in progress, so I reserve the right to change my mind – but the definition I’m kicking around at the moment is: The ability to successfully navigate high levels of challenge and change.

I could go on and on in detail, trust me, but I’d much rather hear from you on this topic at this point.

If you’re still with me: What do you think of when you hear the word resilience? Do you consider yourself resilient? What behaviours, beliefs, or attitudes do you think are related to being resilient in life?

To close, here’s a mini-story I stumbled across recently that made me laugh out loud. I think it’s a gorgeous illustration of one facet of resilience:

Daniel Boone was asked by a reporter if he had ever been lost in the wilderness.

Boone thought for a moment and replied, “No, but I was once bewildered for about three days.”


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.

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

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 2nd 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

Share

When Helping is Hard (Part 2): In The Village

Three weeks after I arrived in Laos I went with Mike out to a village in Viengkham district. This trip was my introduction to The Blessings of the Bai Si. It was also my introduction to Sommai – for Mike and I detoured from the planned schedule just a little.

It was Mike who made the connection, and he came home the night before our trip excited.

“Guess what!” he said, sounding like he had perhaps won two tickets to Disneyland.

“What?” I asked, wary.

“Sommai’s village is close to the village we’ll be in on Friday, so we can go visit! I’ve already told the staff that I want to go up there after the inspections and handover of the water system.”

There were all sorts of things I wanted to say to this… From what you’ve told me, Friday’s schedule already sounds packed. Isn’t this village in the back of beyond? We can’t just waltz in there, smile, and ask to see a sick child. What are we going to say when we get there?

But I didn’t say any of this. Mike has a steady stream of stories like Sommai’s (or worse) cross his desk. After he talks to the staff, makes a decision, and signs the paperwork, he hardly ever gets to hear the end of the story. Here was a chance to close a loop.

That is why Friday afternoon found us scrambling up hills on our way to Sommai’s village. It was raining. It was slippery. We had no umbrella. My sandals, then my feet, then my pants, became caked with thick mud. Halfway up one of the slopes I saw something reaching for my foot – undulating in a skinny, searching, dance.

“There are leeches!” I said.

“Yeah,” Mike said, with a big grin. “There are. Isn’t this a great adventure?”

You,” I growled, “are an adventure.

“I know,” Mike said, in ridiculously high spirits. “That’s why you married me. And now you’re stuck with me. Oh, watch out for that buffalo poo!”

After we reached the village Edena led us straight to Sommai’s house. We climbed the bamboo ladder, left our mud-caked shoes at the door, ducked beneath the low thatched roof, and walked into a different world.

A grandmother was tending a small fire in the corner of the room. Between its light, and the sunlight pushing in through the open doorway, it was immediately obvious what had almost killed little Sommai. His mother was holding him in her lap, tilted to one side to keep the enormous abscess up the back of one leg and buttock – an abscess that was still only half healed – off the bamboo floor. When she shifted him later we could see the scars of a second abscess covering his tailbone.


We sat. We smiled. They did not smile at us. Little Sommai started to cry and I didn’t blame him – I couldn’t imagine that strangers had bought anything but pain into his life recently. His mother hushed him. I wished I had thought to bring a toy.

Behind us, other villagers started to slip in the door and line the walls, sinking down to sit quietly and watch us. Edena did her best to translate, and over the course of half an hour, cross-legged together on the floor, we slowly we pieced together the following information.

Yes, Sommai was getting better. His mother was washing the sores every day with water, and sometimes medicine from the hospital.

She bought out a small plastic bag and showed it to us. Inside was a little bottle of iodine, one of hydrogen peroxide, and some gauze.

“Iodine,” Mike said to me. “It kills bacteria but sometimes it also kills good tissue.”

“So does hydrogen peroxide,” I said, pretty sure we were right on this but not absolutely sure. I wished I were a doctor. Or that I had an iPhone with reception so I could check our facts. Or that there was any sort of pharmacy within a reasonable distance. Or that I had a magic wand.

“Do you have anything else to use?” Mike asked her.

No.

“We just built a new gravity-fed water system in this village,” Mike told me. “I saw a tap outside when we came in. At least she doesn’t have to walk as far to get water now.”

“How are they going to pay back the loan?” Mike asked Edena.

“Are you thinking about Matt and Hilary’s money?” I asked Mike.

“Oh yeah,” Mike said, brightening, “Matt and Hilary.”

The bills had come to four million kip, Edena reported to us – about $487. The family was responsible for a quarter of that. They would sell their water buffalo to repay their loan.

“How many buffalos do they have?” Mike asked.

“One,” Edena said. Mike and I looked at each other.

By the end of half an hour Sommai had long since stopped crying, and was looking at Mike with wide, dark, eyes. He even smiled once or twice in response to Mike’s own large grin.

Outside the house, after we had thanked the family for their time and taken our leave, Mike and I conferred.

“They can’t sell their buffalo,” Mike said, visibly concerned. “That’s their only productive asset. Maybe we can give them something now, to help, but I don’t know how much I have on me.”

He pulled out his wallet discretely and started to take inventory.

I turned to Edena.

“Is that good idea?” I asked. “Or not very good idea?”

“Not very good idea,” she said, shaking her head.

“Let’s talk about it later,” I said, motioning him to put the money away. “It wouldn’t be good coming from us directly. Not right now, anyway.”

“Yeah. How about I just buy some little snacks for the kids then?” Mike asked, searching for something, anything, we could actually do.

“That’s OK,” Edena said.

So Mike bought some snacks and ran them back up to the house. When he came back he was smiling.

“You should have seen how he beamed when I gave him the snacks,” Mike said. “The adults put him on his feet and helped him walk across to the door to get them.”

“I hope they’re doing a lot of that,” I said. “He’s lost a lot of muscle tone on that side.”

We were mostly silent on the walk back to village #1. How was it possible that we could be right there, in the village, sitting down with the family, and still feel so helpless?

[Next time in Part III of this story, Score One For Policy, Mike makes a difference one piece of paperwork at a time]

  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

Share

When Helping is Hard (Part 1): That sort of decision

This story starts in May. In May, Mike was in Laos in the middle of his first seven weeks at his new job with World Vision. I was in LA wrapping up my own job. Mike was trying to find his feet in a new place and in a new life. I was trying to disengage from familiar people and a familiar life.

We were in very different places – not just physically – and as we spent my evenings and Mike’s early mornings talking via skype, I frequently found myself feeling torn. I did want to hear the honest truth about how things were in Laos and try to support Mike through the first shockwaves of this change. But as I was tearing myself loose from LA and preparing to step into the whirlwind I also, often, found myself longing to just hear the reassuring message: “We totally made the right decision. Everything’s great. You’re going to love it here.”

Some days I got that. Many days I didn’t.

The night that Mike first told me about Sommai, I didn’t.

The day before, Mike told me, he’d received an urgent phone call from a staff member, Edena, who was based in a field office four hours outside of Luang Prabang. There was a very sick sponsored child in her district, Edena said. Sommai was seven, and lived in a remote and inaccessible village. There was no cell phone reception or road access in this village – it was another hour north by motorbike, and then a twenty-minute walk into the hills.

Edena didn’t speak very good English. She couldn’t explain what might be wrong with Sommai, but she did manage to convey that he needed urgent medical care or he might die. She wanted Mike’s authorization to send him to the district health center, but here was the big problem with this situation (or, rather, the tenth big problem): the family was very poor. So poor that, even with the organization committing to cover most of the bills that would follow, Edena didn’t think that the family had the money to pay their quarter of the treatment costs.

So Mike was left wondering what to do. The organization has many good reasons for its policies requiring some family contribution for medical care. There are also good reasons why it’s standard practice that the family pays the initial costs that are incurred and then files for reimbursement. Mike couldn’t just ignore these policies, but could he really sanction delaying or denying assistance over what was (to us) a relatively small sum of money?

As soon as possible after Edena’s call, Mike met with child sponsorship staff in the Luang Prabang office. Together they searched for a solution.

No, the staff confirmed – Mike could not circumvent these policies just because he felt like it. Perhaps, the staff suggested, the family could borrow some money from the village development bank (a small community fund set up in many villages to help in emergencies just like this one).

Only, three hours and numerous phone calls later, it turned out that this village didn’t have one.

Then they discussed whether Mike should write to the national director and ask for an exemption from the family contribution co-pay.

Mike was torn on this, and in the end it was the national staff that tipped the scales towards a no, citing two things Mike already knew. The organization supported thousands of children and they couldn’t make exemptions for all, or even most, of them. Perhaps even more importantly, the staff said, if they sought an exemption in this case many other families in the village would also claim extreme poverty. No one would pay their share, and it would ultimately make the job of the field staff much more difficult.

“Sommai’s family will find a way to borrow the money from relatives or friends, or maybe the staff in the field will help out of their wages,” the Luang Prabang staff told Mike. “We should wait.”

To Mike – a month into the job – it seemed like a gut-wrenching gamble to take on the life of a child, but he took their advice and sent the message back to Edena. The organization would help. As per policy they’d reimburse most of the medical expenses, but the family had to come up with the initial co-pay.

“What do you think?” Mike asked me that night in May, over skype, “How do you make these sorts of decisions?”

In California, sitting alone among half-packed boxes in our quiet living room, I shrugged even though he wasn’t there to see it. How did you make that sort of decision?

“I don’t know, Mike,” I said. “I don’t know.”

Sommai lived. Over the next day or two the family did come up with the copay – they borrowed money from their relatives, and others who lived in the village. Sommai was transferred to the district health center. Soon after that, on the urgent recommendation of the district center, he was transferred to Luang Prabang where he spent six days in hospital before he was discharged.

After his return, from back in the village, Edena reported that he was still a very sick little boy, but recovering.

A month later, Mike and I were still chewing over this case. One beautiful evening in June, three nights after Mike arrived back in California, we took a break from the chaotic hard work of boxing up our lives. We sat on the porch with our good friends Matt and Hilary. We sipped sauvignon blanc. We layered triple cream brie and dates on water crackers. We talked about Sommai’s case, and others, all night.

You never stray too far from these conversations when you’re in a job like Mike’s. Physically you can be thousands of miles away, sipping wine and eating imported cheese, but the questions and the dilemmas don’t stay behind – they never stray far.

So Hilary and Matt got an earful. They plunged into the experiential waterfall of Mike’s early days in Laos with full attention and keen interest.

Three nights before we left Los Angeles, we had dinner with Matt and Hilary again. As we were leaving Hilary passed me an envelope. Inside was five hundred dollars in cash.

“Here’s some from us,” she said, “Our part. Maybe it’ll help. Maybe next time there’s a Sommai, or you see a need, maybe it’ll help knowing you have some in reserve.”

We were both awed by this generosity, and grateful, but Mike was also a bit worried.

“Money’s tricky,” he said to me later. “What if we can’t use it soon, or they don’t approve what we do with it? What if…”

“Stop it,” I told him. “Matt and Hilary love us. They gave this to ease burdens. They trust our judgment and know that we’ll be best placed to see ways this can be used. They won’t care if it takes months, or a year. You are not to worry about this, of all things.”

[Next time in Part II of this story, Mike and I visit Sommai in his village]

  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

Share

Humanitarian work, psychology, and staff support

Happy Monday! I hope you had a great weekend (and spent less time at the computer than Mike and I did). Never mind – this time next week we’ll be in Cambodia at Siem Reap.

Primarily because there are no good medical or dental facilities in Luang Prabang, Mike’s organization provides for one week of Rest and Relaxation (R&R) leave every six months. Thankfully, we don’t need to use this R&R to head to a doctor or a dentist, so we are going to explore one of the wonders of Asia instead. There are even rumors that Mike will not bring his work computer on our five day trip.

So this week, before we take a bit of a break from it all, I’m going to have a humanitarian-work week on the blog. I’m going to tell you the next installment in the story of little orphan girl, and talk about how difficult it can be to spend money to help others in ways that do no harm. I’m going to think a little more on blessings.

Before that, however, I’m going to flag a new page on my blog for you! While Mike was drafting reports and signing many, many, documents this weekend, I was working on a page for those interested in finding work in the humanitarian field.

I received a letter from a stranger last week that set this in motion. She is studying psychology. She said:

“I have always hoped to find a way to combine my passion for community development work and psychology. I was wondering if would be able to tell me what your pathway was getting into the work you have done, and whether you have any contacts or suggestions of ways I might be able to gain an internship next year?”

During the almost seven years that I worked as Director of Training and Education Services for the Headington Institute, I was asked something along these lines fairly frequently by students and by interviewers. So I’ve pulled up some of the interviews, brushed off my answers to the most frequently asked questions, and put it all in one place. If you’re interested in humanitarian work and staff support, wander on over and check it out.

Back on Wednesday with more stories.

Cheers,

Lisa

Share