Tag Archives: development work

Best of Year One in Laos

It’s been just over a year, and 132 blog posts, since we moved to Laos. To celebrate that milestone, today I’ve drawn together some of the best of this last year’s blog posts.

Unless you’re independently wealthy and have way too much time on your hands (or you’re bedridden and desperate for entertainment) I doubt you’ll want to read all of them, so I’ve put them in categories for easier browsing. I’ve also marked a couple of my favorite funny posts with a double asterisk like this ** for those just looking for a laugh.

Thank you all for tracking with me and Mike on this journey. Blogging about our adventures and misadventures during this last year has been one of my favorite things to do. That’s partly due to all the emails, comments and other messages we’ve received. I am so grateful for your interest and your support.

So, thanks again for traveling with us through Year 1 and here’s to Year 2. I have no doubt Year 2 will bring plenty of adventures of its own as well as answers to a couple of key questions that are currently on my mind: Will Mike arrive in Australia before our son? Will my ambivalence about parenthood ease once the little guy is on the scene? Are we crazy to take our baby back to Laos? Will my memoir find a publishing home? And, will Mike give our whining, needy, Zulu dog to the Vietnamese noodle sellers down the street before I return in October as he keeps threatening to do?

However, all that is still to come, and in the meantime here is a glance back at an amazing year…

Cross cultural issues and our life in Laos

Family and pregnancy

Humanitarian work

Psychology

Writing

Over to you: I’d love to hear whether any particular post impacted you this last year or whether there’s anything you’ve been wishing I’d write about. If so, drop me a line or leave a comment below. Thanks again!

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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.

Lessons learned about Laos, parenting, and development work, in Phonxai

On Monday, Mike and I plus the friends we have in town at the moment (Mum, Dad, and three little boys aged six, three, and 8 months) traveled up to Phonxai so that Mike could inspect a school in progress. This was an all day endeavor that involved renting a landrover and spending more than six hours traveling – about five of them on dirt roads.

As always when I travel up to the villages here in Laos, it was illuminating. In no particular order, here is a summary of things I learned or relearned on Monday.

1. Northern Laos is lush with mountains and winding dirt roads dug into the side of steep slopes.

2. Water is life – the rivers paint the valleys a vivid green, even when the hills are a dusty and parched brown.

3. In Lao, X is pronounced S (Phonxai is pronounced “Ponsigh”)

4. If you spend five hours in a landrover on dirt roads when you are four months pregnant you’ll end up feeling well frothed on the inside. Also, you should not drink a great deal in advance of this trip, and you should definitely wear a sports bra.

5. British kids will find even the cool season here in Laos uncomfortably hot.

6. Boys who are three and six years old have an incredible capacity to repeat the same observation or question numerous times (e.g., “gosh, it’s very bumpy, isn’t it?” and “are we nearly there yet?” and “why not?”)

7. If you let these same two little boys sit in the back-bench seats of the landrover together (even with two adults back there as well) trouble will erupt roughly every thirty seconds as long as they are both awake. You will find yourself repeatedly saying things like:

  • “I said, bottom on the seat! If you can’t stay sitting down you’ll have to come sit in the middle seat with mum.”
  • “Leave your brother alone! Don’t touch him! Not even one finger!”
  • “Stop singing that song! I mean it, you have until the count of five!”
  • “Try not to throw up, OK? Take deep breaths, look out the front window, and here’s a plastic bag just in case.”

8. If you want to make little boys deliriously happy, all you have to do is get in a landrover and drive back and forth across rivers – stopping every so often to let them walk across a bamboo bridge adjacent to the crossing.

9. Little boys will be quite enamored with squat, bucket rinse, toilets and very probably decide that they’d really rather have this type of toilet in their own home.

10. People all over the world are fascinated by each other’s babies. If you are a mother carrying a baby, you don’t need a word of the local language to effectively communicate on this subject.

11. Lao children in the classroom are remarkably well behaved, despite being packed onto backless benches. If a strange adult walks into the classroom they will leap to their feet and greet you with a polite sabaidee in unison.

12. It is a lot easier for non-profits to raise money to build schools than it is to fund teacher-training programs, but many rural schools suffer from a shortage of good teachers.

13. Rice banks (a village-run storehouse of rice that village families can borrow from during the hungry months and then repay the loan plus five percent interest after harvest) do great things in helping to reduce food insecurity. In one village we visited, of the 93 families in the village more than 60 borrowed from the rice bank every year. The rice bank had been started with an initial, donated, “fund” of two tons of rice and now had a total fund of about six tons of rice.

    Mountains in Northern Laos

    Water is Life

    Bamboo bridge across river in Northern Laos

    Fun at river crossings

    An old school building in Laos

    Children in a new school building in Laos

    Even Lao children find it too hot sometimes

    Learning about the village rice bank

    Inside the rice bank

    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

    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

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    The circle of your passion

    It’s been a week. For me, it’s been a week of finishing the draft, enjoying a brief high, then falling (temporarily, let’s hope) into a big black woeful hole of not feeling like doing anything at all, and wondering how we can possibly have been in Laos three months already, and whether the rumours are true that we’re staying here for the next couple of years. On that front, it appears so, unless the powers that be mandate otherwise. I’ve had ample time to mull all of this over during a string of nights when sleep eludes me until late – midnight or 1am – and sometimes only arrives after the sort of help that comes in little bottles with child-proof caps on them.

    For Mike, it’s been a week of waking up early – in the 3’s or the 4’s, occasionally the 2’s – with his mind jumping ahead to the day. The biggest meetings of the year took place yesterday, and coincided with a week-long delegation of all sorts of people that be all sorts of powerful, and not all of whom arrived on the scene happy. We think they be leaving happier, we think. There was a lot of smiling and nodding at the big partnership dinner last night – then again there was also lots of beerlao, which tends to help with the smiling (but not with the sleep, no, not with that).

    A couple of weeks ago Mike and I had dinner with a friend, Gabrielle, who Mike first met in the Vanuatu almost three years ago. In January we had dinner with her in Melbourne. Since then she’s moved to Hanoi. Two weeks ago she swung by our new town.

    So we met at Utopia and drank Saffron Robes and cheap Chilean wine and gazed upon the Khan River and talked. We talked of things that humanitarianers often seem to talk about when they cross paths for an evening and drink and look at rivers.

    1. How and why did you decide to make this last move/take this last job?
    2. How are you finding this massive uprooting and replanting of your life?
    3. What about the job itself – where are the rewards and the pressure points?
    4. Is it worth it – this move, this job, this whole field …

    There is a lot wrapped up in that last question. I could write a whole series of posts just on the different variables that come into play when trying to calculate the opportunity-cost of this work and of this lifestyle. There are issues of meaning and purpose to be considered. And efficacy, community, motivation, finances, and safety. And, of course, passion.

    Gabrielle calls this sort of conversation tumbleweeding, which I think is a delightful word. It brings to mind a tangled ball of wiry stalks all intertwined – dense enough to hang together in a round yet light enough to be moved by the wind. A tumbleweed bounces and spins at the same time as it skips along. A tumbleweed goes places. (Sometimes it just goes in circles, but that too is appropriate.)

    I wonder what usually happens to tumbleweeds in the end. Do they pick up so many leaves and twigs on their journey that they eventually stop moving and settle into being just a pile of sticks? Do they get snagged on bushes, never to work themselves free? Or do they break apart – thin pieces of brush skittering and sliding in every which direction?

    So, passion. That was our primary focal point that night.

    “Are you passionate about writing?” Gabrielle asked me.

    “Sometimes I get a great day, or hour,” I said. “Those moments are incandescent. I lose track of time. Afterwards I’m tingling with that happy sort of electricity that comes when you don’t want to be anywhere else, doing anything else. I’m totally buzzed.”

    “But,” I continued. “At least as often, probably more often, I sit there and it’s hard, and I struggle, and I want to be almost anywhere else, and I hate it. Except I feel compelled to do it anyway.”

    “That’s passion,” Mike said.

    “Huh,” I said.

    Why do I primarily associate vocational passion with the electric, positive, purposeful, buzz? Wishful thinking, maybe, or is it possible to have those joyous mountaintop moments without trudging through some valleys? Are mountaintop moments over-rated, anyway? Should we really be aiming for a nice picnic blanket halfway up a pretty green slope?

    And, if what we were talking about really is passion, how can you live inside the circle of your passion without it consuming you?

    That’s what we talked about for most of the evening, sipping our wine, staring at the river, tumbleweeding around. We didn’t come up with the right answer, because there isn’t one. But Mike and I wandered home through the dark streets feeling refreshed and ready to face the windstorms of tomorrow.

    After the week we’ve just weathered, maybe that’s what we need this weekend – some tumbleweeding. Or maybe a river. Or friends. Or some wine? Looks like we have options.

    What about you: Do you feel like you’re living inside the circle of your passion? How do you keep from being consumed?

    P.S. I could practically see the parental eye rolling in Australia when I mentioned wine (again!!). So, my beloved mother, this picture’s for you. It’s Mike, weeks ago now, disposing of the last wine we had at home because it was simply wretched stuff. The bamboo, much to my surprise, has suffered no ill effects.

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    What price a child’s life?

    This afternoon Mike and I sat upstairs on the deck at our place, looking out towards the trees. It was pouring rain. Water was sheeting off the tin roofs of the houses behind us and running down the big green leaves of the coconut trees – arcing off and dropping towards earth in one, unbroken, stream.

    We were up there because Mike had quit the kitchen table, which was burdened by our two laptops and a stack of documents eight inches thick that he’d bought home to sign over the weekend. The stack was peppered with neon tags demanding his signature.

    “Mr Michael,” the tags read, one after another.

    Mr Michael. Mr Michael. Mr Michael…

    On this quiet Sunday afternoon Mr Michael had worked through all these documents, not pausing until near the end, when he came across three requests for reimbursement. These were all related to cases where a sponsor child had gotten sick out in their village and the district health centers hadn’t been able to address their problems and had recommended transfer to the provincial health center in Luang Prabang.

    It costs money to transfer sick children to the provincial hospital, and when three children get critically ill in one district within a month, it costs more money than has been budgeted for medical emergencies. Significantly more. As in, more than half the budget for the entire year.

    “It’s not three cases,” Mike reminded me, when I went to see where he’d gone and found him sitting at the table on our deck, staring out at the rain. “It’s four. We also have little orphan girl.”

    Ah, yes. Little orphan girl. Little orphan girl whose story began two weeks ago now, when Mr Michael received multiple phone calls on a Saturday requesting him to authorize the medical transfer of an eleven-year-old child from Luang Prabang to Vientiane. The doctors in Luang Prabang said they couldn’t treat her here, that she had a problem in her brain and that she would probably die if not flown to Vientiane for specialized medical care immediately.

    Mr Michael authorized the medivac. At first, it seems, the doctors in Vientiane thought she had Japanese encephalitis – she could not even sit up, or swallow – but after a week of testing these results came back clear. So she does not have encephalitis, but no one is any the wiser yet on what she may have.

    At least, this is what we think is going on. It’s very difficult to get accurate information. Whatever the doctors in Vientiane are saying gets filtered through at least two other Lao speaking staff before it reaches the office up here. To complicate matters further, little orphan girl herself doesn’t speak Lao, much less English. Little orphan girl is an ethnic minority child who is too poor to attend school, where she would learn Lao. So she only speaks Khmu, and the doctors only speak Lao.

    I was speaking about this with the local staff member on the case during our house-warming party on Friday night.

    “So, no one knows what is wrong with her brain,” I said, trying to make sure we were on the same page. “But now she needs help to get her muscles working again?”

    “Yes,” the Iokina replied. “But the doctors say the problem will happen again. They say she will die.”

    “But they don’t know what the problem is?” I said.

    In summary: No. They don’t know what the problem is. They don’t know when “it” might happen again. They don’t know when she might die – it’s just that Iokina seems pretty certain that she will, at some point, especially if we send her back to the village with her fourteen-year-old sister and elderly grandmother.

    “Do you think she should go back to the village?” I asked.

    “Yes,” Iokina said, shrugging a little in that helpless way that needed no translating.

    “We tried,” Iokina was saying, without words, “and there’s only so much you can do for one child.”

    So Mike and I are left wondering. Is that really what the doctors have said? How do you weigh and filter this information that has come up to us across many miles and two significant language barriers? Would physiotherapy help her, or is the primary problem neurological? Are there any Khmu speaking physiotherapists in Luang Prabang that could coach her on exercises she could do at home? If so, how could we find them? How are her sister and her grandmother going to be able to help her when they need to be tending the rice fields so they can all eat? And, of course, how much is this all going to cost?

    How do you put a price on the life of a child?

    “The emergency medical fund is for emergencies,” Mike said today as we sat on the porch watching the rain. “This case is no longer an emergency. We don’t have the capacity to take on long-term rehabilitation cases. We cannot continue to pay for her treatment indefinitely when no one yet knows what may be wrong with her. She has to come back from Vientiane.”

    “What then?” I asked.

    “I don’t know,” Mike said. “I have to go in to the office early tomorrow before we head out to the field. I’ll see if I can get some more information.”

    We sat and stared at the rain for a little while longer, and then we came inside and went back to work.

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