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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

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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

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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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