Some babbling about money...

Corruption happens, right? It could be a bumper sticker or a trendy t-shirt in any company or organization in any country in this world. The safe but real answer to this reality is sin, of course—we live in a fallen world and the old axiom regarding “absolute power” and my own new slogan of “what else do you expect, anyway?” belie the roots and pervasiveness of this problem.

We would all like to think though, when watching bleeding heart commercials on television or those sentiment-inducing slide-shows in church, that when we send our money to an organization (missions, relief and development, etc) it always ends up in the right hands, with minimal percentages being spend on overhead and administration. We would hate to think, for instance, that 50% of the proceeds of our donations are allowing the workers for that organization to live in the lap of luxury (through either inflated salaries and benefits or from people “eating” the money) while the other 50% fails to cover the costs and therefore sends the organization back to your doorstep begging for more money. We would also hate to think that the money we faithfully send in order to fulfill our mandate to feed the orphans and widows could be used as a source of power to oppress persons who should have been helped.

Is there an acceptable level of corruption? In order for some of our money to reach those poor and needy, is it a necessity that some of it line the pockets of those pushing it along the way? We in the west cannot deny the cost of our own bureaucracy (and therefore cannot think we are immune to this problem). Although we might not have scandals the size of ENRON in all of our workplaces, we all know the slimy details of money spent here and there that isn’t necessarily flush with the budget line.

If the answer to this question is “NO,” as I sometimes am wont to think, what is the answer? We are all sinful creatures and prone to pursuing our own motley agendas at the expense of the greater good, and so the answer cannot be just to find the “right people.” A very ethnocentric/colonialist answer is that we westerners should be present in the administration of all of these organizations whom we in our benevolence support and with our superior spiritual/accounting/organizational skills we will assure that money donated gets to where it should go without any “funny funny” business going on. We, of course, do not include in our calculations the percentage of donations it takes to keep us comfortable—our hot showers, our high fences and night guards, our imported groceries and large vehicles—while we assure that the money is all used for those needy people for whom it is meant. Besides, I have already proposed that we are not immune to this corruption; just, perhaps, less likely to take obvious opportunities as often because we are not living hand to mouth or looking every month for money to put our children through school. In short, we live far from the edge of need and so it could be that it takes greater impetus to move us to such actions.

If the answer is “YES,” as in a certain degree of corruption is allowable in our Machiavellian world of getting done what needs to be done, then is there a percentage we should aim for? For instance, assume that at least 30% of the money we send will either disappear or be used for extraneous purposes, or both. We could consider that money the cost of avoiding having to do the leg work of turning that money into the food that goes into the child’s mouth in Darfur, or Bangladesh, or Honduras. Because, lets face it, it takes a lot of work for that transformation to take place. Instead, we let the “locals” do the work, and the money they may or may not eat is compensation for the work they are doing on our behalf.

What I really want to know is—do you care? Does this matter to you? Don’t assume, by the way, that just because I’m posing this question I have evidence against all your favorite charity recipients—I don’t, I have only seen enough to raise questions.

When you write a check to Sally Spiritual or Good Works Inc, is it to assuage some guilt in your soul or out of a genuine interest in helping these very real and very human people on the other side of the world? If it is the former, than it really doesn’t matter where the money eventually goes, the process of writing the check (or using paypal, etc) has been done on your soul. You can check James 2 off the list.

However, if it matters to you how many kilos of rice your money is going to buy, and how many mouths that rice will enter(or, for that matter, which farmers grew that rice and if they were paid for it properly in the first place), we have a serious need for some accountability. Hold your church, your missionaries, and your favorite relief organizations accountable for the money they receive. Read the annual reports they send you—do a little footwork and explore their operations, what percentage of their staff are nationals or expats. You have a responsibility beyond the checkbook if only because we do live in a fallen world, and it does matter where the money goes.

In addition, we need to take a good look at the money that our government sifts out of our taxes to send for foreign aid. Where is it going? Is it going to the countries with the most need, or the countries where the governments are favorably compliant to (or complicit with) our own government? Where are these governments putting the aid money? (Case in point, the global fund scandal 2006 here in Uganda, one of the results of which was preventing our clients from having drugs for about a month.)

Corruption happens. It is true, but as donors we have a responsibility. Further engagement with the recipients of our funds will not only hopefully lead to better use of those funds, but also increase our own awareness of what the money is doing, which parties it is helping, and give us understanding beyond the 30 second commercial that got us to drag out our checkbook in the first place.

Jacob

Jacob lost his wife to HIV. He has been coming to our clinic for about five years now. Apparently the staff (and his wife, before she died) had a hard time convincing him to come in for care, but he finally did. He has a few children; an older daughter called Rose is his primary caretaker now. Rose is 18 and is a full time student in University, as well as taking care of a very ill father and her six year old brother Roger who is also HIV+. Jacob probably contracted TB last fall, but the disease worked on his body for months before we caught it. Insidious weight loss, a cough that got treated like a common respiratory tract infection, fevers that weren't identified..the result of this mis-diagnosis was a two month admission (Jacob is blessed enough to have a brother with a job who footed the bill for the admission..in his own words, the investment in keeping his brother alive is keeping his brother's children out of his house...) and Jacob has now been a homecare patient, post admission, for two months. We find him almost the same every time..emaciated, depressed-looking, sitting in a wooden chair in his ten-by-ten foot living space. He has just completed the initial phase of TB therapy, and is also on antiretroviral therapy. He struggles with painful peripheral neuropathy, a common side effect both of the ARVs and one of the TB drugs.

Jacob is the perfect example of the horrific combination of TB and HIV. Because TB is a disease of the immune suppressed, and our HIV clients are immune suppressed, it is a match made in--well, not heaven for sure. TB also spreads really well in crowded conditions, which for most of our clients is their life in a nutshell (no pun intended.) TB also spreads really well in our crowded reception area, where patients often wait for hours to see the doctor. We are only lucky (is that the right word? that Uganda doesn't have a really big problem with drug resistant TB at this point.

It would behoove us to screen a little better, to have a more open waiting area--but mostly it would be good to catch the disease before we found our patients wasted and unable to move out of bed, and beyond whatever help we have to offer.

TB therapy (and I am so far from an expert on it, what I know I've learned from our client's experience) is fairly hellish. It involves a certain time frame of intensive therapy (three to four horse-sized pills a day, which often cause nausea and vomiting) and then a few more months of slightly smaller pills(that still come with their own set of side effects). If this course of treatment works, then they are finished with treatment. If it doesn't ,it means they probably have drug resistant disease, and need a second line therapy. Luckily, this therapy is available here.

However, our client's tolerance for long courses of intensive therapy is very low. This burden of medication (even if it is free) comes on top of the burden of the rest of life. Generally the caretaker is a woman,the bearer of all other responsibilities in the family. As one of our clinical officers said yesterday, it is ridiculous that people keep dying from a disease that is completely treatable--and the treatment is even free!

So what is really keeping clients from tapping into this free therapy? Is it fear of the drugs? Ignorance on their part? My boss likes to say "blame the patient last.." this is a good motto, so we could look at failures on the part of the medical system. I could list for you many different structural changes that might make it more likely that we would identify people with active TB early in the disease process (some of these changes are going to be implemented soon in our clinic, thanks to some new staff with energy to burn), but I am sadly unsure that even these hopeful interventions will make much of a difference. The disease burden here is so high, the medical staff so overworked, the support systems (labs, x-rays, medications) are so unpredictable or unreliable...

I have had a few patients pull back from being bedridden with advanced TB. One client, who I was sure (in my cynical, bitter mind) was going to die managed to recover by the grace of God, and was spotted yesterday zooming up to the clinic on a bodaboda with a new hairstyle. If anything was going to give me hope, that would be it.

So what kind of hope do I have for Jacob? As he sits in his small hut, under the shade of many papaya and guava trees, he looks at the house he was building for his family before he got sick. He has the blessing of free medication, the blessing of family (a daughter with more inner strength and reserve than anyone I have met so far, and a brother with financial resources) and the blessing of still being alive, today, which in and of itself is the biggest testimony to God's grace in his life.

Regardless of global fund scandals that steal our drugs, overwhelmed medical workers, reception areas that spread TB among our clients like the plague, and pill-burden of too many treatments, I pray grace for Jacob and his family. Grace and mercy for all of our clients who are fighting not one disease, but two. Strength for the women who care for them, and faith for those who bring the medical expertise--that we would keep working towards the elusive goal of healing.

Some random photos for your pleasure...

#1-A birthday celebration with some of my friends. They were excited about the chocolate cake which Jennifer and I cooked over charcoal.
#2-Josh and Emily at their good-bye dinner celebration
#3-Eric, Arianne and I at Sipi Falls--eating our breakfast of Chapati egg rolls. Judge not until you taste-one of my favorite things to eat here in Uganda!
#4-An outing with the clinic post-test club to a mosque, thus the headcovering.

The Prouty

Some of you may know that for the last two years I have had the honor of riding in the Prouty Bike Ride and Fitness walk. Each year, many people (thousands? can't remember) ride and walk in the community of Dartmouth to raise money for cancer research at the Norris Cotton Cancer Center (of which I am still a proud employee). The nurses at the cancer center have had a team for a few years now called "Team Hope" and have ridden in support of and in honor of our patients.

Sadly, I will not return from Uganda in time to join the team this year in riding, but I wanted to send them greetings and encouragement as they train and prepare for this year's ride in July. I also want them to know that I am with them in spirit, and I spent some time "training" on a bike in the village of Hoima to try and get into the spirit of the ride. The pictures of that training session are below.





Just so you know, neither the chicken, the child, or the cows were harmed in the taking of these photos.