January 29, 2009

This child missed school on Wednesday because his uniform shirt was dirty. That makes me so mad.

“Mission Partners”

I love language. I can’t get enough of words. I love the challenge of figuring out how best to express myself and articulate my thoughts and ideas with the precision that language offers us. I like how language use shapes reality and words have meanings that can be contested. I like how meanings of words change over time. I just read a quotation from the 16th-century where “ecumenical” was a term of opprobrium.

It is this love for language that explains one of the big hurdles I had to cross before I decided to become a missionary. Some of you might recall that the word itself - missionary - was an obstacle for me. There were too many negative connotations I associated with the word for me to want to describe myself with it. Nor could I let myself brush off the word lightly and pretend it didn’t really apply to me.

Needless to say, I overcame that hurdle by wrestling with the word and learning more about the theology of mission that underlay it. That process was healthy and helpful and led to a deepening of my faith and the opportunity to think about some issues I had never seriously considered before.

Well, my feet are about to be swept out from underneath me and that process is about to be rendered moot. I learned last month the Standing Commission on World Mission wants to change all references in the canons from “missionary” to “mission partner.” It will be voted on at the Episcopal Church’s General Convention in July.

I think this is a misguided proposal. My understanding of the rationale is that the new phrase better reflects what missionaries actually do and are. Of course partnership is a part of mission. But so too are eight gazillion other things, some of which I’ve written about on this blog, like reifying, teaching, relating, learning, playing, sharing, dancing, driving, advocating, and on and on and on. I just saw a draft document of some new mission promotion materials and the words used there to describe missionaries included partner but also ally, friend, companion, pilgrim, supplicant, builder, listener, witness, co-traveler, advocate, and many more.

Sure, sharing is part of partnering but isn’t partnering part of teaching? Isn’t partnering part of companionship? Friendship part of effective listening? Witnessing part of standing with? Calling us “partners” privileges one part of mission at the expense of all the others. Why not call us “mission learners” or “mission sharers” or “mission relaters” or “mission pilgrims” or “mission supplicants”? The advantage of the term missionary is that it encompasses all the attributes of mission doing and mission being.

Now I admit that missionary is a contested word. The idea of mission I just sketched out is probably not shared by everyone in the Episcopal Church and definitely not by all Christians. But the response to a contested word is not run away from it but grab hold of it and wrestle with it. That is what I sought to do when I realized I would be a missionary if I came to South Africa. The word missionary truly and honestly describes what I am. I don’t want to run away from that.

I don’t know why I remember this but when Bill Clinton spoke at the dedication of his library in December 2004, he kept using the words “progressives” and “progressivism” when he was obviously talking about liberals and liberalism. Apparently to his mind the “l-word” had been so debased by conservatives he couldn’t use it anymore. It was a contested word. But rather than using the word proudly and reclaiming it, he ran the other direction to a new word that described the same ideas he has always promoted.

I can’t help but think that is what the Church wants to do with the move to “mission partners,” ceding “missionary” to, among others, our more evangelical brothers and sisters in Christ. The Episcopal Church - as I learned when I wrestled with “missionary” - has some very good theology of mission and ideas about being a missionary that I would like to see spread far and wide. But we won’t spread our ideas anywhere if our first step is to give up the necessary vocabulary.

Language and word choice matters tremendously. “Missionary” - underlain by strong missiology - is a good and accurate word that deserves to be retained.

UPDATE: Just as I was posting this, I received an e-mail from the Church Center with a further defense of the term. It reads in part,
"It is probably easier to change a name rather than a cultural mindset at this point." It is no doubt easier but I still do not believe it is the correct decision. "Mission" and "easy" have never gone together in my mind.

A couple recent ones from the camera

January 27, 2009

How to save a life

It is amazing what anti-retroviral drugs can do for sick patients. Pakama, the woman who was so seriously sick with HIV last May and June and with whom I spent so much time navigating the health-care system, now betrays hardly any trace of her past illness. She is taking the right combination of drugs and is so healthy I barely see her because she rarely has to come to the clinic. (Nobathembu, another very sick woman I once wrote about, is also now shockingly healthy. She was practically dancing in the clinic this morning.)

During those long weeks of nearly one-on-one attention with Pakama, I often daydreamed about a day when she would be able to walk on her own and speak without running out of breath. But I’m not sure I ever really believed it would happen. It has and it’s shocking.

I mention her because about a week ago she came to the end of her tuberculosis treatment. It was eight months worth of pills, which she was starting just as I was getting to know her. As I did the paperwork to discharge her from our records, I noted to Jenny that she had finished. We both marveled at how strong she was and how much she had improved and then Jenny said to me, “You know, she only made it to the end of her treatment because of you. You saved her life.”

This made me very uncomfortable. I don’t like how it imputes so much agency to me - let’s be serious, who I am to be saving lives? - and it minimizes the numerous other factors that contributed to Pakama’s improved health. When I go to write the resume line for my time in Itipini, am I really going to write as one of my accomplishments “saved lives”? I don’t think so.

One time when I was in the volunteer ambulance department, I arrived on a scene first and soon after the patient had had a heart attack, started CPR, and did it all the way to the hospital. It worked, kind of. He survived another week, in a vegetative state, before dying. Someone noted to me then that I had saved his life and I was uncomfortable with the idea. I preferred to say to myself that I had “prolonged” his life, given the quality of life he enjoyed after my intervention. But in Pakama’s case, she has a pretty good quality of life and, while anything can happen, there’s no expectation she’ll die anytime soon.

This line of thought reminds me of Esther’s response to Mordecai’s plea that she help save the Jews. Basically, she says, “who I am to do anything?” Mordecai says, “Who knows? Perhaps you have come to royal dignity for just such a time as this.” (4:14) Basically he’s saying, “you’re the one in the right place at the right time.” To the extent I did anything to save Pakama’s life, I did what I did because I happened to be the person who was in the right place to offer assistance at a time when she desperately needed it. Isn’t that partly what mission is about? Putting ourselves in a new place to be of assistance when needed?

As a coda to this story, it turns out that one of the new high school students we are supporting this year is Pakama’s daughter, Babalwa. I had thought Babalwa was Pakama’s sister but Babalwa told me on Friday that she was Pakama’s daughter. I was a bit surprised and, as I had been thinking that week about Jenny’s comment, I didn’t know how to respond so I just sort of said, “oh” and looked away. But as I did, I could detect a look of gratitude on Babalwa’s face that told me she knew what I had done for her mother. And that was significant for me.

Buying lots of stuff

I have successfully navigated the treacherous terrain of back-to-school shopping with the group of high school students we support in Itipini. On Friday, I took the students in grade 10 and on Saturday I went with the students in grades 11 and 12.

Before we left, I had them all make shopping lists of what they needed. Last year, when we arrived in the store, they would keep seeing things and claiming they needed them. This year, I could check the items against their lists. That modest change along with a few others helped me feel much more in control of the process than I did last year.

The uniform shopping was fairly straightforward. Unlike last year, the first few stores we visited had the right-sized trousers and shoes so we didn’t have to go all over town late into the afternoon. We went to the giant wholesale place where we have an account and spent hundreds of dollars on back-to-school supplies. I know the manager there and she was helpful in getting us boxes of stuff taken down with the forklift. I was constantly worried we were spending too much money but overall the experience was mostly pleasant. There are some fun and interesting new students I enjoyed getting to know better.

Here are some of the pictures.

Technically, the idea is that we support students who live in Itipini. “Support” means we help them with school fees, uniforms, and supplies. I ended up taking 15 students shopping over the two days but not all of them live in Itipini. I was a victim of my own generosity (generosity with other people’s money, I should note).

Of those 15, 11 live in Itipini - seven new and four continuing on from last year. (The fact that there are seven new students, three of them boys, I find so incredibly delightful and surprising.) Last year during my English class, some of the students who live in Itipini brought along their friends. Naturally, I came to know those friends and now this year they have come asking for help. I was a bit torn as to what I should do in response.

On the one hand, I actually do know these students so they meet a requirement of mine for support, namely that I have a relationship with the person. Just because they don’t live in Itipini doesn’t mean they aren’t living a pretty deprived life. And the reasons they have for needing help are often quite legitimate; I’ve already written about Ziyanda whose father died last December and other students have similar hard-luck stories. Because they are continuing students, it is important that they take the grades in consecutive years (rather than, say, taking a year off to earn money to pay for fees). If they don’t the school will make them start again. In Ziyanda’s case, this is particularly important because she is in grade 12, the final and most important year.

But I’m reluctant to spend our resources on people not directly connected to Itipini because I worry about not having enough money, about diluting our influence, and about setting a precedent that opens the door in the future to more and more non-Itipini people. Plus, I think that some of these students, no matter how how hard-up they may sound, could scrounge together some money from their families. There is always more money floating around than I realize. And I’m reluctant to spend the money because I don’t want to confirm the stereotype that white people have lots of money they can toss around however they want. I am very budget-conscious and want people to know they can’t just treat me like a giant ATM machine.

Ultimately, it didn’t seem very graceful to exclude some needy students on the grounds of their address. That “technically” four paragraphs ago should tip you off to the law inherent in the statement. If we can help these students, why shouldn’t we? (But there are plenty of other students who need help and because they don’t know me, won’t get my help. How is that right?)

My decision, then, was to take them along with me on the shopping trip and concentrate on making sure they had school supplies. All of them are returning students so they have last year’s uniform to wear again, perhaps a little small or a little worn but it’ll do. I explained to them we would make the first payment of school fees - about R300 - due this week and they would be responsible for paying off the balance - about R400 - over the course of the year. They quickly assented to that offer, which confirms for me there is at least some money in the family. Yes, the family might have to sacrifice to pay for it but isn’t education worth a little sacrifice? And by having the family invest money in the education perhaps they will take more interest in how hard their children work.

After I wrote that story about Ziyanda and her father, several of you have written to ask how you can support her. I intentionally do not make pleas for money on this blog but to forestall any more e-mails, if you are interested in supporting Ziyanda and the many other students like her - not to mention the 110 in primary school - the best thing to do is donate money to African Medical Mission, the organization that pays all our bills. They are about to receive some whopping big bills from this past weekend’s shopping trip.

January 24, 2009

It’s all connected

Here’s a story about how issues and problems here cannot be addressed in isolation from one another. It’s somewhat complicated and involved but I bet you can follow along with all the names.

On Tuesday, a young man named Mbuyiselo came to see me. “Please,” he asked me. “I want to go to school this year. Any school but I want to be in school.” It’s hard to turn down a request like that, especially one said as fervently as he did.

Before Tuesday, I was only vaguely aware of Mbuyiselo and only then because he belongs to one of the more dysfunctional families in Itipini. (And that is really saying something.) One of his older sisters has a serious mental disability and simply cannot take care of herself. Usually, she is happy and a pleasant nuisance - often she just sits on the bench outside the clinic for hours on end - but about two weeks ago she took a broom and started beating some people with it. Not for the first time, her mother had forgotten/didn’t want to/been too busy to take her to the psychiatric clinic to have her prescription refilled.

The mother, Ntombi, has her own set of issues. Another of her daughters had a child a few years back, decided she didn’t want him, dumped the boy on her mother, and went off to Johannesburg where she hasn’t been heard from since. That child is named Anele and last December he graduated from pre-school and just began first grade this week. Ntombi is overwhelmed by life and shows no interest in looking after Anele. Here’s a picture from when I first became aware of him, soon after arriving here.
As you can see, he looks pretty neglected. He wasn’t going to pre-school and just hung around all day. We spoke with Ntombi and the pre-school teachers and kept an eye out for him and he became a model student (in terms of attendance). I was especially glad because it meant he got to eat every day. More than any other child I’ve ever known, his actions demonstrate just how needy he is for loving attention. He is always clambering all over for me and hitting me for attention. That sort of clinginess I usually find repelling but he and I have, over the last year or so, come to an understanding about my boundaries and his needs and I really like him now.

Back to Mbuyiselo. I was only aware of him last year when he came in to the clinic one day and we realized he was part of the family. It turns out he was going to a high-school in town and doing pretty well. Jenny and I took to referring to him as the “success” in the family and pinned all our hopes for the future of the family. Unfair, perhaps, but we’ll base our hope on whatever shred of evidence we can find.

That one visit to the clinic was all I knew of Mbuyiselo until his visit on Tuesday. So his request came as something of a shock. Didn’t he have a school already? Why did he seem so desperate? What had happened to our “success”?

It turns out he didn’t finish school last year. His father got pretty sick and he had to stay at home and take care of him a lot of days and so he never wrote his exams. Plus, he didn’t really like that school - it wasn’t as good as we thought, I guess - and his eagerness to go any place else was proof enough of that.

The trouble was when he showed up I had literally just returned from registering six new students at high school and was resting on the laurels I felt I had earned from making the process so easy and stress-free for all of us. I had used up all my goodwill there cutting in line and getting students into the right classes that I wasn’t eager for a return trip.

More importantly, the first day of school was on Wednesday and there was a very real possibility that all the slots for grade 10 were full. Plus, he didn’t have a report card from his previous school, which he needed, and he didn’t have an application for the new school. It was a lot to get done by the next day. I told him all this but he seemed willing to try and I didn’t want him to sit around for a year with nothing to do without at least trying to get him registered in school.

Shockingly, everything went smoothly and by noon the next day he was registered. He went to his old school and got a copy of his last report card. (Amazingly, they had it.) I had an extra copy of the application form. I did some serious sucking up (in Xhosa!) with the proper authority figures at the high school and got him squeezed into one last spot in grade 10. The hardest nut to crack was the “uniform teacher” whom I had to convince to allow Mbuyiselo attend school for three days in his street clothes until we could buy him a uniform. (He had given his old one away to a younger brother now at his old elementary school.) But even this teacher melted under the full-court press of my charm. (Ha!)

Mbuyiselo was effusively grateful and I was feeling pretty pleased with myself. But there was still at least one more outstanding problem. I wanted to see Mbuyiselo’s father, Wilson. It didn’t make sense to send Mbuyiselo to school if his father was still sick and needing help. I’m no great diagnostician but the symptoms Mbuyiselo described made me think of HIV. I had checked Wilson’s card when we returned to the clinic and saw we had suggested he have an HIV test several times last year but he never came in for one. The last time he had been in the clinic was August even though he had been sick enough to keep his son out of school much more recently. (Stubborn men not wanting to go to the clinic!)

Mbuyiselo took me to Wilson (sitting in a bar, not looking particularly HIV-stricken) on Wednesday afternoon. My Xhosa deserted me and I struggled to explain how we had just got Mbuyiselo registered in school and how I really wanted Wilson to have an HIV test soon. I tried not to make it seem like a quid pro quo but that’s how I was thinking about it - I get your son into school and you get an HIV test. The conversation was really frustrating because I just couldn’t find the right vocabulary and I left thinking it had been a failure.

So I was pleasantly surprised to see Wilson show up at the clinic this morning, wait patiently, and have an HIV test. Not at all surprisingly, it was positive. He’ll come back on Monday for a CD4 count and I wouldn’t be surprised if he qualifies for ARVs right away.

If there’s success in this story, it is very limited and hard to see right now. But what is important is that I think we’ve managed to go some distance to untangling a knot - the way Wilson’s illness affected his son’s education - and changed the trajectory of some lives - Mbuyiselo in school, Wilson on the path to health. There are still untold obstacles to achieving those goals, there is still an incredible amount of work ahead, and even then they may never come to pass. But things are moving in a better direction now than they were on Tuesday morning and that is reason for a little satisfaction and joy.

A slice of my life

This post, like the vast majority of posts before it, was posted at an Internet cafe in Mthatha. (They don’t actually serve coffee.) I take for granted my trips to this place but some of you might be interested in one or two aspects of this slice of my life.

First, the cafe is at Mthatha’s largest and newest mall, the Plaza. The Plaza has a terribly-designed parking lot so I always go in the back way to avoid the choke of traffic. That means I frequently end up parking in an area watched over by the same parking attendant. Here she is.
I don’t actually know her name (yet) nor she mine. The car I drive has African Medical Mission stickers on the doors so she calls me, variously, “African Medical Mission,” “African Medical,” or, best of all, just “African,” which I definitely am not.

(When I first wrote about parking attendants on this blog, some of my second-grade correspondents in South Carolina wrote to ask what kind of guns they used to guard my car. As you can see, she is armed with nothing fiercer than an umbrella - for the sun - and it is hard to get her off her crate most days.)

Then I get to the Internet cafe and plonk myself down. This cafe has opened since I’ve been here and I was so eager for them to open I was actually their first customer before they even opened. It is a family business, run by a young man, his wife and their assorted siblings and I am well known to all of them, so well known, in fact, they let me go online even when I don’t have the money with me because they know I’ll be back soon enough to repay them.
Because I am on the clock when I go online, I quickly get sucked into the online world of e-mail, blogs, and news and whatever other tasks I need to accomplish. I get so absorbed in that world that I shut out the (considerable) noise around me and forget where I am. Reading my e-mail or the news, I could be anywhere in the world, wherever events are happening or people are writing to me. So it comes as a bit of shock when my time ends and I gradually re-enter the world of Mthatha. After reading so much English, what is most shocking is that the babble of voices around me is in Xhosa. I take a moment to readjust to the reality of where I am and head back to the car.

How good are schools here?

The federal government just took over the provincial department of education:

OFFICIALS from Pretoria are preparing to take control of the Eastern Cape Education Department following years of poor academic results. The move shocked provincial administrators, who admitted yesterday they had no idea of the impending takeover by Pretoria.
In other news, our little school up the hill just received a letter saying it has been designated a "fee-free" school. Great news, right? Except the principal reports there is no corresponding effort to make up the lost revenue so he still wants people to pay fees this year.

January 21, 2009

The missionary who now knows what he’s doing

One of the great things about staying in a place for an extended time is that you get to do things more than once. You might recall a story from last January when I spent most of a day dashing around town with a group of new high school students to ensure they were registered and ready for the first day of school. You might recall I didn’t really understand what had to be done and I didn’t even know where the school was.

Well, it is the beginning of the school year again and there are more new high school students. But now - informed by the experience last January and everything in between - I have a much, much better idea of what needs to happen, when, and why.

Yesterday I drove our six new students around town, copying the necessary records to accompany the application, getting the ID photos taken, and getting them officially signed up at school. I even used a personal connection I’ve developed over the past year to ensure they didn’t have to spend hours (literally) waiting in line to register at school. In all, it was a much smoother and enjoyable process for me than it was last year.

Remember, the reason I get involved in the education of these students is that it costs money to go to high school, about $75/year just for school fees. In addition, there are fees to get the ID photo taken and to actually submit the application. That doesn’t count the cost of the uniform or the necessary pens, paper, and so on. I have been bleeding money all week, all for legitimate reasons.

And it’s exciting. There are six new students in grade 10 (the first year of high school) with the possibility of a seventh. Here they are.
What’s great about this picture is that there are two young men in the group. This is fantastic! Last year, I despaired of my gender every time I realized there were no males from Itipini in high school. To have two is wonderful. Of the young women, I don’t think any of them have children.

Meanwhile, there is still last year’s group of students to be concerned about. A couple who failed are dragging their feet about going back to school but the ones who passed are ready and willing to go.

My English class last year ended up attracting about five students who don’t live in Itipini but heard about the group from their friends and came along. Ziyanda was one of them.
She’s going into twelfth grade and is really smart - she did well in school and she speaks great English. She came to me yesterday and it was the first time I had seen her since last November because she had spent most of the break in her family’s rural village. The reason she wanted to talk to me is that she needed help paying school fees. While I am happy to help anyone learn English, we have to draw the line somewhere on paying school fees and that generally means we don’t pay fees for anyone not living in Itipini. Of course, in extenuating circumstances we could be a little more pliable so I asked Ziyanda why, when her family could pay the fees last year, she needed help this year.

Her circumstances definitely qualify as extenuating. Her father worked in the mines near Johannesburg and sent money home. But he was killed in a mining accident late last year and the funeral was in December. (When someone matter-of-factly tells you this story, how do you respond?) It sounds like her mother is working but there are other children in the family to support as well. I said we’d work something out. It seems fair and she is a very talented student.

Coming up next is the excursion into town to purchase new uniforms. Last year, when the students confirmed every stereotype about women and shopping, it nearly killed me. We’ll see on Friday if a year’s worth of knowledge and experience helps me endure it any more easily. Stay tuned...

“Hand me my chalice, it’s the one that says…”

I nearly had a car accident with Samuel L. Jackson the other day.

There I was doing a three-point turn in the middle of the road and he came barreling around a corner in the telephone company truck and nearly hit me. But when I recognized who it was I got out and had to speak with him.

Alright, so I didn’t almost hit the well-known actor. Actually, the guy driving the truck was the priest at church. There’s a priest at church who I swear looks like Ving Rhames and this one who bears a passing resemblance to Samuel L. Jackson. Naturally, I find myself thinking of the movie “Pulp Fiction” frequently in church and snatches of its (incredibly profane) dialogue float through my head at the most inopportune of times. (As in the title of this post, which I’ll let you “Pulp Fiction” devotees finish yourself.)

After our near accident, we exchanged a few pleasantries and that was that. Still, it’s yet one more sign of how different the African church is from the American that clergy have jobs on the weekdays that may have nothing to do with their priestly status.

By day, telephone repair man - but on Sundays, man of God!

I also almost got in an accident with the bishop a few weeks back. A while before that I cut off the same nun in traffic within two minutes at two different intersections. She sure knew how to lean on her horn!

Words worth remembering

I just finished Heart of Redness by Zakes Mda. If you’re interested in a slice of Xhosa culture, I highly recommend it. The story is good, too.

The point made in this passage below is an obvious one but one I realize it is very easy to forget. Dalton is a white man who has lived his entire life in a Xhosa village; Camagu is a Xhosa man who has spent most of his life in the U.S.

John Dalton is preoccupied with water affairs. It is weeks now since his water committee closed all the communal taps. The villagers are refusing to pay. When the chief calls a public meeting to discuss the matter, the few who come say, “You, son of Dalton, you got money from your business friends and from the government to start this water project. Why don’t you ask those people who gave you the money to maintain those taps? How do they think they will be maintained if they do not come to maintain them?”...

[Camagu says] “You went about this whole thing the wrong way, John. The water project is failing because it was imposed on the people. No one bothered to find out their needs.”

“That is nonsense,” says Dalton. “Everyone needs clean water.”

“So we think… in our infinite wisdom. Perhaps the first step would have been to discuss the matter with the villagers, to find out what their priorities are. They should be part of the whole process. They should be active participants in the conception of the project, in raising funds for it, in constructing it. Then it becomes their project. Then they will look after it.”

Camagu is of the view that, as things stand now, the villagers see this as Dalton’s project. He thought he was doing them a favour when he single-handedly raised funds for it and invited government experts to help in its construction. It was only later that the community was involved. Dalton hand-picked a committee of people he thought were enlightened enough to look after the project. The villagers were given a ready-made water scheme. It is falling apart because they don’t feel they are part of it.

“That is the danger of doing things for the people instead of doing things with the people,” adds Camagu. “It is happening throughout the country. The government talks of delivery and of upliftment. Now people expect things to be delivered to them without any effort on their part. They expect somebody to come from Pretoria and uplift them. The notions of delivery and upliftment have turned our people into passive recipients of programmes conceived by so-called experts who know nothing about the lives of rural communities. People are denied the right to shape their own destiny. Things are done for them. The world owes them a living. A dependency mentality is reinforced in their minds…. That is the main problem with you, John. You know that you are ‘right’ and you want to impose those ‘correct’ ideas on the populace from above. I am suggesting that you try involving the people in decision-making rather than making decisions for them.”
It is very, very easy to assume one’s own good intentions and ideas are broadly shared.

January 17, 2009

Below Zero?

Apparently, it’s been pretty cold in North America lately. My parents sent me the weather report (35 below) and I saw this picture from Fairbanks, Alaska on a friend’s blog.
Meanwhile, we are sweltering through the summer here. The first week back after Christmas brought the kind of heat that just makes you sweat while sitting still. This past week was cooler in that I only sweated through my shirt when I started moving around. Combine this with a bunch of people in Itipini who don’t have regular access to baths and it makes for a pretty ripe-smelling clinic.

For fun, I told my co-workers how cold it was in the U.S. and Canada. Have you ever tried to explain how temperatures can be below zero? To a group of people who have never experienced it? I’m not sure if they took me seriously that it could actually happen. People here know what it is like to be cold but when people here were wearing winter hat and scarves, I was wearing shorts and t-shirt. Even saying “really cold” doesn’t encompass temperatures below zero.

Then I tried to explain that when I lived in Alaska, I had a winter coat that cost $400 (courtesy of the Nome Ambulance Department). They really couldn’t conceive spending that much money on a coat or even what would make a coat cost that much.

Getting It Done

I care about my mail. Every week, I eagerly await my issue of The Economist magazine, not to mention the letters that get sent my way. My mail gets sent to me care of African Medical Mission. AMM mail gets sent to the Mthatha Hospital Complex where it is then sorted into our box.

After Christmas, there was a huge pile of mail (the hospital gets a lot of mail) that took them forever to sort. This was a source of aggravation for me for a couple of days because every time I went there the guy behind the desk was sitting around doing nothing (literally) but said he was too busy to sort the mail. Eventually, and without much tact or respect for cultural differences, I went through all the mail myself to find my Economist and a few other Christmas cards. I was pretty crabby with the employees and they with me.

This week our box has been notably empty and there was no big pile waiting to be sorted. After too many days of this in a row - I wanted my Economist! - I asked the guy behind the counter where the mail was. I was fairly polite this time (even though it is so tempting to be rude in situations like this). I made sure to greet him and ask how he was. “Unfortunately,” he told me, “we don’t have transport to get to the post office to pick up the mail.”

“Fine,” I said. “I’ll give you a ride right now.”

He didn’t think I was serious but I was so we went off to the post office and picked up the week’s worth of mail. When we got back, he helped me sort out AMM’s items, my Economist, and about four letters for me. We also had a pleasant conversation and he told me all about the trouble he has getting transport to get to the post office - every day he has to make a request to the transport department for a ride to the post office (like many people here, he can’t drive) but that is almost always ignored so he often hops a ride with the maintenance department if they are going into town. It didn’t excuse the huge pile of unsorted mail after Christmas but it did make me warm up to him. Also, he was a genuinely friendly guy.

Here’s a story that is tangentially related. Last week, I had a tough problem to solve at the TB clinic that oversees all our patients. One of our patients had lost his record of treatment, a green card all TB patients get. Even though he was ready for it, I knew the clinic wouldn’t switch him over to the next phase of the treatment if he didn’t have the card. Since we had our own records of his daily attendance, all I wanted was a blank green card that I could retroactively fill out and get him switched over. But bureaucracy reigns supreme at this clinic and I knew I’d have to pour on some serious charm, in Xhosa, to get another card.

In the event, that was exactly what I did. (I swear, those nurses at that clinic are going to adopt me as a long-lost son and fix me up with all their daughters before I leave.) The key thing was I didn’t talk at all about the green card for the first two-thirds of our conversation. I made sure to properly greet them, ask about how their holidays were, wish them a happy new year, and talk about anything except the one thing I wanted. Then when there was a brief lull, I told the story about our patient. Without even my asking for it, a nurse pulled out a blank green card and handed it to me. I asked some more mindless questions, bade them farewell, and was on my way.

Frequently, I have to remind myself of the importance of taking the time to greet a person and ask how they are. Xhosas care about that sort of thing. In the rich world, we don’t. We burst in, make our demand, and get on with business. I’ve done that here with not very successful results. But when I take the time to greet a person, it seems more likely that they will help me. (It helps that in greeting them, I can show off a little Xhosa, which, coming from a white person, always goes over well and helps lower a few defensive barriers.)

If someone were to observe these interactions, with the mail guy and the TB nurse, and measure how I used the time, a high percentage of the time would probably be devoted to non-work items, like the greeting. Some sort of efficiency consultant might suggest I was wasting time. But really, all that non-work time is just greasing the skids for the actual work and making things a lot easier.

I observed a few posts back that “what matters in this town is not what you know but who you know.” That’s still true and I hope my new relationship with the mail guy bears fruit in the future. But it’s also important to know something about the culture of the people you know so you can use your relationships with them to the greatest possible advantage.

There's been too much text on this blog lately

Missing Out

One obvious point about living way far away from friends and family is that you miss out on important events. My great-uncle recently passed away and I wasn’t able to be at his funeral; same for a great-aunt of mine who passed away last year. I would have loved to be at both events but it’s not really practical given the great distance that separates me from them.

I just got wind of another impending event I am sure I am going to miss. My cousin is a helicopter pilot and just got a new job. He e-mailed the family recently about a 15-foot pontoon boat my grandmother owns:

What I had mentioned to Grams, was if there was no interest with any family members keeping the boat that I am interested in purchasing it, and teleporting it to Thunder Bay (and no one worry about how I am going to do that, I'll get er' done).
Slinging and carrying a boat over hundreds of miles of northern Ontario! How neat would that be to witness! And here I am stuck in South Africa.

January 14, 2009

Lies, Damn Lies, and…

We’ve had a lot of scraps of paper around for a while with annual totals of HIV tests done in the clinic. This week, I put them all in one file. I haven’t figured out how to post charts or graphs on this blog but here are a few statistics of note.

Between 1999 and 2008, there were 1141 tests done in the clinic. Of those, 415 were positive, about 36.3%. This should not be seen as an HIV prevalence rate, however, because there’s no way of knowing how representative of the community our sample is. Also, it doesn’t mean 1141 individual people were tested. People can be tested more than once, particularly if the first test was negative.

More than two-thirds of the tests, or 769, were done on women. Clearly, though, they’re getting the virus from somewhere or giving it to someone.

In 2003, the single most tests were done, 251. Last year, we did only 89 tests, part of a general decline in the past several years.

Though the overall positive rate is 36.3%, that has ranged from a high of 48.2% in 2004 to a low of 15.9% in 2000. Those 2000 figures, however, are clearly outliers. The second-lowest figure is 2008 when 25.8% of the tests were positive.

I’m working on a way to organize the data by the age of the person being tested. I might have thought once that the rate would be higher among younger people, i.e. those of my generation, but I’m not sure anymore. I’ll be interested to find out.

An Open Wallet

In my time here, I have come to the conclusion that giving someone in Itipini money is one of the last things I should do. There are often good reasons for handing out money - to help someone get seen at the hospital or as a micro-credit loan, for instance - but that money shouldn’t be the first thing that is exchanged. This is why I have come to emphasize the importance of relationships in my work here.

I am also reluctant to give out money because I don’t want to reinforce the stereotype of the white guy who just hands out cash and thinks he’s done some good. In fact, I think that sort of thing can do more harm than good most of the time. Money is corrosive and it changes the dynamic of every situation when it is introduced, very rarely for the better.

But I’m not perfect, as my experience here never fails to remind me, and sometimes I give out money more quickly than I would like.

On Tuesday, a young woman I had never seen before came to me and said she wants to go to school this year and needs help doing so. Her parents are long gone and she lives with some friends. Because it was a busy day and her English wasn’t great, I didn’t get all the information I would have liked, like how old she was, what grade she had finished, and what she wanted to study. She told me the name of the school she wanted to attend (sort of a vocational school for people without high school diplomas) and I told her to go get more information about cost, program length, and so on. But somehow she knew where I lived and knew it was close to the school and prevailed upon me to give her a ride there at the end of the day.

We were accompanied by one of our pre-school teachers, Nthantisi, who also lives near me and often prevails on me for a ride home. Nthantisi has a heart of gold and quickly took this young woman under her wing. I was also beginning to like this young woman. The car ride took on this feel of “we’re all going to help you get a better education.” It felt good.

When we arrived, they went inside and checked things out. They came back excited. There was a mandatory entrance exam happening only on Wednesday, the next day, and she had been given the last spot to write the exam. All she had to do was fill out an application form, pay 25-rand for the form, get an ID picture taken to go with the form, and return the next morning. There was also the possibility of a bursary that would pay her tuition and room and board for the year. They were both convinced that everything was working out for a Reason and God was involved. There were lots of “Praise Gods” in the car.

Of course, there was the small problem of money, namely the 25-rand for the form, the 20-rand for the photo, and 5-rand for the taxi to get back the next morning. They both looked at me expectantly.

Let me just say, I would have been an awful downer if I hadn’t reached into my wallet and pulled out 50-rand (about $5 U.S. at today’s rates) and given it to this young woman, which is exactly what I did. I would have been popping a big balloon that had rapidly been inflated. I would have been seen as single-handedly stopping her chances for success.

But I couldn’t help but feel a little disappointed in myself when I handed over the money. Here I was, Mr. Sugar Daddy again, the white guy who was only good for a car ride and the necessary cash. (On the plus side, at least I am good for something and not completely worthless as I can often feel around here.) I barely knew this young woman and I was handing over what is a fair amount of money here. I couldn’t help but think that this young woman could have started this application process a while ago, instead of waiting until the last minute and we would have had time to build up a relationship before this moment.

I was tempted to stop this post with that last paragraph but then I remembered a recent e-mail from a friend who told me to remember how grace fits in to all this. So perhaps I need to be more hopeful and see the confluence of circumstances on Tuesday as a shining example of God’s grace at work in the real world, all of us playing our appointed roles. And now I’ll just try to build up a relationship after the fact. I told her to come see me on Thursday so we could talk about next steps.

January 11, 2009

Enough Dead Babies

I was at the nearby government clinic on Thursday, helping a new HIV patient navigate the anti-retroviral prep system. A nurse in the maternity section called me over. “There’s a young woman who gave birth to a stillborn baby this morning. She’s all by herself and we haven’t been able to get in touch with any family members to decide what to do with the corpse. But she says she lives in Itipini. Can you help us?” Leaving aside for the moment the tragedy of a teenage girl giving birth to a stillborn baby all by herself in an impersonal ward with no privacy at all, I agreed.

I didn’t recognize the young woman but I immediately recognized her last name because it turns out she is the niece of a woman about my age, named Nolizwe, whom I know very well. She is so well-known because she has been equal parts protagonist and antagonist in my time here. She can be a talented and helpful person but most of the time I find myself getting angry at her for drinking her life away and ignoring her children. The young woman who had just given birth said she had no other family besides Nolizwe around. (None of us thought to ask where the father was. The idea of a teenage father taking responsibility for his child is so unusual here as to not even merit consideration.)

I located Nolizwe in Itipini and told her her niece had just given birth and Nolizwe had to go to the clinic to help out. Nolizwe protested, in Xhosa: “I don’t have any clothes. I don’t have a blanket,” all necessary items for taking a baby out of the maternity section. It was then I realized I had forgotten an important detail. In Xhosa I said, “Nolizwe, the baby” - and then paused not sure of what I was doing and then decided to plough ahead anyway - “is dead.” I used the Xhosa euphemism that would translate better as “pass away” but it didn’t do much to cover up the shock of the news. Nolizwe sat down and started crying. “How did I end up in charge of this situation?” I thought to myself. “And what do I do know?”

Eventually, Nolizwe - aided not at all by my limited efforts to soothe her in Xhosa - stopped crying, got in the car, and came with me back to the other clinic. There, she decided we needed to find her brother who could provide some expert male advice. We drove to find him and found him sitting under a tree with about eight other guys, all of them passing around beer bottles. He wanted no part of the situation and told Nolizwe to sort it out herself. I might have caught more of that conversation but I was accosted by one of the drunks, who insisted I give him a job cutting the grass in Itipini (what grass? it’s a dump!) and wouldn’t take no for an answer.

Our options boiled down to calling a funeral home to pick up the corpse (and figuring out a way to pay for that another time) or giving the corpse to the family for a burial on their own. I’ll spare you all the details but we opted for the first choice. By this point, the workday was long over and I left Nolizwe and her niece to sort out the situation, knowing that at some point they’d come asking for money for the funeral and we’d likely help them.

This situation, while tragic through and through, should be the kind that made me feel good about my role here - being able to talk about a sensitive subject with some facility in another language, being able to help a family in a difficult time, and so forth. But it left me with nothing but bad feelings. While describing the situation to Jenny at the end of it all, I called the dead baby a “thing,” which it assuredly is/was not. I couldn’t help but be suspicious of Nolizwe’s tears throughout because she has played me so many times in the past I could only imagine her scheming through the tears to use the situation to her advantage; I didn’t want to be “too generous” with her. I kept wondering how this situation had become “my problem” when the baby wasn’t even born in Itipini (unlike a past stillbirth) and the mother hadn’t been to our clinic in four years. I wondered if the brother would have been more helpful if he hadn’t seen Nolizwe in the company of a white guy, who was chauffeuring her around.

Maybe I would have felt better about everything if it hadn’t been a face-meltingly hot day and I hadn’t been dealing with a handful of other challenges simultaneously - sorting out the HIV patient and another really sick guy, taking a young girl to the hospital to prepare for open-heart surgery, figuring out which students were serious about going to high school next year and needed our support, deciding with Mkuseli how to register elementary students for school, and in the midst of all this having yet another run-in with the Mthatha traffic control.

Our motivation can be so simple - help others. But when that motivation is mediated through all the exigencies of the real world, the end result never seems to be quite what we imagined.

And I’ve really had enough of dead babies.

January 10, 2009

On Work

My God, people sure are lazy around here!

Alright, so that was just to grab your attention. No one can watch how hard people work here just for daily survival and believe they are lazy. But… the other day I went to the hospital where we get our mail and saw a big pile of post-holiday mail waiting to be sorted. I left and came back later in the day to check again. Still, the pile was just waiting there. I came back just before the day ended and the gigantic pile of mail was just sitting there. Frustrated, I asked the two employees why the mail wasn’t sorted. “We are busy,” replied one. As he spoke, he was staring off into the distance, his chair pushed back from his desk, and doing absolutely nothing productive, except, I imagine, counting down the minutes until he could go home. His co-worker was reading a sales flyer. I wanted my mail so I sat down and began sorting through the pile. I think in the U.S., I either a) wouldn’t have been allowed to do that or b) would have generated enough embarrassment in the employees, they would have sprung into action. Here, the employees just ignored me and thought to themselves (I assumed), “thank goodness he is doing it for me.” Later, a new employee showed up and asked to borrow a pen. I said she could have one when the mail was sorted. That didn’t make me very popular but I got my Christmas cards and was on my way.

I see this approach to work in virtually every day around town. Sometimes when I interact with the nurses who are the prime movers in the health system here, I am stunned by what I see as a lackadaisical approach to their jobs. After all, if there’s anything that has ever made me believe in Martin Luther King’s great phrase “the fierce urgency of now,” it’s waiting in a hospital with a sick and dying person. There’s millions of dying people all over the country but it seems to me at times that there’s no urgency in confronting the issue.

One explanation is simply cultural. I’ve been told before here “you hurry everywhere” and that is certainly true compared to the pace of life here.

Another possible explanation is general work weariness. After all, I only see a handful of the patients that the nurse who runs the ARV clinic sees and I’m sure she is more than a little bit overworked by the burden of the people who come to see her. This is fair and might even be a useful corrective to my sometimes charge-ahead attitude to patient care.

I think there’s another kind of weariness, though. Life can be exhausting here. It is likely that a nurse - or any employee I encounter in my day-to-day work - has several people at home to support. Maybe a sibling has died so she is raising her own children and her nieces and nephews. Perhaps one of her children has already had a child so she is now both a mother and a grandmother. Because jobs are relatively scarce when someone gets one he or she likely ends up supporting a tremendous amount of people. (In Itipini, I sometimes think the most effective thing we do is pay salaries to our dozen employees. That money supports a huge contingent of people and I always marvel at how far our employees can make it go.) In addition, the work of daily survival is harder here. Washing machines, running water, and stoves that turn on at the flip of a dial are not as readily accessible here as they are in the rich world.

In this context, showing up to work might be a bit of a relief from all the pressures of life at home. If the daily battle for your own survival and that of your family is so exhausting, perhaps when you get to work you don’t have the energy to charge full-speed ahead every moment of the day. Several times when I was a volunteer EMT and had a few calls in the middle of the night that significantly cut into my sleep, I would show up to work the next morning and pray for a quiet day in which I could spend a chunk of it staring off into the middle distance and doing nothing in particular. Is there a similar dynamic at work here?

The trouble is the scale of the social problems in this country require an “all hands on deck” approach virtually all the time. There’s not a lot of time for middle-distance staring. There are people dying in the hallways of the hospitals before they can be seen. And it’s not just nurses who confront this challenge - government bureaucrats, teachers, and so many others need to pay concerted attention to their jobs.

I’ve been working up the justification I’ve just presented for virtually my entire time here and I think it is a sound one. And yet… sometimes I just can’t get past the belief that people here are complete slackers. If “African problems demand African solutions,” as I have come to believe, how do we arrive at those solutions with a bunch of people whose work ethic is something less than what I think is required?

January 8, 2009

This is neat

African Medical Mission, the organization I work for, has a new web site.


Check it out. If you've been reading this blog for a while, you've probably seen most of the pictures before.

January 6, 2009

The Short, Fat Arm of the Law

(This is a longer story than usual and not at all about any of my usual topics. But read the whole thing and I think you’ll like it.)

In my time in South Africa, I have been occasionally stopped by what I would call roadblocks, set up by the traffic control police who stop vehicles to check for safety. Usually, a cop takes a look at my license, checks my inspection sticker, and I am waved on. I make sure to greet them in Xhosa, they marvel at a white guy speaking Xhosa, notice the “African Medical Mission” signs on the car, and away I go. I don’t like these roadblocks because they slow down traffic and create safety hazards. And I really don’t like them because I believe they are not allowed in the U.S. because they violate the illegal search and seizure part of the Constitution. (Lawyers out there can correct my constitutional guesswork.) But I realize the rules may be different here.

On Sunday, I skipped church - gasp! - and was driving into town to buy a new toaster to replace my broken one. “‘Vengeance is mine,’ says the Lord.” Indeed.

Shortly after setting out, I saw a roadblock. I got waved down and prepared for nothing more than the usual display of my license. But when I showed it to the police officer, she said, “Alaska?” and walked off to show it to her supervisor. I expected her supervisor to wave me through. She didn’t. The first police officer came back and told me I needed an international driver’s license and I would have to pull off to the side of the road. I asked to speak to the supervisor before I did that, assuming I had a rookie cop who didn’t know the rules.

But the supervisor was unbending and kept insisting I needed a international license even though I explained how on the twenty or so previous occasions when I have been stopped my license has not presented even the slightest hint of a problem. “But it’s the law; those other police don’t know it,” she responded. “Don’t you think you should teach them the law before you teach me?” I asked. She just grinned maliciously and didn’t answer. “Can I see the law?” I asked. “We have that at the police station; you can see it when we get there,” she responded.

Before I drove off the road, I asked to speak to the guy in charge of the whole roadblock. He was equally unbending. He showed me his license. “If I tried to drive in Alaska on my South African license, would they let me?” I explained they would because South Africa and the U.S. have a reciprocity agreement where they mutually recognize licenses. (Lawyers can again correct me here.) He didn’t believe me and just whistled and said, “yho, yho, yho” as men do here when things are not going well for me.

I resigned myself to pulling off the road with the twenty or so other cars that had been stopped. A few unlucky souls had forgotten their licenses at home; a few others were driving obviously un-roadworthy cars. I was the only white person. When someone asked me why I had been stopped and I explained the reason he looked incredulous. “You are from America and they stopped you?” I agreed it was a bit unreasonable. Usually my white skin keeps me from ever getting into situations like this.

The plan, evidentially, was for the police to finish their “operation” (as they called the roadblock) then drive all of us law-breakers in a convoy to the police station where they would write us all tickets, impound our cars, and send us on our way. This struck me as horribly inefficient - why not just write the tickets here instead of causing a gigantic traffic jam at the station or deal with us individually as we were pulled over? - and I was again bemoaning African inefficiency when a woman in the car ahead of me started asking exactly the same questions. Apparently not all Africans are inefficient; just the ones with important jobs.

At one point, the first supervisor I spoke with came over and showed me a license from Nigeria. “This is what you need,” she said. “See, it says on it ‘international drivers license.’” The license clearly said, “Republic of Nigeria, National Drivers License.” I pointed this out to her. “No, it says ‘international drivers license.” I explained it didn’t. No matter how hard I tried to explain this to her, she wouldn’t accept that she was clearly mis-reading it. What do you with a person like that, especially one in authority?

In the movie “Michael Clayton,” George Cloony plays a lawyer whose job it is to solve unexpected problems that crop up among the firm’s wealthy clients and lawyers. Fortunately, I have my own personal Michael Clayton in Mthatha. Her name is Mary and she is African Medical Mission’s business manager. She has lived in Mthatha her entire life, is fluently trilingual, has experienced every possible thing this town could throw at you, and - and this is really helpful - knows half the town. I gave her a call, explained the situation, and she said she’d come right down.

While I waited, I had a chance to observe the “operation” in action. It was a mess and it appalled me. Most cars were flagged down, checked, and sent on their way. But if a vehicle was waved down and just kept on going, no one made any effort to chase after it or stop it. There were several buses that had been stopped but as the section of road where this roadblock was was not particularly wide, they partially blocked the road, making it dangerously unsafe and I saw several near accidents.

The more senior cops kept coming and going in their cars, obviously trying to demonstrate their importance by not being around. Some cops just wandered around disinterestedly, clearly wanting the operation to be over. Other cops just hung out in clumps. A few wanted to demonstrate the authority conveyed by the lightweight, fluorescent jersey they were wearing that said “traffic control” and were strutting around showing off. There is clearly no physical fitness requirement to be a traffic control officer as there were a couple grossly overweight cops, including the initial supervisor I had spoken with. She still had my license and was clearly delighting in the power she had over me. She kept taunting me by waving it around and slapping it against her hand. I tried to ignore her but she kept wanting to talk to me, mainly so she could show off that she had my license and I didn’t.

Watching the whole “operation,” I couldn’t help but think of my own experience managing a fairly large group of people into one common task - an evening program at a summer camp. It was almost identical. Then, there were the counselors who tried to show off their importance by acting like they were in charge; there were the counselors who clumped with their friends and ignored the kids; there were the counselors who did everything they could to get out of the event, agreeing it was a great event they just were too busy to be a part of. And on and on. (Before anyone accuses me of pointing fingers, let me say I have been each of those counselors on different occasions.) This roadblock had even less discipline or coherence than the typical evening program.

Mary soon arrived and it was a thing of beauty to watch her work, cajoling, pleading, joking, laughing, hugging, upbraiding, knowing when to take a break, and on and on. Under her explicit instructions (“keep your mouth shut!”), I said not a word. (One or two might have slipped out but under her glare I shoved them back in.) She knew at least four of the senior cops there but not the guy in charge (who wasn’t there when she arrived) and it took probably half an hour to get them to let me go. Basically, she got them to let me drive to the police station on my own instead of in the convoy. Then we waited for the convoy to show up - lights blaring, sirens going, showing off how significant they were, and blocking traffic in both directions on the street (efficiency, what efficiency?). It might have been more impressive but the cops didn’t have enough room in their vehicles for all the officers at the roadblock so several of the cops had had to hitch rides with the soon-to-be impounded vehicles in the convoy. Mary spoke to the guy in charge when they arrived, he looked at us like he’d never seen us before, and we were on our way. The whole thing had taken about two hours and the toaster store had closed in the meantime.

I was never seriously worried about anything in the entire ordeal but I just found it all so aggravating. It made me so disappointed about South Africa that they could have such an undisciplined, inconsistent, and incapable traffic control force whose members were clearly more interested in reveling in their own (perceived) authority rather than enforcing the law, which they apparently do not know. Mary mentioned to me at one point, “in this town, it is not what you know but who you know.” I know this to be true in most parts of the world even when we kid ourselves that it is not. But to see the truth of this statement so blatantly is just disappointing. What about the people in Itipini who know no one? How do they get ahead?

I’ve been here for a while now, long enough at any rate to start being hopeful about the future of this country on a number of levels. But this just sets that feeling back miles. How are South Africans supposed to get ahead when they keep scoring so many “own goals”?

I called a lawyer friend on Sunday night and he said he’d get me a copy of the National Traffic Act I can keep in the glove box. That would reassure me more if I was more confident in the cops’ ability to read what is in front of their eyes.

More fruits from the garden

We returned from the holiday break to find that the garden was overflowing with tomatoes. I helped Mkuseli harvest some of them. Some had already gone bad, which proved to be quite delightful. The garden commands a great view of Itipini and the children running between the shacks so I threw the rotten tomatoes at the kids in a giant game of dodgeball. I don’t have very good aim. Even with a few rotten ones, we must have got five dozen good, ripening tomatoes.
Half the harvest

I had the bright idea to put them on one of our tin roofs to ripen in the sun. That provided a great perch from which to huck a few more rotten ones.
UPDATE: Thanks to all of you who've told me that tomatoes actually don't ripen best in the direct sun. I still have a thing or two to learn about gardening yet, I guess!

On the playground

January 4, 2009

Presence vs. Change

I told a story several posts back about a man who was admitted to the hospital recently. The point of the story then was how I had to make a return trip to the hospital solely to ensure he had been wheeled from the x-ray department to the point where he would be transported to the correct ward. I did so, left his admit instructions clearly on his stretcher, and left.

There’s more to the story. A few days, after I assumed he had been admitted, I was at the hospital for a different reason and decided to check in on the patient just to say hi. The trouble was I couldn’t remember which ward he had been admitted to so I aimlessly strolled through a few likely wards (they let me do that around here) but had no luck. I was on the verge of giving up and leaving when I decided to take a swing through the casualty ward. This is the sort-of equivalent to an ER in that it is where the really sick and infirm go when they first arrive at the hospital. I have spent a lot of time here with a lot of very sick patients with AIDS.

As I rounded the corner into casualty, there, lying on a stretcher in the middle of the hallway, was my man. He smiled at me and greeted me as if it were the most normal thing he’d be in the hallway of the hospital three days after he was supposed to be admitted to an inpatient ward. In that time, it did not appear he had been seen or even noticed and certainly not admitted to any ward. To top it off, his health records that had had the admit instructions very clearly written on them had been lost and no nurse seemed to know anything about him. I had to step outside for a bit to make sure I didn’t blow up at someone. It was incredibly aggravating. To make a long story short, I eventually prevailed on the nurses and doctors to see the patients, his card was located, and he was admitted.

But the experience raised for me a question I consider quite frequently: I spend an enormous amount of energy helping people get into “the system” - be it health care of education - but what happens when “the system” is wanting? What’s the point of directing people into the prevailing structures if those structures can’t help them?

This is a conundrum that confronts a lot of people on the “front lines” of social development work I think. I want to be present with people and use that gift of presence to help direct them to sources of help greater than what I can provide. For instance, when I have spent lots of time over several weeks or months with really sick HIV-positive patients, the greatest thing I have been able to “do” for them is to be there with them. I can’t get them the pills they need but I can point them in the right direction and help them get there.

There’s a way in which I think presence and a desire for systemic change are odds with each other and may even be mutually exclusive. On a very basic level, my work here is all about incarnational ministry. I choose to be present and become a part of the way of life here as best I can. To that end, I’ve become friendly with some of the nurses who administer the anti-retroviral program I try to direct patients towards. On countless occasions, these relationships have helped grease important wheels and made my life a lot easier. But I still get frustrated with the health-care system these nurses direct. I still want to change it and make it less bureaucratic and more efficient. But if I did that, don’t you think those nurses might get a bit offended and take my criticism of their system for personal criticism? And if I spend all my energy trying to change the system, will I have enough left over for the ministry of presence?

Long-term missionaries implicitly accept that their work will primarily be about the small victories that come from being present. Broader systemic change can’t come from people who are working - however gracefully and effectively - at the lowest levels. It takes a different kind of missionary to do that sort of work. There is immense value in both but I don’t think they can be done simultaneously by the same person.

After my experience with this patient - he waited 72 hours to be admitted when his admit instructions were clearly written down! something is wrong with that! - I wonder what the significance of presence really is. If the system is this messed up, shouldn’t we be directing all our energy towards changing it? But what about the people who need the system now and can’t wait while we pursue our quixotic and likely never-ending quest to fix it?

The school year begins again in a few weeks and that means countless days sorting out school fees and uniforms to get children into school. It’s an important task but when I remember what the school is like I occasionally ask myself, “Why bother?”

We've been fortunate these last few weeks to have a visit from Ian, a volunteer who was hear in the late 1980s and is now back checking out the place. He has a blog of his own, which is interesting. I especially like the pictures he scanned and posted from his time here way back when.

The blog is at http://immichie.wordpress.com/.