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?”