Bodies and Souls

The training on diagnosing and treating mental illness went smoothly right up until it didn’t - which was the point at which we offered $5 to each participant for coming, staying on our tab for four days, and learning how best to care for their patients. 

One older head nurse began drinking during the last meal and wouldn’t stop – apparently, we were to be his DD in order to see the condition of the route to the hospital where our seminar was held. 

I had given up a precious Saturday for the closing of this training and was doing everything except literally flapping my arms and hooting to herd everyone to the door like a bunch of lost (or drunken) sheep.  Unfortunately, 3:00pm to 4:30pm saw a steady stream of complaints and a lovely zigzag of pointing fingers that would’ve intrigued a seasoned knitter. 

“You can’t expect us to come here for $5!  It’s $10 each way for some of us!”  - Head Nurse 1

“You should have lied to the donors – they don’t know the reality of the situation!  You should have said you were paying room and board, and used that money to pay us directly instead.  We’re Africans – we know how to débrouillons-nous!”  - Slightly Less Diplomatic Hospital Rep

“We would have come anyway, because the training is the important part, but you should have told us it was going to be $5.”  - Slightly More Diplomatic Hospital Rep  

“You really should be paying them more.  This is ridiculous.”  - Department of Health (governmental) Employee

“Our annual budget was cut by 35%!  It’s the donor’s fault!”  - My Organisation

“But you’re our partner on the ground – you provide the planning!”  - Donor Rep

Someone give these people whatever the all-fired heck they need to go home because I have a date at 6:30pm and if I miss it, I swear to cow…  - Me

“Where is the Medical Director??”  - Head Nurse 2

He’d been perfectly aware of our budget, had been provided with a copy, and had accepted it – he could have shared it with the participants, and apparently should have.  He wasn’t available for questioning because he was in another village for the day – ostensibly for supervision, but likely because he foresaw the dung hitting the windmill.  In the end, we scrounged up $10 per participant just to get them to go home and not drink themselves into a stupor at a boarding school for nursing students; anything to set a good example.  In return they refused any amount and went home in a right snit. 

“Well, it’s actually the fault of the head nurses themselves; they get all this money from projects in their health centres and they’re used to helping themselves!”  - General Consensus on the Way Home

There is an appalling lack of responsibility and accountability here.  No one wants to be the bad guy, so we all blame each other and keep doing the same stupid things and expecting a different result, thought the person who’d helped modify the budget and thought that $5 was a perfectly acceptable amount of motivation to attend training, but who’d kept suspiciously silent during the kerfuffle. 

But do you see why lying is bad?!  Why we can’t justify paying both room and board and a daily transport fee?!  I don’t care if UNICEF offers a per diem of $10/day – per diems, in my world, are for qualified people’s time and input for a study or a policy change, not for glorified students!  Even as an Indian, you don’t see me asking a university to pay me to attend classes, do you?!  HMM?!

Answer:  No.

So we will now personally visit each participating head nurse in their individual health centres (which were deliberately chosen far from the hospital in various directions with the idea that they may be the most in need of support and training) in order to give them $20 for learning something, and to provide them with the registers in which they will record the mental health cases they receive (and which they will stop using when the pages run out or when the project ends – whichever comes first).  We cannot just wait for the monthly meeting, at which time they would all meet at the hospital anyway, as this would have added insult to injury.  As a result, they would’ve made life (and results) difficult for our female field worker, who would have to deal with them for the remainder of the project. 

In the end, we all learned several important lessons:

Medical Directors are perfectly justified in encouraging local partners and staff members to lie to donors because they just don’t understand the actual situation – and apparently cannot and should not.

The government officials who have a vested interest in the continued filling of this leaky bucket – less work and responsibility, and higher consulting fees under the guise of ‘capacity building of the national system’ - are in the right.

Donors should be giving more vast sums of money with less control and demand for accountability – it’s imminently clear that largely uneducated, poverty-stricken rural recipients (supposed beneficiaries – after a long line of middlemen) with large families know how best to use available resources and the nation-wide improvements in the last 50 years prove it.    

It’s the fault of NGOs for starting this terrible practice of providing external, material incentives for learning – and it’s up to all of us to continue it because locals need money; it is the key to social and cultural change, as well as supporting families of 8-10 children.

Wherever the fault lies, it’s a good thing the Bible has something to say about crushing the head of the adder and the asp.  Or is it the young lion?  Maybe the young rat...

He had to quit school to provide for his little brothers and
sisters after rat dad walked out and rat mom was killed on duty

On another date night set to the sound of a much smaller rat asphyxiating very slowly in the kitchen, I had to continue to wrestle with this theme of mercy and justice.  After listening to the hideous creature cry miserably for over an hour, and having Joseph gleefully demonstrate just how to put it out of its misery, I finally womaned up and gently hinted that Butters should just step on its head.

And my (I use this term very loosely) Anabaptist man delivered. 

Because sometimes cruelty wraps itself in the softest mantle of kindness.