traveling man

This month has been a little bit unusual for me as I take a little
detour from my usual duties of doctoring, seeing patients in the
hospital, doing surgeries, teaching, etc. I've spent most days this
month away from the inpatient duties as we've been going out into the
community to get the community buy-in for nutrition outreaches and
educational programs (more to come soon), I was doing the music for our
SIM retreat, and now am going to head off for a little break with my
folks down to Botswana. Tomorrow I'm off with our executive director to
visit one of our referral hospitals to examine some monetary issues and
get perspective on the medical care they give there. It's good to leave
the hospital because it gives perspective on why I'm working there, but
it always brings up some guilty feelings as you know the people who are
left behind have to work harder to cover for your absence. No decisions
get made in that independent vacuum that we like to fool ourselves into
thinking exists in America; we can do what we like and the only one it
affects is us. That's an unusual perspective compared to most of the
majority world and one that most Zambians have a hard time understanding.

Zamcowboys

Had an unexpected encounter with my visiting neighbor the other day who
styles himself as the 'only Zambian cowboy'. We were able to swap
horseback riding stories (me: trail riding experiences at camp, him:
working in a stable in Lusaka), compared cowboy boots, and discussed the
merits of straw versus felt cowboy hats (me: pro-straw hats in hot
climates; him: pro-felt hat durability). I have to say, I figured when
I came to Mukinge that I would encounter some different cultures, but I
fully did not expect to encounter Texan culture half a world away. He's
gone back to Lusaka now to finish his course in lab technology, at which
point I am completely sure he will be the only Zambian Cowboy Lab Tech
in the country.

Mukinge...and one string

I was reading about and anecdote this week about Paganini giving a
concert where first one, then two, then three of his strings on his
violin broke. He reportedly finished the concert, and then played the
encore on the single remaining string.
Whether the story is true or not, it resonated with what we do here at
the hospital; despite no phones, our water coming and going and often
full of black sludge, intermittent electricity, overflowing toilets,
lack of funding, absence of IV's and syringes and tape and so forth, we
continue to play our concert for the people around us, and hopefully
most days it still sounds, perhaps not Paganini-esque, but like a simple
song of love and care for the people in the hospital, their families,
friends, and relatives. I'm constantly touched when a patient
unexpectedly reminds me that they can hear that song too, even on days
when I feel like the concert has to grind to a halt because too many
strings are broken.
So, here's to Mukinge....on one string!

the three 'selfs'

I've been reading a lot about cross-cultural relationships and service
recently. One of the new watchwords for any overseas mission are the
three 'selfs': self-governing, self-sustaining, and self-propagating.
These principles I think came about as an attempt to learn from previous
mistakes (yes, it can actually happen!) of neo-colonialism and
superiority complexes often brought in the past (and still brought some
by visitors, aid relief, and so forth) with devastating consequences.
Despite how things turned out, no one had a vision to come to Africa and
create dependency, unsustainable solutions, and destroy the local fabric
of society. I think these three 'selfs' provide important safeguards to
ensure that those models of developmental change don't happen again.
I can't help but remain uncomfortable with the three 'self' model,
however, on some fundamental levels. One comes from the nationals
themselves, some of whom have viewed this movement as an abandonment
that they neither asked for or particularly wanted. Is a forced
abandonment such a good thing? On many levels, it ignores the reality
of the economy of poverty in many of the places where these ministries
work. When a family subsists on 1-2 dollars/day, it is ludicrous to
expect any ministry to that area to ever be 'self-sustaining' without
significant economic and infrastructural changes occurring first. This
simple fact is obvious to the nationals who live and work in these
areas, but in an emphasis on 'self-sustaining' and 'self-propagating'
these concerns are swept aside. Jeffrey Sachs makes the point that
poverty has a threshold below which all interventions eventually lead to
nought because they lack the necessary impetus to grow. If that
threshold level has not been reached, a premature transition to
self-sufficiency will result in the ultimate destruction of the services
and ministry in the area. One could ask that very question of the
hospital where I work -- in the rural areas in our province there is
currently ONE Zambian doctor working in the whole province (at our
hospital already, I might add). Most of our patients total income for
the year will likely be between 200-300,000K (around 90-100 USD). Is
that a situation where the local populace can be expected to support a
hospital?
Although perhaps well-intentioned, I feel that the three-self principles
are an attempt to provide a somewhat easy solution to what is a
difficult problem, requiring humility and sensitivity -- how to be
willing to put yourself at the disposal of your Zambian/national
colleagues and trusting them to spend you wisely. How risky is that --
to open your own resources, money, time, professional gifts, and let
someone else in the community decide how they will be spent instead of
you deciding yourself? Such a concept is almost anathema to someone
from the individualistic cultures of the West where donations should be
ear-marked, reported on, and tightly controlled even after the money has
been given. Such a concept leaves you vulnerable to the people from the
other culture perhaps using more of your resources than you intended
them to, or spending them on different priorities, or even perhaps
'wasting' them, at least from your perspective.
I think that kind of partnership, however, is the one that we are
modeled in the Bible (see the Corinthians giving to the Jerusalem
church, for example), and is one that ultimately shows love and trust
for each other in ways that the 'self' model misses.
Self-sustainability is not a realistic goal; even self-propagation is
almost impossible to contemplate. I think we need to abandon that
thinking and instead look for a servant-partnership role for overseas
missions. I think we have a responsibility to continue to be involved
and supportive to the same levels that we were before, even if we are
not 'in charge' in places like Mukinge anymore. I hope that people
haven't chosen to leave places like Mukinge because that was too hard --
a statement something like 'if I can't be in charge of my things, then I
think I'll just take them and go somewhere where I can'. I don't think
that was the case in the past, but the fact remains that Mukinge (and
many other places like it) have been slowly abandoned by their brothers
and sisters in the West.