Saturday, August 30, 2014

My Failure

A few days ago a former colleague shared with me that another former associate was facing some difficult times. He was doing alright financially and at work, but his wife had been diagnosed with cervical cancer. The local hospital had declared it inoperable and he had taken her to the University of Chicago Hospital, which is a teaching hospital. I called him and he asked me to pray for him. He said he was hopeful that his wife will be healed, and that many other friends are praying for them. I offered him help with looking after kids or any other meaningful help, but he lived a ways from me, and though he acknowledged my offer politely, did not take me up on it.

This friend is a very socially active person. In the days when we worked together he organized the local Indian community to donate food and supplies to a local humanitarian organization called Loaves and Fishes which helped the homeless. He also teamed up with the pastor at a large Assemblies of God church to work with his community to support Loaves and Fishes. He has been working with the mayor and leadership of his city to support community activities among Indians. He is a leader in the local shakha or wing of the community organization Hindu Swayamsevak Sangh. This organization enables training in Hindu virtues and doctrine. Borrowing a page from Christian youth education, they have Sunday school-like classes, along with social activities with a cultural twist, including regular picnics and camps. He has hosted Hindu victims of persecution from countries which have treated Hindus shabbily, and his love for them is genuine.

Often in conversations he would complain about his job and the fact that many people around him do not respond to his work rightly, that often there is unfairness in performance reviews. He firmly believes that Indian ethos means essentially good things, and anything such as rape, female infanticide or other social ills in India are in fact foreign and the result of the advent of Kaliyug, the final dark ages in each cycle of an aeon, which repeats itself infinitely.

Over the past few weeks many events in my life took my attention away from his case- sicknesses and deaths of near and dear ones- and I followed his updates on Facebook. Recently he mentioned that his fruits and flowers which he placed before the idol in his home showed traces of a sacred flame, and felt that these were signs that God was listening. He also posted messages of thanks to over a hundred (literally) friends individually. These people had visited him, helped him tangibly, bringing food, prayers and other elements of support. He posted pictures of some of them, and was touched by their support.

From my own interactions with people, I have often wondered how much they are called to sacrifice to move out of a community with such strong ties and pledge allegiance to Jesus. To a person whose life revolves around such community ties, we often offer a poor imitation of the real thing. Missionaries, especially cross-cultural ones, intentionally offer them real and sincere friendship, but I wonder if such things could ever be a match. Granted, my friend was so active socially, that a lot of this is natural. I doubt that even if with my own family and friends numbering in the hundreds, I would receive such love and support in such a situation from so many.

Is it any wonder then, that when we approach a person with the message that Jesus loves her, she finds it nothing more than a well-intentioned generic message of God’s love that she could uncover from any religious text anywhere? The message of Jesus’ sacrifice is singular and unique, but as we proclaim it as a proposition, without proof in and through our lives that He indeed loves her, I don’t believe that what we are proclaiming is in fact the full gospel. If that were the case, we could send notes containing the basic message of the gospel and not inter into anyone’s lives at all.

In the book ‘In the Company of the Poor’, Gustavo Gutierrez, credited with coining the term ‘Liberation Theology’ in his 1971 book ‘A Theology of Liberation’, says, “Liberation Theology begins with the question, ‘How do we tell the poor that Jesus loves them?’” Sharing the gospel with the poor must accompany our understanding of their longing for justice- and not only eternal justice, but temporal justice as well. Without the missionary herself identifying with the poor and actively undertaking to accomplish justice on behalf of the poor, I believe that what the missionary preaches is in fact not the Gospel. Liberation theology is often accused of having a horizontal focus with even an intentional denial of the propositional gospel. This is not universally true of liberation theologians, though, and while I think this is a serious mistake and denies the gospel outright, I believe the propositional gospel as a proposition, as a set of facts without a personal context is not the Gospel. The propositional gospel must inform the contextual evangelization and the love of the missionary for the people in order for it to be the full Gospel.

There are reports of people having come to faith by just reading the Bible. The Holy Spirit works to accomplish what we cannot. I believe that this upends all our claims to be effective workers for the kingdom. In that sense, the propositional gospel enters into the lives of people through God's direct intervention. More often, though, God works through people to make this happen- and He himself seals the deal through conviction, repentance and faith.

History is replete in many places, and often in India, of missions attempting to replace a community’s most cherished attributes with a culturally compromised version of the Gospel- and not just in the songs, religious text, practices, holy days and community. Sometimes this is necessary, but often not so much. I feel I have let my friend down in his time of need- but many others, some from his community and some others from outside it- have not. In my goal to be an intentional missionary to everyone that I come across, I have failed miserably to care enough for this person. And this should be food for thought as to whether what I’m sharing is the full Gospel.

Tuesday, August 26, 2014

Giving up on God

I found this article in The Guardian and posted a comment on it. The link to the article and my comment are here:

Article: http://www.theguardian.com/lifeandstyle/2014/aug/25/ebola-africans-die-god-american-doctor?

Comment (appearing on Page 8 of the comments section):

I think this is an important question to ask. Is Dr. Brantly justified in thanking God, when many others are dying of the same disease, some even after receiving the medicine that Dr. Brantly did? I think the answer, unfortunately for most people, is not and cannot be simple. We have all heard the reasons that believers tend to give: that God has a better plan for everyone that we cannot see, that man, not God, is responsible for these deaths, because of our callousness towards those in need, that God’s purpose in suffering is to save or strengthen souls.

While these explanation serve to strengthen faith in believers, people who ask questions like the one Ms. Hanson asks are not looking for these answers. For each question there is a context, and Ms. Hanson shares hers: the inability to relate to God as being transcendent from physicality (this is significant, and not puerile- as a transcendent God could be misunderstood to be absent or uncaring), the lack of divine retribution for offenders (or as a corollary, sorrow and pain for many devout), a view of the faithful as being intellectually impoverished and as peddling God. These do not cover the range of reasons as to why people disbelieve, but they are some that are mentioned in the article.

It is important to realize that God’s goodness does not necessarily equate to principles we have derived, say from nation-building or economic efficacy. Therefore it does not translate to pleasant lives for all- or for that matter, even pleasant deaths; or equal economic status or rights. This is not to say that such things are not good- but our judgment of God is not based on whether several thousand die of Ebola, is it? Isn’t it based on the question why even one person has to die at all- of Ebola or anything else? Or in other words, isn’t it based on why there is any suffering at all?

Works by people like Dr. Paul Farmer show us how in history human beings have created systems that have killed others. Poverty has not appeared in a vacuum. It has been even intentionally created and perpetuated by people. In his book, Infections and Inequalities, he demonstrates how diseases like AIDS, Ebola and TB, as well as natural disasters strike and kill the poor disproportionately. The 2010 Haiti earthquake cost the country its entire GDP, and 250,000 people died, while millions were injured or displaced. Earthquakes do not kill many people directly, falling buildings do. We have the technology to prevent these building collapses, and they have been proven only recently in California, how even with a moment magnitude of 6.0 no lives were lost though there was financial damage- a mere $2 Billion as one newspaper estimated.

People looking for a simple answer to God’s workings are not likely to get it, because such people are not asking real questions. For example, you could ask me: “If God exists, what does his toenail look like?”- as Ms. Hanson asks in the article, clearly in a facetious manner, but the point is well taken. That question is not so much a question as it is rhetoric. Ms. Hanson clearly gave up on God much before she says she did. The question to ask, then, is this: “My heart and mind are looking for meaning, in my life and in the lives of others. When people die of horrific circumstances in the millions, I fear that there is no meaning. Is there meaning anywhere” The search for God is a sincere search for meaning.

I would like to tell you that there is indeed meaning, and it is people like Dr. Brantly, Dr. Farmer, Dr. Gary Haugen and several others who follow God’s call to serve those who are victimized, who find it. Many others do as well, even without such sacrifices. It is not my place to judge them. They are content with the answers they have been given. Each of us must seek God from our own vantage points.

If the history of our struggle against suffering could be juxtaposed against our agonizing questions, we find that God has indeed intervened on our behalf. We claim science has delivered Dr. Brantly, and not God. Dr. Farmer’s research, as that of many others, shows that pills alone don’t make anyone well. The heart of God makes ways to reach each of us, despite our active campaigns against it. “Giving up on God, ever” is a statement that reveals intent, not conclusion. I pray that you will continue your search.

Friday, August 22, 2014

Soulless Faith

The pithy sayings that permeate our lives in church: "if you find a perfect church, don't go there- you'll ruin it", or "there are no perfect Christians, only forgiven ones" aim to discourage seekers from finding a people who could be held to the standard of Jesus. But how about if a person looking for a church was in fact looking for Jesus himself- the perfect spotless lamb of God? Shouldn't she find Jesus among the people? Sure enough, she may find Him if she were to use a magnifying glass- in the songs, praises, homilies, quotations from the Bible, and so on. Often they substitute genuine passion for passionate oratory, music and "relevance" as evidenced by their astute understanding of prevailing zeitgeist

.But what if she found a people who wouldn't allow non-Christians to join their schools, and did charity instead of seeking real justice in the world, who cared about personal piety rather than the spiritual bankruptcy of the world, of political victories rather than kingdom victories, of allaying one's conscience rather than always living in the tension between the world's tragedy and Jesus' hope? 

I have seen this since coming to the US- and though initially disillusioned, this eventually gave new meaning to those pithy sayings. Truly, there are no perfect churches- but there are churches in which the gospel is long lost, then there are churches which are "Bible-believing" in that they believe in a set of propositions that sum up the Gospel, which if you believe you are saved, but whose lives don't look very much like they are indeed saved. I think this is the case with every person who was saved in the third world and has come to the West hoping for maturity of faith and fiery passion, the kind they see in some of the missionaries who visit their country every so often.

Unfortunately, just as they do not find such passion, most of these people succumb to the culture and become passionless themselves. They become the imperfect church. Curiously enough, in my experience, I have seen something else happen- the passion that once symbolized the churches in India, fledgling at the time, has been long lost- though they are now thriving in therms of the number of members and seekers and the resources at their disposal. Their conversation betrays a strong theological understanding and a global experience with the practice of such theological discourse.

In my opinion, the sooner a person discovers this the better. The disillusionment that follows may yet give way to a renewed desire to be not conformed to it, but to change. People I have seen who are pillars of faith have been often the most troubled. They are our teachers along the way.

Paul Farmer from Mountains Beyond Mountains:

If you’re making sacrifices, unless you’re automatically following some rule, it stands to reason that you’re trying to lessen some psychic discomfort. So, for example, if I took steps to be a doctor for those who don’t have medical care, it could be regarded as a sacrifice, but it could also be regarded as a way to deal with ambivalence.

I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that because you should feel ambivalent. 

The tension between the world's tragedy and God's hope- we should always live there. That is the only place to have real hope. We cannot take our eyes off either end. Even as we lessen our psychic discomfort, it should never be fully done away with. Even as we may be discouraged often, we must never lose hope. On the one hand, our churches revel in God's abundant provision- of salvation, of hope, of creature comforts, of healing. On the other, we defend ourselves on being imperfect- why should we? Shouldn't we lament instead that the person of Jesus isn't found among ourselves when a lost soul comes to seek him?

Monday, August 18, 2014

Mountains Revisited

After so many years, I listened to the Audio Book version of 'Mountains Beyond Mountains' again, the book that first talked to me about Haiti and inspired me. Annie Dillard is right- it unfolds with a force of gathering revelation. It was all I could do to hold back from tears towards the end, just before the Afterword, when Farmer, Kidder and assistant Ti Jean have spent 11 hours walking to seek out 2 patients and resting under a tree in the starlit Haitian night on the way back to Cange.

I read this interview with Kidder on Huffpost recently, by writer Mark Klempner.

MK: Do you feel you were able to get to the truth of what makes Farmer tick, and how his organization has been able to gain so much traction for their idealistic principles?
TK: The little t truth. The big T truth doesn't belong to us.

Wednesday, August 6, 2014

Persons of Promise

India’s Public Sector in 67 Years of Independence

‘Commanding Heights’. That was the phrase which India’s first prime minister, Mr. Jawaharlal Nehru used to describe the role of the government in shaping India’s economy. For well over 50 years this was true in India, nourished by substantial investments, broadened in scope and size, encompassing financial services, healthcare, education, mining, manufacturing, food production, services, manufacturing, research, transportation, hospitality and tourism, this philosophy was followed assiduously by each succeeding government. The private sector was reined in by an elaborate system of licenses, permits, taxes, inter-state levies, joint-sector (public-private partnership) agreements and other devices that kept checks on profits and investments. In the early nineties, following a well-publicized liquidity crisis, the Indian government began a long process of policy change, involving overseas loans, currency deregulation, divestment from many public undertakings, encouraging foreign investment by institutions into its financial markets as well as direct investment into its industries, the movement of currencies across India’s borders, and other reforms.

Early on India’s creditors- the International Monetary Fund, the World Bank and other overseas lenders and investors insisted that the divestment take place fast and decisively. There has been foot-dragging on this which has persisted to this day, some bolstered by arguments which had merit, others simply due to political, bureaucratic and populist inertia which has often proved counter-productive. Often the divestment initiative has overlooked some large industries which are profitable and has remained within government ownership and control, some others which are unprofitable have been spared the ‘fire sale’ due to large numbers of people employed in such industries, who would face the prospect of mass layoffs under private ownership.

Public Sector- both a Mogul and a Pauper

In retrospect, it may have been a good thing that India began this process slowly- first allowing for less than 50 percent private ownership in key businesses. Reviewing the history of hasty divestment in Russia following the collapse of the Soviet Union and the resultant oligarchies and the flight of capital and cash across their borders, India as a fledgling free-market economy did well in restraining the process as it did. However, the process itself has been devoid of a clear policy as far as the responsibilities of the government in the economy and society are concerned. And thus, the government retained control of several large businesses in manufacturing, mining and services, while neglecting sectors that desperately need their increased and aggressive investment such as public healthcare or law and order.

Even a cursory review of the so-called ‘general hospitals’ in India’s public health reveal to the observer that the number of physicians, nurses and support staff is hardly sufficient to serve the number of patients, not to speak of the infrastructure required for prevention and care. In addition, as is the case with every developing country, infectious diseases, especially ones that strike the tropics seasonally, such as dengue and chikungunya, not to speak of virulent diseases such as cholera, lay waste to thousands of people who could otherwise receive life-saving care and restoration relatively quickly and easily. This reveals other areas in which such investment in sorely needed- sanitation and the availability of clean water across the country, for instance- the prevalence of cholera, especially in the Central Indian states of Maharashtra, Orissa and West Bengal. There is strong evidence that cholera is often underreported in the country as well. States which have severe sanitation problems in the northern regions of the country have not reported cases as frequently as have states such as Kerala, where sanitation is far less of a challenge. Trust in public institutions is low, and for good reason.

Law and order in India has received much less investment. The current framework, built by the British, has creaked and groaned under the severe load of cases, which has resulted in untold numbers of people waiting to get justice in criminal and civil cases, some languishing in prisons waiting for arraignment for decades together, others incarcerated without proper procedure or just outright bullying by the police. Corruption festers in the environment. Low pay, a severe lack of resources, improper knowledge or training in police process or forensic analysis, judicial incompetence or corruption, methods of prosecution or defense which border on manipulation of the law in subversive, often illegal ways, and a myriad of other ills have plagued this system.

Needless to say, these pathologies- as is always the case in every developing or underdeveloped country- affect everyone, but they affect the poor with particular violence. The middle classes, the upper middle classes and the upper classes try to circumvent such challenges using the private sector- and thus the prevalence of large, well-equipped private hospitals, medical schools and private security businesses. The poor by necessity have to depend on century-old systems which are funded poorly by public finances.

It is easy to say that Indians have become apathetic to the conditions of the poor, and there is truth to this. Clearly due to lack of space, homes of the wealthy exist cheek by jowl with the shanties of the poor in India’s large cities. I’ve heard the rich whine about the fact that they are forced to endure such sights, but few have talked about the problems of the poor. But this fact, while significant, may hide the reality that there is only one entity that has accountability and the mandate to ensure that basic services are accessible and affordable to every citizen- the public sector.

A look at the so-called ‘Navratnas’ in the public sector (http://en.wikipedia.org/wiki/Navratna) reveals a myriad of business owned by the government- nearly all of them capital intensive and in fields where the government shouldn’t be operating- engineering consultancies, hospitality, airlines, manufacturing, insurance, mining  and other sectors. A case could be made that part of such businesses- such as insurance and banking- which serve the underserved need to be controlled by the government. But clearly the underserved are not the only people such institutions serve. A large number of staffers is another reason to withhold privatization, but this is not an insurmountable challenge- the public sector businesses have been offering early retirement packages to employees for years; and non-controlling private ownership in these industries could release capital into basic services that Indians sorely need.

The Poor

It is important to understand who we mean by the ‘poor’. As a child, I saw many ostentatious acts of charity which made it clear that such acts were given magnanimously by the rich to the poor. A relative created a clinic and named it the ‘St. Joseph’s Poor Dispensary”. My father found this offensive, and I shared this distaste. He often remarked that using the word ‘poor’ is in fact a reminder to both ourselves and those about whom it is used, that they are inferior in some sense. He tended to interpret in unorthodox ways Judas’ comment in the passage found in Matthew 26: 7-13 about using the perfume from the woman’s alabaster jar for the poor, rather than wasting it on Jesus. Jesus responded to this statement from Judas this way: “The poor you will always have with you, but you will not always have me.” My father’s explanation of this was that Jesus was being sarcastic towards Judas; that he kept talking about the poor all the time, and not at all about Jesus himself.

While I understand this line of reasoning, there is another point of view which presents itself. In his book ‘Infections and Inequalities’, Dr. Paul Farmer writes:

The objectification of the poor is, of course, a risk run by anyone who employs some sort of class analysis… At the same time, I’m not skittish about using the term: striving to understand a commonality of constraint is hardly tantamount to denying the salience of personal experience. I’ve been impressed, in my work in Haiti and Peru, at how often people use the label “the poor” to describe themselves. These people do not share nationality or gender or language or culture; they share only their relative social positioning at the bottom of the ladder.

I too have seen often that the poor use the term to describe themselves. In my father’s understanding, this could be the result of systematic and consistent tagging of such people by others, and they have now internalized such tags, bringing with them the idea that they are lazy, filthy, uneducated, incompetent, and incapable of real accomplishment or emancipation. In Farmer’s view, their usage of the term denotes an accurate understanding of their social situation, which can help them relate to the world correctly and seek solutions intelligently. In my mind, both these points of view have merit, but I believe Farmer’s view can lead the way to hopeful solutions. Emancipation or liberation begins with understanding one’s condition, and addressing it bluntly.

So, who are the poor really? Objective measures to define poverty abound, and can be used to approximate the level of poverty experience by a population. I will not debate the actual measure used, although this too has been a contentious issue, especially in recent years in India. I will however point out what symptoms accompany the poor.

If one’s income, assets, social standing, geographical location or available infrastructure- both public and private- cannot assure a basket of goods and services that must be deemed basic needs (although this basket will necessarily need to accommodate qualitatively more, not less, such goods and services as time goes on and human development takes new definitions), then they must be understood to be poor.

For instance, if a patient cannot receive preventive care for infectious diseases already mentioned, via preventive medicine, routine checks, sanitation, nutrition, protection from the elements and other safeguards, she must be understood to be poor. If a child cannot receive good quality primary education (K through 12) that prepares him for employment opportunities, the child must be understood to be poor. Granted, this often depends on several factors, such as teachers, differences in quality among schools and so on; but having a common set of high standards to which to adhere across the country is only reasonable to expect in any country. If a person needs to spend an unaffordable sum of money to get a good lawyer to defend herself against allegations of civil or criminal misconduct, she must be understood to be poor. If people are typically denied their Miranda rights, or have their premises searched without a warrant, or spend inordinate amounts of time in incarceration while awaiting their arraignment, they must be understood to be poor. If a population suffers from cholera because their neighborhood adjoins railroad tracks along which they relieve themselves, they must be understood to be poor. In short, people who are indeed at the bottom of the social ladder know that they are poor and have no qualms about describing themselves that way, because they see it only too clearly. It is upto the economist to strive to define basic needs- and this definition must vary slightly on the basis of circumstances.

NGOs and the Public Sector

In several recent publications by different authors such as Linda Polman and others, a growing consensus around the role of NGOs has arisen. This consensus claims to not know the solution, but unanimously castigates humanitarian organizations for prolonging the very misery they hope to avoid in places of conflict or disaster. There are authors who posit various solutions, but none of them satisfy- precisely because they add the disclaimer that such ideas only address the challenges faced by NGOs, and do not guarantee their own standing as real world solutions to real world problems.

Dr. Farmer in ‘Haiti after the Earthquake’ approaches this differently. Throughout his narrative of Haiti’s earthquake and its immediate aftermath, he records the bitter debate between those who advocate prevention alone and those who call for immediate care. Farmer, along with experts in the fields of disaster relief and infectious disease, call for aggressive initiatives in both. He describes how poorly equipped the ‘general hospital’ in Port-au-Prince was to deal with the aftermath of earthquake. Prior to the event, it was poorly equipped. Hospitals such as Zanmi Lasante, which Farmer himself had helped create, and the venerable Albert Schweitzer hospital, did provide good care- but the one organization that had the mandate and the only one with the accountability to serve the people of Haiti was stretched and overworked beyond its capability to serve the injured and the dying, who numbered over in the hundreds of thousands. Due to this, several overseas aid organizations and professionals came to help, and they lived alongside the afflicted in tents, which gave the city the name ‘Tent City’. Over a quarter million were dead under the buildings and several more injured, and each tent clinic was like a mini-republic, following its own processes. Some stayed on after the worst effects had abated, and some moved on. Farmer commends the life-saving work they did by pointing to specific successes and how such feats altered the lives of the patients, and it is tough to see how any of it could be a bad thing. But he also laments the fact that humanitarian aid groups bypassed the public sector instead of strengthening it. The general hospital had been crying itself hoarse for support which Haiti’s dilapidated public finances could not supply, and the NGOs, church groups and private clinics provided care far more than building capacity internally. The organization that needed strength was clearly the one that had the mandate and the accountability to serve the poor- and unfortunately it did not get it.

In India, this has worked itself in different ways. Several private health systems such as the Christian Medical College (CMC), still a charity registered in New York, have now become local in operations and leadership. They have carried out work on behalf of the poor and taught and equipped medical professionals with training and resources that are world-class. They have also worked alongside the public sector in service to the poor. While CMC remains an organization where the poor can receive quality care, the number of such facilities has not kept pace with the number of people who need them, and the public sector, as mentioned earlier, remains underfunded and overworked. It is a common sight to see thousands of people waiting in line to see a doctor at the General Hospital in Cochin. All but those cannot scrape together even the most meager fees to pay depend on this facility. Others use private hospitals of differing quality, some affiliated to churches, others created by investors to optimize profits. Some of these private hospitals offer care comparable to the general hospital, but with less waiting time and slightly higher, albeit subsidized rates. Others have multi-million dollar helicopter landing pads on their rooftops, cafeterias offering a variety of cuisines, a fleet of rapid response emergency vehicles, professionals on call and facilities for exercise and entertainment. These newer organizations rarely, if ever, lend a hand to those waiting at the General Hospital.

This gives clarity to the central idea that the government is the one organization that has been given the mandate by the people to offer quality preventive and curative care to the people. Similarly it is the one organization to which we give the “monopoly on the legitimate use of coercive force through law enforcement”, as Gary Haugen puts it in his book ‘The Locust Effect’. While private security abounds in all third world countries, India being no exception, the police force is underfunded, overworked, ill-trained and rife with corruption.

The capital freed from releasing all or part of the ownership of large public sector industries could be used as investment and for the immediate relief of several urgent needs which are basic, and must be provided to everyone.

What of Missions?

Given that it is the role of a country’s own government to provide both preventive and curative care to its citizens; private mission organizations need to work alongside the public sector to the extent possible. This does not preclude providing direct care, especially in medicine- but it does mean that the public sector must be a partner in the process. This could be accomplished in multiple ways. Thinking long-term into medical missions, figuring out ways to keep track of personal medical histories, implementing EMR to assist in the process, teaching medical students to build local capacity, sharing date with the public sector about demography, disease and prevention, are all part of the package.

It is easier to quote specific examples rather than prescribe a process to illustrate this point, because each need demands a different process. Organizations such as CMC, Dr. Farmer’s Zanmi Lasante and other which have invested into teaching local medical professionals have created strength in the nation’s capacity to address medical needs in their home countries. Many have worked with the public health systems in these countries to bring relief to people. But the capital necessary to create more public health facilities and ensure that the professionals are well-paid (a necessary criterion for self-sustaining models) needs to come from the government. Similarly organizations such as Freedom Firm or International Justice Mission which expose the sale and purchase of human beings always work with the law enforcement systems in home countries- an incredibly hard and thankless job- to bring justice to the poor.

Will criticisms cease if NGOs worked with the local public sector? No, but they will make far fewer mistakes. Recently two SIM missionaries, Doctor Kent Brantly and Nurse Nancy Writebol, who were infected with the Ebola virus in Liberia, were given a choice whether or not to be treated with an experimental serum which had not yet been tried on humans, but had shown good results with monkeys. They chose to take it and have been showing improvements. Many people, especially Africans, have been outraged that such a serum was not provided to Africans who needed it most. Although there is real ethical consideration behind the decision to not give the serum prior to clinical trials, given the tragic history of such experimentation in the past in Africa, such voices argue- not without merit- that Africans could have been given the same choice to accept or refuse the serum. Just today, a Nigerian nurse, who treated the first fatality in that country from Ebola just 2 weeks ago, has died from the disease. As the outbreak continues and over a thousand are on course to suffer from the virus this week, the question looms large.

Of necessity, shrill voices will do down the committed missionary, bringing demoralization in its wake. But commitment, passion and expertise are not enough to bring about success. The process of healing a country is complex and ultimately dangerous if the ability of a local population to heal itself is compromised.

Persons of Promise

I titled this article ‘Persons of Promise’ for a reason. In seeking justice, an angle from which to partner with the poor, is to invest in for-profit enterprises. Microbanking and charitable investments are often acts that go beyond the profit-motive. However an economy does not subsist on such extraordinary acts, but on investments to profit investors. Beyond basic needs, the market for goods and services must be open to private enterprise and competition- which is the basis of my argument that the Indian public sector must divest in order to invest into basic needs.

Missions should think- while providing direct care- about strengthening the private sector and enabling individuals to partner with overseas capital to create enterprises which have a business case. I work in an industry which has created 3 million direct jobs and 12 million ancillary jobs in India- all of them positions which pay very well. For an economy to get into gear, to keep producing and being pulled ahead to produce more by fiscal and monetary policies, the initial capital must prove to be a catalyst to employ, to produce, to save and invest; and not only as immediate relief. This is why for-profit businesses are the only realistic solution to capital inadequacy.

I wrote this account bearing in mind a Haitian friend who had lost his job and would be in trouble if he did not find one fast. But in a country where unemployment runs at 80%, how will he manage? I think of how several entrepreneurs have managed to employ themselves in India, and a way out of this dilemma may be for my friend to partner with an overseas investor to create a services business for export. In my line of work this often takes the form of outsourced business processes or technical services. The huge machinery in India that has been privately created to scale such operations to industrial proportions may preclude my friend from achieving such spectacular success, but at an individual level, these are small but effective steps to take.

Sara Groves talks about a group of businessmen from Minneapolis who went to a country in Africa looking for a person of promise who was educated, capable and willing to commit to service in that country. These men would then invest their resources, skills and knowledge into the person. For days they did not find anyone and were frustrated. On the penultimate day of their trip they drove into a village which had been laid waste by HIV/AIDS and contained only kids. They were led by a teenager and had nary an item of clothing among them. Groves tells us that in an instant these men became like fathers, even giving of the clothes they were themselves wearing at the time. When they returned to Minneapolis they decided that the kids they saw would be their persons of promise and they will pour their collective resources and skills into them, to create a community that could then be a catalyst for change in the country.


Just as the public sector has a mandate to serve the poor, the people who will lead a society will by necessity need to be people who are vested- local, self-sustaining, skilled, enabled and empowered. These people must be the focus of our missions.

Thursday, July 31, 2014

Free Market and Basic Needs- Lessons from Haiti

I’ve long held the view that ideologies trump solutions every time but the kernel of truth contained in most ideologies could be opportunistically applied to find solutions and to placate those baying for blood at the mention of a worldview he/she opposes.

In my view the “free” market, the laissez faire industry, a social safety net, government control and accountability for the frameworks and infrastructure that constitute the basic needs of people are not contradictory. Moreover what is meant by government control and accountability is situational- it is different in different places, times and situations, and needs constant revision based on equitable principles. Elsewhere I have argued that economic progress as measured in macro terms such as GDP, NNP-MP, Per Capita GDP adjusted for purchasing power parity and so on is insufficient and even counter-productive.
In Haiti, Tom and I had a conversation on how India compares to Haiti. Tom offered the view that India was in worse shape. This is true if you took absolute numbers into consideration- such as the number of HIV/AIDS patients, the number of people below the poverty line, the number of people without access to clean water and sanitation, etc. 

But when I suggested this to a colleague in our company (a white collar professional who is paid highly and would be considered among India’s 1%), he was visibly upset- he mentioned that the per capita figures told a vastly different story. The per capita GDP with or without adjusting for purchasing power is way above Haiti’s. In nearly every social, political and economic indicator, this would appear to be true- from his perspective. In office a few weeks ago, after Mr. Modi became India’s prime minister, my boss and an American colleague were discussing the social challenges in India. The American colleague mentioned the caste system to be at the root of these problems. My boss was not pleased about this and claimed that the caste system had long been abolished and was not operational any longer. He is a Brahmin, and if one allows for some wiggle room, maybe he is just plain ignorant of the realities faced by Indians at the other end of the spectrum. But he too was right in a way- from his perspective.

I think it is important to note that both these points of view are right. I would like to add another view, which I think is the most important among them all. If one were to use the “per capita” point of  view and list every individual in the lowest third of the population (or lowest strata; the exact percentage does not matter in our current consideration), and tried to understand how many of them have access to resources that would be considered basic needs- clean water, equal and real opportunity to jobs, access to those jobs, good education (in the business language of the community), safety from structural violence, punitive justice, roads, sanitation, healthcare, communications, nutrition, shelter and other indicators to be revised as they are added to the list of essentials- one would find that each country would need to aggressively treat the conditions as if they would a dangerous pathology.

Such treatment would need to be initiated first and foremost by the public sector. We entrust some of these duties- such as the machinery for law and order (police, lawyers and the judiciary) to the public sector (lawyers being overseen by the Bar) because we believe it is the fairest method to govern them effectively. The police is the only monopoly on coercion we allow in any country, except in extraordinary circumstances when the military or peacekeepers take on that role. This is because we fear that coercion can and will be abused by any other party. In fact, of course, even the police forces in many countries routinely abuse their authority. This is another reason why the people in the lowest strata in third world countries need protection. Private security is among the most booming businesses in these countries, and with a combination of private security, bribed officers, lawyers and judges, the rich can and often do get away with crimes- while the poor are often mistreated for crimes they may not have committed. So says Gary Haugen in ‘The Locust Effect.’
In ‘Haiti after the Earthquake’, Paul Farmer makes the point that international aid, social workers, short missionaries (like ourselves at HART) and organizations like the UN have bypassed the public sector and set up NGOs, international political outfits, church-based charities and for-profit organizations to do what the public sector should have done. They are both effective at what they do and ultimately destructive in waylaying the foundations that make for good governance- the lasting and self-sustaining institutions in every country that is driven by local leaders and participation.

In India, institutions like the Christian Medical College with campuses in Vellore and Ludhiana were initiated by American missionaries, in particular by the founder, Ida Scudder who arrived in India as a short term (for those days) medical missionary. Today it is among Asia’s largest teaching hospitals, and though it received oversight from a New York charity, it is very local and self-sustaining. There are several such stories in India of institutions that have been created by others, but nurtured by Indians- my own alma mater, Madras Christian College and other such as St. Stephen’s College and Stanley Medical College being examples.
Without local leadership, they will perish- just like the abandoned windmills described by the anthropologist Tim Schwartz in his book ‘Travesty in Haiti’. Noone knew where those windmills came from, who built them or when. Some missionaries let him know that an unremembered foreign aid organization had built them in the early 1990s and the US military personnel helped maintain them during the occupation, but after they left had fallen into disuse and abuse- some people had ripped out their guts. To Schwartz this was an accurate picture of foreign aid in Haiti- its rips gutted by people who had other uses for it.

In Mountains beyond Mountains, Tracey Kidder describes when he first met Paul Farmer during the occupation in the 1990s. Farmer had gone into the US military compound to speak to a captain about apprehending a murderer who was running amok. People were losing faith in the military because they had failed to bring him to justice. The captain replied that he would love more than anything else to slam him, but he did not as yet have enough evidence that it was he who committed the crimes, though everyone in the village knew for sure. He said he had to follow due process, and without it the military leadership would lose all credibility and would jeopardize its own integrity. Farmer argued back that in a country which (at the time) had no constitutional law, arguing for due process was not logical. Kidder states it was an unusual sight- Farmer who clearly considered himself a champion of human rights arguing for penalty without trial and the captain who had come to Haiti as an occupier arguing for due process.

This highlights the tension between providing direct assistance and building systems which support lasting changes. Both are necessary- and indeed people like Farmer have been doing both. Haugen and his organization have been successful in working with local law enforcement- in spite of widespread corruption and different motives- in creating such lasting change.

In the end local leadership- represented by the public sector- must be responsible for the basic needs of the people. All else is icing on the cake and must be subject to the vagaries of the free market. This is true for India, China, Brazil, Haiti and even the US. If there are 2 million HIV/AIDS affected Indians while the economy has been among the fastest  growing and the third largest in GDP by purchasing power parity ($5.42 trillion) terms in the world, is India really in better shape than Haiti? Ask me another.

Tuesday, July 29, 2014

Even More Post-Mission Thoughts

Local doctors, nurses, physicians’ assistants, medium and short term missionary doctors, social workers, the long term missionary-priest. This would be my ideal mini-ecosystem for medical care in the village in Haiti that we serve.

The advantages of having local professionals is clear. What is less clear is how a well-paid team of professionals can invigorate the economy. High-paying jobs create an average of 4 other jobs in developing economies- I can’t cite the source at this time, but as someone with a business, accounting and economics background working in an industry which has created over 3 million jobs in technology in India and 12-15 million ancillary jobs in the process, I can speak with some personal knowledge to this fact.

A Haitian doctor would earn $6500-7000 a year. Even if half the money goes directly into the local economy (and it will because she would need to build a home, purchase grocery, pay service providers who will maintain the premises, coo, clean, attend to kids and perform several other functions), the economy would prosper so much more. Add to this the other roles I mentioned and it would build a core economic mini-ecosystem in the village. In addition, the medium and short term missionaries could help in building an EMR with internet connection for use by all future teams who come to assist.

In addition to this, a doctor needs to learn more and perhaps teach other aspiring doctors.

What would this cost? Here are my estimates:

·         Doctor’s salary: $6500
·         3 nurses: $4000 X 3 = $12000
·         1 physician’s assistant: $4000
·         EMR maintenance and hardware (high estimate): $2000
·         Doctor’s training and ongoing learning: $2000


For about $27,000 a year, we could support this team of professionals. What would take for it to be a committed figure, given that we are slowing down on funding the constructing church building? A core amount to be raised and entrusted for 2 years- this would leave 1 year’s expenses in escrow, earning interest at 2% or more at a local bank and paying for future increases in pay, while allowing the mission to fund the current year’s pay.

******************************

I went to the Wheaton Public Library to get another copy of Gary Haugen's 'The Locust Effect' for Alma (I already have a digital copy on Amazon). But I couldn't find one, though I did find Paul Farmer's 'Haiti after the Earthquake'. There is a touching passage about an incident Farmer encountered a week after the quake- this speaks so much of the Haitian heart for God and his people:

"Late one evening, about a week after the quake, I spent the better part of an hour trying to convince a gasping, skeletal, young woman, her lungs half-consumed by tuberculosis, not to join the exodus that had emptied the wards after yet another aftershock. We were both inside when the shaking began, and I remember putting a hand out to steady her oxygen tank, which weighed almost as much as she did. Never had I imagined such a scene: grasping the top of a heavy tank inside a trembling building and trying to comfort a patient and wondering whether the whole place was about to come down.

The patient's name was Natasha, and she was alone, except for a young man sitting on the bed next to her. I assumed he was a family member, or perhaps a nurse's aide. It turned out that he was a Good Samaritan, who'd never met Natasha before. He'd just traveled from a town south of Port au Prince with his own sister, badly injured when the quake destroyed their modest house. His sister had died a few hours before, he said, and he'd not yet decided where to go. So he lay down, alone in a fog of grief, in an empty hospital bed.

And then the ground started to shake again. He leapt up to join the general exodus, but saw Natasha straining against her life-saving contraptions, including the oxuyen tank. He stayed in the building and did his best to calm her. Blood was seeping from around the IV catheter in her arm; panicked, she was also tugging against the tube that piped oxygen into her nose. Claire Pierre and I arrived just then and begged him to stay until we could find a staff member to assume these duties. They were both there the next day, still unassisted, but by then he was sitting next to her, reading from a well-thumped Bible. He had also gone out into the fractured streets and found her something to eat."