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.

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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."

Monday, July 14, 2014

More Post Mission Thoughts

Some more thoughts, having to do with my attitude towards short term missions. STMs or as we call in our church STAMP trips have been criticized a lot, and for good reason. Most such trips do for people what they could or should do for themselves, thereby creating dependency and eventually destruction of industries which could prosper without such intervention. Donating food, clothes money, etc have a place- but they cannot make up the whole mission.

HART in my view has been more successful than most other trips. Some of the reasons, I think, as these:

1. Each STAMP trip revolves around supporting an anchor missionary stationed long-term. In this case the anchor missionary is Father Roosevelt who is local and invested long-term. There is great trust between him and his people. Often a foreign long-term missionary lacks this trust, but does carry a lot of trust from his church or support teams back home. The inverse in true in cases where the anchor missionary is a local leader. In HART's case both these problems are non-existent. Father Roosevelt is not supported for his daily living by the Detroit churches, he is invested in his people and he carries enormous trust in Detroit. Each time he visits there is great love and affection, and many STAMP trips have over several years seen his work for themselves and come away impressed.

2. In HART's case there are 2 'medium-term' missionaries, one of whom is committed enough to go to Haiti at least once each quarter. He also spearheads the construction effort for the church HART is building in Haiti. The accountability is stronger with these missionaries' efforts. But such medium-term missions arise out of personal desire and investment into the people. They have found their own personal missions- in the case of one, supporting orphans with medical care and other resources. The bond between the local mission and the overseas church becomes stronger with this quarterly contact.

3. STAMP missionaries are committed to go each year to the same country. In our church each year different STAMP missions target different countries. I remember a STAMP trip to India a couple of years ago, and another one a few years previously, but the frequency of contact and constant investment isn't there. In HART's case there are a few countries they are invested in- Haiti, Uganda, Cameroon, and some others- but this list is limited, and the team is committed to travel to these places each year. The number of people on each team is limited to 25 people but the wait-list is 25 people-strong.

4. Medical care is sorely needed in this region- this does not necessarily create dependency. Without this medical care the people simply will not get any other such care. Best of all, the missionaries make it clear they they are there because they love Jesus. The youngsters who go with the team live in spartan facilities with 25 people to 3 restrooms, having 2 meals a day, supplemented with energy bars they bring with them. Eventually though I think HART would benefit from having a Haitian missionary doctor stationed long term and supported by the church financially.

5. HART is made up of people from 3 different parishes. This is great, and creates the best form of accountability. Also it provides critical mass for the number of people who could be a part of such trips.

6. The 'No Negativity' clause works wonders. Mission trips are often compromised by hurt feelings, sarcasm and other such issues. Most of the time HART missionaries were kind- I can vouch for this, as I myself messed up on several occasions- particularly my lack of care in keeping my sickness to myself- but people were forgiving.

7. Often having heart for missions means saying No to a trip. In this case Tom let me know that his wife did not come because she felt it would be good for some others to be a part of the trip. A true missionary is intentional this way.

I have not yet been on a college church mission trip. But I sometimes wonder if our mission trips could learn from this one. We usually have an anchor missionary who is financial supported by the church and other churches, but local missionaries who partner with them (if they exist) are not heard of at all. In our church we pray for the missionaries we support but not local partners. Such partners also do not come to our church to interact with us. The lack of communication, except in the form of periodic emails requesting prayer and detailing small events, makes for an impoverished form of partnership. Considering that our missionaries are supported financially (each family getting $4000-$5000 a month), this is strange.

We pride ourselves on being a sending church- the fact that half of our annual budget of $6 M goes into missions speaks for itself. Besides this the STAMP teams support themselves, and the long term missionaries raise funds from among the congregation as well as other congregations, which is not a part of the $3 M missions budget. It is likely much higher than the 3 HART parishes put together. We are present in several countries- I wonder if we are spreading ourselves too thin in this way. Alma and I support 2 missionary families in India financially, but the inadequate communication and partnership is not a good thing. There is a lack of clarity as to their work, and there is typically no mention of local ministry partners, no requests for prayer for such people, no introduction of such people to the team in the US.

Medical missions in my view are an excellent way to minister to people. I do not see a focused effort to build such teams in our church. A lot of point to ponder.

Tuesday, July 8, 2014

Post-mission thoughts

I'm still processing all that Haiti meant to me, and I look back and realize that 9 days have the power to change the course of a life. I had not actually expected this though I was told this time and again. The common mission model is that of having an anchor missionary in a place and having teams of short term missions full of eclectic people with varied skills come in to do focused work throughout the year. The anchor missionary should be accountable and trustworthy in order to be able to do this effectively. To avoid situations wherein teams of short term missionaries go to third world countries to build a house that noone lives in or paint a building that then gets abandoned, the missionary needs to plan for these short term trips in advance.

I'm glad to say that our Haiti trip works well in that limited sense. It is only once a year that it happens, but Wayne State University is going in December, and I believe other teams go there as well. Father Roosevelt is clearly a man of the people with his heart firmly planted in Point a Raquette. He lives in modest conditions, and while there are those in the US who would ask why he is building a church when he could use the money to help the material needs of people (like a disciple famously asked Jesus why a woman would spend so much money on buying a perfume to wash his feet rather than spend it on the poor), he knows his people and they love him- it is so obvious.

I also see genuine faith. The petty differences in denominational affiliation that mark us out in the US or for that matter in India do not apply here. Protestants here seem not to carry so much baggage from the protesting attitude stemming from Reformation history against the Catholic church. Catholics on the other seem very similar to protestants in their worship. The sermons I heard and conversations I had with both US and Haitian leaders in Haiti point to this fact. The "bipolar gospel" or the "evangelical two-step" that makes a firm distinction between salvation of our souls and the desire to see God's justice accomplished among the poor also doesn't seem to exist. The people I met were worshipers and seekers of justice. There is no such thing as a "mercy ministry"- it is part of the package.

I've thought long and hard about going back with the same group. It opened my eyes to be part of a Catholic group, the leaders of which are Christian in every way that I consider myself to be. But I wonder if the future holds another opportunity to make more opportunities to go with another group. HART has a group of 25 who go yearly- they also have a waitlist that is 25-strong. After 5 years of serving God in this way, this has become an established mission group. They also go to Uganda, Cameroon and other places.

Father Roosevelt tried hard to get Joyce to return independent of the group. She wasn't sure, but clearly there is great need for more people to go. If we can have another group going to Haiti it would help the cause. I checked with Tom to make sure there would be no issues concerning a different denomination serving with him- he assured me that there would not be.

A recurring piece of conversation is the capability to implement EMR. Each year they talk about it but where there is scant internet access (except in the rectory) and difficulty in carrying networking equipment, computers and printers, not to mention the money needed to customize the EMR for the Haitians' needs, it has become a tough task. Although this is the case, I have an idea to create spreadsheet-based EMR that is not networked. Just like the triage forms we use now, we could fill out this information in a spreadsheet-based form which would then be consolidated into a table. The data from the triage, nurses, doctors and the pharmacy would then be consolidated at the end of the trip, and uploaded to a central location. It would need laptops (preferably tablets) with Microsoft Excel installed in each, as well as portable light printers capable of printing 1000 forms each day. Each station (doctor/nurse/triage/staff) would need to have one. Clearly this would limit our ability to carry pills and equipment due to baggage restrictions, but if we could get this equipment to Haiti as a one-time expense, it would help future missionaries. I will talk to Tom about creating this.

Another thought I have been having is about creating awareness. Tom and I talked about the intentionality of missions. Most of us in the team could afford to buy a ticket to Haiti and back with our own money. But one of us, Dr. Post created a letter that he sent to friends and associates in order to raise funds for the trip. This way a partnership could be established and more people could share in the riches of God's kingdom- the rules of which are to serve people that he came to save. Both Tom and I have had conflicting thoughts about publishing our activities on social media, in that we need to be careful to draw a line of distinction between promoting ourselves and sharing the news of God's transformation of the Haitian people. This is tough because our own motives are often mixed.

Friendships are among the most treasured souvenirs of this trip. Besides the friendships among missionaries, the bond between people in Haiti and myself is a priceless thing I would not trade for anything. It has been a very long time since I have seen people go out of their way to do something out of love, even simple things. This opens up a whole new dimension of Jesus' character that I have seen but also seen it fading away over the years.

More such thoughts, and I will try to pen these down in the next few days...