when the data doesn't know your name

It’s overcast today, which seems quite representative of how everyone around here is feeling. Yesterday, a little boy died who shouldn’t have.

He was extremely ill and needed more intensive care, and the staff at the clinic knew it. They told his mom that the child should go to the hospital right away. They handed her a referral note and when mom asked how soon the ambulance would arrive they simply said: the ambulance only comes for maternity cases.

It’s a phrase I hear regularly these days as this is the new policy. One of the most reckless public health initiatives I’ve encountered in my 12 years, I don’t know who specifically wrote the new ambulance rule, but it’s maddening. Patients (who are not pregnant) needing the hospital (25km away) are expected to stand on the side of the road and pray someone picks them up, which is doable if you are sniffling or in need of a mere consultation, but absolutely insane if you are unconscious or actively dying. Family members trying to save their loved ones often rush to our home where they speak the words, “maternity only,” leaving us to decide whether to pick up the government’s shirked responsibility – or not.

Not that it changes anything, but at least we know where the policy came from - just follow the money. The vast majority of funding in the health sector right now is targeted at MCH – maternal & child health. Zambia’s statistics are more than embarrassing when it comes to birth outcomes for both mothers and newborns and the influx of money is specifically meant to change that. So long as numbers stay happy and programs are deemed successful, the money keeps flowing which creates huge incentive for health departments to push systems that please the funding source – at whatever cost.

In Zambia, MCH is the priority of today which means that if you are neither pregnant nor post-partum, you are quite literally not the priority. This narrow emphasis has meant that emergency medical services – such as ambulances – have been reserved primarily for maternity cases in an attempt to save all the women in labor… at the expense of everyone not in labor.

The father of the sick boy rushed to our house and begged for help. I explained that while we would normally take him, Jeremy was in Lusaka with the vehicle and that he needed to push the issue with the nursing staff and remind them that an emergency is an emergency – maternity or not. He shrugged his shoulders in a way that resonates with how I usually feel when talking to government workers: preemptive defeat. He turned and slowly walked back – not rushing, since there was no where to rush off to. I shrugged also, mirroring his sadness and simply murmuring in his general direction, this sucks.

Four, short hours later, the sounds of mourning grew audible and the little boy died while an ambulance somewhere sat waiting for a “priority” case to call.

Wavering between acceptance and rage, I called Jeremy and talked/screamed/wept into the phone. We invest so much into community health, give me one reason why we should keep doing so while the people who can save the lives won’t!  The steady voice on the other end reminded me that the clinic staff are just following orders from someone above them – probably from someone who doesn’t care either, but is also following orders – orders from someone who is probably not in this country and whose paperwork keeps them detached from localized pain.

Fighting for women’s health might include reserving life-saving resources for mothers in need but truthfully I don’t think the woman burying her child today feels any bit of solidarity in this fact.

The ambulance policy is just one piece of a much larger MCH package by which women and children are being victimized for the sake of better outcomes on paper. Along with the promise of an always-available ambulance, our village received a “mothers shelter” which is a waiting house for women who live far and need a place close to the clinic to stay while awaiting childbirth. The concept makes great sense. On paper. But after the NGO seconded the building to local staff, the warm and welcoming maternity “shelter” soon became a concrete and controlling maternity “jail.” All women – even those who literally live across from the clinic ­– are required to move into the shelter a minimum of a month before delivery. If a mom goes into labor without having slept in that shelter, she is issued a fine. If the fine is not paid, the child’s immunizations are withheld until she pays.

Awesome. (insert face palm) 

Women loathe the shelter because they are consistently under-fed and constantly worried about the children they have left unattended at home. Many resort to using herbs and traditional “medicines” to induce labor – the only hope of jail break.

Apparently the only way we can improve delivery outcomes is to hold mothers hostage. After all, according to clinic staff, “You know how these women are.” Actually yes, yes I do, I know quite a lot of them, and they would love a safe and competent delivery in a place where they are treated with dignity and respect. And what’s happening here is not that. I was once asked by a regional MoH official why I chose to birth my children in America instead of at our local clinic and I couldn’t find any words for him other than, “are you serious?” The disconnect is unreal.

I have two friends who delivered babies in the last month. One mom, six weeks after moving into the mothers shelter delivered a baby that only lived a few hours. Mom had torn significantly during labor but the attending nurse, wanting either to protect herself or to avoid recording the infant’s death, decided to handle the stitching on site. For three weeks, mom was refused discharge while “waiting for her swelling to go down.” Finally the family demanded referral. Transporting her home from the hospital, I asked what the OB-Gyn had said. Sitting on her left hip and staring blankly out the window she answered, “he asked who the hell did this to me.” I gripped the steering wheel a little tighter, stewing on how I’m sure my friend must be so glad to have spent two months in maternity prison only to walk away empty handed and unable to sit.

I ran into another mom-friend crying outside the shelter. Her eldest, a three year old, had fallen into a fire and been terribly burnt. With mom gone at the mothers shelter and without a consistent person to watch him, the boy had been neglected and seriously injured. I encouraged her to go home and take care of her son, reminding her that she could come back if she went into labor. Wiping tears from her eyes she explained that she couldn’t leave because she wouldn’t be able to pay the fine. Realizing she wasn’t going to take my anarchist advice and just walk out, I told her I’d look after her boy’s burn care. With every dressing change, listening to him scream for his mommy, I felt both their pain. A few weeks later, mom went into labor and this baby too did not live. She went home to her burnt child, and wept bitterly for days.

Every funeral feels like emotional deja vu and I yell into the phone at Jeremy who is missing all this while enjoying ice cream in the capital, Is this what “saving mothers” looks like? Systemic violence and denial of agency, and still, the children die? I don’t believe for a moment that the public health experts want this. I’ve seen their shiny white pick-ups arrive for data collection, occasionally accompanied by a researcher from the US, looking very “fresh-out-of-Michigan-in-the-winter-white.” Brilliant minds have rallied around the challenge that is improving maternal & child health and their skilled research is meant to drive productive change. The data says “do this,” so the money creates systems to “do this” and the people on the ground are told they’d better “do this” – but I’ve attended three baby funerals in the last month and something here seems remiss.

And maybe, today, the people who call the shots and cut the checks are staring down at papers and not people, and they are looking at numbers and not names, and they will produce P scores that say this is all ok because, “on average,” the initiatives are working. But 184 villagers will gather around another little coffin tonight, and a mother will bring her burnt child to me for a fresh bandage, and a young woman will wince as she gingerly sits on a wooden stool, and none of them have the luxury of knowing where their stories fall on the scatter-graph. 

I don’t believe that the researchers who are driven by faceless data and impersonal  indicators are evil or that they hate women, but I don’t think they hear the stories that matter either. “Data,” as compared to living, breathing humans are two different sources of information and the unspoken confession of the NGO world is that data is just less messy to handle.

Sometimes, I’m frustrated by our search for funding to make our work go farther and deeper only to hear, “you’re too small.” Really? And by too small you mean too intentional? Too compassionate? Too relational? I get your math and what you mean by “efficient,” but my moral compass won’t lead me down that path. The individuals matter. The Big Numbers will win the Big Grants, but neither will feel the weight of grief resting on this village today. A small body will be lowered into the ground and the data capturers of Big Aid will take no responsibility because they didn’t even know his name.

Raphael.

His name was Raphael.

pastors' response re: OCC

Last year, I wrote a blog post concerning Operation Christmas Child in Zambia and the breakdown in expectations between box packers and what is happening on the ground. I particularly highlighted that churches are paying money to the National Team to receive their boxes. Since this post has recently re-gained traction, OCC has published an official response.

The original blog post can be read HERE, and OCC’s response can be read HERE.

As many, many people have forwarded OCC’s note and asked me to respond to it specifically, I feel morally obligated to do so. However, not wanting to speak on behalf of our region’s Pastors without their input and permission, my husband, Jeremy, and I chose to first sit and talk with the leadership of the Mansa Pastors Fellowship. What they had to say was challenging to say the least. Desperately wanting to see change, the pastors requested that their words be shared with the larger audience that continues to follow this issue.

To provide readers with the most accurate account, I’ve chosen to transcribe the conversation with our local Pastors. My words are italicized, and all plain text are direct quotes from the Pastors. The transcription has been edited slightly for readability and length, but none of the pastors words or sentiments have been changed. Bracketed text has been inserted for clarification purposes only.

---

26, October, 2018

Location: Wetuna Gardens, Mansa

In attendance: Missionaries Jeremy & Bethany Colvin, and four members of the Executive Leadership of the Mansa Pastors Fellowship.

 ---

The number one question I’m getting is, ‘has this issue been resolved,’ and I’ve been avoiding giving the answer because I don’t feel like it’s my place to give your response.

[Reading of OCC’s official statement, passing out to pastors, after which the pastors take turns speaking.]

Some more than ten years ago, the same [National] team came to Mpika with one gentlemen from America and his wife. I was just invited, I wasn’t in the management team. During the discussion, that gentlemen from America was explaining that these shoe boxes reach the beneficiary free of charge. ‘It’s free. It’s covered in the costs.’ So… when his explanation was heating up, it was perceived it was going to attract questions, like, ‘why are we paying?’ and so [National Team Member] came out and spoke in Bemba, saying, “Bane, ifya ku sosela tafyawama…” (Brothers, tattling is not a good thing, let us not report each other.) And the gentlemen from America asked, “What are you saying” and [National Team Member] said, ‘I’m just clarifying for them,’ as if we weren’t getting what he was saying. And so in a matter of ten seconds, he [National Team Member] changed everything that the gentlemen from America was saying. To shut us up. And no one could speak against that. And it has haunted me for years that none of us was bold enough to tell the truth. And that gentlemen went with that perverted version of what is happening. What’s happening now is just a repeat. When they came to Mansa they brought a pre-typed letter saying that everything has been resolved and we the leaders refused to sign it.

I was very disappointed when I read this letter from OCC because they are shooting these gentlemen [fellow pastors around table] and hiding criminals in the name of this update. The least they could have done would be send some folks who are not a part of this, and instead they send [the National Team] to come and ask us questions. But there was nothing like questions, they just came to threaten us by saying “your children will not benefit from this.” And they have carried out their threat. Last year we did not receive boxes and this year, since we have not heard anything, we conclude we still aren’t receiving. They came to shush us. It was a rebuke. As if we are doing something scandalous, trying to stop something that’s beneficial to the children, when actually the key issue is trying to expose an immorality that has been going on.

They [the National Team] are the principle suspects. They are cashing in on the program. Why should they be sent to investigate? [OCC] should have sent an independent person or group to come and hear from us. That could have given us a fair trial. But now the same group comes here… what kind of investigation is that? They’ve been in this thing for more than ten years. And they have been manipulating the system.

[National Team Member] has bought a truck, and that is the same truck he uses to deliver the boxes. We suggested here, “Can’t we send our own truck to collect the boxes” and he said, ‘no, you have to use our truck,’ because it belongs to him and he charges [for its use], and that money goes into his pocket. Is that not corruption?

When we were told how much we should pay per box, for Luapula Province, it was more than K200,000 ($20,000) and for Mansa specifically it was K40,000 ($4,000). To bring a truck from Ndola to Mansa, you can hire that [a private truck] for K3,000 to K4,000, now they’ve charged K40,000 and where has the rest of that money gone?

Before the boxes come, they [National Team] has to come and do a training, but when we look at the cost implications of the [training], we pay a flat fee per church but then each individual Sunday School teacher has to also pay and you are required to send a set number of people to the training per X number of boxes you are to receive which forces the churches to send more people to the training, each of which have to pay to attend. The [National Team] says the money goes towards their accommodation here, but what happens is they will come and see us in Mansa, Samfya, Nchelenge all in one trip without sleeping here yet still having collected all that money. And this doesn’t include the payments the children have to make.

And when they [National Team] came they said, “No, the reason why we are charging you is because there are other regions that are more vulnerable, like Shangombo,” and then when you call Shangombo, you find out that they’ve paid too, so its all a lie.

They [the boxes] are not helping in terms of building the church. If anything they are destroying the church. Our colleagues from Ndola have not been faithful. We are not against paying something, but when the money does not go for what it was said it was for, it’s going into someone’s pocket, and then they declare that God has blessed them… that’s what we should discourage. And so if the same individuals are being entrusted with the task, then I would say, its better not to have it. Unless if they [OCC] can find a fairer system to help the churches. Because like our brother said, they [the National Team] has been doing this a long time. This is something they [National Team] has gotten used to, they aren’t going to change. If they [OCC USA] is going to keep using that same channel, then I think let it not come to us.

The little I know about Americans is that they champion the spirit of openness, the free mind, freedom of expression… now when we want to express ourselves, someone comes and says ‘shut up’ and follows with an action – suspension – now are they representing the spirit of the donor? Let the American people know that when things are pointed out by the locals here, they [National Team] stop giving boxes to people who are reporting those wrong things.

We are the people on the ground. We know ourselves. We are Zambians. And these people are Pastors. How can I submit to [National Team pastor] who is cheating me? If it were just a secular person we could just say, ‘well they are sinners,’ and let them go. But these are people with collars, showing the world that ‘we are servants of the Lord.’

What has to be highlighted is that an investigation has not been done. What was done could just be termed as a cover up – an intimidation. OCC, Samaritan’s Purse from the United States has not investigated. What’s missing categorically from this process is an independent inquiry towards the actual interest of protecting the huge investment that is being put into all this. It’s no longer even what we can call a gift box. They [the donors] would be amazed to learn that the children are buying these gifts and those people are proud to sell. I remember one of them [national team during training] trying to encourage us, “even I’ve benefited a lot just from doing ministry to children.”

In this section on the official response, it specifically says that the $9 covers shipment to the countries and to the 1,100+ delivery sites within the country. I don’t know how you read it, but it makes it sound like boxes are supposed to be sent from Ndola to Mansa and then from there the distribution costs are upon you. But what I hear you saying is that you were even willing to help cover the Ndola to Mansa cost – which just shows how much grace you have in the situation. But this is what a few hundred thousand people in the US are waiting to hear, whether this issue has actually been resolved in terms of the churches still being charged to cover transportation to the distribution sites – Mansa, Solwezi, Choma, Chipata etc. That’s what people are waiting to hear.

Actually I just called Reverend [name withheld] since I know they are still receiving boxes and I asked, ‘Were you charged anything this year?’ and he said ‘Yes, we paid for the boxes as a church.’ And he explained that they were told, ‘Don’t charge the children but you as a church pay for the boxes,’ and they were given an amount to pay and he also said, ‘We know how these people are, they’ve really benefitted from these boxes so just know that the way you’ve started talking to them, you’ll not be receiving boxes,’ and I said, Exactly! We didn’t receive and the Reverend said, ‘yeah, that’s what they do.’

These things are not gifts any more. These are enterprises. Those people are no longer qualified to represent Samaritan’s Purse. We speak for Zambia. We have to do whatever it takes for the sake of the children we are representing here. We know that those people are stealing from the children – it’s not speculation. It’s not rumor. Because [states denomination/branches around the whole country] has paid money each year for the children we have registered. We have receipts. It’s everywhere. It amounts to thousands and thousands of dollars. That’s what has been covered up. And no one seems interested in that.

Are there things that you want HQ to know?

We don’t agree with the statement that the matter was resolved because those who came to investigate are the suspects and secondly, the whistle blowers have been suspended for two [cycles] so far. Was this the resolution? Or is America aware?

We have not seen the values that OCC has projected to us applied in our region. If OCC can come up with a different [National] team whilst they are carrying out a proper investigation it will really serve us.

How connected in the past have boxes been to child evangelism. Are children coming to know Christ or are the boxes just a demonstration of Christian love.

The program is not happening like its supposed to. The same kids get the boxes over and over, and it’s the ones that can pay for them. [Evangelism] has been the emphasis [of training] in the past but practically, no. When they [National Team] comes they conduct those programs and say, ‘this is a tool for evangelism, and the emphasis is that the child will know how Jesus loves him through another child sending them this.’ But this is not evangelism. A lot of people are participating thinking we can just pay ten kwacha and get a box and go home.

If we could convince them [the donors] to just send it [the funds], it would be a very good idea, because I feel that even though this is for the sake of Christmas, the things that the kids get, and we thank God that what they are getting is American standard, but still it doesn’t really meet the needs of the children. These kids get a box – they’ve never been to school! They might get a toothpaste that is of a higher American standard, but we also have toothpaste here. So it’s nice that Christmas comes once but we can use cheaper things and in that way Christmas can go on and have a more lasting impact. Maybe we can convince some to just turn that [their box] into money. Because child-centered programs are incredibly important. And there’s a lot that can be done to mitigate the challenges that the children are facing.

People have asked us if there are alternatives. What if we were to put together a list of needs within the churches (school fees, blankets, clothes etc.) and collect funds to connect people with Mansa directly to meet tangible needs?

It can really have a lot of impact. We would be more confortable if our friends in America would be able to convert their boxes into cash so that we partner with Jeremy & Bethany [choshenfarm.org] in terms of administration and accountability for those resources. As we partner with you [Colvins] it would be an opportunity for the Church to focus on what it’s supposed to do and in a way that its supposed to be done. We have to go the Biblical way with structures of accountability. It’s not about dishing out money, its about making sure that things are done Biblically and people are accountable to leadership that is set.

We didn’t know what to do about this whole thing but the sharing you did, God used it to try and help us find the way to really address an injustice. We were stuck. We thought they [the National Team] was the beginning and the end. We didn’t know there was elsewhere we could report and other contacts we were able to get through to and you were able to do that for us and I think that was a major breakthrough. And now we are hoping that we can use our voice and correct this – even if they [OCC] doesn’t support us any longer – but maybe correct it for the other regions that are receiving, that would be a major breakthrough, and God will have really helped us.

I think the transparency of this is really helpful and people are going to thank you for taking something that was previously in the dark and putting it into the light.

---

Meeting closed in prayer. 

why you should think twice about giving “gifts” to the poor

A gift! How thoughtful! Thank you!

I remember back in the day, driving to spend Christmas with certain relatives, my mother would always prep us with, “now remember, no matter what, you need to say ‘thank you’ and be grateful, ok?” Now that I have kids, I’ve taught them a similar script – A gift! Thank you! – and I’ve communicated my expectation that they not embarrass me by being ungrateful brats.

I’ve thought about this lesson a lot lately – how saying thank you is an act of both gratitude and basic decency. Furthermore, I’ve thought about it outside the context of my childhood Christmases in America. I’ve thought about all the gifts that we personally are asked to hand out on behalf of donors and even more about the thousands of OCC gift boxes being packed NOW that will pass through our region next spring. OCC is by far the largest “gift-giving ministry” working world-wide and as such they provide the most obvious examples. Among the many negative articles circulating about OCC lately (like this, and this, and this, and this) one push-back comment I keep seeing is, “Remember, these are gifts.”

I’ve written about OCC myself – more than once, in fact – so I obviously have thoughts. But it wasn’t until recently that I honed in on that repeated phrase – remember, these are gifts. Every time my eyes read that line, I’d think, yeah, so? until Jeremy and I were talking about it and we remembered to pass the phrase through our magic ‘America filter’ and it donned on us – Mom’s telling us to be grateful, regardless.

The third world and missionaries like myself who are attempting to serve here, have spent a good amount of time and energy trying to communicate a specific message to the generous peoples of the first world: random stuff from America is not helpful. But then mom reminds her kids again to be grateful… and what’s left to be said?

WELL, how about this:

The following is why I believe “But it’s a gift!” is neither relevant nor appropriate, and why you should think twice about giving “gifts” to the poor.

Let’s say a friend of yours has been struggling financially. She finally comes to you and says, “hey, I need to fill this prescription for my kid, but it costs $50 and I just don’t have that,” and you respond, “Aw, girl, you know I love you! Here’s a gift basket of stuff from Toys R Us worth $50!” And she just stares at you and doesn’t immediately say thank you and you get all feely and annoyed by her ingratitude… Your actions would have been unreasonable, right? No one could be that insensitive or crass as to not meet their friend’s stated, pressing need… Right???

Meet the need first is fairly intuitive in this case. But the reason why most Americans don’t respond as instinctively when it comes to giving unnecessary gifts to the poor overseas is that they are too far removed from third-world poverty to get it.

America has a lavish gift-giving culture; we give presents for everything!  New Baby! House Warming! New Job! But despite this generous tradition, many, if not most, of the people we are giving these gifts to aren’t simultaneously looking for solutions to life-threatening situations. Most Americans have never been confronted with the either/or dilemma of “meet a desperate need” or “give a random gift instead.” The struggle is quite literally foreign to them.

The driving proviso behind, “But it’s a gift!” is that Americans (as a generic unit) can afford to spend money on unnecessary things all day, every day – and we assume others do to. BUT, the developing world does not function this way. Luxury is appreciated when it comes, to be sure – but by luxury, I’m not talking fancy jewelry and the latest iphone. Luxury in our village is water that has spent time in a fridge, a car ride (instead of a bike ride) to town, and getting to eat the gizzard of a chicken. So let me say this: it is ignorant and tacky to pretend that frivolous luxury is a reasonable replacement for basic human needs that are not being met.

You can give any single unnecessary item from Target to your best friend and rightly expect a thank you from her because she probably has a roof over her head tonight. You can give a bag of party favors to your neighbor kid and even tell the goober to say thank you to you because chances are good that kid is getting fed tonight. If your friend didn’t have a house and your neighbor didn’t have food and you knew that but decided to use your expendable cash to buy trinkets instead, the word ‘negligent’ would be appropriately applied.

In the place where we live, families routinely go hungry, don’t have shoes and can’t send their kids to school. Our neighbors sleep in crowded huts, wear the same clothes for a week and walk miles to see a nurse. And yet, with this scene as the backdrop, the same American Church that can manage to buy millions of dollars worth of “Just because we love you!” gifts refuses to use those same dollars to alleviate human suffering.

Americans have the luxury of having skewed priorities because, by and large, their needs are already met. What would truly change the American-gift-giver’s perspective is an exit from the first-world bubble and a true desire to know what the legitimate, third-world needs are. From much experience, I can say that, once on the field, it does not take long for American bauble to look alien and offensive when the intended recipient in front of you is either hungry, sick or afraid.

In case I sound like a gift-giving curmudgeon, let me free ya’ll up: Buy the candy and the bouncy balls and the glow in the dark toothbrushes. Yes. Go ahead and buy them. And send them! But here’s the caveat: Do that AFTER you’ve made sure that each and every recipient has a home and clothes and food and everything she needs.

You see, that same mama who taught me to be grateful at Christmas also taught me how to spoil the people I love. Here in the land of Where there is no Target, we have to wait for many of our American items to come across with visitors. Because space is limited and our list is usually pretty extensive, I have to do some negotiating with my mother to make sure that the innate Grandmother urge to spoil her grandkids doesn’t usurp actual necessities. Because I know she loves me, I’m free to say, “Grandma, the kids don’t need sugar. They need vitamins and socks and school supplies. Can we prioritize that instead?” And Grandma always says, sure! Because as much as she loves – and lives – to spoil those grandbabies, she cares about them enough to make sure their needs are met first.

So she sends vitamins and socks and school supplies… and all the s’mores ingredients that the left-over luggage space can handle. Despite my joking protest, the spoiling with sweets isn’t bad. We just need the other things as first priority. If I had told Grandma our needs and she had said, “I DON’T CARE. IT MAKES ME HAPPY SO I’M SENDING MARSHMELLOWS AND NOTHING ELSE…” Well shoot, Grandma. That wouldn’t be very loving, now would it?

If your gut reaction to negative press for OCC is, “they should be thankful,” you need to recognize that it is your purchasing power speaking – not compassion towards the poor. Because yes, all humans should be grateful for gifts, no matter what. But it is not ingratitude that leads those of us working amongst the poor to make the needs known. It is necessity. And urgency. And Stress. And if that does not call you to sympathy, you are in this for the wrong reasons. 

Giving gifts to the poor aught not be a consumer activity. But when first-world donors announce that they will only pay for that which makes them feel good, this “generosity” takes on a controlling element that needs to be exorcized. A true gift is one without stipulations, including your desire to “participate” or “teach your kids the true meaning of Christmas” or to foster some artificial “connection” to a small child far away.

Leveraging financial privilege in a way that self-gratifies and puts the rich-giver ahead of the poor is not Christ’s way.

Psalm 41:1 says it right:

Blessed is the one who considers the poor.

Are you considering?