When Helping is Hard (Part 1): That sort of decision

This story starts in May. In May, Mike was in Laos in the middle of his first seven weeks at his new job. I was in LA wrapping up my own job. Mike was trying to find his feet in a new place and in a new life. I was trying to disengage from familiar people and a familiar life.

We were in very different places – not just physically – and as we spent my evenings and Mike’s early mornings talking via skype, I frequently found myself feeling torn. I did want to hear the honest truth about how things were in Laos and try to support Mike through the first shockwaves of this change. But as I was tearing myself loose from LA and preparing to step into the whirlwind I also, often, found myself longing to just hear the reassuring message: “We totally made the right decision. Everything’s great. You’re going to love it here.”

Some days I got that. Many days I didn’t.

The night that Mike first told me about Sommai, I didn’t.

The day before, Mike told me, he’d received an urgent phone call from a staff member, Edena, who was based in a field office four hours outside of Luang Prabang. There was a very sick sponsored child in her district, Edena said. Sommai was seven, and lived in a remote and inaccessible village. There was no cell phone reception or road access in this village – it was another hour north by motorbike, and then a twenty-minute walk into the hills.

Edena didn’t speak very good English. She couldn’t explain what might be wrong with Sommai, but she did manage to convey that he needed urgent medical care or he might die. She wanted Mike’s authorization to send him to the district health center, but here was the big problem with this situation (or, rather, the tenth big problem): the family was very poor. So poor that, even with the organization committing to cover most of the bills that would follow, Edena didn’t think that the family had the money to pay their quarter of the treatment costs.

So Mike was left wondering what to do. The organization has many good reasons for its policies requiring some family contribution for medical care. There are also good reasons why it’s standard practice that the family pays the initial costs that are incurred and then files for reimbursement. Mike couldn’t just ignore these policies, but could he really sanction delaying or denying assistance over what was (to us) a relatively small sum of money?

As soon as possible after Edena’s call, Mike met with child sponsorship staff in the Luang Prabang office. Together they searched for a solution.

No, the staff confirmed – Mike could not circumvent these policies just because he felt like it. Perhaps, the staff suggested, the family could borrow some money from the village development bank (a small community fund set up in many villages to help in emergencies just like this one).

Only, three hours and numerous phone calls later, it turned out that this village didn’t have one.

Then they discussed whether Mike should write to the national director and ask for an exemption from the family contribution co-pay.

Mike was torn on this, and in the end it was the national staff that tipped the scales towards a no, citing two things Mike already knew. The organization supported thousands of children and they couldn’t make exemptions for all, or even most, of them. Perhaps even more importantly, the staff said, if they sought an exemption in this case many other families in the village would also claim extreme poverty. No one would pay their share, and it would ultimately make the job of the field staff much more difficult.

“Sommai’s family will find a way to borrow the money from relatives or friends, or maybe the staff in the field will help out of their wages,” the Luang Prabang staff told Mike. “We should wait.”

To Mike – a month into the job – it seemed like a gut-wrenching gamble to take on the life of a child, but he took their advice and sent the message back to Edena. The organization would help. As per policy they’d reimburse most of the medical expenses, but the family had to come up with the initial co-pay.

“What do you think?” Mike asked me that night in May, over skype, “How do you make these sorts of decisions?”

In California, sitting alone among half-packed boxes in our quiet living room, I shrugged even though he wasn’t there to see it. How did you make that sort of decision?

“I don’t know, Mike,” I said. “I don’t know.”

Sommai lived. Over the next day or two the family did come up with the copay – they borrowed money from their relatives, and others who lived in the village. Sommai was transferred to the district health center. Soon after that, on the urgent recommendation of the district center, he was transferred to Luang Prabang where he spent six days in hospital before he was discharged.

After his return, from back in the village, Edena reported that he was still a very sick little boy, but recovering.

A month later, Mike and I were still chewing over this case. One beautiful evening in June, three nights after Mike arrived back in California, we took a break from the chaotic hard work of boxing up our lives. We sat on the porch with our good friends Matt and Hilary. We sipped sauvignon blanc. We layered triple cream brie and dates on water crackers. We talked about Sommai’s case, and others, all night.

You never stray too far from these conversations when you’re in a job like Mike’s. Physically you can be thousands of miles away, sipping wine and eating imported cheese, but the questions and the dilemmas don’t stay behind – they never stray far.

So Hilary and Matt got an earful. They plunged into the experiential waterfall of Mike’s early days in Laos with full attention and keen interest.

Three nights before we left Los Angeles, we had dinner with Matt and Hilary again. As we were leaving Hilary passed me an envelope. Inside was five hundred dollars in cash.

“Here’s some from us,” she said, “Our part. Maybe it’ll help. Maybe next time there’s a Sommai, or you see a need, maybe it’ll help knowing you have some in reserve.”

We were both awed by this generosity, and grateful, but Mike was also a bit worried.

“Money’s tricky,” he said to me later. “What if we can’t use it soon, or they don’t approve what we do with it? What if…”

“Stop it,” I told him. “Matt and Hilary love us. They gave this to ease burdens. They trust our judgment and know that we’ll be best placed to see ways this can be used. They won’t care if it takes months, or a year. You are not to worry about this, of all things.”

[Next time in Part II of this story, Score One For Policy, Mike and I visit Sommai in his village]