Development dilemmas

Igor and I were contacted a few months ago by a small US non-profit organization that was trying to make a humanitarian aid donation to a hospital in one of the Chornobyl-affected towns not too far from Kyiv. The US organization has worked with Chornobyl-affected communities for many years, but I’m not sure if they’ve done a big humanitarian aid shipment before. They were having a hard time getting responses from their contacts in the town, and ended up writing us asking if we could call there. To make a long story short, we understood pretty quickly that this town and this hospital were not interested at all in going through all the rigamarol that is required to receive humanitarian aid in Ukraine.

The US organization had already started the process on their end, though, having collected several thousand dollars in contributions and started working with a bigger US not-for-profit to put together a shipment. See any problems here? Might want to talk to your beneficiaries before you start preparing a donation.

So we made contact with another hospital in the Chornobyl-affecteded territory, and after confirming their interest in receiving a humanitarian aid shipment, we suggested the US NGO donate to them instead. They quickly agreed. And then the real fun began.

Igor and I would love to see this hospital get some help. Their budget has been slashed this year, and the place was already not so hot to start with. We toured the surgical and intensive care wards earlier this year and wow, was it ever eye-opening. I know the doctors and nurses are doing the best the can with what they have, and I don’t mean any criticism of them at all. They just don’t have much to work with. Most of the buildings within the hospital complex are over a hundred years old, and much of the furniture and equipment I would put in the same era. The one ultrasound machine they have is from the mid-1970’s. We were told there are no computers in the facility.

This hospital is also a bit leary of humanitarian aid, having had some not-so-great experiences in the past with so-called donations. They showed us the incubator that doesn’t maintain a constant temperature, donated by a European country a few years ago. I have heard such stories before, of companies and organizations (even governments) unloading old, broken, and/or expired goods onto needy institutions as so-called humanitarian aid. It’s very sad, I think, and while they may get good press at home, they seriously hurt their own reputations in the recipient countries.

Anyway, Igor and I have had to do a lot of negotiating (much more than we ever expected to need to do) with both sides of this arrangement to get them to understand each other’s needs. The US organization has been focused entirely on just filling a container with medical equipment (no medicines, thank goodness, ’cause that’s a whole huge nightmare to import), without really taking into account the local needs. We had to be very insistent in conveying the hospital’s requirements that no used furniture or equipment can be accepted for the maternity or pediatric wards. The point person for the US organization got really frustrated with me for pushing this point over and over, and finally snapped “It’s not like we’re sending junk! It will be gently used and refurbished.” I wonder if she’s ever thought about the consumer protection and other laws that limit the kind of goods that can be used in US hospitals? Why, just because it’s a poorer country, should the people in Ukraine be expected to settle for crappier stuff? “Who are you doing this for?” I finally asked her. “For yourselves or for the patients and staff of the hospital?”

We also had negotiating to do with the hospital, explaining that no, it was not reasonable to ask for several million dollars to build a new wing of the hospital. We did pass along their comment about no computers, though, and much to my surprise the US organization scrounged up some used laptops that they will send with some people in May. We have had to work cautiously with the hospital, though. No one is very interested in taking the time to fill out the lengthy application forms, which of course are all in English, but we have insisted that while we will help (mainly by translating), they have to do the bulk of the work themselves. Other than our first meeting, all business since has been conducted by official letters. This is cumbersome and slow, but Igor insists that it is the best way so as to avoid any confusion and negative accusations later on. I trust him on this, and agree it’s better to be safe than sorry, and a written record is our safety net.

The latest dilemma occured last week, when I received an “urgent” email from the US organization asking to talk as soon as possible. It seems that in the description of services provided that were listed in the hospital’s application form was “Family Planning”. This caused the application to be bounced back from the big NGO to the one we’re working direclty with. I guess in the US, “family planning” is code for abortion. During our phone conversation, the US NGO folks said “I know abortion is legal in Ukraine.” “As it is in the US,” I interjected. “Yes, yes,” she conceded, “but this is a Catholic organization and they are concerned about it.”

Amongst all the important and valuable services the hospital is providing to tens of thousands of patients a year, in an economically depressed region that is also suffering from a range of Chornobyl-related issues, the entire application was boiled down to someone’s interpretation of the term “family planning.” A term which, I might (and did) add, includes actual planning of families, like pre-natal care, counseling, parental classes, and yes, contraceptions and probably abortion.

We seem to have averted the “crisis” by talking to the hospital and getting their confirmation on all the services they provide that constitute “family planning”, which pretty much match the services I described. We passed along the information, and are awaiting the next steps of the process.

I am still struggling with my own personal dilemma of being really frustrated with the American organizations for their assumptions and their willingness to dump this needy hospital because it provides a legal service – or at least it seemed like they were willing to dump the hospital; I wonder what they really would have done if we’d reported back only “yep, they do legal abortions.” I wouldn’t want to jeopardize the hospital’s chances to receive this much needed equipment, though, which meant I had to squelch my own personal reaction and resist telling the Americans to shove their humanitarian aid where the sun don’t shine.

I imagine they are struggling with their own compromises. Even though we’ve all quietly agreed to shade the subject in gray, I imagine it still is hard for them to support what they perceive to be a medical procedure that is wrong. How would I feel about providing medical equipment to a hospital that conducted legal female circumcision (aka female genital mutilation)? I would have serious issues with it. But perhaps I could do my best to not provide equipment or supplies that could be used for this procedure? This shipment will presumably not include equipment used to conduct abortions, although hospital beds, medical gowns, surgical gloves, sterile syringes… I don’t know. I’m still angry at them for their assumptions, but I’m also still struggling with the dilemma.

Update April 2010: Giving the wrong way