A terrible tension we live in:
The micro view: A man stops me in the hospital today and greets me. I recognize him as the father of a 3-week old baby that died last night. The baby came in from home in a serious state, and despite our best efforts, did not pull through. It came about that the parents are strong Christians, they have six kids, and this was to be their last, mom having gotten her tubes tied in the last couple weeks. Because his child didn't make it long, his bill is not big, maybe 50 USD. I would guess that his standpoint is that he is a poor Christian man, who brought his baby to us, and we didn't save him. He looks to his brothers and sisters for help.
The macro view: Tenwek Hospital has been here for over 50 years. We see 130,000 outpatients a year, and admit over 13,000. We do innumerable surgeries. We have tons of donated professional labor from missionaries and volunteers. We have donated meds. People give donations for our buildings. We receive HIV/AIDS grants from the US government, to provide care for HIV patients. The patients are charged for the care they receive. And if you come to the hospital with a monetary need, say to hire another doctor, or to pay the nurses more than the sub-government wages that they currently receive (resulting in high turnover which affects patient care), you will get a single answer: There is no money for this. Why? I have talked to a lot of people about this, and though I'm sure the answer is multifactorial, the biggest piece seems to be collections. We don't actually get paid for the fees we charge. Why? Again, multifactorial, but the biggest reason seems to be that the community has had 50 years to learn that we are money-givers, and won't enforce our collection policies. Thus, even many who can certainly afford to pay, don't. I'm told that the hospital has the deeds to huge amounts of land, taken as collateral for bills. They could claim them, force the people off their land, sell the land, and then we could run our hospital better, with less turnover, and more financial sustainability. Anyone want to go for that option?
My reaction to all this is to largely take a 100% retreat from any financial investments or giving. Just be here to be who I am, instead of what I can give. This is less than satisfactory, for reasons I'm sure I don't have to enumerate (read the book of James), but also because (from what I gather) becoming a full member of African society includes some element of financial interdependence. So the answer doesn't seem to be at either extreme, which means that the answer is going to reside in some place of tension. And it can be terrible at times.