A rant, updated

The day after I posted my angry indictment of the Ugandan health system, we got word that the shipment of ARVs, for which we had been waiting for months, had arrived at Bundibugyo hospital and that some of them would be brought down to Nyahuka for the ART clinic the next day. It was a huge relief to everyone, and I can only imagine how much more it means to the people who are benefitting from these drugs. Only one small problem remained – Wednesday, the day of the ART clinic and the promised delivery date for the drugs, we got a phone call that no one would be bringing them. “This person is busy…” “I’ve just been called to a meeting…” “He can’t come today…” The drugs had made it all the way from Kampala and were then sitting a scant eight miles from the health center, and no one felt it worth their while to do their job and transport them that last stretch. I was livid; I could have hit someone. It was simply infuriating that a medical system could be that broken. It’s fascinating to me that people being paid for this work can simply ignore it to that degree, especially when not doing it can directly cost people their lives. So, into the 4x4 I hopped and drove up to Bundibugyo town to pick up the drugs, a very simple task for which I’m no more qualified than anyone else, only that I was willing to do it.

That made me think. Was my quickness to jump in the truck and go collect them one of the reasons that no one would bring them? If there were absolutely no other way, would someone from the hospital have brought the drugs? I wonder if some of these behaviors prevail because some people know that, when it comes right down to it, the bazungu (white people) will do it anyway. There’s no doubt that everyone, including me, feels less responsibility for work that will get done without them. I wonder if my eagerness to help may in fact help perpetuate the brokenness of the system. I wonder where the line is between helping where help is needed, and permitting people to shrug off responsibility, allowing the system to remain broken. We have sometimes talked about the principle “First, do no harm” – creating dependency is definitely harmful in the long term, but how do I try to meet people’s needs in a way that doesn’t create some level of dependency? It’s hard to know. And then a part of me always says, “forget all that theory, just see if you can do something to improve someone’s life.” I think that it’s good to have that attitude as well, but then you can quickly come back to the problem that what’s good in the short term can create long term problems. So, stepping back, my reasoning has taken me nowhere. I’m still at a place where systems are broken and I can’t do anything about it. A place where I don’t really know how to balance meeting needs against creating dependency.

I suppose that, if this were easy, I’d have already read the answers in a book.