Unlearning

Our supervisor Suzanne asked us what we learned during our trip. It was really hard to answer her. It felt like we did more unlearning than learning. This isn’t actually unusual, but what’s unusual is for me to admit this, even to myself. Sometimes after I get back from a trip, I focus on writing down all the ideas which give me a comfortable feeling of certainty. For example, I feel confident that a rural hospital in DRC can make some progress at plugging its leaks, losing less potential revenues, and becoming more sustainable. It seems like in our trip reports, I focus on such comforting islands of truth, while ignoring the raging sea of confusion all around them. Here are a few examples of areas where I feel like I know less than I did before.

1. How involved should we get in church politics?

Both CMCO and CEFMC (Congo’s two major Mennonite church denominations) have been going through a certain amount of upheaval recently. Different people tell us different things, and most people’s point of view makes sense – until we hear the next person’s version. Sometimes I think we don’t have enough understanding of the situation to take sides. However, we do take sides in a way, through our actions: in a general way we support lay initiatives, and involvement of laypeople in church decisions, rather than unilateral top-down decisions. We support free movement of information and informed debate by sharing information when we can. We also require clear reporting and accountability for money that we give to others, no matter who receives the money. And we try to share information about what MCC is doing in Congo, always including specific dollar amounts, even before people ask, so as not to give anyone a chance to use knowledge about MCC as a way of holding power over others. But beyond this, we try to stay fairly uninvolved.

I have quite a lot of ambivalence about whether we should get more involved, or not. By not getting more involved, are we empowering some in the church at the expense of others? Would that happen regardless of how involved we got? Are we taking ourselves too seriously if we think that MCC’s involvement actually makes a difference to anyone here? Or are we underestimating the effect that our involvement, or lack of it, has on the situation? Will we look back in five years and conclude that staying relatively uninvolved helped contribute to more dysfunctional, authoritarian leadership? And yet, how can we possibly refuse to work with rural hospitals just because some faraway, high-up leadership is involved in a conflict or isn’t publishing transparent financial data? These questions continue to niggle at me.

2. We saw first-hand that it’s not a good idea for a hospital to replace an accountant with a cashier, while letting the cashier continue to be a cashier, essentially supervising himself. That is a conflict of interest. But, how does knowing that prevent it from happening anyway?

3. Theft happens. Medications can be stolen right from under the nose of an excellent medical director. Fortunately, the theft was discovered and a new system was instituted in which the pharmacy doesn’t collect money from patients directly. The next month, sales in this pharmacy almost doubled, reaching levels never attained since the beginning of the project. Was this a coincidence? How much other theft is happening that we are unaware of? It’s likely that detailed analysis of pharmacy revenue patterns helped us to discover this theft. That feels kind of good… I guess.

4. It’s better when different donors don’t support the same beneficiary at the same time and in the same way. E.g. WHO giving medications to Kajiji hospital when they already have plenty of medications. Perhaps the recipients of the double gift can be convinced that they don’t need more WHO medications and that other health centres can benefit from these. But the larger question is, how can hospitals here deal with the reality that different donors will always be choosing to give them things, based on their own priorities, and without necessarily consulting the hospital? How should they organize their pharmacy to deal with medications from a variety of sources and with a variety of prices? Technically, this problem is solvable, but only if there is a good, collaborative relationship with the Health Zone office. If that is lacking, then a lot of things will continue to stagnate.

5. When a church’s sound system is turned up too loud, I will no longer endure sitting in special visitors’ chairs right next to the main loudspeaker. I will get up and move to the back of the church, where things are a lot more interesting anyway. The woman next to me will whisper questions and explanations, I get to practice my Lingala, and smile at beautiful babies. The downside is that someone might make a comment from the pulpit about our decision to move to the back, and everyone might stare at us. But after some reflection and consultation with various people, we have determined that we are not deeply offending anyone, and so we will choose to take care of our ears first. In some ways we can fit in, but in other ways we will always stick out.

6. It’s a lot of fun to play “Big Boss, Little Boss” (a card game) with hospital staff, as long as you change the game a little so that the top position is “medical director” and the bottom is “travailleur ordinaire” (i.e. the grass-cutter, sweeper, or cleaner at the bottom of the salary scale). People got really into this game where everyone competes for the top position, everyone gets to heap abuse on the person at the bottom, roles are constantly shifting but things are rigged to keep the top person at the top, and you can complain all you want to about the injustice of it all, in the presence of those people with whom you work every day. It was a good reminder to me that there are many things we don’t understand about how power works in a rural hospital.

7. The air in Kinshasa is extremely polluted. We noticed this from the airplane when, several kilometers outside the city, we flew into a thick white cloud. At first we thought it was a fog or mist, but the pilot explained that we were just back in Kinshasa smog. It’s worse than usual now, at the very end of the dry season. As soon as we arrived, both John and I got headaches that persisted into the next day. Coincidence? Dr. Benza asked John once what impressed him in Europe during our vacation. John said, large trucks that drive quietly with no emissions. We all laughed loud and long at this bizarre concept. In any case, we and our fellow Kinois are all waiting eagerly for rain.

Maybe on this trip I learned that it is OK to stay afloat on the messy sea of uncertainty, rather than docking on an elusive piece of solid ground and holding on for all I’m worth. Or maybe I learned that the ground really isn’t that solid anyway.