On Sustainability

I have a few thoughts that have emerged from recent conversations that I would love to share, not as an expert, but as one who is learning. . .these matter a lot to me right now, stepping into a new role of leading our non-profit to support the hospital.

The essence is deciding what does success look like?

A question for mission projects and non-profits everywhere in the world – is what we are doing sustainable?  What long-term impact is the work making on individuals and on society?  Is it bringing about health and better quality of life and happiness?  Nowhere is this a larger question than in Africa.  For the last 50 years, doctors at Kijabe have been addressing questions of sustainability.

The historical solution to sustainability at Kijabe, and in many place, has been education and training.  Raise up talented Kenyan doctors and nurses, and enable them to provide high quality health care.   Unquestionably there is huge impact in teaching and training – much of Arianna’s time and legacy is doing this, and we see the growth day after day and month after month of our trainees into excellent clinicians that will impact the lives of countless patients.

But is it sustainable?

There have been two major ways of in thinking about development work in Africa, and most of us tend to fall into one of the two categories on a regular basis.

1.  Nonprofits try to “fix” things in Africa.  We can offer expertise, wisdom, training, solutions.  We can teach spiritual truths and practical wisdom to make life “better.”
2. If we are good fixers, sustainability and empowerment will follow and the work will be self-sufficient and have no need for out influence.  Aka, eventually we will work ourselves out of a job.

I would say that most mission and development work is built on the idea that premise 1 and 2 are end-goals. I think though, as end goals,  both fall ridiculously short.

Belief 1 encompasses a bit of arrogance and the assumption that life in America is better than where we are working.  Another problem with belief 1 is the temporary nature of a fix.  A great example is my buddy Sam, a 12-year old boy in Kijabe, who really wants a bike.  We brought over an old bike from the states and I let him use it.  I could easily give it to him permanently, and seemingly that would “fix” his need for a bike.  But the reality is that it gets flat tires every few weeks and needs a new inner tube, and he is not in a position to take care of the maintenance.  So I would be giving him a fix that would be very short lived.

Yet another issue is that if the “fix” is the measure of success, then what does it mean when the fix is not achieved?  Is the work invalid if not carried to completion?  Have we failed if we build a beautiful new children’s hospital, and the paint is peeling off the walls a month later?

Belief 2 is founded on the idea of a “fix” in a different form, that local people are best able to fix their own problems and better their situations than an outsider.  Maybe if the patients themselves had painted the walls, they wouldn’t have been worn so fast. . .this could be true.  But what if the metric of sustainability is slow to come, or even impossible?  What if, after 50 years of training at Kijabe, the hospital still needs staffing by missionary doctors?  Does this mean that sustainability, or the fix, has failed?

Likewise underneath belief 2 is a faulty supposition that cultures and people should ultimately function in isolation.  That if we can teach a man to fish, then we can and should leave and go about our work both in good conscience.  But what if his fishing pole breaks and he has no means to repair it?  Or, worse, what if our fishing pole breaks and he would have the solution, but we have made him so self-sufficient that he has no incentive to help us?

I am coming to think that development work should be based on a third premise, one that has less to do with the process than the outcome and that the “fix” and “sustainability” are both false metrics of success.

3.  Actual success is measured within the context of mutually-beneficial relationships

If the first two are solutions, then it means that I can board a plane, travel to the other side of the world, set something up, then climb back on the plane and go back to my former life as if nothing happened.  Start, finish, move on.  The Swahili term for foreigners – Wazungu – actually comes from the work kuzanguka – one who goes around and around.

But the third measure, something that I think is more and more true the longer we live in Kijabe, is that the reality America needs Africa as much as Africa needs America, and on a smaller scale Arianna and I need Kijabe just as much as Kijabe needs us – and that success is found in understanding and working out this reality.

One of the beautiful things about Serge, the organization we are joining, is a beautiful core philosophy – that each one of us needs the gospel just as much as anyone else.  The doctor is in need just as much as the patient.  And that mutual need can be a fantastic basis for relationship.

This mutual need in a Christian sense can be linked to mutual need in a friendship sense – a true, deep friendship can happen only when I need my friend just as much as my friend needs me.  There is something about sharing a life together of combining hopes, dreams, resources, goals and working together that creates a true friendship.  We both need Christ and we both need each other, and in fact our lives are dependent on this.

“I no longer call you servants, because a servant does not know his master’s business. Instead, I have called you friends, for everything that I learned from my Father I have made known to you.” John 15:15

Jesus is changing the disciples’ concept of the basis of their relationship.  Yes he is the Messiah, the King of Israel, but he has chosen to set this aside, to be on the disciple’s level – to need the disciples – and to call them friends.

Part of why we loved Kijabe so much on our first visit was the realization that Arianna was not a better doctor than her Kenyan co-workers.  That Ima and Sarah were rock-stars and they could be side-by-side in the trenches together in all the hard days and sleepless nights.  And now those who were colleagues have become friends, those we laugh with, cry with, and dream with.

I finally have a department at work. . .people who in short months have gone from colleagues to friends.  We do work hard, and probably increase the amount of work for each other double.  But we also laugh together, twice as hard as we work.

Ironically most of our departmental work is on belief 1 & 2, fixes and sustainability for the hospital.  But I think that just being at the table together, day after day, means that we have already achieved a success far greater than any program or project.  We are serving together, rather than fixing each other, and that is a good thing.

So what does this all mean?  I do not exactly know. . .I do know that it means there is no magic bullet or formula for progress, especially if progress is not the end goal.  That deep love and friendships are the most important things in any part of the world.  That relationships can and do cross oceans and borders.  That persistent faithfulness moves mountains.  And that whatever continent you are on, if your friend gives you a chocolate birthday cake, then you are beginning to make progress!

 

*Several additional thoughts, especially on wazungu coming and going. . .there are often good reasons why missionaries or development workers leave the field.  Disease, war, family crisis in home country.  We know people who have experienced all three.  Do they need to end the relationship – maybe?  One team has tried and tried to return to a war-torn part of South Sudan with no success.  They call and communicate with Sudanese friends in the area or who have fled, and despite many prayers and searching every option, there is little hope of returning.

Another situation that several workers faced at Kijabe in past decades was corruption.  These two men stood against wrong practices and consequently were dismissed from their jobs.  Fascinating though, either could have left bitter, and I’m sure there must have been heart-break and feelings of betrayal.  But both still work in Kenya, and despite whatever happened in the past, I have seen both do tremendous work on behalf of Kijabe Hospital in the past year. . .in an unofficial capacity, in ways that are completely voluntary, and will not receive notice or fanfare.  But they are an amazing inspiration.