As I come to the end of my placement, my last day in the hospital was today, I've spent quite a bit of time reflecting on the last 26 months spent with VSO & volunteering in Cambodia.
Recently I was talking with a friend of a friend who works for a large international NGO & I asked her how other NGOs view VSO. VSO is regarded, I was told, like a cultural holiday for middle class people or Raleigh for the middle aged. It was not considered 'proper' development work by many.
So has the last 26 months just been a glorified cultural holiday for me? Is volunteering with VSO not proper international development or humanitarian work? Where do I go from here?
I can't contest that this is the view that other agencies or people have about VSO, after all everybody is entitled to their own opinion, but I can argue against the assumption that VSO is a holiday or that capacity building does not represent effective development.
If VSO is a holiday I think I need my money back.
It has been a great experience living in another country, learning a new language, making Cambodian friends & learning about a new culture. The Cambodian food put pay to the Cambodian weight loss plan. But working with MoH health workers in MoH facilities & watching people needlessly die each day hasn't felt like much of a holiday to me. Especially as the purpose of my stay here was to capacity build the health service & improve health care here - to see healthcare failing (& by extrapolation me failing to improve it) so spectacularly is hardly compensated by the nice weather or the cheap cocktails.
Well when I say nice weather, if I was an NGO worker on an enormous (relative to local living costs) salary, who could afford AC & all the other ex-pat luxuries, then I'm sure temperatures of 40+˚C and >90% humidity would be lovely. Or if I lived in a house with a roof that didn't leak directly over my bed, maybe the rainy season - all 6 months of it - would be a bit nicer.
The cocktails really are cheap here but then again so is life.
VSO gives volunteers a living wage comparable with local salaries. This means that you need savings if you want to live anything other than a local lifestyle especially if you have financial commitments at home - mortgage, professional memberships, insurance etc. it is wise to have savings. My little 'holiday' in Cambodia has cost me a 5 figure sum - this has been despite considerable support from my family & mainly due to expenses in the UK rather than any extravagances in South East Asia. I budgeted for this as part of the cost of volunteering (along with my sanity) & if I had wanted a cultural holiday I could have easily have chosen instead to spend this amount on an around the world ticket or travelled around Asia on a shoe string for the same amount of time.
I chose VSO because I believe in their approach to development. Of course there is a place for international aid, humanitarian work & big budget development work but studies have shown that in health, I can't comment on other sectors, capacity building although expensive & time consuming leads to effective & sustainable change. But rather like a glacier or glass creep, progress is almost imperceptible & no one individual can claim to have seen any major impacts resulting from their work. It just takes time to change peoples behaviour & attitudes. You have to look hard for the changes & they sometimes appear in the most unexpected places.
I have found ego to be a huge factor in development. There is an innate human need it seems to get recognition & plaudits for work done. To work without acknowledgment, praise or thanks is not easy. To never see the fruits of your labour can severely impact on your own motivation & self belief.
I am/was an emergency physician so I have for a long time been used to seeing the response to my interventions & the effect of my work. I thrived on this. These last 2 years have been a constant struggle to keep positive & focused on what I am doing & assessing whether it is the correct approach or not.
Reflection is good practice, too much reflection will tear you apart.
I've worked weekends, evenings, public holidays here, Easter & Christmas. I have lost sleep worrying about the work I do. I have lost years off my life because of the frustration & anger generated by my role.
Have I convinced you yet that VSO is not a holiday?
So is the work VSO does any less effective than other NGOs?
I have had the advantage of volunteering with VSO whilst also working closely with a USAID, big budget NGO. I have seen first hand what is good about VSO's style of development work compared to the 'shiny white 4x4-AC-per diem-visit once in a while & tell you what to do' approach.
There is power in staying in a place, day in - day out. There is a beauty in role modelling best practice over months & months. There is a connection that is made with people that transcends snacks & donations of equipment. There is a respect, slow growing, that develops when you stand along side the people you want to change.
And the truth is - you are the one that changes. Because as I was once wisely told, to change other people you must first change yourself. The process of capacity building is a subtle, almost subconscious symbiosis.
I have written a report recording all that I have done, I think I know what I may have achieved, I am doubtful about the sustainability of any of it, but what is there that I don't know about the impact I have had here? What still remains unseen by me? How can any NGO truly know what its long term impact is even though they will write reports about the perceived impact in the very short term?
But capacity building can occur beyond what you can see or planned. Sat with my VA writing her final review she told me this, "I feel that now I can talk freely about things that before I didn’t think
I could share my ideas. This gives me confidence. I can be more open in the
future."
In pre-departure training there was a lot of talk about 'empowerment'. I quickly became quite cynical about the over use of this word in the development circle. But after 26 months here I had an epiphany - I have actually empowered my VA. I wasn't trying to empower her - I was interested in her, wanted to learn from her, wanted to share ideas & to support her as she always supports me. And what do you know - by complete accident - I only went & empowered her. Not sure her father will be too pleased about it!
A visiting Anaesthetist to theatres at BTB recently was impressed that one of the Surgeons wanted to know more about fluid balance. Now I am not taking full credit for this but like a dripping tap, mine & many others effort's over the years must have increased awareness & attitudes towards fluid management in surgical patients - maybe soon the sink will be full!
Who knows what other unseen outcomes my crazy Barang behaviour may result in. I may never really know, which makes writing final reports & fund raising bids a little difficult. It also makes it harder to convince people of the effectiveness of capacity building when people would prefer to see a goat or a long drop toilet as a solid or concrete outcome to their donated money, rather than an intelligent female living in an unequal society feeling more confident to express herself with in her own context or doctors thinking sightly differently about fluids for their patients - a bit harder to make a fridge magnet out of that - hey?
VSO may not be at the cutting edge of development work but sometimes a sharp knife is not the required tool for the job.
Where next? - well Lewis Carroll put it best with this following extract from Alice in Wonderland -
'Would you tell me, please, which way I ought to go from here?'
'That depends a good deal on where you want to get to,' said the Cat.
'I don't much care where,' said Alice.
'Then it doesn't matter which way you go,' said the Cat.
I'm actually heading in the direction of that big shiny USAID 4x4 vehicle with AC & per diem but my consultancy fee is significantly reduced & I will keep working with the same health care workers I've got to know over the last 26 months, who I am sure will continue to change me whilst simultaneously driving me completely crazy.
No doubt the blogs & the litany of despair will continue.....
