Sunday, August 10, 2008

Leaving Liberia!

Wednesday is my last day in Liberia. While I’ve enjoyed working with the team here there are many things that I can’t say I’ll miss. While the strange generator schedule (on till 2am every night but off all day Saturday), bad (and expensive) food, nearly continuous rain and horrid roads are on this list, the thing I’m happy to be leaving behind the most is the Ministry of Health. These guys take the corruption cake, down to the last crumb. Trying to work with this incompetent, lying bunch of crooks and fools has been infuriating, ridiculous and sad.

There is a lot of humanitarian and development money coming in to Liberia, and everyone, especially the government, is trying to get their fingers in the pie. Unfortunately when the money goes to the government, it is more likely to disappear into someone’s pockets than go to benefit the people it was intended for. Everyone here talks the talk about “building local capacity” and says nice things at meetings when the government is in attendance like “partnerships” and “joint implementation strategy” but underneath the façade of a desire to involve locals in improving the country and behind closed doors, many NGOs express extreme frustration with working with government. Everyone is competing for development dollars including the government and local NGOs. The competition can get ugly. We NGOs are accountable to our donors and demonstrating that we spent their money responsibly. We are also required to work with the government. Unfortunately having two bosses can lead to problems, particularly when one of them is more interested in lining their pockets than helping their people.

I’ve spent a great deal of time since I’ve been here working on sorting out a fiasco with a mosquito net distribution. Few people understand the problems involved in distributing these items, which at $5 each are a valuable commodity. Unless a distribution is done correctly (including physically removing the net from the package and hanging it in the recipient’s house), the nets will be on the market within 5 minutes of being given out. I can understand why, $5 will buy a lot of food, and if people don’t see the benefit of the net (perhaps because they don’t know that mosquitoes transmit malaria) then they are likely to sell it, use it for a fishing net or a wedding dress (we’ve seen all sorts of original uses for mosquito nets). A bigger problem is large-scale theft of thousands of nets during the distribution. Unless properly supervised there is a huge risk of large quantities of nets disappearing. The problem is, who do you trust to do the supervision? How do you get enough trustworthy people to carry out such a massive operation in remote areas with little access?

The methods of theft are very creative, and can happen at all levels. Forged documents, faked signatures, lying government officials and stealing staff all play a part. I can’t get into the specifics because of the political implications, but a large quantity of nets from a recent distribution of nets purchased by a European government have turned up on markets in neighboring countries. There will be huge political fallout from this and there were several local and international NGOs involved. The Ministry of Health insisted that the NGOs use local people including local Ministry staff for the distributions. Guess what, nobody can account for all of the nets they were given! The Ministry is doing its best to discredit the international NGOs while not criticizing the local NGOs involved in the process (and a key figure at the Ministry has his own local NGO that was awarded a contract to do the distributions – can you say conflict of interest?) so that they can get the contracts for future distributions. The Minister of Health and the ambassador for this country is involved.

Every time I go to a meeting the government people tell us international NGOs that we are here working for them. However, as I said, we are accountable to our donors, not to the government. The government is trying to convince donors to give money directly to them instead of to NGOs. They want to be in charge of money and programming but they are so utterly incompetent that donors will never fund them directly.

I went to a meeting on Friday at the National Disaster Management Commission. There has been huge flooding in Monrovia and the NDMC wants to do an assessment of the scope of the problem. We have the capacity to do indoor spraying to help prevent malaria so I went to the meeting to see what they planned to do for this “assessment”.

They spent the first hour arguing about how to conduct the meeting and who was going to be in charge of what. I thought I was going to lose my mind. I brought up the point of what exactly are we going to assess? Nobody could answer that. Do we want to count the population affected? How do we do this? Do we want to do a survey of how many people are sick? How do we do this? They had absolutely no clue as to what to do. They have no vehicles, no camera, no fuel, and clearly no technical skills to carry out any type of meaningful assessment. Every time I tried to bring up a point I was shut down by the Ministry of Health representative, who clearly did not want to hear any criticism or suggestions for how to carry out the work. So I decided to keep quiet and never attend another meeting. There is little point being involved in such a useless activity, especially if they don’t want to listen to and learn how to do it right. The guy listened to all of the input from the Liberians, but would hear nothing from me.

I was warned about the hostility towards international organizations and staff, and every time I go to a meeting I see it. The Liberians certainly don’t want anyone telling them how to run their affairs, even if they are totally incompetent. Fair enough, but then in the next breath they are asking us for money and support. You can’t have your cake and eat it too!

Here’s another example. We have been trying to set up a sentinel surveillance system for malaria in the country. This is a simple reporting mechanism where a few facilities are chosen and people trained to report on malaria incidence to monitor trends and watch out for epidemics. Obviously we have to work with the Ministry of Health on this. However, they have made ridiculous demands like we need to buy them vehicles, provide fuel, computers, and per diems (oh my god the omnipresent demand for per diems to do anything, I’m so sick of it!!), none of which are necessary to develop this system. There is no money in the budget for any of this. They have ground the discussions to a halt over these demands. Greedy, greedy, greedy. Who cares about helping people? I want a new Landcruiser!

So many of you are probably asking why I continue with this work with this level of frustration. Believe me there are days when I ask the same question of myself. However there are other days when things go well with my own staff, when I get to teach someone something new, or I learn something new that make it worthwhile. Of course the ultimate goal is to reduce human misery and suffering, but on a day to day basis you never get to see this happen. You have to take your victories when they come, because they are few and far between!

I’m sure that it is much the same in Indonesia, but at least I’ll be in a much nicer setting, with beautiful beaches, good food and plenty of things to do outside of work! Unfortunately it is going to take me 3 days to get there!! I overnight from here to Brussels, 12 hour wait in Brussels, go to Amsterdam, then 15 hours to Jakarta, overnight in Jakarta, then on to Aceh. What a nightmare!

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