Excitement reigns as you work through the checklist for that first overseas assignment. You learned a few phrases in the tribal language, trying to absorb everything about the new culture found in the mission brochure. To prevent some incredibly stressful moments that first year, I’m sharing these three critical cautions for newbie international volunteers—Part III.
The final post in this series may prove the one you benefit from the most. I’ve found it essential in every country where I’ve served. Some months, the issues popped up on a daily basis; at other times, I’d be taken by surprise.
If this is your first view of the series, and you’d prefer reading the first two posts before this one, You’ll find the link on each of the headings.
Caution ONE: The nationals want to make you feel welcome at any cost.
Caution TWO: The nationals seek your medical counsel, regardless of our training or the consequences.
Caution THREE: You may make poor decisions due to assumptions and inadequate local information.
While I’ll end this caution with a medical illustration, I realize that most volunteers aren’t leaving with a stethoscope in their suitcase. The caution applies to any project with which you become involved.
Construction
Many international workers come from societies where projects to help the community are often staffed by volunteers. Naively, I thought the community service thing encompassed the globe. Truly, a painful awakening.
This is how it happened…
We arrived in the remote West African location at the invitation of the village leaders. They expressed a genuine need for medical care, offering to help us in any way to establish a clinic. In fact, they assured us the community would prepare the baked mud bricks to use in the construction of said building plus a house for the expatriate volunteers.
What a joyous day when the entire community—men, women, and children–turned out to have a part in the bricks. It felt like a day of celebration. Women and girls carried basins of water to turn the dirt into mud. The boys bent over short-handled hoes to stir up the ground. Young men with expertise in forming the bricks stuffed the iron –rich clay mud into the wooden forms. Of course, the old men shouted advice and criticism all the while the younger men worked. (That’s their part in any project.)
Once dried, the young men stacked them, and the fires baked them into sturdy building materials for the clinic walls.
What we didn’t discover until the next lot of bricks needed to be prepared was that our definition of community volunteer differed from that of this village. No one told us this particular population knew nothing of working for the good of the community. None of the leaders let us know–before, during, or after–that those hundreds of people expected to be paid for that one day of labor.
Weeks later, when the mason called for another smaller load of bricks to finish the job, not a single volunteer appeared to help that day.
Our false assumption sent us scrambling to come up with money not on the budget, as well as significantly delayed the project.
Tip: Be sure that you and the national leader you’re working with on any project are on the same page—using the same definition of terms.
Critical decision-making
During the horrendous Ethiopian famine of the mid- ‘80s, I served as the head of a makeshift pediatric clinic and hospital ward. Our corrugated tin facility provided services for 58,000 victims, more than half of whom were children. We had only basic equipment, with a limited offering of even the standard intravenous fluids for children.
One morning, the Ethiopian father of a seriously injured child carried his son to the remote location of our clinic. The boy of eight or nine years presented with second and third-degree burns over 60% of his body.
After providing appropriate emergency treatment and applying burn dressings, I asked the chief nurse to arrange for transportation to the regional hospital. According to my training and experience working with burn specialists before I left for overseas, I knew the boy would die without proper intravenous fluids.
The chief nurse voiced his concern about the possible dangers along the primitive rocky dirt highway to the hospital. Apparently, the control over the various villages along that route changed hands on a daily basis.
Any vehicle on the road after dark posed a threat. If the military held the village, they’d suspect us of being part of the rebels. If the militants held the village, they’d likely take the Land Cruiser from us, possibly abducting any medical personnel in the vehicle.
I did give his warning a brief consideration. My understanding of the situation was this: We might have trouble along the road though no one could be certain. On the other hand, I felt certain that the boy would die without proper care.
I believed that God would protect us, or give us the grace to be taken hostage if that better served His purpose. I always prayed for my patients but didn’t feel any check from the Lord that we shouldn’t leave the camp. My motto-to-live-by has always been, “I’ll do the best I can and let God do the rest.” Fear didn’t enter into the decision-making.
In retrospect, I can admit I’d have made a different decision if I’d had all of the facts. Perhaps God kept them from me because He wanted us to make the trip. Perhaps, God just let things play out as they did to help me learn to have more information next time?
Thirty years later, I don’t know for sure. I do know that I made major changes in hanging on to my western assumptions and obtaining vital information.
Naturally, I expected we’d leave for the hospital immediately, especially if we needed to return from the hospital before dark. I had no idea how long it took to drive a hundred kilometers on the rocky road but felt certain we’d not be able to maintain the usual highway speeds of home.
I’d filled my colleagues in on treatment plans for those hospitalized and arranged for the adult clinicians to split up my remaining clinic patient-load after we left. I continued examining patients and writing scripts, expecting the call to get in the Land Cruiser at any moment.
The noontime dinner call came first.
I’d correctly assumed that we’d take one of the two already-fueled Land Cruisers in our camp, so didn’t understand why we’d not left. I didn’t know that we needed written permission from the military authorities in the camp across the road. They saw no reason for our request; the patient was just a kid, after all.
By mid-afternoon, I heard the roar of the diesel engine. I ran through the ward with last-minute instructions, being certain we’d not return before dark in about four hours.
I’d incorrectly assumed that those put at risk by this journey would be limited to the boy, his father, the driver and me. By my calculations, I figured the driver would be the only one obligated to make the trip.
What no one told me was that the SUV would be completely filled with personnel, plus another patient squeezed in just before we pulled away. Nine lives in danger, besides mine.
We arrived at the hospital with my little guy and one adult female patient. It had taken nearly five hours to cover those one hundred kilometers. I expected to stay with my patient until they admitted him to a bed so I could speak with his doctor. That’s when I found out two things:
- Our travel permit expired at midnight. We had to be in camp by then.
- Even with only a few patients waiting, the admission process took hours. I couldn’t wait, and no doctor could be found to speak with me.
While I knew the return trip after dark held some potential danger, I assumed we’d just drive slowly enough not to be a threat, right? Talk about naive.
As we approached each village, my Ethiopian friends scanned the area for moving bodies, reporting to the chauffeur the location of any motion. As soon as we entered the village, he flipped on the dome light. “Hold out your stethoscope,” he ordered me when I asked why in the world he turned the light on. “If there’s anyone out there watching us, I want to be sure they see your white skin in here. If they’re close enough to see the stethoscope, they’ll know you’re a doctor. Maybe that’ll keep them from shooting us right away.”
When the vehicle came to a full stop in the middle of one village, and the driver lowered all four windows, I knew we had trouble. I turned to look out the window of the front passenger seat—right down the barrel of an AK-47.
The driver and the heavily-armed rebels had a heated discussion while the rest of us silently stormed the gates of Heaven with our prayers.
At last, the windows began their slow ascent. The driver started the engine, and we carefully drove out of the village at about ten kph.
Once we’d cleared the final village, concern turned to the clock. Would we make the deadline? With our camps so close that they saw the flickering of our candles, the military commanders would certainly know if we’d returned or not.
At 11:45 p.m., we rolled over to the dining hut. Our colleagues poured out, whispering their cheers. They’d been praying for us all evening–many on their knees for hours. Some feared we’d been taken by the rebels; others wondered if they’d arrested us.
Whew! What a hero, huh? Saved the boy’s life at the risk of my own—and the six other passengers. If only the story ended here. It didn’t.
The following week, I looked up to see the boy and his father walk right into my clinic room, exhausted and hungry. No one had changed his bandages; only the remnants of those I’d applied hung from his torso.
Turns out the father didn’t like how the hospital folks treated him and his son. After they had waited a few hours, he put his son on his back, and they began the 100-km walk back to our camp. The duo had just arrived back that moment.
We found food and water for them. Then, I cleaned his wound the best I could and re-dressed his horrible burns.
The little guy did just fine with the treatment we could offer. Of course, he did have residual scarring, but he more than survived without that hospital stay.
So, the bottom line? I risked my life, and the lives of the others in the vehicle, for nothing. It had not been necessary at all, regardless of what my western training said.
I learned a very important lesson that day long ago. I can’t assume I know what’s best, just because it’s the way we do it in the west. I can’t assume that all hospitals work like at home—about anything, not just admitting patients.
And, perhaps the most critical lesson, I learned that I must fill in all the blanks by asking specific questions before making critical decisions. I mustn’t assume the nationals will tell me. Usually, they think I already know.
Tip: Recognize that, whatever you think you know, it might not be enough to make the best decision. Ask specific questions—even those you think you already know the answers. Be certain of all the facts before deciding.
One last thing for newbies to recognize: You are the guest in their country. They are doing their best to help you accomplish your mission/project. If there’s any lack or inadequacy, the responsibility for it lands right in your lap. Don’t criticize the nationals. Let them help you learn to succeed in their country!
I hope these three cautions and tips have added to your understanding of service in the Third World. Let me know in the comments area if I didn’t speak of something you’ve been wondering. If I don’t have your answer, maybe another reader will.
Please share any experiences you’ve had, including your tips. I’m still serving overseas and need to continue to learn.
