Is financial collaboration possible?

By Ryan

I find myself often stressing about being a good steward of the support entrusted to us. Money issues here in Congo are so very different than what I know. I recently wrote this response to a friend who wanted to donate to us.

Thanks so much for your willingness to partner with us. The needs are great here and financial support is greatly appreciated. Right now the main source of expense we have is on patient care. Shannon is able to pay for patients' medical bills and generally spends about $1000-1500 per month. Our current support level is able to cover this and our other living expenses, especially since Samaritan's Purse covers much of these.

The really challenging thing here is that money does not solve heart issues and can provoke them. We are seeking wisdom on how to partner with the hospital, but corruption, mismanagement of resources, lack of communication, and little to no maintenance make both big and little support a huge challenge. For example, I have wanted to update the laboratory here for about $15,000, but there is no financial system in place to ensure that consumable test supplies are replenished. Practically everything here is hand to mouth. There are no budget or savings accounts. They make decisions based on how much money is in the cash box at that moment. It is horribly short-sighted and makes planning for any projects practically impossible. I am also interested in investing in a solar energy system for around $250,000, but right now there is no one here who is capable of maintaining this system and there is not a clear system of reserving money to ensure that the batteries are replaced every 5 years.

All this to say we would love your financial support, but we also really need your prayers for wisdom in how to use the support we have been entrusted with.

Much like a parent teaching personal finance to teenager, it is a hard place to be when you want to help and have the financial resources to help, but you also understand that helping by just giving will do more harm than good. The difficulty, just like parenting, is that it is a lot of work to take the time to teach financial responsibility. It is even more difficult when you take culture into consideration. In this culture, financial resources are meant to be consumed as soon as they are available, and if you do not consume them your community will come asking for them and if you do not give to those who ask you are often ostracized.

Often I feel like missionaries are primarily viewed by the Congolese as fundraisers, and if we are not bringing in money, we are chided.

The systems of Africa, as described in the book “African Friends and Money Matters,” is microeconomics-focused, whereas Americans see things in terms of macroeconomics. A prime example of this is that, here, broken-down cars are often repaired in the middle of the road and not moved to allow traffic to flow normally. This short-sighted advantage helps the owner of the car but hurts the entire system of traffic movement. It is this micro vs macro view that can, in part, describe why traffic rules are not followed in much of Africa. Everyone seeks to get a small advantage for themselves at the cost of the entire system breaking down. Completely blocked roads from traffic jams in Kinshasa are often the result of multiple cars passing other cars in oncoming traffic lanes, resulting in 5 cars face-to-face with 5 other cars on a 2 lane road. That leads to a 3 hour delay as cars disentangle.

Another challenge described by a fellow missionary here in Vanga is learning to be patient. One of the tactics of the hospital is that when a critical need is brought up and identified, they will wait until the missionaries lose patience and pay for it. This tactic, mixed with a lack of will to get certain issues addressed, leads to lots of delays and a general frustration. This waiting puts the breaks on improvements and maintenance.

An example of this has been playing out as I have been working with Shannon to get an emergency maternity Cesarean section OR operational. The funds for this project were set aside around 5 years ago, but it is still not operational. The room is constructed, but on our arrival, there was no electricity, among other things. We found out that a lightning strike took out the inverter which converts battery energy into usable electricity. The hospital did not devote any resources to repairing this. We took matters into our hands and had a colleague purchase a new inverter and batteries for the maternity from Kinshasa with money from our account. Despite that this was nearly $3000 of equipment gifted to the hospital, it was like pulling teeth to persuade the hospital to provide the wire and outlets to install them. When you operate on a hand-to-mouth system, each expense takes away from the bottom line of paying the salaries.

Side note: salaries here are rarely if ever paid the 1^st of the month. This is because the hospital has to wait until enough money comes in to the hospital from patient fees the proceeding month to pay salaries. Often salaries are paid between 15 and 30 days late. There is no monthly budget or reserve account to help balance out the ups and down of the seasonal fluctuations in patient care, so the whole staff feels the effect of, say, a broken down inverter, because they do not get their salary for a few extra days.

The Maternity Operating Room is still not functional due to a lack of planning for the needed materials which they are trying to gather now: linens, medicines, and the OR table. Poor planning led to the purchase of an OR table that cannot be adjusted to a gyn position for common OB/GYN operations; thus, it is not practical.

Money may solve some issues here; however it often creates bigger issues in the minds of the individuals here. One person recently said that a weakness of the hospital is that they do not have an external financial support. Donations without any cost and cooperation from the people here appear to lead to a sense of entitlement and a lack of personal responsibility which, in turn, encourages passivism and lethargy. Also, as a hospital with missionaries, many people with sufficient money come here on the chance that they might be able to get free medical care. It makes it very difficult to know who really needs help and who is playing the system.

Is financial collaboration possible? I am not sure, nor do I know what it will look like at this point. I ask this question because this is what I seek with the Hospital of Vanga. Collaboration is my goal, but at this point it is still a moving target. How much support is appropriate, what investment should be required from the hospital, how can proper budgeting be put in place which is in line with the mission and vision of the hospital, and more profoundly, how can I address the issues of the heart related to money that seeks to cheat the system at every level?

In the coming months, I hope to be appointed Budget Director and a Hospital Analyst. The administration seems hesitant to give me either of these positions likely because of the authority this will give me to reveal areas of weakness or mismanagement. My hope, however, is to begin strengthening collaboration by helping to give my analysis of the financial and hospital management so better decisions can be made. Yet, decision making here could be a whole blog in itself. Essentially, the structure of a Western style board of directors and various administrative meetings are in place, but they appear to me as mostly a show, while the real decisions are made by the chief of the hospital on his terms without oversight or accountability from a board of directors.

I would appreciate your prayers that God would give me wisdom and discernment to see clearly through a very cloudy and confusing system and that the administrative staff would be honest with me and turn from dishonest practices.

I am wading into a very delicate area as I look at finances and my hope is that the mismanagement described to me by the staff is a result of lack of training and ignorance by the administration and not intentional corruption. If the latter, I will have a much harder time getting reliable information and avoiding parallel forms of administration which usurp anything I try to do. I fear the administration is a small clique where everyone watches out for each other and covers up what needs to be hidden from the greater staff.

Pray also that I might be able to find a reliable individual in the administration who might stand for justice and work with me to root out the bad weeds.

I think my feelings are a little bit like Joshua after Moses has just died and Joshua is placed in charge to lead the Israelites into war. I am stepping into unknown territory with very little experience and a fear that my enemies might overwhelm me. I hope that I can “Be strong and courageous” Joshua 1:8, be obedient to his call, and that God will part some rivers and break down some walls so truth and justice will win.