If the poor are among you . . . do not harden your heart, nor close your hand from your poor brother; but, instead, freely open your hand to him, and generously lend him what is sufficient for his need in whatever he lacks . . . for the poor will never cease to be among you; therefore I command you, saying, 'You shall freely open your hand too your brother, to your needy and poor in your land.'
Deuteronomy 15:7,8 & 10
Earlier this week, B. and I were walking through the Surgical Pavilion when he directed me to a semi-private room. 'You remember the patient who couldn't walk that we gave the wheelchair to . . . he's got pressure wounds.'
We came to the bed, but it was empty. 'No, B., he's in bed 1A, not 2A.' 'No, not that one . . . he's a different one . . . this is the one with Potts.'
Potts Disease is TB of the spine. Before coming to Niger I had never heard of Potts Dx, let alone treated a patient with it.
Before coming to Niger 'Tuberculosis' was of very little concern to me . . . all it meant was my yearly PPD skin test and Airborne Precautions Protocol Drills. I think I may have had one patient with suspected TB while working the US . . . or maybe I'm thinking about a random episode I saw of House, MD. Yeah, I think someone had TB once on House.
But here in Galmi, TB seems to be a differential for nearly everything. Funky cough . . . TB. Funky joint pain that isn't osteomyelitis . . . TB. A typically developing kiddo that has a year-long history of night fevers and functional loss of ambulation, sitting and head/neck control . . . TB. Spinal pain with no mechanism of injury, you got it . . . TB.
So, what do we when the TB is treated, but the meds don't work? When a patient's body just doesn't heal . . . we do the best we can.
But what if our 'best' just isn't good enough? What if our 'best' actually does more harm? What if our good intentions result in pressure ulcers, a long hospital stay, and a great financial burden for an already extremely poor family?
Don't get me wrong. We did what was necessary to equip our patient and his family with what he needed to know to avoid pressure sores. B. and I adequately repeated ourselves, and made the family repeat back to us; we demonstrated to them and made them demonstrate their understanding to us. They left reciting the mantra of 'weight shifting every 15 minutes' and they expressed verbal understanding of the need to build up sitting tolerance in the chair.
Three weeks later, now in the hospital, it was apparent they hadn't followed through on our advice.
But our efforts weren't enough, in this case.
We had given him what we had available . . . a makeshift donated chair with wheels and the standardized cushion that accompanied it on an expensive container across the Atlantic. But what was needed was a specialized chair, with a specialized cushion and weeks of therapeutic intervention.
But none of that was possible. So we did what we could to . . . help.
A visiting American nurse once looked at a piece of donated DME we were about to give to a patient and said to me 'This is terrible quality.' I agreed with her. It was equipment that she had brought with her; she shrugged and said 'But it's free.'
Because somehow free translates as good.
What has happened in our thinking . . . that when it comes to the poor, a little bit is enough?
Being an Occupational Therapist in Galmi, I've had to grieve the reality that something is better than nothing; my definition of best practice has in fact changed to fit the context of Niger. But I have also had to step back and learn to say 'incomplete treatment will do more harm in this case than nothing at all' . . . and I've had to come to terms with that reality.
It is an American cultural value to 'try'. We like to help . . . we like to make an effort . . . we like to solve problems. As a society we believe there is no obstacle too great that we cannot figure out a way to overcome it. It's like Swiss Precision and German Efficiency, our American Doing.
But when are 'good intentions' just not enough? When do we pause and ask to ourselves, 'Will my efforts do more harm than good'??
And if we cannot respond to that question, to whom are we turning to find out the appropriate answer in the cultural context?
What did God mean when He said we should generously give what is sufficient for the needs of the poor? When looking at the word sufficient, the definition puts 'enough' and 'adequate' right next to each other. But when I read those words, there is a chasm between 'doing enough' and 'doing adequately'. One feels thorough, the other minimal.
I recently had a Nigerien colleague remind me that if something given causes a greater burden to the one receiving, it is not a gift. It may have been intended, by the giver, to be a blessing . . . but the burden has actually made the gift a curse to the recipient.
So what do you think? Where's the line between 'enough' and 'adequate'? Which takes priority, my intentions or the needs of the recipient? Does helping in fact hurt? (no really, I want to hear what you have to say on this . . . lets get the conversation going in the comments section.)