Giving A Hand- Ugandan Hospital and Volunteers

The Muscle of the Big Society?

The rhetoric of The Big Society has gone stale. The charity sector was quite wary of it even when it was fresh. But even after these years, it has not quite died. Volunteers remain the muscle of most charitable activity. Within a UK charity, the motives for seeking volunteers are a mix of opportunism and vision. But so are the motives for offering to become a volunteer. Go to a developing nation, and the mix becomes stronger, the contrasts greater.  This article lays out some of this, as a caution to the confident, and a help to the anxious.

My wife and I worked in a faith based hospital in Pakistan in 1978, Nepal 1986-89, rural Uganda in 2008-2010 and visited hospitals in India.  Though quite remote, the hospital in Uganda was not a small place. It comprised of a 240 bed hospital, over 300 staff, a primary school, school of nursing, a hydro-power company, a large child sponsorship programme, and sundry other projects.   I was responsible for group finances and some HR and sat on the management committee.

Visitors or Volunteers

Visitors or volunteers? Either way, there could be said to be four varieties:

  • The “3rd World Virgins”. Those who’ve never visited developing nations. Never seen ragged kids running down the streets.  Never seen rickety buses heaving with passengers.  Never seen women doing backbreaking work on small-holdings with just a simple hoe. They could be: medical students, backpackers, short-visit foreign doctors, family/friends visiting working expats.
  • The “Holiday Time Missionaries”. Donors who for many years have visited during their annual leave. Those who have caught a vision for the place, but who also enjoy the attention from giving out gifts.
  • The “Active Retired”.  As being 60 is the new “50” there are quite a few who are happy to be felt useful. Happy to be using their professional skills once again for a few weeks a year. Happy to be somewhere warm or interesting. Happy to be in a happy African church.
  • And of course, the “Longer Stay Mission Partners”. Rather than career break, it means a broken career, or the security of a house in UK foregone, to come and stay for a few years or many years. They may have worked in several places abroad. Because of nationality, language and culture, they will always be visitors. But strangely, they become visitors when returning to UK too.

What we observed about visitors and volunteers was not seen to apply to The Longer Stayers. They knew the pitfalls, usually having fallen into them in their first few months in their new country.

Volunteer Money

Having lived and worked in Pakistan and Nepal, we knew that money speaks loudly. But in Uganda it spoke louder than I had expected.  There were so many visiting foreigners.  Almost all foreign visitors were awe struck by the lively welcomes they get when they arrived in Uganda. In the context of the comparative poverty of the welcomers, these welcomes had a massive impact on the visitor or volunteer.

And they came in large numbers. My Ugandan hospital saw 200 foreign visitors a year who came with big hearts – and open pockets. Lok Hospital Thane, Mumbai saw not so many, but it was a smaller hospital. Christian Medical College Vellore would see many more, though as it was a much larger place, the relative impact was less.  This drizzle of small amounts of money on quite a lot of people made the donor influential[1]. For example, see the case study below:

A foreign visitor/donor had offered a hospital the equivalent of £5,000 and needed a response within a fortnight.  However, the money had to go on children’s ward for: new incubators.  Not repairs of existing incubators, not on relevant staff training, nor on upgrading the physical condition of maternity ward (as the children’s ward was in fairly good condition).Management discussed the issue. Some said we should accept the money and put say incubators into store for future use, fearing that we were at risk of losing the money.  Others said we don’t need more incubators at this point in time, but were worried about losing the money.

Management didn’t accept the offer at that meeting, but later the gift with strings was accepted. The donor’s will prevailed over the professional judgement of staff at the hospital.  The donor believed that they had a sounder insight on the real needs that the relevant staff.

This was not rare.  It is very hard indeed, in the context of uncertain funding and high inflation to say to say “thanks, but not for now”.

Volunteer Expertise – Living With Practical Fluidity?

Staff are always reluctant to turn away volunteer expertise too.  To say “we can’t use you at present” to visitors offering their time and labour. This arises from both the poverty perception (we are a poor community – so never say no to an offer) and a practical fluidity.  By “Practical Fluidity” we mean, when you are seeking a job in a UK or international organisation you expect to be given a detailed job description and person specification, perhaps with associated KPIs.  With many smaller UK NGOs and faith based bodies, the job description will exist, but the understanding that “you will also need to muck-in when necessary”. With those bodies in places like Uganda or Nepal, they may be missing altogether.  There is a general idea of job aims, but the applicant is expected to carve out the role for themselves.  It is a case of going and making yourself useful.  Practical Fluidity can work. But it works as long as:

  1. the volunteer appreciates this and is ready for make-and-do; and
  2. there really is a general idea of job aims, not just that the Chair of Trustees wants the implicit prestige of having a larger number of expats on his diocesan projects; and
  3. if the general idea of job aims do not work out, there is general support for working out something else with the new arrival.

This is in large part about social relationships. Putting it at its most brutal: if you turn up and there’s really nothing for you to do, as long as you develop good personal friendships, work will eventually turn up. As there are always something to be done out here.

However, problems can arise when practical fluidity clashes with poverty perception.  One wonders whether in reality the cries for help are louder than the real opportunities for help.  And the oft heard comment in this sector “it will take you a little while to work out what really needs doing” means not more than, “this is a poor country – now you are here go and find something useful to do. And chuck some of your own money into it if it needs some cash input”. For example see the case study below:

A UK volunteer charity offered a hospital a community health nurse.  A seasoned English volunteer nurse already on site was keen to ensure that the potential new volunteer came to a hospital’s school of nursing, especially as the seasoned expert was leaving the following year.  The hospital was keen to use the new volunteer for public health work in the community too.After the volunteer community health nurse arrived in Uganda, the school of nursing said very early on that they did not have enough work for this new volunteer.  Then opportunities in community health were examined in detail, and several key nationals in the hospital who had their own small programmes voiced interest.  But getting practical action rather than sweet words proved virtually impossible, as only modest new money was found from UK.

The new volunteer ended up driving out to hillside villages on their own, rather than in a multi-disciplinary team as originally planned. In the end, with only small work in the school of nursing and with little broad support for public health, the new volunteer left prematurely.

Management or Mama/Papa?

In Uganda, Rwanda, Nepal, India and elsewhere, factions and plotting is endemic. Faith based bodies will live in peace with bodies of other faiths or secular organisations, yet fiercely battle within.  Management styles that are essentially based on family and clan, do not work well with the demands of large and complex bodies like large hospitals. Nor in dispersed but linked bodies like Anglican or Roman Catholic dioceses or agencies[2].  An anxiety of the dangers of disunity moved staff to view the hospital, and indeed, the heads of department as surrogate mama/papa.  They do not see themselves as co-workers to meet client needs, but as members of a family with senior staff as the parents.

The reasons for all this lay well outside the issue of volunteer impact and volunteer donations. However, the drizzle of foreign money unwittingly feeds this paternalistic model. Small foreign church or personality based charities rely on developing key relationships with one or two persons on site. Considering significant amounts of money often is distributed though these de-facto agents, strong and personalised relationships develop. One manager I knew called the chair of one of closely linked supporting charities, “Daddy”.  In British English, saying “you are my father” is a really strong and very personal thing to say.  In Uganda I heard it often, and as in this case, not from a junior.

The volunteer can become complicit, slipping into the papa/mama role. For the “3rd World Virgins” and “Holiday Time Missionaries” this is heady stuff.  Giving £300 to a charity in UK never felt like this: the huge and immediate positive feedback, the warmth and wave of gratitude. And £300 in Uganda, Rwanda or Nepal goes a lot lot further than it does in UK. The donor gets drawn into the lives of African or Nepali normal families, in a way that giving to ex-offenders, the homeless or disabilities in UK is not so possible[3]. I knew of a volunteer who had rolls of money in their pocket, and after the most modest of consultations, cash would be readly dispensed, to “the quick and the (English speaking) brave”.  National staff were exasperated, but did not want to wish ill on the lucky with their windfalls.  In terms of Transactional Analysis, the Adult-Adult relationship readily slips into Parent-Child[4]. We are not far from the worlds of paternalism and in a previous era- paternalistic colonialism, of the mind at least. Indeed, critiques of welfare provision say that just such a paternalism exists in UK too and it grows dependency[5].

When the donor organisation or key players work in Adult>Adult and the done key player(s) seek Child>Parent, then Crossed Transactions take place, meaning and understanding is retarded.


That of the relationship between volunteer donor and national donee. Between giver and receiver. Because the gap between the two is so large and internet and cheaper air travel brings them so close, the relationship will never be an easy one, that a dependency mentality will grow, that it evolves into a relationship of power and paternalism. Addressing this is in small to medium sized projects in Uganda or Nepal will require changes in behaviour on the part of small scale donors/supporters in UK, challenges to donees in recipient projects. And perhaps occasionally – saying “no more” will be of more help[6].

(c) Bill Lovett

May 2011, revised May 2015

[1] The swing from unrestricted to restricted funds and increasingly directive donors is seen in UK charities too. Indeed it is reported that UK charities are finding it difficult to fund core operations as unrestricted funding (as defined by the UK Charity Commissioners) declines, Third Sector 3rd May 2011.

[2] An grim example of this in the public domain is Revd Kalimba Jered’s book “Church and Society in Rwanda” 2010, which describes church factionalism after the genocide in Rwanda. The horrors of 1994 did not draw churchmen towards the bigger issues in life.

[3] The Finance Act 2010 (UK) is likely to intensify this relationship. It has new rules for the donor to require the donee to give more detailed information to what purposes the money was actually use, and when, even leading to independent verification. Local management autonomy could be impaired further.

[4] Eric Berne “Games People Play” London 1966, and many others since.

[5] EG “Cameron must take this chance to end the giant evil of welfare dependency” Spectator 1/8/2010.

[6] This observation has been made many times elsewhere, e.g. drastically so by Dambisa Moyo in “Dead Aid”, London 2009.

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