I’m a Doctor – give me a house, a car and 3 maids.

All Doctors in the Ugandan Public sector laid down their stethoscopes a week ago, and there is no end in sight. Their demands are off the charts.

“A senior consultant doctor or professor will be the highest paid health worker, with a gross salary of Shs 48 million, a five-bedroom house, 4000cc vehicle and three domestic workers.”

This seems insane. They are asking for 12x their current pay, and a whole lot of other perks. To locals here though, it makes some sense, and with just a bit of digging we get a great insight into 3 major issues. Inequality, cultural expectations and the ridiculous political situation in Uganda.


Inequality

Poverty is bad – inequality might be even worse. First the inequality between rich countries like New Zealand and Uganda. New Zealand’s GDP is over 60 times that of Uganda. Senior New Zealand doctors earn more than 10 times their Ugandan colleagues. Unfair right! Yes…… but not as unfair as the situation within Uganda itself.

Earning 1000 US dollars a month, senior Doctors in Uganda already earn 20 times more than the average Ugandan. In New Zealand, Senior doctors only earn 3 times the average person, which I think is brilliant. Senior Ugandan doctors are demanding a 1200% salary increase. $12,000 a month. $150,000 a year. Yes that’s right, they want 12 times their current salary. They would then earn more than a senior New Zealand doctor. Absurd! Should doctors in one of the poorest countries on earth, earn more than doctors in one of the richest?

Ugandan GDP vs doctor salary

This would mean a Ugandan doctor would earn 250 times the current Ugandan GDP. Effectively this means that 250 poor farmers would earn the same as only one doctor. Isn’t that horrific! Unfortunately this is the trend around the world. Salaries increase while the poor aren’t much better off.

Cultural expectations of Big People

In Uganda, even more than in western countries ‘Big people’ are expected to display their status through lavish living and big things. There are a lot of expectations on ‘big people’ here, and this helps makes sense of the obscene extras demanded “…a five-bedroom house, 4000cc vehicle and three domestic workers.”

Big job = Huge house (5 bedrooms!)
If you’re a Big Senior Doctor in Uganda, you’ll need a 5 bedroom house. First so everyone can see you have the biggest house in the neighbourhood, and second so you can support all 20 your family members who expect to live with you for free because you’re a doctor.

Big job = Huge car (4000cc)
Google image search “4000cc vehicle” and see the huge 4WD cars that every big doctor clearly needs. A doctor isn’t a real doctor until they look down on you from the windscreen of their Range Rover! Status and heirachy are the name of the game, illustrated by the biggest doctors (senior ones) getting a 4000cc 4WD, while ‘medium’ doctors get a more modest, 2500cc car. Perhaps a corolla?

This cultural norm makes me quite sad, as environmental concerns become irrelevant, and good health goes out the door as soon as you earn decent money. You’ll never see anyone with a high salaried job here on a bicycle, even if work is just down the road. Its culturally inappropriate just not the done thing. Junior doctors riding the public buses complain to me that other passengers deride them. “Get out of the bus. Why aren’t you driving your own car? You’re a doctor!”

Big job = 3 domestic workers
(Women running around doing everything for you)
It may seem unfathomable that one person should ask for 3 domestic workers. Remember though that the workers aren’t just to look after them, but also their 20 family members who will insist on living in their huge house. Nothing demonstrates  status and opulence like having a gardener carefully prune every bush, one maid cooking and the third washing your clothes.

Ridiculous Political Situation

President Museveni has been the big boss boy for longer than I’ve been alive. Nearly 32 years. The huge issue at the moment is him becoming Mr. President-For-Life, by scrapping the presidential age limit (75 years). As much as many people don’t like Donald Trump, at least the longest he can be there is 8 years! To help secure this life presidency, Museveni handed out an official bribe of 8000 US dollars so that every one of the 431 Ugandan MPs to hold “consultative meetings” in their district.

Many people, including the health minister herself believe this official bribe triggered the strike. Maybe a salary of 200,000 dollars a year is fair enough, when MPs already earn about that much. Many people are asking the question. Why should a poorly educated MP who is driving their country into the abyss, earn more than a highly qualified doctor who is saving lives?

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6 Million Dollar Red Cross Heist

Have you given to the Red Cross recently? Your money was stolen. Nearly 6 million US dollars of it. Stolen by rich, well connected thieves – hundreds of Red Cross staff. How do you feel about that?

First, I deeply respect Red Cross for both investigating and apologising. Recently I haven’t given to Red Cross (as they seemed like a big, inefficient NGO), but this humble and honest announcement has made me reconsider. Uncovering “overpriced supplies, salaries for non-existent aid workers and fake customs bills” is not easy, nor is admitting this kind of painful situation to the world. What happened to them, happens to every NGO operating in tough contexts. The only difference is that Red Cross talked about it.

Second, the five million discovered will only be the tip of the iceberg. If they found evidence for 6 million stolen (5% of the 120 million donated), the actual loss will be much higher. Perhaps 20 million, maybe more. They only found the sloppy thievery. Corruption done well is untraceable.

3 Lessons from the Red Cross Heist

1) Most NGOs hide theft. Red cross didn’t. One survey showed that 3 out of 4 fraud cases in large NGOs don’t get reported to the public. A year ago Israel accused a World Vision Staff member of stealing millions of dollars to give to ‘terrorist group’ Hamas. Although this particular allegation is unproven, theft Is guaranteed in an NGO working on a huge scale, in a difficult unstable region like Palestine. Even if World Vision are doing an great job, there will still be theft. World Vision leadership told the world that they didn’t think there was corruption going on in that project. “Our own ongoing audit has not uncovered any diversion of funds” they said. A zero theft scenario isn’t possible. World Vision are either hopelessly naïve or lying through their teeth. Either way, World Vision are hiding theft. Red Cross made the unusual decision to both investigate properly, and not to hide it. Well done. One report estimated that around 2 billion dollars was lost by NGOs to fraud in the UK alone in 2016. Did we hear about it?

2) Many (if not most) NGO workers steal money in corrupt countries. Its not just 1 or 2 bad eggs. There was theft in all 3 countries, through a variety of mechanisms. Hundreds, if not thousands of workers were involved. Unfortunately stealing money from the most vulnerable is part of NGO culture. Here in Northern Uganda even good people will steal if they feel there’s a decent chance they won’t get caught. I’ve seen it in my local church, higher church leadership, individual health centers I manage, NGOs, local government, central government, everywhere. I’m not saying people here are bad people. Stealing money where you can is just the behavioural norm. Good people steal. Only the best people don’t.

2) Don’t automatically trust NGO leadership. In western countries, we have this idea that aid workers, or people working for NGOs are usually virtuous and want to help people. In developing countries, NGOs are like any other institution. NGO jobs are often the most lucrative jobs and everyone knows there is ripe opportunity for extra “allowances” or just straight up theft. In Ugandan Institutions (and I’m sure in many developing countries), the best way to rise in an organisation, is to keep quiet when money is stolen, and buy patronage (paying people around you to keep them happy and quiet). If a superior steals money in Uganda, if you speak out you are gone, and other NGOs won’t hire you. Workers higher in the organisation are MORE likely to steal money than people lower down. First they have more opportunity, and second that may be they got to the high position in the first place. Trust needs to be earned, slowly and carefully.

4 Things Red Cross (and other NGOS) can do better next time

1. Be honest with the public about corruption in our organisation. Red cross have made a great start with this announcement. Its like giving up alcohol or cigarettes – you have to acknowledge you have a problem before you can do anything about it. Most NGOs don’t. Add a “loss to corruption” line in your budget. Report all theft to the public. Address the problem, don’t ignore i

2. Lock up the thieves. There needs to be a disincentive to steal. Right now there isn’t. In Northern Uganda, NGO workers caught stealing only get sacked. Often the rest of their contract gets paid out too, which is madness. In my organisation, we’re not allowed to take thieves to court – only fire them. In the last few years I’ve heard of at least 50 rich NGO workers caught red handed stealing money intended for the poor and vulnerable, and no one has gone to jail. NGOs need policies that anyone caught stealing WILL be taken to court with no exception. Yes the corrupt police and court system makes this difficult, but try your best. Its great that Red Cross say they will “hold their workers to account”, but I doubt any will end up in prison.

3. Play hardball with corrupt Governments. NGOs are slow to learn this lesson, and often bow to the will of corrupt, mega-rich government officials. You’ve got power, use it. As corrupt as NGOs can be, government officials are much, much worse. Why are the Red Cross paying customs duty on anything? They are there to help the country out of an Ebola epidemic, a crisis. The Red Cross and other NGOs should insist on their donations and equipment being exempt from government fees like customs duty in a crisis. If there are no customs bills, there can be no fake customs bills.

4. Pay locally appropriate salaries. I’ve said this before, and this stuck record will continue. As soon as staff have an inflated salary (especially in short term jobs), they see the job less as a real job, and more as an opportunity to grab as much money as possible before the magical money fountain stops flowing. They are blinded by dollar signs in their eyes. Paradoxically, your workers will steal less, be more satisfied and get better work done on a fair salary than a bloated one.

5. Put foreigners in charge of the money. I don’t mean white people, I mean foreigners. Keep control of the money outside of the corrupt local systems. It’s an Ebola Epidemic. You are not there to grow local capacity, you’re there to save lives. If qualified and experienced Nigerians and Kenyans managed this money, there would have been much less corruption. Foreigners don’t have the local connections to leverage with government officials. They don’t have the family pressure to feed out money. They have the incentive of ongoing work in the organisation if they do well. Keep the control of your millions outside of the corrupt in-country systems.

I hope this fantastic announcement by Red cross continues the growing awareness around the world of the real situation. We need Red Cross to continue saving lives in crisis situations, with all the dollars we gave them, every last million.

Red cross cracked.gif

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This is why we need elections

When the police tip off the target before arriving and the Mayor blocks municipal officers from doing their job, how do you get a law enforced?

I haven’t documented all our failed experiments trying to get Gulu’s sachet alcohol ban enforced. For many months, it was just too depressing. One time our team identified 3 big targets, all suppliers of many smaller shops. We then waited around while police took four hours to get organised, then at the last minute, the head of the operation started saying we didn’t have enough ‘evidence’ to go.  We finally convinced him. When we reached the first two targets, we found them locked. In the middle of the day. The police didn’t seem surprised. Another time, we managed to reach open shops that hadn’t been tipped off in advance, but police and municipal officers were so disorganised and leaderless that searches weren’t done properly and very little was found.

Definitely time for a new experiment. We scrapped harassing police to lead operations, and we’ve decided to forget about the Mayor. The District Chairperson, the highest political office in Gulu, ranked above the Mayor, appointed his deputy ‘Simon’ in charge of alcohol law enforcement. In the shots below, you’ll see Simon and his hand-picked team, accompanied by police, raiding shop after shop. So far there have been three operations in different sub-counties. I accompanied them on two missions, camera at the ready. The strategy upon reaching each trading center was simple: split up, search each shop, and load the illegal sachets and plastic bottles of gin into the back of the pick-up. Any shop keeper found with a large quantity was arrested by police. I stood in the bright sunshine watching Simon and his team move about confidently and purposefully, and felt months of built up frustration subside. From Unyama and Awach sub-counties, 22 large boxes of sachets and plastic bottles were impounded, and 5 shop owners arrested and fined. In Paicho sub-county 15 boxes and 2 arrests.

Simon’s team captured ‘Royal Navy’ branded sachets:royal navy captured
Below: This shop keeper was busted with 5 boxes of ‘Chief’ brand plastic bottles.

DSC06202

Also impounded: boxes of ‘Uganda Waragi’, produced by Uganda Breweries. Thats the fanciest brand. first capture

These successful missions with Simon show the power in local democracy. In Uganda, Police are only really accountable to central government, and therefore are usually never held accountable at all. Accordingly, they don’t care about their work and look for any opportunity to take a bribe. Local government employees with their job-for-life contracts and pensions waiting tend to play it safe, avoid confrontation and do the minimum required. Local elected leaders, on the other hand, have at least some sense of accountability and want results they can tell their people about. I think Simon and his team were proud of these operations. I also believe action and actually getting stuff done is more fun than sitting in NGO workshops and pointless meetings. Whether or not we stick with this exact method, we’ve definitely made a breakthrough. Phew.

Heres Simon, giving an impromptu talk to locals and shop keepers on why this law is important:

DSC06209

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Birth in the Bush

Locals say Oberabic Health Center is ‘in the bush’. Although there’s plenty of forest around, that’s not what ‘in the bush’ means. It means a long way away. A long way from healthcare. A long way from electricity. A long way from prosperity.  There’s no place to deliver your baby safely within a 15km circle of Oberabic. In some directions its 30km. If you’re in labour, even 5km can be too far to walk.

Oberabicmorning.jpg

Tonight, Adong and Acan pace the maternity room. Then sit. Then lie. Then pace. Hands on hips. Arched backs. Their husbands, sisters and mothers watch on. Its 9:30pm at night, and the labour pains start to bite.

Labouringmothers.jpg

Nurse/Midwife Chris stands between the two soon-to-be mothers. Labour isn’t easy

At 3:00am, superstar combined nurse/midwife Chris delivered Adong’s baby. Everything went smoothly, but its not always the case. The most important intervention which stop mums and babies from dying, is to have a skilled attendant deliver the baby. Chris knows how to use drugs and equipment when things go wrong. Chris knows when the situation is so bad the mother needs to be sent to hospital.

Oberabicbaby.jpg

Adong’s boy. You may wonder if its OK to think black babies are cuter? Its OK. They are.

Adong is 23, and this is her 3rd baby. When Acan delivers in a few hours, it will be her 8th. Before she goes home, Chris tries to convince Adong to use family planning so she can at least have a break from new kids for a while. She says no for now, but promises to come back in 2 weeks to discuss it again. Will she really come back? Chris is confident.

Oberabicgrandma.jpg

Grandma admires her new grandson. Acan (right) is still in labour!

Chris is confident because he does an amazing job helping women take control of their lives. In the last year over 600 women have received some kind of family planning at Oberabic. ‘In the bush’ at Oberabic you have more options for family planning than in many clinics in the developed world. If you want to wait for 1 month, 2 months, 3 months. 2 years, 3 years or 5 years Chris and the team have you covered!

Chris.jpg

Chris with the ‘family planning’ cupboard. 8 different family planning options!

The irony is, the most helpful (and cost effective) thing we can do for these women is not to deliver their babies, but help them have less. If like Acan you have 8 kids, you don’t get education or serious paid work, and you are utterly dependent on your husband. You may also put your daughter on the same path. If you have 3 children, you’ve got a chance, and so does does your daughter who you can afford to send to school.

Attitude.jpg

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Mayor saga: the come back

petition-hand-over.png(Above: Sheik Musa Khalil on the left has been fighting alongside us since the beginning)

“He has arrived; he is in office.”

Excellent. Against all odds, we have everybody in the same space. Media present? Tick. Religious leaders? Tick. Mayor in his office with no known escape routes? Tick. Ready for ambush.

Since the Mayor intervened and ruined the last sachet alcohol-impounding operation, he had affectively blocked all enforcement by refusing to let his enforcement officers take part in operations. Theres a lot riding on this ambush.

Our District’s former Anglican Bishop (still an influential figure) and Muslim Sheik lead the way with a gaggle of media swarming behind them. At first, I tactically remain outside. The last time I saw the Mayor, we both lost our tempers. I waited. Then my phone rang and I was summoned inside to join the discussion. Things weren’t going well. The Mayor dodged everything, weaving in lies and half truths. His attack was threefold-

  1. He claimed enforcement was unfairly targeting certain businessmen in the town area, and that we should be going out to the villages. This is true but justified- the main suppliers of illegal alcohol are in town!
  2. He claimed that business owners had not been properly ‘sensitized’ to the ordinance, and there should be multiple meetings hosted for business owners to have ‘input’ into implementation of the ordinance. Firstly, the news about the ordinance had already saturated the media since its launch the previous year, and business owners had already had illegal product confiscated! The time for ‘sensitization’ had clearly passed. ‘Sensitization of business owners’ is at best a delay tactic to make sure nothing happens, and at worst, an opportunity for business owners to rebel and swing things to benefit their profit focus.
  3. Most bizarrely, he claimed that the first round of impounded sachets were never actually burned, and that the big public bonfire was ‘faked.’ How on earth he thought this ridiculous claim would even help his position, I’m still not sure. Afterwards I provided the video footage and photographs to the media of the sachets being burnt.

The Mayor completely dominated the discussion. The religious leaders (who I clearly had not prepped strongly enough), folded under his pompous display of authority and importance. Too gentle, too polite, their message demanding the Mayor release his enforcement officers for operations was lost. My own attempts to ‘up the anti’ were shushed. We left, I felt deflated.

Outside, we reshaped things with the media, and managed to rework the message to make it stronger!

Despite having essentially failed in our main mission of influencing the Mayor, our ambush had an unexpected positive result. Perhaps frustrated by failed ambush, the Muslim Sheik called the District Chairman and they went on radio and thoroughly dressed down the Mayor. The District Chairman then resolved to go above the Mayor’s head, and ensure enforcement would go on, with or without the town enforcement officers. Boom.

Most of the media coverage was on local radio, but a local reporter also wrote it up on their news blog. 

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Sabotage by Mayor (the sachet saga continues)

The operation hadn’t exactly been going well anyway.

“These officers….” Anthony, my fellow ‘observer’ of the operation raised an eyebrow and sighed as we watched 20 police and 15 municipal enforcement officers wander, aimlessly and timidly along the busy wholesale street they were supposed to be raiding to impound illegal alcohol. The head of the operation was no where to be seen.

“Come on, they aren’t really checking these shops.” I led the way into a dimly lit, densely packed store. Armed with a cell-phone torch, a quick peep behind the counter revealed a jackpot. Somewhat relieved to be given a clear instruction, officers removed the illegal products. Having instigated at least a little action, we headed off to target another shop.

What felt like just moments later, I heard shouting and looked over my shoulder to see a growing crowd swarming. We rushed back over to find an irate shop owner standing over the pile of confiscated products yelling into his cell phone. At his feet were boxes of plastic sachets of spirits. There were also some plastic bottles and small glass bottles of spirits. The head of the operation and other officers stood nearby, looking uncertain and nervously requesting the shop keeper to calm down.

Then the Mayor arrived. Obviously at the shop keepers summons. He proudly strutted in, crowd parting to allow him to take center stage to start pontificating. Struggling to get close enough to hear what he was saying, I caught phrases like “unfair targeting of municipal businessmen,” and “now they want to take your glass bottles,” and “defend Gulu’s economic interests.” Each sentence got cheers from the surrounding shop owners, presumably his new private supporters. On my phone, I tried in vein to convince a higher power (i.e. the District chairman) to come and intervene. Then the rain started, and the police officers cowered further under the shop eaves. Operation aborted. The officers scuttled back into the vehicle, the shopkeeper packed his goods back inside, and everyone left.

 

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As unjust and illegal as the Mayor’s actions had been, I realize we had made a critical mistake. The target of the law was the cheapest, nastiest spirits in plastic sachets and bottles. There are, however, some glass bottles of 200ml, which are also now technically against the law, which has a minimum packaging size limit of 250ml. The police weren’t wrong to try to impound the smaller glass bottles. But the language of our movement has focused on plastic packaging, and so the Mayor felt justified to come running to “defend” the business owners. Had we made it clear to the police that they should stick to confiscating plastic bottles and sachets, we might not have been thwarted.

I kicked myself. The worst news came some time later. Indignant, and possibly also receiving financial inducements, the Mayor decided to completely block the municipal enforcement officers from taking part in operations. Because the police required the presence of local government (because, they say it’s a local government ordinance), I was sure this would block all further enforcement. Eventually, it was decided between all parties that we would collectively “overlook” the glass bottle issue and focus 100% on plastics. I visited the Mayor personally to try and smooth things over, assure him that glass bottles would no longer be targeted. Let me just say that his response was such that for the first time, I lost my temper to a ‘VIP’ official and walked out of his office.

Next time I saw him, there was plenty of media with us.

P.S  For those confused about these different products:

(Above left): different brands of sachet alcohol, 40% spirits, 100ml, 20 NZ cents
(Above right): the 200ml of spirits in glass bottle- 40% spirits 200ml, about 3.50 NZ dollars…technically illegal, but not really a problem.

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3 Good, 3 Bad? – Labour Lollies

I can’t believe I’m doing a political blog post! Apologies to non New Zealanders who don’t care about the political tides in a few tiny meaningless islands somewhere near the bottom of the world.

Here are 3 policies I like, and 3 I don’t from the Labour Party. Don’t get me wrong, I love the increased support Labour are getting and I think Jacinda is great, but the policies? Mixed feelings. I also don’t think either the good or the bad ones are very significant.. Tinkering around the edges, nothing more. What do you think?

Like

  • $25 Tourist tax. Awesome. Should be even higher, should have been done long ago. Levy tourists, who by definition are Rich from a Global perspective. Done, Next. Most other touristy countries do it – here in Uganda its $65 dollars!
  • Irrigation and bottled water tax. Using our water has an enormous environmental cost, and whoever is using it should start to actually pay some of that tax. My only problem with this policy is the tax should be even higher than they’ve stated!
  • 8 billion extra spent on healthcare. Great. Healthcare needs more and more money, it’s the nature of the beast. Throw the money at it. I don’t mind if you don’t specify where it goes, the health policy bean counters can sort that out


Don’t Like

  • Free Tertiary education for 3 years. Lolly throwing policy. Favours the rich, as a disproportionate number of rich people go to university rather than other forms of tertiary education. If you are a blue collar worker who doesn’t study, no benefit for you. Obviously baby boomers and young people love this $^#&, but that doesn’t make it the best use of money.
  • Lower GP fees for all. I actually like Nationals policy better here. Fees should be free or super cheap for poor people. Others can afford 35-50 bucks. Under 2 hours work for a GP visit? That’s 100 years away here in Uganda. 10 bucks cheaper for everyone smacks of meaningless populism rather than sensible policy. “They have literally copied National’s announcement from last week targeting low income New Zealanders, and tacked on a $10 universal subsidy over the top,” – As much as I dislike Steven Joyce, hard to Argue with.
  • No Capital gains tax or raising taxes on the mega rich. I wonder how Labour will afford all their lollies, without raising taxes. It doesn’t make sense. I know they are swinging a bit to the center to get votes and its working, but that doesn’t mean I have to like it!

 

 

 

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