Youth in Yangon

March 11th, 2013

Shanghai, China

Song of the Day: I'll make a man out of you (from Mulan)

Mood: A bit pooped (I've been recovering from a cold)

The kids of Yangon

Note: The pictures on this post will not directly tie to the words surrounding them to protect their privacy. As well, most of our work is with teenagers while there are some pictures of younger children here.

 

Liars, cheats, and thieves

People do whatever they need to in order to survive and care for themselves and their children. Desperation can create anti-social behaviors such as lying, cheating, and stealing. We've seen all of these behaviors repeatedly in our work with the Yangon street kids. At this point, it is virtually impossible to trust anything that comes out of the kids' and their parents' mouths.

These kids make terrible decisions. Some use glue. Others chew betel nut that stains their teeth. They almost never go to school or tutoring, even if it paid for. They gamble on the street. Most don't work. If they don't have enough money to take the bus home, they sleep in alleys, or on the floor of the train station. They lack long-term thinking.

Their home situations are heartbreaking. One boy's parents are dead. Another's father is dead and mother will be in jail for human trafficking for 2-10 years. 15 months after she was caught, there has been no sentencing. A third boy's father abandoned his family and ran off with another woman. Now the mother doesn't let him go to school so that he can earn money to support the family.

 

Even with all their problems, they are still kids. They like to be play sports. They like attention. They're curious. They like to learn. As easy as it is to dismiss them, these kids are still human beings who are loved by God. Sure, statistics predict that these kids will probably die early, never shape culture or make important discoveries, and will use up more of society's resources than they contribute. Yet, these kids still matter and deserve to be respected.

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For those of you who are interested, I added more thoughts on how to give most effectively.

People in poverty

Poverty research has shown that even when people have enough money to buy enough food to be over the poverty line, they continue to spend money on entertainment such as televisions and religious festivals. The poorest people are often willing to put up with hunger in order to dance, have fun or eat better tasting food.

If you are interested in helping people, it is essential to understand what drives them and help modify incentives so that people will want to help themselves. For example, malaria nets can save millions of lives, but even when many people in Africa receive malaria nets as gifts, the nets can sit unopened or unused. In part, it is a problem of education: they don't understand what the net is for. In part, it is a problem of understanding: they don't comprehend how using the net could save the lives of their children. In part, it is cultural: it is not in their culture to accept something as a gift. If they were charged a very small amount, the cost would make value the net more and they would actually use it. For anyone interested in development, you have to have empathy and really understand how other people operate and work in that reality. It is foolish to just put on a rich American view that if you give somebody something they will use it just as you expect.

The reason I find it difficult to have a less optimistic view of the situation is that it is emotionally difficult. Oftentimes, people with resources only travel for short periods of time. They see a need and want to address it by providing money. They simply don't have the time to be involved in the lives of the people they want to serve. Giving money makes people feel good without costing much time or though.

It is also hard because we have to assume that people don't want to help themselves in the way we think they should. We can't understand how anyone would pay for a religious festival when they don't have enough to eat, but it happens frequently. Even though many of the Yangon youth are Muslim, they spent a month's rent on a Hindu festival.

In addition, we have to come to grips with our own limitations. Just because we want something better for people we care about, it doesn't mean that they do in the sense that they are willing to put in the time, energy, and discipline to take advantage of opportunity. I hate to have to recognize my own powerlessness because it is humbling and discouraging. It's heartbreaking to watch the deterioration of someone you care about and know there is nothing you can do.

The closer that we can see situations as they true are, the more we can make decisions that are aligned with our values and make the largest impact. That should be the overall goal, but achieving it will take a lot of intentionality and effort to overcome our emotional resistance.

 

Rules and learnings

Here are a few basic rules I've used over the years working at MicroGrants, SNF, and talking to philanthropists:

1. Don't give money directly to the kids. Find a place and give the money for the kids so it never has to go through their hands.
2.  You are probably not qualified to determine who is worthy. Work with a partner agency that has a better understanding of the situation.
3. Set realistic expectations. When dealing with poor populations, you will have a lot of "failure." That's okay, is natural, and doesn't mean that trying to help isn't worth it.
4. Cons are good at what they do. Many people want to make an emotional connection with the people they help. Many of the artful dodgers we know here recognize that and use it as just one of their many tools to get more money. Don't expect that just because you give someone money they actually want to have a relationship with you. Just because someone is cute, doesn't mean they won't play you.
5. Time can be more valuable than money. Kids need emotional nourishment in addition to the provision of basic resources. Many of my Christian Yale friends' parents took jobs that made less money so that they could spend more time with their children. I don't know any child or parent that regrets it.
6. Match effort levels. You'll only burn yourself out if you continue to want to help people more than they want to help themselves.
7. Maintain humility. For reasons beyond our understanding, people respond different to the same incentives. Some of the kids will make it off the streets, while others will die here. For each kid, we are trying to do what is best, while also accepting our limitations.

Healthcare in Yangon

March 1st, 2013

Yangon, Myanmar

Song of the Day: I Can't Help Myself (Sugar Pie Honey Bunch) by The Four Tops

Mood: Excited to start the next leg, sad to leave my family

Healthcare in Yangon

In the fall, I am starting at Wharton to earn an MBA with a special focus on healthcare management. I want to expand my knowledge base about healthcare delivery while I travel and a new friend, the Motherly Anesthesiologist (M.A.), generously connected me with hospitals and doctors in Yangon.

A hospital created to serve foreigners and well-off locals

The church clinic

Churches here deeply care about the needs of the community around them. The leaders of one of Yangon's churches determined the most pressing need for their community was access to affordable healthcare. As a result, M.A. and the Physiology Professor co-founded this clinic 10 years. Now, it treats 9,000 patients per year for an equivalent of ~$12,000.

Meeting the Physiology Professor and the Motherly Anesthesiologist 

These two amazing women started the clinic. At age 75+ they remain active in teaching and helping others. I hope to continue serving others with the same vigor when I am their age.

Even though the clinic is Christian, anyone in need is treated. Many people from different religious and ethnic backgrounds come from far away because they know that they will be treated with dignity, respect, and love.

When M.A. (in pink) found out I didn't have a cell phone,
she insisted I use hers until I left Myanmar

The clinic even treated one of the boys from the Professor's street kid ministry for free. They gave him a check-up, drove him to another doctor, took his x-rays, drove him back, gave him medicine, and scheduled a follow-up visit out of the goodness of their hearts.

At lunch after church

Compliance

In the US, patients not complying with medication prescriptions cost the healthcare system between $100 and $300 billion each year. (Source: Atlantic) Failing to comply can lead to a myriad of negative consequences such as increased drug resistance, hospitalizations, and risk of death.

We were able to see non-compliance firsthand. The boy said his medicine was stolen when he slept on the street instead of going back to the place we had rented for him and some of the other kids in the at-risk youth ministry. Even if he still had his medicine, not following the treatment protocol was a risk. Doctors say that many, many patients don't understand that they shouldn't take their entire course of treatment at once and the most important part of every appointment is explaining how to take pills.

The doctors were very clear that the boy's pain was a result of a lifestyle choice
and pain would continue unless he changed

Tuberculosis is relatively more prevalent here, especially among poor populations.
Luckily the doctors ruled TB out

The very night that we came back from the doctor, the boy made the same bad decision that caused his condition. The Professor asked the boy why he continued to do what brought him pain. He replied, "I don't know." When the Professor asked why it was bad, he responded, "Because it hurts my lungs and it makes my head funny." At least intellectually he understands the consequences of his actions. We can only hope that it will eventually lead him to change.

Pointing out the areas of lung damage 

It's impossible to help people that don't want to help themselves. It's also so hard to admit your own powerlessness when working with kids who might not have enough perspective to make good long-term decisions and especially those who are addicted to a substance. I agree with expert advice that if you're caring about others, your level of effort should match their effort, but it is still hard to wait patiently for people to want to change when you see the negative consequences.

The Anesthesiologist

The Anesthesiologist took me around to many different care sites. In addition to starting the clinic, she has had quite a remarkable life. The government used to pay for anesthesiologists to have fellowships abroad, and the Anesthesiologist was sponsored to study in the UK fifty years ago. Because her Western classmates were better prepared, she spent many, many hours studying to catch up and averaged only three hours of sleep per night. However, she succeeded and also studied at Stanford in the early '90s.

The government found that very few anesthesiologists would succeed like M.A. and stopped sponsoring anesthesiologists to study abroad. As a result, M.A. was one of less than a handful of foreign-trained anesthesiologists in the country for decades. 

In America, there are many more male doctors than female doctors and I wondered if it was hard for M.A. to be a doctor and get a scholarship as a woman in a patriarchal society. She said that it wasn't a problem in Myanmar and there is an even split between male and female doctors.

M.A. had trained nearly all the top doctors in Yangon. Everywhere we
went, she checked up on her former students and updated contact info

The woman in the middle is the head of the OR of one of the hospitals
we visited. M.A. has known her since she was a girl 

Searing loss

One of our stops was to visit M.A.'s friend after surgery. She is in early thirties and had her uterus removed two days before we saw her. She and her husband were childless and when I asked the husband how he was doing, he confessed how hard it was because now they would never be able to have children. In this culture, not having children is very stigmatized. It would be so hard to not be able to have kids if you really wanted them. The woman is a teacher and I think it would be doubly hard to work with children every day and not be able to have your own. I prayed for them at the end of the visit, and I hope that God can continue to comfort and encourage them in the days ahead.

Identity disguised to protect privacy

Making the rounds

M.A. connected me with one of the best neurologists in Yangon. He is so well known that when I was going through my pictures with a stranger at the Chinese embassy, he immediately recognized the doctor by name and I earned mad props for knowing him.

We were able to visit his clinic and see him in action:

Everyone has a unique sense of humor. This doctor loved his snow globe 

We were able to go on the rounds together:

For those who are wondering, he was wearing scrubs too,
but took them off before the picture.

"Sanitized" communal ICU slippers

Delivering care at the clinic

This girl could not be comforted

A busy day at the clinic's pharmacy

Cleaning up after oral surgery

  

Detroit and Yangon

February 15th, 2015

Yangon, Myanmar

Song of the Day: Call on Me by Eric Prydz

Mood: Grooving

Detroit and Yangon

(Source: http://detroitontap.blogspot.com/)

For all their differences, Yangon and Detroit have a lot in common:

Some of the streets have the same name:

 

Source (wikipedia)

People like similar things

On my block in Detroit, people used to huddle behind a car and shoot craps. I feel right at home here:

Yangon even has a waffle house

The best rapper is named 'Ye and he likes shoes:

 

(Source: MTV, kanyetothe.com)

Perception that light = beautiful:

One time in Detroit, I was playing Frisbee with kids from the community. One African-American kid asked me for sunscreen, and when I said I didn't have any, he wanted to stay in the shade. He said that he didn't want to get darker and that he was going to bleach his skin when he was old enough so he could look more light-skinned.

In Yangon, nearly all of the billboards and music videos show people with skin much whiter than any citizen I've met here. Many of the other places I've visited in Asia associate beauty and health with paler skin.

Many people here have told me I'm handsome. Some even go so far as to say I look like a particular celebrity. The week before I left Detroit, strangers at Panera said the same thing. You decide:

(source: teaser-trailer.com)

We ate at a restaurant in the shape of a giant duck.
I borrowed part of one worker's traditional outfit

Perception that white = rich:

In America, the average black household has a net worth of $4,995 (CNN June '12), which is probably higher than black households in our neighborhood. The 8% of my zip code that isn't African American usually lives in the nicest area of the zip code and owns the most expensive houses. Some of the few white people in the poorer areas are from my church and are resourced (e.g., doctors). They live there as a choice and not out of necessity. There are exceptions, including some of my friends, but the general rule that white people in the neighborhood are relatively "rich" covers the majority of cases.

In Yangon, the situation is similar. If you are white, you are probably a foreigner. If you are a foreigner, you could afford a plane ticket to get here. This makes you "rich" because any international travel is beyond the means of the vast majority of locals.

Street merchants informally charge a "white premium" when negotiating with foreigners. Oftentimes, especially tourist sites, the price discrimination for foreigners is formal and the fees have to be paid in US dollars. Even at tennis courts, we have had to pay five times the amount of locals.

Local currency. About 855 kyet = $1 USD.
(Note how bills for the same denomination can be different sizes)

Children struggling to thrive

In Detroit, family sizes are often large, and mothers often raise children without the support of the fathers. If the parent(s) can find a job, the pay is often low so they need to work long hours to care for the basic needs of their family. For many reasons, many children are often neglected and unsupervised.

In one extreme example, I knew a mother who drove to a party 800 miles away and left her 8, 11, and 16 year old sons home alone. During the trip, she ran into trouble with the police and will be jailed for the next couple years due to outstanding arrest warrants for past felonies. When her boys heard she was in jail, the oldest son took the family's welfare card and fended for himself. People from our church cared for the younger boys until a more permanent solution was found. Although concerned people can make a difference, there is nothing like having two loving, involved parents. When that doesn't happen, children suffer.

Our work here deals with kids in similar situations. One boy is an orphan. Another boy's family has been in jail for a couple years for suspected human trafficking and he has been living on the street. A third boy's father ran off with a woman and abandoned his family. At 14, the boy is the breadwinner for his mother and sisters. Although the Professor  buys food, secures housing, gets the boys into school, and helps them find jobs, progress seems difficult to sustain. A kid can learn the multiplication table one day and sniff glue the next. A boy can shows us he has learned to read one day, and play poker and telling us he is adamant about quitting school the next.

Looking at pictures from previous visits

He is the hardest worker and the best student

Talking about long-term thinking and job opportunities with the help of a translator

Why do we work with kids that lie, omit information, steal, and consistently make bad decisions? It's a question we often ask ourselves.

One reason is mercy. God loves humans unconditionally, and that includes the most righteous saint to the children we work with or the crackhead that peed on my house in Detroit. Even though people can be poor and make bad decisions, they still deserve dignity and respect.

Another reason is justice. Not everyone has the same opportunity, and what we are trying to stand in the gap to give these at-risk kids a chance. It may be the best chance they have.

Yet, even though we have resources, we're fully aware we can never be these kids' saviors. Unless the kids have a vision for their future and want to have a better life, there is only so much that can be done. In the same way, God needs to work in the kids' hearts for them to become Christians and experience the full and abundant lives we want for them.

The odds are against us and our success rate will be below 100%. In each case, we don't know if they will capitalize on their opportunities or become just another victim of the streets, but we are trying to do what we can to develop character and boost the odds as much as possible. 

Good people trying to make a difference

In both places, there are a lot of good people helping improve the lives of those around them. In my previous post,  I talked about the Liberator's work with World Vision. We've also met people from UNOPS and the Burnet Institute who are working to improve public health. In Detroit, our church runs a literary clinic and a sports program among many outreaches.

   

One of the good organizations here is Helping Hands. It is organized by the wife of an Australian diplomat and helps teenage boys get a basic education and develop practical skills by repairing furniture and selling to westerners. The daily operations are run by the Foreman and he also helps us help the boys. You can read more about him on the Professor's blog.

Talking with the Foreman about how to best help the kids

Creating a game plan on how to help the kids when we're away

Detroit and Yangon are very different in many ways. But, there is also a surprising amount of cultural similarities as well as a basic humanity (both the good and the bad) that unites us.