How do we best help those in need, and as importantly, when do we stop?
In countries like Australia, the US or across Europe, you often see images of suffering on TV. Children who are unable to go to school, people who are fleeing persecution or natural disasters. Our first instincts are to help.
The next instinct should be to ask: how do we know when to stop?
3 years after starting OIC, a project that will establish speech therapy in Cambodia, we now know how we’re going to get out of Cambodia, and cease to exist.
Let’s take a step back.
In 2012, I arrived in Cambodia and began working with a local non-government organisation (NGO) named CABDICO. They ride motorbikes for hours along dusty roads visiting children with all backgrounds and abilities to provide basic services like physiotherapy and special education. In these villages, there are no health centres and no hospitals.
Through CABDICO, I met Ling, a child who slurred his speech and hence could not go to school. My CABDICO colleagues were at a loss as how to help Ling – they didn’t have any knowledge in speech therapy. Not only this, there was not one single Cambodian speech therapist in country.
This meant that hundreds of thousands of people, especially children, could not communicate to their full potential. Either they could not talk clearly, or at all, or could not process incoming communication.
An equally large number of people had difficulties swallowing, where food and liquid would enter their lungs, instead of the stomach. They could contract pneumonia and then die. Without speech therapy, these people were dying young.
Upon learning this, I felt a mixture of isolation and helplessness.
If the big organisations, including the United Nations, were not doing anything about this issue, what could one person possibly do?
Over several months, I talked to many people to learn what had already happened. Afterwards, I sat down and laid out the options.
Ling needed speech therapy to get into school now, so I could organise for some volunteer speech therapists to come from my home country of Australia. This would be relatively easy to do. Speech therapists back home would jump at the opportunity to fly to Cambodia and be of service.
But children often need speech therapy for months, if not years, and while that might help Ling, what would the long-term impact in Cambodia be? We’d be giving a man a fish.
Okay, I thought. I could organise for volunteers to come and train my CABDICO colleagues. They could then use their new skills with children like Ling.
Under this model, we’re teaching a man to fish.
But these volunteers had minimal understanding of local context, and after they left, what happens next? What happens when local people changed jobs, moved on or had families? What happens to the knowledge then?
This model had been going on in Cambodia for at least 15 years, and there was still no university course or government policy on speech therapy, let alone awareness of the need.
It became clear to me that we couldn’t give out fish, nor could we teach people how to fish. We had to help Cambodia build its own fishing industry.
We needed to build a profession.
I have to admit that when I first started articulating this vision, I didn’t know how we were going to get there. But I did have a few key principles in mind.
We would not start an NGO.
The goal of NGOs in Cambodia should be to hand over work to local organisations and government. And yet, NGOs are not set up to achieve this. It’s in the NGO’s best interests to keep on justifying it’s existence.
For example, let’s say an NGO was set up to give every Cambodian a widget. Once it achieved this aim, the organisation would be redundant. Donations would drop off and people would lose jobs. This isn’t in the best interests of the NGO.
I didn’t want to set up an NGO because it would make it harder to dissolve it when we reached our goal.
We would push for maximum Cambodian government ownership from the beginning.
This means not setting up a hospital or clinic to deliver free speech therapy services. Despite the immediate need, I didn’t want us to create something to eventually hand over to government. I’d rather government took as much on as possible from day one.
With the help of some wonderful people, we started to set up OIC: The Cambodia Project. The project part of the name is important, because we set up a project that sat under the parent organisation, CABDICO.
When OIC delivers what it sets out to do, the project ends. And we all go home.
What we are trying to achieve is articulated in our vision: Speech therapy is led by Cambodians and available to all who need it in Cambodia.
This is inspirational, it’s aspirational, it’s clear.
However, the reality is that OIC cannot be around to see this through. It’s unlikely we’ll get there in your or my lifetime, especially when we don’t yet have one speech therapist.
So, what is our exit point from Cambodia? When do we know that the job is done?
100 speech therapists employed by government by the year 2030.
By this stage, there are multiple university courses, there is government policy and buy in, there is awareness and job creation. There may not be enough therapists to cover the whole country, but there is enough for the government to take over and keep going.
By 2030, OIC may not have achieved its vision, but it will have achieved something that can be continued by government. OIC will no longer be needed, and will exit Cambodia.
When I met Ling, I felt an immediate desire to help. I wanted to help him speak more clearly and go to school. That commitment hasn’t wavered. But in helping him, I never wanted OIC to lose sight of the bigger picture. To set up a solution which is not only Cambodian-owned, but also Cambodian-lead.
By working out when we were going to stop, we’re on our way there.
Hopefully we can achieve something with a long term vision, while not forgetting those who need our help now.
What’s Ling up to now? Due to our pilot project, he’s attending school for the first time. But he’s not just attending, he’s excelling. Ling is coming second in his class.