Given the nature of today’s anonymous post, WhyDev is unable to verify the details of the story below, but we believe it is valuable to publish given the ethical questions it raises. Names and identifying details have been changed to protect the privacy of individuals.
What does ’saving‘ a child really mean? Ask 10 people and you’re liable to get 20 different answers.
Here’s a situation where this question was implicitly asked but I’ll let you decide whether or not anyone was ’saved.’ As extremely discomfiting as this situation is for me, I’m putting it out to the wider development community with hopes of starting a conversation about how we can stop similar occurrences in the future.
I am currently affiliated with an NGO that works on health systems strengthening in East Africa. Pretty standard stuff – malnutrition, maternal mortality, village outreach, and the like. Recently, the founder turned the formerly-secular NGO into an explicitly-evangelical one, and with the shift came missionaries dedicated to ‘soul harvesting’ and ‘crusading.’
But ultimately, this is a story about an 11-year-old boy, Micah (not his real name). He was found by the side of the road one evening and was brought to the nearby health centre, where one of the missionaries happened to be working. We don’t know exactly how he ended up there, though the working hypothesis was that his mother tried to poison him and left him for dead. We’d later learn that this is almost certainly not true.
Whatever string of events led Micah to the side of the road, he was in rough shape and alone at the hospital. The missionary wanted to help, made phone calls to community members, and became involved in his case.
Micah required a higher level of care, so the missionary insisted that he go to a better-run private hospital, all expenses paid by the NGO. The missionary then had the police hastily write up a note giving our organisation the right to take the child, so he went into surgery and came out with one less appendix and one additional eight-inch incision on his abdomen.
As he recuperated, the conversation shifted to what was going to happen to him after he was discharged; a group of at least six members of the organisation, along with one community member, tasked themselves with deciding Micah’s next home – with no single person responsible for the decision or for his care. Relatives were unreachable and the paucity of available information meant that no good option seemed to exist; orphanages were discussed, but shot down for not being ‘right’ and for taking too long to accept him.
And so the missionaries decided that, while they attempted to sort out proper placement, he would stay with us. They wanted to save a child. Please do not misunderstand me – all of them are extremely kind, caring people who only had the absolute best of intentions.
But, that’s exactly the point – as we all know, and as this story will show, extraordinarily good intentions can be extraordinarily dangerous.
Before continuing, it’s instructive to note a few things. First, a police report was never filed in a case of what was assumed to be attempted filicide; while we now know that it wasn’t, at the time that was the working assumption. In some areas, it would be commonplace to forego police action; here it is not. The missionaries did receive a handwritten letter giving them the authority to take the child to the private hospital, but that was the extent of police involvement. A suitable post-discharge plan was discussed but not seriously considered by the group of seven; many orphanages were available, but never truly considered as an option.
So, Micah was taken from his community into an NGO home that is teeming with foreigners and bereft of other children. He was placed in the care of people who neither share his language nor his culture. While it’s a little facetious to say that he was ’kidnapped‘ (technically, the police did give consent; whether it was theirs to give is a separate, but important, question to ask), it is fair to ask whether this was truly in his best interest or if it was appropriate to do.
If this was the end of the story, it could probably serve as the start of a good discussion on the promise and the peril of good intentions and whether these actions are ethical or advisable.
But it’s not the end of the story.
Micah arrived in the late afternoon and walked into a room full of foreigners. For the next hour or so, a member of a nearby church translated as the missionaries explained what was going on and asked a number of questions about what had happened to him. It was clear that he was extremely uncomfortable, and understandably so.
Micah became the ’house boy,’ and as no one was specifically accountable for his health and wellbeing, no one was responsible for him. None of us are able to speak more than a few words of his language, so we got by with a few hand signals. He warmed up to us, watched television, and ate.
But not in that order. By the time someone noticed how much food he was eating – including things he probably had never digested before, like burgers and chips – it was clear something was wrong with him. Micah’s a skinny kid, but he looked six months pregnant; he was eating too much and it was all staying in his now-distended stomach. With no one accountable for his care, this was allowed to slip by for far too long.
A day later, Micah was in extreme pain, so the missionaries took him to the hospital – the same one he had been discharged from days earlier. The doctor put an emergency nasogastric tube through his nose to reduce the distension; after the tube was in, the doctor said that his stomach ’deflated like a balloon.’
He later said that Micah’s stomach was dangerously near rupture, and that he was, unequivocally and without exaggeration, ’near death’ and ‘nearly killed;’ his stomach could have perforated or his abdominal distension could have put too much pressure on his lungs.
Micah spent the week writhing in discomfort, as the nasogastric tube kept him from distending. After myriad tests and consultations, the surgeon said that the valve between the stomach and intestines was not opening; this could require surgery to fix. But ’could‘ does a lot of work there – the condition could also work itself out in time.
In other words, a decision had to be made, but the medical officer of the NGO was out of the country, and we could not get a hold of him. He’s from the country but not the region, and had not been involved in Micah’s case in any meaningful way. Ultimately, the surgeon had to leave for the airport, so Micah didn’t have surgery that day.
This was a remarkable stroke of good luck, as the doctors were able to take the nasogastric tube out, and Micah began to eat. Bit by bit, his strength – and his smile – returned, and he was discharged days later, no surgery necessary.
He is back in our home once more, but this time one person is responsible for his health. I’ve had more than a few conversations with that person about the need to find him a suitable home as soon as possible, and it seems to have had an effect. I’m hoping he gets better, and finds a new home, soon.
So, uncharitably, it could be said that a NGO – with the best of intentions – took a child from a hospital and was the proximate cause of his immediate readmission and ’near death‘ experience. But even the charitable version leaves much to be desired: an outside group took ownership of a local child, failed to understand the risks of doing so, failed to take care of him, and – most importantly – failed to keep him safe.
There’s no question that his life was in a precarious situation before the missionaries intervened; he was a sick child who desperately needed help. But did he need help from his own community, or from outsiders who felt they were doing the right thing by removing him from it?
It’s possible that Micah’s community would have allowed him to overeat, or would otherwise failed to provide him the appropriate atmosphere conducive to convalescing. With a pyloric valve issue, it’s possible that, eventually, he would have returned to the hospital.
But would he have nearly died? Would major decisions about his health have been made by outsiders?
Are such situations simply unlucky or avoidable? Is this a one-time, isolated case of hubris, or is it proof positive for the broader claim that outsiders – even with the absolute best of intentions – are fated to cause more harm than good?
What if the child would have recovered as normal – how does that change conceptions of right and wrong? What if my organisation would have done a better job of taking care of Micah – then would it have been OK?
I don’t have answers to those questions, and am grappling with them myself. I only know a few things: this situation leaves me deeply uncomfortable, deeply furious, and deeply ambivalent about my tangential relationship to it, and it seems to me that no child was saved.
In this case, good intentions were enough – to nearly kill a local kid.