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i don’t talk much about my job on this blog. i should talk about it more since it’s the reason we’re here, but the day-to-day is the most difficult to make interesting. especially since, what do i do? i manage. trust me, though, this “day in the life of a manager” will be more interesting than most.

our organizational project staff recently surpassed the minimum number of employees required before obligatory national benefits kick in. in other words, our staff’s take-home salaries just got cut into because we now pay a lump sum to the national social security fund (NSSF), in addition to the standard “pay as you earn” employment taxes. i am a democrat and will fully stand behind increased taxes so i can see improved roads, better schools, more public libraries and parks. but in a country where there is no direct evidence of where your tax money goes (you should see the roads here), it’s hard to feel good about carving into a person’s hard-earned salary. surprisingly, though, when i talk to my staff their unanimous response is “it’s our responsibility.”

i like to think i’m a good manager. when given the opportunity, i gave a long-time, committed employee increased administrative responsibilities and concurrent bump in job title following his completion of a bachelor’s degree, i gave another employee a well-deserved raise, and i increased the proportional benefit paid by the organization to each employee’s NSSF account. i felt good after all of that, then i felt like crap after today.

as i alluded to in an earlier post, the requests for money (and jobs) sharply increased immediately after we put up the signposts marking the office in kampala. people - neighbors, strangers, passersby - came daily to ask for one thing or the other. then, late one morning jarvis sat on my patio and quietly explained to me how he had survived the rwanda genocide (he showed me scars on his chest and shoulders from where he was stabbed and bludgeoned) but now he was HIV+ and he had progressed to a late stage of AIDS where his antiretroviral drugs could no longer help him. his mother in rwanda, who had lost all of her children in the genocide except for jarvis, did not know he was HIV+ and he wanted to go home to her before he died. all he wanted was the $20 bus fare to get from kampala to his home village in rwanda. jarvis and i were strangers, yet somehow he knew my name. madam paige, please some small, small money to help me. i said yes, then walked inside the house and cried. saddened by his story but also afraid of all the others who would come knocking on my door.

after jarvis, phil and i decided that we would just take care of our own, our employees. we can’t take care of everyone, so better to take care of the few that we can. we would say no to strangers and to help shelter me from the recurring knocks on the door accompanied by tragic, heart-wrenching histories and pleas for money robert would screen visitors at the gate. maybe it sounds harsh from where you are, but from here it’s a necessary filter. then, our plan backfired. an employee (we’ll call him “john”) asks either phil or me for money every day. one day for food, one day for a loan to start a small business, one day for hospital fees for his dying father. i pay him a competitive wage - not great, but comparable to others in his position - but with a wife and two young daughters and being the sole breadwinner he struggles to make ends meet for his family. the unfortunate twist: he is HIV+.

yesterday i realized the time had come to say enough is enough. i’d seen it coming a long way off and knew if i didn’t set the yes/no barrier i’d always be saying yes (or at least feeling like a heartless schmuck anytime i said no). management is all about verbalizing roles and expectations, and enabling people to achieve targets. so, john and i sat down to talk. the end-product was a mutually agreed upon and signed pair of “contracts.” the first was a letter of agreement between the organization and the employee outlining compensation and benefits (salary, allowances for food/transport during workdays, medical allowances for self and immediate family members). the second was a letter of agreement between paige & phil bowen, as people, and john, as a person. the two of us will pay for his daughter’s school fees, medical costs associated with his HIV+ status, and the cost for him to attend driving school and get his driver’s license. no more, except under extreme circumstances. the line was drawn.

fast forward one day later - today. john is sick, most likely with malaria. he needs to leave work to go to the hospital to seek treatment. as a manager, i stick to yesterday’s guns and say that he knows what i and the organization can and will pay. as a person, i struggle. if i say no when he asks for money to go to the hospital, it could mean the difference between life and death. paige, the manager says, “it’s the principle of it. the parameters were set, agreed upon, and should be followed. all employees are equal, i cannot make an exception for one and not the others.” paige, the person says, “it’s the principle of it. we have the money, he doesn’t. we don’t need it so badly, he really does. we can so easily help him.”

the twist to this particular story is that today he didn’t ask me for money. he didn’t ask for money, i didn’t say no. but, my moral dilemma comes in that i didn’t offer.

somehow phil and i got into a discussion (debate? argument?). i don’t know exactly what about because undoubtedly we agreed that our intent was to keep john alive and healthy. i think the debate was over how to do that. i was convinced that i needed to fit any money-giving into the parameters set yesterday. if untreated, malaria can easily kill a healthy person in africa. malaria is much more likely to be fatal in an immuno-compromised HIV+ person. if i could fit his illness under the category of paige/phil paying for HIV+ medical costs or if i could fit it into the organizational allocated monthly medical allowances, i would pay the money. no questions asked. phil just wanted to give money recognizing that really what did it matter what he was sick with - he’s sick and he needs to be better. who cares how we justify paying it, let’s just pay it. my quandry came in trying to balance paige, the manager with paige, the person. paige, the manager put policies and procedures in place to direct future actions. paige, the person saw all of that fly out the window the moment it became a question of healthy and sick, life and death.

phil and i talk about not wanting to become jaded. so many of the expats we meet have a skewed version of priorities and we’ve never wanted to be like them. maybe it’s difficult to not become jaded to a moderate degree, though? 10.5 months ago i don’t imagine i would have battled with giving someone the money to get drugs to treat malaria. after months and months of being asked for money, though, i’m feeling less willing and more stingy. i don’t want to be, but i am. the more i’m asked for money, the more i say no. it’s a vicious cycle for everyone.

ironically enough i had meetings all day today to work on a grant proposal for a community-based malaria project. i work all day everyday to make people’s lives better. i work so that populations can be healthy, “the big picture” as betsy put it. i feel good about what i do, but today i fear that i didn’t see the big picture at all. maybe the big picture is remembering that $6 is so little to me and is so much to a sick person who could die without it. we’re talking about a person’s life. how much bigger can you get than that?

in addition to my role as a manager, i’m a public health-er. true to my public health roots, i know that prevention is worth a thousand treatments. the amount of money lost annually in africa on malaria alone is astounding. the poorest households in uganda spend up to 34% of their household income on malaria each year. when john first started working for us he told me that malaria came from eating mangoes. when his 5-year-old daughter got malaria at the start of the raining season, i asked him if she slept under a mosquito net. his response: no, we don’t have any mosquitos. the public health educator in me kicked in and we talked about how mosquitos transmit malaria and the best way to prevent malaria is to sleep under an insecticide-treated bed net. i convinced him to buy one for his wife and daughters, the most vulnearable to malaria. sadly, he didn’t have enough money to buy one for himself, too. now he has malaria. although i didn’t offer him money today to go to the doctor, tomorrow i can start righting my wrongs by buying him his own insecticide-treated net.