Thursday, January 30, 2014

Charity For Fun and Profit

I had dreams of doing exciting medical charity work from the very first day I entered medical school.  I envisioned being dropped into international zones of illness, injury and biohazard with a single medical responder bag strapped   to my back. I wanted to do it for nothing more than the adventure, the experience and the egotistical   satisfaction of making a difference in a few, or a few hundred, lives.  Throughout Internship and Medical Residency I studied what I was taught, but I kept  a secret eye out for certain tricks and techniques.  I keenly studied the procedures that would come in handy   the day I was stuck in the middle of the jungle with just my wits and a scalpel. These were the romantic and heroic dreams of an unjaded young man.
I believe in Charity.  It’s what my parents taught me.  

The selfless giving of one's services, money or goods to those in need is a rare concept of unparalleled Purity in this harsh and complex world.

If only it was that simple.

In my younger days this is how I believed charity worked:  

1.   You discover a universally needy, desperate situation.
2.   You pull together a team of skilled and unskilled, unpaid volunteers who believe in doing the right thing.
3.   Like-minded others, who could not join you, donate their goods and money freely with no strings attached.
4.   Airlines, hotels and meals are generously donated by those able to in the area surrounding the desperate situation.   They recognize and support the assistance to their less fortunate community.
5.   Extra baggage fees are generously waived by the airlines and your pure heart occasionally gets you a Business Class upgrade.

It turns out that number five is just outright laughable.  But as for the rest, I soon discovered that finding a unicorn that shits rainbows is a more common occurrence.

Charity, like all great and worthwhile endeavors  has a learning curve. Eventually I figured out how to get things done. The system takes commitment, patience and perseverance. I also recommend the fluent use of tear-jerking catch-phrases, photos with children and a little necessary bullshit.   

All charities are not alike.

First, a short lesson in Charity.  Charities are often referred to as non-profit organizations or 501-C (tax exempt) organizations.  They are also   known   as NGO's:  Non-Governmental Organizations. By definition, NGO's  are not-for-profit, tax exempt and, while often politically associated, they cannot be a political party.

Confusing?  If not, let me further destroy the simplicity of the Charity model.  

NGO's may not (officially) include government representatives in their membership, yet they are legal corporations formed by those who must claim independent operation without any connection to government. Then once formed, they work with governments.  If you need a frame of reference consider the organization of the church.

This has got to result is some serious Karma.
I've worked with many charities in the last twenty years. The charities were big and small and I was both paid and a volunteer. \ I will not be naming all the names--I'm just not that kind of guy. As in my other blogs, none of this is fiction.  In my occupation  fact is always stranger and more interesting than fiction.

In the 1990's a close friend introduced me to SEVA Foundation (, a charity out of Northern California.   While targeting a few issues, mostly they save the eyesight of people in harsh, remote regions of the world where blindness is equal to a death sentence.  They flew a group of us up to the Tibetan plateau where we moved from town to town and set up a number of mobile, rustic eye hospitals.  Our surgeons cranked out nearly 400 cataract operations per day.   Our field hospitals were often nothing more than an empty school room filled with equipment moved in and out daily.  We lived hard, but we lived well. We spent nights in tents circled by wild yak and dogs in the middle of fields.   We ate unidentifiable food daily. It was an unparalleled experience.  Even as a rookie charity worker I could see that SEVA was run by pro’s.  The project was well-funded, meticulously designed and had well-defined goals.  Frankly, everyone kicked ass.

For a charity founded by a group of Berkeley Hippies (a founding member is Wavy Gravy, the official Clown of the Grateful Dead)  they run their projects like a tight, efficient corporation. No waste.  Solid planning.  Preparation before putting boots on the ground.  They had what so many others in the charity world lack:  management. 

Which brings me to my next experience.

In 1998 I met a local, faith-based Los Angeles group of volunteers who had donated    medical goods and work in a Liberian refugee camp in West Africa. Tens of thousands of Liberians fled their country in a vicious civil war.  This war was world famous due to the horrific practice of government soldiers chopping off people’s hands so that they could not vote. The UN had pulled out of the refugee situation a year earlier leaving nearly fifteen thousand people with no medical clinic to serve them.  It sounded like a great project for a needy group.  When I was asked to be Medical Director of the mission I instantly agreed.  

We were what people call a “Grass Roots” organization - “Grass Roots” translates to “we don’t have any money.”  For a job like this we needed equipment and we needed cash.  We sent our crew of volunteers out to scour the LA pharmacies for donations of medicine and goods.  I had a large general practice of my own back then and sent business to a lot of referring doctors and pharmacies.  I reached out to them.  I called each one personally and told them I needed donated cash and goods for this worthwhile project. I told them I’d prefer this to the expensive dinners and Christmas presents sent to me yearly with the intent of kissing my ass.  In a little over three weeks I raised nearly fifty thousand dollars and we’d collected two hundred pounds of supplies. 

The charity Founder and Director was a well-spoken man in his forties with a booming baritone preacher’s voice and persuasive tone and smile.  During every trip he would substitute preach at local African churches and fill the room with fire and brimstone and gospel and Jesus.  The parishioners would cheer and clap and fall down.  They’d speak in tongues.  He was a huge draw.   His heart was in the right place, but alas, he was a terrible manager.   He would send us off in the early morning to the refugee camp where we’d work from sunup until sundown until there was no more light to see the patients.  We were seeing nearly three hundred patients per day in small concrete shacks that baked in the West African sun.  This group of medical and non-medical people were some of the hardest working, least complaining volunteers I’ve ever worked with.  They  were one hundred percent in everything they did.

The requisite "charity picture."
Our Director would show up at the refugee camp for a few minutes nearly every third day and stay for thirty minutes. He claimed he had “ministry and organizational meetings” the rest of the time.  For some reason he booked us in a dilapidated hotel far from the camp which required an exhausting, dusty, extra hour of travel each way. We’d leave early in the morning and return after dark.  A number of modest, clean guest houses were available and much closer to the work, but he said he wanted to support the local woman who ran our hotel. I later found out later that his “organizational work” was conjugal trysts with our hotel manager when he was  not   busy with two prostitutes from Sierra Leone.  He was paying them (and his other bills) regularly with foundation money.  At one point he had run down the money to the point where he refused to pay the poor local boys helping us with our logistics every day.  As he was a religious man, I had my own “come to Jesus” talk with him following that episode to make sure our staff got paid.

I participated in another mission with this hard working group in AIDS-ravaged Swaziland. On this trip our Director managed to allegedly knock up  one of the secretaries in the hospital where we taught HIV care and prevention.  Once I’d heard this I’d had enough.  I told him that the only way I would stay on as Medical Director was if every check needed my signature too.  As this was not in his extra-charity business plan, he refused and we parted ways.  Eventually he was asked to step down and fortunately this group as continued its yearly work in Africa.  The temptations of “free money” are just too much for some charity people to handle.

Around the year 2000 I was asked again to join another “Grass Roots” organization that specifically molded and named itself around the concept of sending American doctors to Africa.  The founder and CEO is an African man who was adopted out of poverty and raised in California.  Fantastic concept:  African who escaped the throes of squalor trying to give something back to the impoverished and sick in continent of his origin.  A pure recipe for charity success, but unfortunately the charity part rarely ever happened for this organization. This is not to say that there wasn’t plenty of charity activity going on. The problem was that the activities and donations rarely made it to the intended people of need.  This charity’s CEO gets an A+ for self-promotion, but a D- for the ability to put successful, sustained projects on the ground.

Our fledgling trip was the result of a few tens of thousand dollars donated by a single group who wanted the money to be spent towards the betterment of women's medical conditions in Africa.  They wrote him a check without question.  I was asked to lead the medical mission on the ground.  I was excited.  It would be my first trip to Ethiopia.  I’d dreamt of visiting and working in Ethiopia for decades.  The team was chosen and the flights were arranged. 

Unfortunately, unbeknownst to me, our director had done little to no ground work prior to our deployment. None of our credentials were sent to the Ministry of Health, nor to the hospitals in which we hoped to work.  We brought a number of medical supplies which were categorically rejected by the Customs Department upon entry into the country.  They were given no advanced notice.  Rookie mistakes for sure, but the people donating this kind of money certainly expected it to be handled professionally.  One of the local doctors who kindly allowed us into his hospital ended up losing his position as Medical Director for doing so.  Lesson learned:  you don’t go reaching into another man’s refrigerator without asking his wife first.

In the end we did what we could with some teaching and well-wishing.  We had an excellent personal adventure, but the mission for charity had to be termed an unfortunate failure.  Hard lessons were learned.  We felt terrible that the mission wasn’t accomplished and that the donated money had been wasted.  The CEO felt differently.   

Charity:  It brings out the Stars.
He lauded this project to others as a huge success and breakthrough project.  It had a major space on his website and would have people believe that he is the guy to get things done in Africa. The current website contains highly exaggerated stories and projects. It has quotes from important people that would lead one to believe that they actually know what this organization does. This PR, and Hollywood’s love for a success story of a poor African making things right, helped his foundation take off.  In a few short years he was having lunch with Jay Z, coffee with Jessica Alba and doing the clubs with Russel Simmons  His stock was rising.  Politicians wanted photos with him and he was regularly visiting Washington, DC for meetings.  I was sent on one of the meetings to meet with California Representative Maxine Waters on what was promised to be her support for a “huge” project that would bring AIDS treatment medicine to needy infected people in  HIV-ravaged Caribbean countries.  I closed my office and flew to Washington for the meeting. The “meeting” turned out to be a face to face discussion with  Rep. Maxine Water’s seventeen year old, still-not-shaving intern who had  started work  for her three weeks earlier. She could not be bothered to meet us in person for longer than a handshake.  Huge waste of time.

All these Hollywood, African government and Washington connections should have amounted to a series of important medical projects in Africa.  And plenty of money to go around. But to this date I am not aware of one sustained African project that has come out of the organization.  There have been many fundraisers and several meetings.  There have been two Los Angeles conferences hosting a number of wives of African presidents.  These First Ladies—notably some of the richest women in Africa—were wined and dined and taken to Hollywood shows.  Money was raised, money was spent. Huge lavish parties were held and yet I’m not aware of a single humanitarian project that resulted from these meetings. To this date there are still a number of vendors who haven't been paid for their participation in the conference.  (I suppose they are expected to be giving services free for charity!) Charity work is sexy.  Charity work can be good business.  Charity work attracts the stars.  But if it never gets to the charity part, what should it really be called?

Ultimately, despite the good wishes of everyone for impoverished Africa, it comes down to a failure of management.  Management is the bane of the charity world. I’m not saying that the CEO’s heart was not in the right place, but he had all the ideas with none of the ability to successfully manage them.  In reality, charity is hard work.  It takes skill, experience and perseverance. Good wishes without good action are no more helpful to humanity than a random cheery Facebook posting. In my opinion people who have never done any charity work rarely have the skills or experience to run their own charity.    Still, it must be working out as I’m not aware that this man has needed a day job since the charity started.

Still, you never know where things can lead. From this previous African charity association  something good and meaningful did happen.  The CEO was contacted by the Clinton Foundation as they were looking for a doctor for a sustained African project.  He told me about the request and I flew from Ethiopia to Tanzania to meet with the Clinton Foundation representative working there. (The CEO did also demand a fee for referring me which was categorically denied.  Old habits are hard to break.) 

Ultimately I took the job and worked with the Clinton HIV-AIDS Initiative as an advisor for a number of years afterward in nearly twenty countries on four continents.  After my previous NGO experiences it was a pleasure to work for a professional, well-mobilized, well-managed foundation. 

One of the reasons for the success of the Clinton Foundation was the concept of putting successful members of the private business sector in charge of charity projects.  They brought private sector skills for success and attention to deadlines and costs.  There was none of the usual non-profit, bleeding heart, Kumbaya “let’s do the best that we can and clap ourselves on the back for the effort” thinking. There was direction, management, cost-containment and realistic goals. Failure was not an option.  With this kind of support I was able to effectively train the local country doctors and nurses in proper HIV/AIDS treatment. I did this in at least fifteen countries around the world.  They then had the ability to go forward to train their peers and create a sustainable, constantly improving situation.  I’d like to think that we provided the biggest ‘bang for the buck’ from the hard-earned charity donations received by the foundation.

Good times with the locals.
I’m getting older and have put in a lot of hard time in hard places.  I’ve done my time on the ground.  I know that you have to pay to play, even when you are donating the playing equipment. These days I believe as much in Pure Charity as I do in Unicorns who crap rainbows. Welcome to the Real World. I don’t know how many more years I will stay on this path of medical adventure, so every adventure has to count now.  I try to work only with the pros these days—the people with vision and intelligence to turn dreams into boots on the ground.  For the time being I’ve moved out of the charity world.  I prefer that socially conscious private sector companies, all too often viewed as the Denizens of the Devil. These companies end up providing more medical care, financial support and infrastructure to impoverished communities, in a more cost-effective way, than the top international charities.  The financial planning is solid and the implementation is militaristic.  I believe that Private Sector funding of specific charity projects is the way of Charity Future.  It benefits a company to support those who work for them and to improve the infrastructure in which they work.  Many of these companies (mining, oil and gas, commercial goods processing) go into a country with the idea of staying and creating profit for years, if not decades.  Most charity projects do not have the ability to sustain their work.  They are in and out creating the equivalent of a Charity One Night Stand.  And most of us know how those usually work out.

These are hard financial times.  During the 80’s and‘90’s everyone had a few extra dollars to donate to charity without the concern that it may never reach its intended victims.  Those days are gone, likely for good.  I find it personally insulting when good money is donated and little to none goes to improve the condition for those   whom it was intended.  Even worse when it is simply pocketed.   Keeping money intended for the poor is a heinous act, probably only a few steps above a war crime. If you are going to donate to charity (and as a reformed Purist I still think you should) do your homework.  Take the time to find out where and how many of your dollars will hit the ground.  There are any number of websites that monitor the activity of local and national charities.  Guidestar and Charity Navigator are two respected sites.   If your intended charity isn’t on any lists you may want to rethink your donation.  Real charity doesn't care about our personal sense of accomplishment.  It cares about victims served at the end of the day.  This is really all that matters.

Above all, my friends, be charitable. 


  1. This blog is equal to Nicholas Kirstof's column and should be similarly shared. I'm going to your recommended websites now to make sure my donated funds get to the people for whom they are intended.

  2. Brilliant! Cheers. Neil Prashad

  3. Wow, Erik, well said.

    I personally refuse to donate money to charities where people walk and drink out of pink bottles, wearing pink shirts, and sleeping in pink tents, what a joke. How much money for hype and how little to the actual researchers.

    You're doing great work, my friend, your bright light is leading all of us.