Haiti and Brooklyn

April 14, 2015

This post is a picture from Haiti and an anecdote from Brooklyn the next day.

Haiti (click to see the full version)



One billion people live on less than $1.25 per day (Source). More than 150 million people are hurt by taking illegal drugs (source). There are more than 220,000 police-reported rapes per year (source). I have many skills in my analysis and I’ve chosen my selected method of engagement (above) with the world’s problems. In certain situations, I’m less able to transition to how to help an individual person.

I’ve passed by glue-boys in Nakuru, the homeless in New York City, and refused Kenyan friends requests for school fees. I’m uncomfortable with this decision (Jesus: to anyone who asks, give), but I have established a philosophy and pattern that is my current choice for most requests (see here for a few examples).Last night, I struggled to psychologically transition between the two.

Driving in New York City, my friends and I stopped the car as we passed a man laying on the sidewalk. He had a bump to the head and was bleeding from his head, ear, and mouth, as well as having swollen eyes and unseen injuries causing him to roll around on the ground some. He was deeply consussed and delerious. His phone had been stolen, his skull cap was 50 feet away and his hat was 80 feet away.

One friend stopped the car, one friend called 911, and I got out to talk to the man struggling  and lying on the sidewalk (NYPD thanks–both the police and ambulance were extremely quick to arrive).

I’m uncomfortable with how long it took me to engage with him as a person to help and have compassion for. Was he homeless? Drunk? Mentally ill? Was there somethings systematically wrong that I was stepping into with no foreknowledge of him or his context and I let this theoretical difference become a distance-creating fear.

In some ways, all of those questions still stand, and my actions fit, but my attitude was slow. After the initial assessment of the area for danger and the victim for potentially deadly trauma, I should have engaged with him as a person. Even worse, if the driver hadn’t stopped, I doubt I would have spoken up, impinged on my friends time and implied lack of compassion, and overcome the possibility that the problem was structural and impersonal–not acute and close to us. We made the right calls to his loved ones and the police, got his hat, and tried to keep him calm and comfortable, but I could have engaged in a more caring, compassionate, and ultimately calming way.

Next time, I hope to make the transition from seeing another in need from one of the statistics to a person–and have the courage to act on it–faster.

Why I’m moving to Rwanda

April 14, 2015

I’m posting two posts in parallel–the more asked for but abstract ‘why I’m moving to Rwanda’ and a post with a picture from Haiti and anecdote from New York.

Why I’m Moving to Rwanda
Many of you have asked me this or been on the receiving end of one of my abstract questions on your own dreams. Here is my answer and the categories in which I’m thinking.

The short version: I intend my life to be characterized by service, learning and love, while I take into account my need for challenge and community in seeking to follow God in using my gifts to make an impact on people’s true good with a particular ambition of using my current freedom to address great needs on the technical side of global health.

The rest of this post just explains what I mean by that 60 word run-on sentence.

Categories: I’ll separate this into four categories (you may have heard me ask you for these in your life, so I’ll include my definitions):

* What I want to Characterize my life: what I want to be true of me no matter what my life ends up looking like.
* My personal needs: traits true of me that I need to take into account when considering the structure of a phase in my life.
* What I’m optimizing: the trait to help decide between multiple possible good directions
* My particular ambitions and responsibilities: What is unique to my situation, past, and preferences. This helps limit the infinite possibilities of the optimization criteria.

What I want to Characterize my Future
These are three traits I came up with senior year of college looking towards what came next and they have only become more true of my desire
Serve: My time should be spent to contribute to something greater.
Learn: I want every stage of life to enable future stages.
Love: Though my bent is technical and abstract (cf. this blog) I intend to care for other individuals, become close friends, truly care for them, and act on it.

My Personal Needs
I’ve noted two major categories of needs I have in order to flourish in a given environment: Challenge and interpersonal interaction/community. These are the main two traits that energize me. Challenges have historically produced virtuous cycles in me requiring order, work, energy, and drive to address–and they are just fun.

I’m also extremely extroverted in the technical sense of being around people energizes me. Having a community to provide this input, play, and engage is a blessing I’ve enjoyed everywhere I’ve lived.

What I’m Optimizing
I follow God in using my aptitudes, skills, experiences, resources, and time to address the way I can have the greatest impact on people’s true good.

I follow God who forgives and gives direction and character to the rest of my life. I’ve lately been considering the following from Paul’s letter to the Ephesians, “By grace you have been saved, through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast. For we are His workmanship, created in Christ Jesus for good works, which God prepared beforehand.”

Following God, i use what I’ve been given–from God, my parents, my community, the many who’ve invested in me and forgiven me–to contribute to others true good. There are lots of things this could look like–if I had the opportunity to make a systematic improvement to fatherhood in the united states, I’d do that. As it is, I see need that I can well address in the area of global health technologies.

My personal ambitions and responsibilities
Currently, I have few responsibilities (OK, really few as I’ve left most of them with various levels of handoff over the last few weeks in Wheaton) as I have no children or major sickness in my family. Given this freedom, my ambition is to contribute systematically to the technical side of global health.

This really attracted me while I was in Kenya and connected with me ever since as a location of great need, where great impact can be made systematically especially on the technical side of things. This could include engineering (some groups like PATH do great work in this space), in operations process, or in IT where I’ve been working lately.

What I’m doing in Rwanda:
Partners in Health in Rwanda is Inshuti Mu Buzima. They have been working with the Rwandan Ministry of Health on developing their Electronic Medical Record system using the OpenMRS platform.

Business Analyst: My first role in Rwanda is as the business analyst. This is the IT concept of someone who helps clinicians or businesspeople understand, define, and approve the way a system could be designed that would help them solve problems. In Rwanda, I’ll be working with the Partners in Health associated health facilities to determine what makes the most sense to work on, how it will be designed, and translate this into what the developers can use.

Software Development Manager: I’ll be managing a few Developers in Rwanda to help solve these clinical needs. We will work to improve how we develop currently, the interactions with the Ministry of Health, and the skills fo the team overall.

Where I’ll be living: I’ll be living and working with PIH staff including Rwandans and expatriots. It doesn’t have all American luxuries but it will be comfortable.

Life update and thoughts

April 25, 2013

Hi everyone, just a quick life update.

I spent the last year and a half at Duke and got my masters in biomedical engineering in December. The classes were great and I enjoyed being at the same school as my brother.

I’ve now accepted a job as an IT analyst at a hospital group here outside Chicago.

I’m rather glad job hunting is over and excited to start a new challenge where I’ll learn about the technical side of healthcare.

I hope everyone’s year is going well.

I’m currently reading “Mountains Beyond Mountains”, a book about Paul Farmer, the founder of Partners in Health. His caring nature, brilliance, and dedication to his patients are well known, but I have been struck with his moral imagination–the ability to imagine the world as it might be–and then his courage to act on it.

For instance, he worked to strengthen the global fight on multiple drug resistant Tuberculosis (MDR TB) knowing that each treated patient cost far more than traditional cases. Some attribute this simply to a myopic physician’s view of simply the patient in front of them. It seems to me that Farmer actually looked further than his contemporaries by imagining the disease course of MDR TB and envisioning the impact of applying resources now to treat it. Many come away from his story inspired to look at the single patient instead of all patients. I see the story of a choice to view all future patients, not just all current patients.

April 12, 2011

Hello everyone, here is an update on my life and activities.

Work and Tenwek

Intern Housing
The first intern housing building has been completed successfully and six interns and two residents are currently living there. The second building will be very similar but with six apartments instead of five and we have just finished pouring the third floor. Currently, we are working to build the staircase to the standards of a building housing doctors–always a challenge, but it becomes a great example of professionalism by the end of the project. The second building is due to be complete June 25th. See it below in construction phase next to its just completed cousin.

CT Scanner
More excitingly, Toshiba donated a CT scanner to Tenwek and we are working to have it installed now. Tenwek currently sends patients three hours away when scans are needed and the machine’s installation will dramatically change patient care for many conditions at Tenwek. We are currently fundraising for the project and are blessed to have just received a $350,000 matching gift towards the $700,000 total budget of the project. Pictured is our team unloading the CT scanner from the container. Two tons is a lot to drag; fortunately, we’ll have professional help to put it in place.

We are working with Engineering Ministries International (an awesome group that coordinates volunteer professionals from all over the ‘States to work on particular needed projects abroad) to prepare the hospital’s utilities (power, water, sanitation) for their expansion. The hydroelectric powerplant made a huge difference when it was installed. Even now, when there isn’t enough water in the dam, power can cost us tens of thousands of dollars in a month. In fact, though we (the hospital) lost money in both 2008 and 2009, the losses were smaller than the amount we paid in external power costs. On the water side, we hope to both expand our capacity and make it clean enough to be comfortable drinking water for everyone.
This is the river from which we get our water (you can see it starts a bit brown) and the waterfall and dam we use to generate power

Grant: Tenwek is applying to USAID’s American Schools and Hospitals Abroad program for a grant towards the construction of a new building for the Tenwek Dental and Eye units. It will be a hugely improved space for them with superior access for their masses of outpatients, improved service facilities, and even a few apartments for trainees to stay. We are in the process of writing the grant now, some of which is fun writing, for instance: how does this project advance American ideas and practices. (and how cool is that computer generated image? It took me a minute to realize how they did it.)

Life at Tenwek
Youth Group:
In the local community, I’ve been enjoying working with our church youth group. The group started less than a year before I arrived in Kenya and it has been great to watch it mature from our early simple bible studies to a group with some studies led by the students, an attempt at a self sustaining chicken farm for eggs, and a mission trip led by the youth to a community over an hour away. Here, they are building (and then mudding) a house for the grandmother of two families of orphans.

Social Life at Tenwek: The life of a guest at Tenwek is always fun, but especially now that I’m living in the village about a mile away from Tenwek. I live in a single room attached to their storehouse on their small farm. The family is nice and it is really cool how they both have salaried jobs, operate a shop in town, and run their farm. I love the Kenyan emphasis on education and, even though their kids are young, sometimes I sit in their living room with them each of us doing math homework–of one kind or another. (Sorry about not having a picture, I need to take my camera into the village).

I will be leaving the Kenya June 26th, so all those projects finishing up in June is both fortuitous and a bit imposing. The Intern housing is set to complete June 27th, the CT will be commissioned June 21st, the Grant is due June 30, and the Engineering Ministries International team should be coming in late May.

More excitingly, I have just received word that I was admitted to the M.Eng program in Biomedical Engineering at Duke where I expect to go in the fall. I’ve begun a review of basically all the math I’ve learned in my life. So far I’m at first semester freshman year of college, but I admit, this is taking up time I might have used blogging (not that there wouldn’t be enough time if I didn’t hang out with visitors so much, but I have no problem with that).

Thanks for everyone’s support

When I give to individuals

November 7, 2010

Though I very seldom take this side in a conversation, it is possible to give too little personal gifts in the third world (usually I take the side that western giving swamps and undermine majority world efforts and that our gifts of time and money should be structured to incentivize work and improvement). Instead, our giving must be structured consciously to help a person. This week I have been part of three local donation processes which are examples of how this might look in the real world.  As you read, notice that the expected value of my total giving only adds up to perhaps $30.

Today, I am giving $1.25 to a local security guard to go towards the construction of his church. I was considering between 60 cents and $1.25 as this was the range that others had given. My gift did not go far towards the construction of the church, but I joined together with the community putting my money towards a deserving project. It can be reasonably objected that I just encouraged Kenyans asking Americans for money and undermining our relationship and if I didn’t know the person or if I gave more, this would be correct. However, in this case I am engaging as part of the community—my donation will not allow the community to be dependent on outsiders, but to see me and those like me as people joining their cause.

Next is a print cartridge for printing school worksheets for a local orphanage. The printer was donated to the orphanage but does not include a print cartridge. The orphanage currently spends approximately $35 on printing each month and one $60 cartridge should last them over six months. As this will save the orphanage money, I will not be donating the cartridge, but instead will merely guarantee the purchase of the cartridge so that if the printer does not work, I’ll reimburse the orphanage ensuring that they take ownership of this method of saving money but need not worry about being unable to provide teaching materials for the next two months because the printer is broken.

Finally, a friend of mine who is my house help (cooks, cleans and does laundry once a week) has a son who I also know who is in his fifth of eight semesters of university to become a teacher. The family does not have enough money to finish this semester and will be unable to take his tests without help. Another family who the father helps and I got together and set up a combination of donation (about $20, partly in the form of interest payments on money he saved with me), loans against his future service (about $250, mostly from the other family), and repayment of what he had saved with us (about $50). This was done after about $300 was donated by the village and $200 from the family this semester and an understanding about the future relation in the payment for the last semesters. This is allowing the son to get closer to a well paying and societally important job without wasting what had already been paid to the school. All that said, we are not sure how he will complete the last three semesters. Kenya does not traditionally use loans as credit is almost impossible to establish, but instead works by selling family possessions and the village coming together to invest in the education of the next generation.

I hope these examples are instructive on how we can think about loving our neighbor, though I’m sure that each could have been done both more helpfully and lovingly, I think the perspective is a good place to start.

We Treat, Jesus Heals

November 1, 2010

The head chaplain at Tenwek had an aneurism in his heart and could have died any day.

An open heart surgery team came to Tenwek and removed the problem with a major surgery including profusion to do the job of the heart and lungs by machine.

After the successful surgery, there was much thanking of God on campus and especially in the church service. Everything was done in the name of Jesus. But I was thinking the whole time, ‘ok, God created us and used these surgeons to heal, but the operation was done by the surgeon’. This was my thought through repeated utterances of “We Treat, Jesus Heals”.

I began thinking though, ‘where does the healing really come from?’ On one hand, if it weren’t for the surgeons, our chaplain would have died. However, I eventually realized the wisdom of 1 Corinthians 3:6-7 in a parallel concept, “…God made it grow. So neither he who plants nor he who waters is anything, but only God, who makes things grow.” Treating, caring, sowing and reaping are important parts of the process, but man controls effectively none of the complexity. For every cut of the scalpel, the body has to heal about 10,000 connections on each layer of cells cut. And this is only the beginning of the healing process not to mention the immune response to any bacteria that enter, the swelling which brings resources to help the connections, or the scar response to make it stronger than before.

Once, when trying to see how complicated we are, I looked up the digital size of the genome, expecting it to be enormous. It isn’t. It fits on a single CD. But with less than half the complexity of Microsoft Windows or a DVD of Avatar, this code defines an intelligent and enormously adaptable 100 trillion part organism. Now that is elegant design.

Our efforts might seem trivial compared to this amazing intricacy. Perhaps our actions don’t even matter. But I think that the miracle of modern medicine is truly powerful. Man is capable of great and wonderful and awesome and terrible deeds. The surgeon really was critical in saving the life of our chaplain. This is perhaps the aspect that most floors me. In all the enormity through log scales of size and our comparatively small capabilities, God “has good works set before us”. He really uses us and if the heart team didn’t come to Tenwek, he really would have died.

What an honor, to be used by God.

African Friends and Money Matters

October 4, 2010

Boy am I glad I’m in Kenya at Tenwek. Compared to much of the content of the book, African Friends and Money Matters, my experience has been far more western than it could have been. Doing business and engineering within these structures would be much more difficult. Not only is this because, while I work mostly with Kenyans, most of my words are with Americans, but also it was evident from driving from the airport my first day in country. Every society has an implied system or culture of driving. My dad taught me that the first rule of driving was to be predictable, this is true all over the world. In the U.S., it is a highly regulated system, generally adhered to beyond what is required by self interest for the larger good of the system. My time in Cameroon is at the other end of the spectrum. To turn against traffic, one had to wait until a motorcycle was turning in the same way as you to cut between two cars, then you could stay along its back tire, giving no room for the driver going straight whose path you were crossing. The next driver behind you would continue right on your back and so on until either the group turning against traffic was exhausted, or a motorcycle going straight made it between two of the turning cars. Kenya is somewhere in between. Turns are reasonably well defined at intersections and roundabouts and there is a convenient honk and light flash language to inform passing. At the same time, traffic lights are ignored to an extent that I laughed at our stopping at one when I was back in the U.S.

This pattern continues for many of the subjects described in the book which took an observation based approach to looking at African relations and personal finances. I very much enjoyed the subject based format of the book which was composed of 90 individual observations, each one well founded but often disagreeing with other observations or implications in a conscious understanding that across an entire continent there is significant variety to culture. Fortunately for me, it turns out that most of these observations are true to a lesser extent in my area of Kenya. With Kenya’s English language (for a lot of people at the hospital at least) and the wealth from the fertile area, the cultural forces leading to the trends in the book are muted in my experience of Kenya. That said, many of the patterns noted in the book are seen clearly here and having someone else notice them and put them into words helps me to understand some of the relations I’ve had here. I especially appreciate the author’s frank usage of his own experience and personal policies in dealing with many of the issues that come from living in Africa as a westerner.

The Good Samaritan

October 4, 2010

One very common aspect of walking the streets around here is having children say to you “give me sweet (candy)”. Near the top of the local high point this has gotten so bad at times that the children have started throwing pebbles if they don’t get what they want. I often wonder where they got the idea that white people would give them sweets but then I see short term visitors giving out whatever they have on them or candy brought just for that purpose. Adults are much more socialized than that. Many will greet you or ask you to come talk to them, give a very good hand shake that will then pull you towards them as they ask for school fees (or a bicycle or to take them to America). It is one thing to give an orange to an orphan (great vitamins) or a loaf of bread to a street kid sniffing glue to stave off hunger, but candy is not good for the child, it can only be used to build a relationship.

This attitude of white people coming and giving stuff was most painful when five foreigners and 35 Kenyans went to a local village to help build a house for two families of orphan children. Most comments towards the end were very positive, but one person talked about how they were happy that the white people came and fixed this problem in their village.


I saw the harmful effects of giving out things on the street but I realized that I would give things to the kids of missionaries at the hospital but would not give out the same thing to a kid on the street who could use the thing (food, pen, whatever) far more. Eventually I came to the conclusion that the difference is that one gift builds up a relationship while the other undermines it.

Not only does a gift on the street alter any future interaction with the kids, but as the trend continues as the children grow up it becomes a learned dependency or what a psych textbook might call an external locus of control. Then an individual thinks that their actions don’t determine their life. In some cases this attitude is justified (injustice or a westerner’s good intentions swamping their efforts), but it is never helpful.

The “Good Samaritan” has been enormously diluted in our usage. Now, anyone who does something nice to a stranger is called a “Good Samaritan”. In the actual parable, the Samaritan didn’t just do a kind act, he helped the injured Jew up, to a hotel, cared for him over the night, and then had the inn keeper take care of him and left the money for the job and giving an open promise to pay for any further needs. The Jew had been ignored by his own people who either didn’t know how or didn’t care to help.

A business ethics teacher of mine defined ethics as the character of courage and creativity to do the right/best/proper thing. We usually realize that the moral life requires courage, but we too often see our options in terms of dichotomies.

The Good Samaritan was first Good because he stepped up and acted with care, but was special because he had the creativity and commitment to take ensure that the right thing happened for the injured.

In our every day life we see a set of decisions to give or not to give but we too seldom think about what action is best for the individual in the long term. Giving a kid a candy isn’t truly good for them, though it is nice. Meeting with an adolescent, playing with a child, developing relationships where we set an example or fulfill a real need is how we truly love. It is the difference between helping someone and loving them, taking their good as your goal.

The Fiddler on the Roof

October 3, 2010

I don’t often review movies but I’ve been preoccupied with thoughts of The Fiddler on the Roof since I saw it for the first time last night.  The movie is timeless partly because it is fully in its own time and place; it’s a conscious examination of the human experience there so we can think about its parallels to the rest of life.  Each song powerfully captures the tension felt by the characters.  Seeing multiple sides of tensions is, in fact, one of the strongest points of the movie as symbolized by the main character’s onscreen broodings portrayed as a series of “on the other hand”s.

The Fiddler on the Roof does seem to sacrifice a bit of formal artistry to capture the culture so well.  The song lyrics often sacrificed being lyrical to being emotively provocative.  And my AP English Language mind really wanted to see the Fiddler theme come more full circle as a metaphor for the village (maybe it does, but I haven’t been able to figure out how, and the movie makes the initial metaphor explicit by addressing it to the camera directly).  The movie even went (mostly) without an overarching thesis or position on the subjects it addressed, preferring instead to simply show the changes happening in the village over time and their initial difficulties without showing how the new marriage forms worked in the long term.  The film’s lack of a strong position on these issues was seen in the main character’s repeated meme “what could I do” as he accented to a number of changes.  If anything, the theme of the movie is ‘life is hard, traditions are hard to keep, and change is tough’.

I highly recommend it.  Listen to the lyrics, think about the themes.  And I am really nostalgic for school where we would have a Lyceum, or Salon, or some other pedantic but fun word for discussion.

The Dream

September 5, 2010

The Short Version
My dream is to some day perhaps fifteen years from now work in biomedical devices for an institution that seeks a profit in order to provide a service. I’m particularly interested in effective, reliable, and cheaper devices for the 90% of cases which have the same needs. An institution like this can be consciously beneficial to its employees and work to strengthen other groups with shared goals. In law, a business is treated like a person. It might act like one—growing, fulfilling its responsibilities, and serving its community.

The Frameworks
Businesses provide the great majority of society’s services but corporate social responsibility is an incoherent concept. A publicly traded company has a contractual, fiduciary, and legal obligation to make the greatest possible profit. This is how the system works and the trust and transparency built up in a few international stock exchanges has allowed a great portion of all business complexity since the Dutch East India Company.

This does not have to be the only option. We should neither take for granted the incredible opportunities for diversified (read safer) complex growth, nor invest our money purely into projects whose function for society we don’t care about. I think people should do what they want with their money. Most people live (or want to live) with greater purpose than their own material advancement.

The Business Example
Not all businesses exist solely to make money. A privately owned business does what its owner(s) wants it to do. This gives it the opportunity to provide greater and more profound public services in certain situations than other corporations. One famous example of this is the Building and Loan, famous to my generation only through the crashes and “It’s a Wonderful Life”. These privately owned businesses provided a critical public good using the banker’s relationship with the community members to allow trust and a judgment of risk to provide home loans to working class families.

This model of business for the owners’ purposes, not just their good, exists in impressive modern versions as well. This year, I nearly worked for a company which did device refurbishment for the suppliers of the equipment. It is successful, but the amazing part of its operation isn’t the repair capability but how it treats its workers in the U.S. and abroad. Instead of merely using workers to provide a service to customers, which it does, the business builds up workers, supplying services it can efficiently provide, encouraging personal growth, and partnering with local churches.

The Benefits
The provision of gainful, educational employment is possibly the greatest development service possible. Not only does it materially provide, but it improves skills, education, and hope. Further, it embodies the economic definition of sustainable because the business operation there is positive net present value, i.e. profitable, so can continue to build up a community into the future through its own actions as well as agglomeration effects. (Aside: agglomeration effects are one the best arguments I’ve heard for the enormous success of areas within China and India. When one business moves into an area, they require many support personnel and institutions to function efficiently. As they spend money to build these up to make their business more efficient, that decreases the cost and increases the incentives for more business in the area creating a virtuous cycle.)

Many current businesses have donations where they provide their services for improved public image or altruism (to the minor detriment of the shareholders) but generally do so inefficiently as they do not position themselves to provide maximum benefit. The business for service can systematically provide their services at cost to groups of the same mission designed to maximize the benefits while costing the business only the time of some personnel. I worked for a health care equipment company one summer. They produced their equipment for one tenth the price they sold it for. This went to pay for salary, testing, approvals, failed innovations, and the other systems required to bring the successful product to the market. It makes sense, but it is not purpose driven. The business with vision can sell the equipment at cost to institutions which share their goals and would not otherwise be able to pay. In this way, the market position of the business can be used to provide valuable goods much more efficiently than NGO’s and other groups which try to provide these services and at effectively no cost to the business.

The Opportunity
I dream of applying this model to the field of medical equipment.

The United States subsidize world medical research and development enforcing patent laws. Increased and increasing demand for lower cost solutions for the same problems we have always faced in medicine creates an opportunity to profitably provide products in this area. Previous systems encouraged the best humanly possible solutions instead of best for the money—that paradigm appears to be changing.

This shift in U.S. health systems creates the demand for the product I want made for both the United States and the world. Tenwek hospital where I currently work uses very few devices designed specifically for a third world context. When I have gone to rural clinics, they seem to use few devices designed for them. Instead they are using the most ruggedized and cheapest options from the first world and making them last. Working to make devices which are reliable and do the job needed 95% of the time is how we improve outcomes for the world while decreasing costs. My impression is that far more often, a failure in health provider systems fails a patient, not their equipment’s lack of advanced features and conveniences.

In this way, the field I dream of entering is desirable no matter what the business model. As I said at the beginning, businesses provide for most of society’s needs. Businesses are incentivized by the market. And the market is moving in the direction in which I am thinking.

The Proof
This model is possible. Aravind Eye Care System has nearly 5000 beds between the five hospitals and 13 additional vision centers. In one year they saw more than 2.5 million patients and performed over 300,000 surgeries, more than half of which were given for free or at discounted prices. They are able to do this, partially, because their biomedical research and production has cut their price of an intra-ocular lens (required for cataract surgery) from over $100 to about $5.

The Difficulties (optional, you have read far and this is just a continuation of my thoughts, but I really think this model can work.)

The three ways in which this entity differs from modern publicly owned corporations, employment benefits, needed product distribution, and private ownership, each pose a potential problem the survival of the group.

First, the ownership model does not easily allow for public small amounts holding and investment. Publicly owned companies work because their accounting can be transparent and their successes and failures quantified. The same issue gives difficulty to NGO’s the world over: how do we quantify success since there is no “util” or measure of good. Thus every investment must be manually studied, an expensive proposition which will slow growth. This issue is not purely detrimental, the significant investment by an owner into the group gives superior incentive to ensure good corporate governance, a way in which the publicly owned model has been mediocre. Additionally, for a large business, though it is a detrimental from a diversity of assets perspective, employees are in a prime position for ownership of the company.

A soft hearted business has the potential be timid with the personnel which make up a company. Each employee must provide a benefit to the company in exchange for employment. Period. Even a company whose explicit goal and structured incentives are to maximize profit can have significant human resource issues especially in a down market. All companies struggle to have their workers believe in the work they are doing. A study of business mission statements found, (to the surprise of the authors who thought that the societally beneficial businesses would have the most loyalty) that the workers of a business are motivated by strong missions in whatever direction. The reason that the best want to work for Google (not Microsoft) is their “Don’t be Evil” motto and actions. They aren’t perfect, but they pulled out of China. They try, so they attract the best.

Here, the model of Tenwek Hospital, where I work in Bomet Kenya, is instructive. Each employee greatly benefits from the hospital, but they are also deeply invested in the mission of the hospital. A good friend of mine at the hospital recently said that he thanks God for bringing him here because he sees the difference between his teenage son and those of his colleagues who sought the highest power job they could attain. My friend’s commitment to the hospital’s mission benefits his workers, the patients, and provides an example to his son. His work allows more complex service than top down management can possibly provide. Not every institution can have the loyalty of a rural mission hospital, but investment by the employees is necessary to mitigate inefficiencies in needed product distribution.

This final difficulty in the inefficiency of delivery of needed goods in a way that will not damage the institution is potentially dangerous. As stated above, we cannot measure good in “utils” so it requires stewardly caring on the part of those who work for the institution at every level associated with the institution’s donations at cost. If a culture of responsibility to the institution fails to develop, that part can become inefficient and will have to be abandoned, simplifying the model to that of the business’s profitable benefit to society plus that of the device refurbusher working for his employees.