Earning Abroad: Doing Rehabilitation in Global Health

Welcome back to Earning Abroad! In this series I’ll introduce you to some inspiring and ambitious friends I’ve met on the road — friends who have found viable work away from their home countries.

Today’s Earning Abroad subject, Wes, just happens to be one of my favorite humans on the planet. Wes and I are fellow Thailand addicts and though I’m no longer based in Koh Tao and he’s no longer based in Bangkok, he hasn’t been able to shake me yet — if all goes according to plan, I’ll soon be visiting him at his new place in Phnom Penh. But it might be hard to coordinate our travel schedules. Wes’ mind-boggling job keeps him on the road three weeks out of every month — the man has crossed 240 borders in the past four years!

And that’s why this interview, out of the entire Earning Abroad series, is the one that I personally most looked forward to reading. Because after all our time spent together in Thailand or chatting online from opposite sides of the world, I still didn’t fully understand what Wes does. In fact, my first draft of this interview was tentatively titled, “Earning Abroad: Doing WTF Wes Does.” And, true story, Wes once concocted an elaborate April Fool’s story about his development job being a cover for his true position in international intelligence for his native Australia, and I believed every word. Frankly, I’m still vaguely suspicious. Read on for what might be the most interesting interview to ever appear on this site — or perhaps another layer in one secret agents’ extremely elaborate cover story.

AB: Walk us through a typical day on the job.

WP: Timezone differences between Western Europe and Asia are poorly designed if you ask me. My phone beeps all night, and if I feel like it, I’ll read emails as they come in. They’re usually pointless drivel – I’m cc’d to a forwarded cc that started from a bcc from some guy who mailed a guy who had something of value to say in the late 90s. But occasionally, I have to do something about them, and that’s where the trouble starts.

I’m in the business of health and disability in low-income and emergency situations. Specifically, I’m a technical adviser. Anyone who reads this blog will have a vague idea of humanitarian development. You probably think it’s sitting cross-legged in the dirt singing songs, or buying your millionaire uncle a conceptual goat to give to a family in a village somewhere. Both of those things do happen. But development is also about working with national healthcare authorities get organised to work with and for people with physical disabilities or chronic diseases, whether or not those people own an abstract goat. Somewhere, someone answers emails at 3:00am to fund, critique, design, troubleshoot or plan all this. Sometimes that person is me.

So a typical day on the job is roughly divided into three varieties. One is churning through the details. Working across 9 or so countries, 10 or so projects at a time, each of them with dozens of individual accountabilities – all done in the complex space of a medium-sized International Non-Governmental Organisation (iNGO), across multiple donors and different national partner organisations – tends to equal a lot of emails. Thankfully, my role is a technical one – that means other people are dealing with the administrative complexities.

And all this is done working for the French. It’s great working with and for the French, but nobody ever accused them of creating simple, clear solutions where a complex one was possible. They argue that things are complex – the world is a dynamic, ever-changing place full of human idiosyncrasies, so our analysis of it should be like that. I argue that if it can’t be made simpler with a spreadsheet or a chart of some type, you’re doing it wrong. But we get along ok.

So this is the second kind of day. I get called in when there’s a problem with the way a project is designed, or we don’t know how to do something we promised a donor we’d do, or if what we’ve done before isn’t working. There are some pretty sharp people working in these projects, so by the time it gets to me, the problem is usually a bit of a mess. I’m the troubleshooter’s troubleshooter, so to speak. My boss, then, is the troubleshooter’s troubleshooter’s troubleshooter. Thankfully she’s French, and finds great beauty in this complexity.

The third kind of day is when I’m on the road, in a project or a program, looking at the stuff that’s happening. These days are good. It could be anywhere from a snowy Southern Afghanistan or Kashmir, or a baking hot Dhaka. These days I’ve pushed further east, so it’s also sometimes under Cambodian mango trees. When I look at the stuff that’s happening, I’m asking whether it’s working, whether it’s managed well, whether we are meeting our obligations to the donor, to our ethical standards and whether we’re doing things efficiently. I’m also usually asking how we can get organised to make sure we’re doing it better in 2-3 years, and whether we can make it bigger, or whether we should shut it down and do something more important.

To give you an example, my organisation supports about a dozen or so physical rehabilitation services in Asia. This is where people come for therapy or assistive devices (like wheelchairs, crutches, prosthetic legs, orthopaedic braces and so on) if they have musculoskeletal impairments. They have well trained people in them, so I’m trying to support those people to develop more skills to respond to future health challenges, like diabetes, heart disease, stroke. These places are not about landmines so much, anymore, but we’re not ready for these huge changes. Most of the clients in these places are road traffic accident survivors or were born with cerebral palsy or other disabling conditions – if you’ve traveled in Asia you won’t be surprised. But our colleagues are not always skilled in these areas, so that’s a big challenge for us. So I’m asking how we can better fund these services so they’re ready for big challenges. Our field isn’t funded too well, compared with the ‘big boys’. I bet you didn’t know that violence and injury alone kills more people than HIV, Malaria and Tuberculosis combined. Bill and Melinda Gates give metric shit-tonnes of cash-money to the latter, but we’re getting peanuts to prevent and treat injury and chronic disease.

But things are improving, and that’s fantastic.

How long have you had this position?

For this organisation in more or less my current role, about 6 years.

How did you come to work in development? What inspired you to find work in your field?

In Melbourne, Australia, there used to be a Health Sciences building in the funky but grimy bit of downtown. I took a train there when I was 16, mostly to check out physiotherapy, which I thought would be a good job. Physio was on the 3^rd floor. I took the stairs – the school for Prosthetics and Orthotics was on the 2^nd floor, and I never really made it to the 3^rd floor. I got talking to one of the lecturers, and talked about opportunities to work in conflict settings. That seemed cool, so a few years later, that’s what I studied. I did a few months in Cambodia as a student in 1999, when there were more cowboys and less organic home delivery schemes and Bentleys. I then wound up taking a postgrad scholarship and set that sort of thing aside, opting instead for looking at graphs in a laboratory, which was a sophomore choice – wise and foolish at the same time.

Then, in 2003, someone with some research skills and knowledge of rehabilitation was required, and so I did some work in India on evaluating the response to the 2001 earthquake. Then I ended up in a job teaching students from Cambodia, Pakistan, Laos and Sri Lanka in an online program. This lead to another short evaluation, this time in Northern Iraq. I didn’t want to do this thing permanently, mostly because I didn’t want to leave my dog behind, but then more or less, I had to. The dog ended up with my friend, and in 2008 I took a more permanent job in rehabilitation.

Was it easy to find a job?

I’m not aware of anyone with the right qualifications and/or enough mojo who wanted to get into development, who didn’t. The job I have now has evolved a lot – partly to fit the times and partly to fit me. But there are all kinds of jobs in development. Some are sketchy ‘voluntourism’ jobs and I don’t really feel qualified to offer an informed opinion, but certainly, some caution is needed before you think you’re actually doing any good in those jobs. But, that is true of all jobs, in my mind, and especially so for development.

A lot of people come to this kind of work through large-scale emergency response type stuff. Haiti, for example, had hundreds of health professionals descend on it. Some will stay around and learn about development principles to complement their professional foundations. Those people might make a career out of it. Others might study development, international relations or similar. I didn’t do any of that, really. It’s just the luck of the draw in some ways. I just applied to a job I saw online. I had done some consultancy work for the organization before, so they sort of knew me – but gave me the job anyway.

How did your family and friends react to your initial departure?

No big deal at all. My stepdad gave me the advice he always gives, which is very sound. “Don’t piss into the wind,” he said, and I have done my best in that regard. The toughest bit was leaving the dog.

How much money do you make? Is it enough to live on?

Much, much less than I would at home. But much, much more than my peers from other countries. It’s enough to live on, but I’m going backwards compared with my peers at home. But that’s the cost of not being a joe-boring with 2.5 kids and a mortgage. I work with some awesome people. People from all over the world. The are interesting, smart and fun. That’s priceless.

Development in general is usually like this – not lucrative, but enough to live on. There are exceptions. Consulting and some intergovernmental organisations pay pretty well, and have handsome retirement benefits and things like that. But NGOs, rightly, tend to be pretty modest. Still some would say we make too much, sometimes hundreds of times more than the average local. I don’t know what’s right and wrong, here. But anyone thinking about getting into development for the money should probably reassess their choice.

What kind of legal hoops do you have to jump through?

I’ve lived in 4 or 5 different countries in the last 7 years. They’re all a bit different. Some are complex and require complex legal processes and paperwork. Others, just turn up and rent a place.

Delhi was a great place to live for 2.5 years, then getting a visa became a bit too hard. There are plenty of interns and expats in India, so your mileage may vary. A stint in France could only go for 3 months because of the visa requirements – quel dommage! So then I ended up in Bangkok, another great place. After 2 years of that, I had to move to Sri Lanka for internal company reasons (of which I did not approve). Sri Lankan work permits are complex to get – but it was possible. The trouble was it took three months of planning and then about 6 weeks in Sri Lanka to sort it all out. My travel load means that is really just not feasible. So recently I moved to Cambodia – at least temporarily. I think it might become permanent. So far, so good. I’ve been lucky to live in these places – but I would like to be able to settle down a little bit. I haven’t had pictures on the walls since I left Delhi in 2010. There are still boxes of homely stuff like cushions and teapots in storage somewhere in India. I should go get them.

What skills do/did you need for this job?

There are two kinds of people: those who can extrapolate and find missing information. I try to be the former.

So, for my job specifically, it’s a mix of analysis, policy research and planning. I’ve learned the ‘development’ bits on the job. I think that’s the way it needs to be. Things are so specific to the situation that you really need to learn the context on the job. Employers know that, so the career path takes that into account. For anyone thinking of a career in this space, there are roughly 4 types of job. First is the leadership and direction – for that, people come from technical and project management backgrounds, many with higher degrees in international relations, management or human resources. Then there are the admin people. These are regular admin people, with the specific added value that they intend to make themselves redundant by training local people how to do that job. This works well. These are people like accountants, human resources people, logisticians and so on.

Then there are the technical people, like me. It could be engineering, health, policy, law, education – whatever. Through internships and perhaps a volunteer contract or two, you gradually get the skills (and attitude) to make a career out of it – or decide it’s not for you. These days I have a higher degree, but it’s not really related to my field. It’s handy for quick credentialing to senior authorities, but that’s about it. There isn’t really specific training to do what I do – in fact it’s one of my ambitions to create some, or be involved in developing a course where my colleagues can get qualified in this kind of work.

Another avenue to this work is the specific emergency response type people, who really sort of supplement the national workforce when those skills are just too scarce locally. Sometimes they transition into development work once the early emergency response stabilises. These people are technical people, maybe medics or other health types, but there is a need for engineers, water and sanitation experts and a swag of niche specialists plus people to manage and get them organized.

What were the best and worst things about working in your field?

This is a great job. I can’t imagine a better job, really. I have seen some amazing things, both at work and alongside it. I have fantastic peers and colleagues. It’s a small sector, so everyone knows everyone, from basically all over the world. This is easily the best bit of a great job. The worst bit, or at least the bit that anyone reading this should think about, is what it means for your career long-term. It’s not always consistent with your ideas about career back home. The more specialised you get, it may get further away from a neat fit into wherever you might like to work back home, if that’s where you want to be. But if you’re worried about that at the start of your adventure into development, get back in your car, fill it with gas, drive to work, and a good day to you.

The other thing that bothers me a bit is that there are some pretty big egos. Most readers will know about the “backpacker Olympics” – the game where someone says something they did, and the next person one-ups it. It’s boring and stupid, and in development is no different. “You were in Mozambique in ’92?! I was there in ’91 living off leaves and twigs.” It’s boring and these people are morons. Many wear zip-off pants and as a consequence, should be set on fire.

What would your advice be to someone seeking to do the same?

If you have no experience or contact with development, then the first thing to realise is you probably don’t add a lot of value right away. You might be excellent at whatever you do at home. But so is someone in whatever country you might end up in, and all you’d be doing is taking their job. But with broader skills – in training for example – then maybe you can contribute to your peers in other countries. This keeps me on my toes – I know I am doing my job well when my colleagues feel confident and skilled to take over. I then need to be entrepreneurial, and find new techniques and approaches in which to work and take our organisation.

It’s also important to remember that a lot of people reading this might be interested in working in development in their own country. It’s not all about expatriates working abroad. Countries that we think of as low-income countries are still pretty cosmo – there are some outstanding training programs and the talent pool is massive. Thankfully, the days of one-way traffic from wealthy countries to poor countries are ending – many of my colleagues working ‘abroad’ are themselves from low-income countries with lots of development activities. Their path might be quite different – starting work in their own countries, before contributing what they know in other places. I’ve got colleagues from India, Nepal, Nigeria, West Africa, The Philippines as well as countries where you can drink the tap water. Of course, people working in social services in their own country are contributing at least as much, and probably a whole lot more, than those of us with fat passports and chips on our shoulders. The distinction of ‘abroad’ is artificial, and the work doesn’t get more valid because it requires a visa and quality shoes.

I think the best advice is still to start by volunteering. People further along in their career can network a bit and try and find specialised areas to work – either as a volunteer or as a consultant of some type. A lot of countries have nationally funded volunteer programs. Volunteer Services Organisation (VSO) in the UK, Australian Volunteers International, and the ‘Peace Corp’, whatever that is. Sometimes these are for people between 18-30, and others for short-term contracts for highly skilled experts to do particular, specialised things. This is still the right way to go.

Others just show up and go and help. This happens a lot around teaching and in orphanages. I don’t really know about those sectors, but I don’t think it’s any more appropriate to turn up to an orphanage and think you have anything to add than to do the same thing at Google. You might have something to add, but they’re the best judge of that – not you. For people reading this who live in countries where there is development work, please apply. Socially motivated, committed professionals are always sought. International development work is not always easy, but it can also be a great way to learn and do some cool stuff. I don’t think there’s anything wrong if part of your motivation is about traveling and seeing something different. But if that’s your main motivation, you’re not going to have a great time when you’re living in a bedsit in Northern Iraq with no money to do anything but ride your bicycle (it’s 46C outside) to the office and use their dial-up internet to search the job market for something better.

What do you know about the world that you wouldn’t have learned as a tourist? How did working in these regions change your experience there?

I just honestly have no idea how to answer this question. Meeting people in some pretty far out places comes to mind. Some people are cool, some are not. It seems pretty childish to say that people are all pretty similar, but it’s true. There are Afghan hipsters, Cambodian beat poets, Nepalese Rastafarians and Thai surrealists, just as there are English Buddhist nuns, American Saddhus and Bangladeshi Sushi restaurateurs. The world is not neatly divided into ‘home’ and ‘traveling’. I’ve never thought of travel as a recreational pursuit in itself. Go somewhere. Do something. Don’t ‘do somewhere’, which is both grammatically clumsy and so vapid it makes me want to flip tables.

What are you doing now? What are your plans for the future?

I wouldn’t mind dabbling in some kind of other job, some day. Maybe do a bit of research with a university. But for now, I have no complaints. Status quo is alright for a while yet. I flirt with the idea of being a divemaster for a while, and sort of freelancing, but I never really go far with the idea. I recently rode a bicycle from Bangkok to Kuala Lumpur, and I wouldn’t mind doing that again when it’s not the hot season, or maybe from Indonesia to Melbourne, or something. Maybe a B&B might suit me, but I don’t have the scratch.

But right now no particular plans. No reason to stay, no reason to go. Perfect.

What question should I have asked instead?

What do you do when you’re not working? You can follow my instagram ‘shocrates’ or check out my flickr which I tend to update reasonably reliably.

Many thanks to Wes for taking a break from his busy days of email responding to share with us! All photos in this post are Wes’s wonderful photography — click to enlarge. And as always, feel free to leave questions or high fives in the comments below.