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A Discussion with Bob and Pat Gempel, Gary Jacques, and Kevin O'Brien, HOPE worldwide

May 22, 2009

Background: In this interview, Bob and Pat Gempel, Gary Jacques, and Kevin O'Brien discuss the work and mission of HOPE worldwide. The participants also speak about the organization's hospital, Sihanouk Hospital Center of HOPE, in Phnom Penh, Cambodia. Finally, they discuss the organization's interest in health care in general, as well as its relationship with the Cambodian government.

The Sihanouk Hospital Center of HOPE in Cambodia does remarkable work and HOPE worldwide prides itself on managing and “growing” this enterprise. How did you get started?

The hospital, which will very soon (a matter of weeks) care for its one millionth patient, is a triumph of interfaith cooperation and partnership. The project came about and has developed through the cooperation of a Jewish journalist, a Japanese spiritual entrepreneur, and a Christian world development organization, working in a Buddhist society. We (HOPE worldwide) have managed the hospital in this unique partnership for almost 11 years. It has grown from nothing to both Cambodia's largest hospital, serving poor people, and a major training center that serves the nation.

Let's back up, to understand better some of the actors. Can you speak about HOPE worldwide and how it began? Is it properly described as a faith-inspired organization? And how is it related to the church on which it is “based.”

You speak of faith-inspired, in distinction to faith-based; we do describe ourselves as a faith-based organization, but we also insist that we are not “faith biased.” HOPE worldwide is linked to and grew out of the International Churches of Christ. The church was already working to some degree towards the goal of alleviating poverty, but there was thought that the church could do a better job working through a separate and independent nongovernmental organization (NGO). That would also allow people outside the church to support the work. So in 1991 HOPE worldwide was founded.

We (Bob and Pat Gempel) were at a life turning point just then. Bob had sold his business, and was exploring new avenues. He had a background in health (Harvard School of Public Health) and an interest in development issues. Pat was working in the area of strategic planning. We had visited some developing countries, especially India, but were not directly engaged in developing country work at that stage.

Was the leading idea for HOPE worldwide at the outset to work on health issues?

No, the focus was on poverty, and the central purpose and guiding philosophy has been and remains a grass roots strategy. This grew out of the Church's (ICOC) experience with planting churches in different parts of the world, and thus a real sense that people on the ground know best how to identify their needs and what will work for them.

When the possibility of managing the Sihanouk Hospital in Cambodia of HOPE came up, we had been working for over five years with HOPE worldwide, on the basis of expanding gradually to different countries around the world, before Cambodia came into the picture. We were, for example, heavily involved in Africa, working especially with AIDS orphans. And in India, the needs of communities there led us to be involved with people affected by leprosy. These people faced discrimination and stigma and found extraordinary difficulty in finding housing, so an early project was both to support them and to help in building or improving housing so they would have a place to live.

Then in 1991, there was an immunization crisis in the United States. Many of our volunteers went door to door to encourage parents to immunize their children. There was a measles epidemic in Philadelphia and a real need to work at the pre-school level to ensure that all children were immunized.

So we were sensitized to many dimensions of health challenges in a wide range of settings.

How is HOPE worldwide linked to the ICOC? Where is the headquarters of ICOC?

The ICOC has no headquarters per se and there is no centralized leadership structure. In practice it is very decentralized, with leadership coming from each congregation.

ICOC began in the United States, growing out of the Churches of Christ, which was established in the early 1800s. It is non-denominational and bible based. It is quite small—some 91,000 active members today, with the largest congregations in Los Angeles. But it is present worldwide. There are about 562 churches. The single fastest growing congregation is in Russia. Some would characterize us as fundamentalist; we would describe ourselves as focused on basic principles and very bible based. Volunteer work is an essential part of the church. That also applies for our international work and for HOPE worldwide.

The country structure is decentralized with each country managing its own affairs.

HOPE worldwide gets about 25 percent of its support from the church. The rest comes from corporations, foundations, governments, and private individuals. There are over 2,000 donors. HOPE worldwide works with partners—we call them that to distinguish from donors, who would have simply a financial relationship. Our partners are very varied. For example, the U.S. Department of Agriculture gave about $5.5 million for our work in Cambodia. It was part of a program to distribute surplus milk. The idea was to market it and give the proceeds to charity. HOPE worldwide submitted and won a proposal to use those funds for the Sihanouk Hospital Center of HOPE.

HOPE worldwide is very decentralized, consistent with our grassroots approach, and the country directors play a pivotal role. Country directors would normally be members of the ICOC.

What are the hiring policies of HOPE worldwide? Are they linked to faith?

Yes, particularly at the management levels. We are quite a small community, so people are known to one another. This knowledge and close community is important to assuring integrity which we see as linked to our faith, but internationally HOPE worldwide is more diverse. At the hospital in Cambodia, for example, out of some 400 staff about 40 to 50 are Christian.

Can you give me a sense of the scale of HOPE worldwide's operations?

That's not easy. Because of the decentralized nature of our operations, many if not all HOPE worldwide offices are self-contained entities, often organized according to local law. We work around the world. The annual operating budget of HOPE worldwide is about $33 million. But to that should be added corporate contributions and in-kind contributions, which are very substantial (about $39 million a year). Then there are the budgets of local organizations. And finally volunteers.

HOPE worldwide has some 1,800 employees in 60 countries. There are many more volunteers. We work in over 1000 communities. We estimate that as many as two million people are involved.

How do you monitor and evaluate HOPE worldwide's programs?

We have quite different approaches in different places, and they vary also by donor and partner. We recognize the real difficulties in estimating exactly how many people we have reached. The Red Cross, for example, puts much focus on counting and they are a partner. So when we work with them we tend to follow their monitoring and evaluation protocols and methodologies. The same would apply for USAID and the Global Fund.

The Sihanouk Hospital Center of HOPE (SHCH) is one of the largest HOPE worldwide operations, and it seems to have a rather unique character. How did you get involved?

It came about largely by chance. We met Bernie Krisher in Tokyo, through friends we were visiting there. That came at a time when Bernie, who had a deep interest in and passion for Cambodia, was looking for a partner to work on his hospital project. Bernie was a refugee himself, and was working as a journalist, and he had become very interested in the refugee problem in Cambodia. He was determined to build a hospital to meet the country's enormous needs. He had become a friend of the King of Cambodia, and the King both asked him (Bernie) to help to launch a hospital and lent his support. Through these networks, he managed to get donations and also the land to build the hospital. Mr. Handa was involved at this early stage, also through Bernie Krisher.

But they had no one to manage and run the hospital. So Bernie was looking for someone.

We, meanwhile, were in Tokyo and just happened to see a small ad in a Tokyo paper, that involved a search for a group that could get rice into North Korea. It was, we think, a chance in a million or maybe something else at work.

We responded to the ad, met Bernie Krisher and also Mr. Handa (who had put up the money to build the initial hospital building and then the working capital that was needed). Then we brought in a young architect from MIT who was willing to oversee the design of the hospital and its construction.

We became involved without any particular experience in hospital management. In fact, looking back, if we had known what would be involved and how much it would take, we probably would have hesitated to take it on. Because we were building not just a hospital in a difficult environment, but the idea was to make it a major teaching hospital, with a nationwide scope. But then we found one of our managers who was willing to take it on, someone who knew Cambodia, whose wife was a pathologist. They relocated from Papua New Guinea and took on the task of establishing the hospital and its procedures.

In short, the hospital came about through a long series of miracles.

How has the development of the Sihanouk Hospital Center of HOPE fit into the Cambodian government's policies for health and hospital development?

The hospital has been developed during a turbulent period in Cambodia. In the early years after the period of genocide and Communist rule, many NGOs ran clinics and hospitals, and, gradually, many were taken over by the government health services. The Sihanouk Hospital, along with some others, is an exception. From the outset, we secured specific concessions from the government. The connection with the Royal Family has been particularly helpful at different stages. We have a clear agreement, for example, that we have freedom on hiring and firing of doctors and staff and that they are compensated according to our pay scales. We work with the Ministries involved (Finance, Health) to assure that we are allowed in kind imports without taxation. We have been successful in avoiding problems in all these areas.

Do you have written agreements to this effect?

Yes. There is a contract. At first, it was quite open-ended and indefinite but it has become more specific over time. We need to renegotiate every ten years or so. Bernie has been active in helping to clarify the formal administrative arrangements.

What are the medium- to long-term expectations for management of the hospital?

The agreements are basically open-ended but there is no expectation of a transfer to the Ministry of Health. The government is happy with the way the hospital is run and financed. The operating budget is assured both by Mr. Handa (World Mate) and by HOPE worldwide.

What about your relationships on health policy issues at a national level. For example, you pride yourselves that you offer all health care free of charge. Is that a national practice or policy?

Our policies and practices are in fact quite different from the general national policy, and in most of Cambodia health care certainly is not free of charge.

That said, we have found ourselves increasingly involved in and invited into the policy discussions on health nationally. Indeed, we have been involved in drafting the NGO statements on health for donor meetings and participate in many meetings and deliberations. We serve on the Coordinating Committee for the Global Fund.

Health care in Cambodia faces a myriad of challenges, and is far from where it should be, but it is improving.

In general, the government's ideal model is probably to see a health care system that is entirely publicly managed. There is a tendency to have a disparaging view of the private sector. There is an effort, a rather difficult one, at a general level to hammer out a public private partnership idea and framework, but it is still far from clear. There is an unease in dealing with private sector actors at various levels. What is likely to emerge, though, is a public private model that also has, epitomized in the example of the Sihonouk Hospital Center of HOPE, centers of excellence that are equal or superior to what the government itself can provide.

And there are always issues when funding is involved, with a very clear preference for seeing funds coming from various partners going to or through public coffers. We have seen this tendency at play with various programs financed by donors like the British development agency (DFID) and the Global Fund.

All told, the government is happy to have us here and appreciates what we are able to offer. They appreciate what we can offer to the very poor, with our policy of free of charge care, and with our contributions to the training of Cambodian medical staff—doctors, nurses, and technicians.

What is the role of faith in the work of HOPE worldwide and how would you link that to the work in Cambodia?

HOPE worldwide's worldwide policy is that we do not proselytize. Ours is a compassionate ministry. We leave that to the church (ICOC) and it is our policy that we serve all people, whatever their faith, and that in our community work everywhere we do not work in any way to spread the Gospel.

Our view is that our work speaks for itself. And we go out of our way to make it clear that our goal is not to convert or persuade but to serve.

If an individual we work with or who comes to us is a church member, that is a different matter.

What is HOPE worldwide's view on speaking of faith as part of your work around the world, and how has that taken form in the Sihanouk Hospital Center of HOPE in Phnom Penh?

The policy that I describe clearly applies in Cambodia. And in general this is clearly understood by all concerned with the hospital.

The question of proselytizing nonetheless has emerged as an issue, as part of broader concerns in Cambodia that Christian groups working in the country have an evangelizing agenda. The hospital took some quite unwarranted criticism at one stage. There were reports in the Cambodian newspapers about evangelizing work, that reflected comments by a non-Cambodian Buddhist monk. Fortunately, people like Bernie Krisher were well aware of our stance and the issue was swiftly dealt with and put to rest, with a scorching article by Bernie in his paper.

The Sihanouk Hospital Center of HOPE is a different kind of venture for HOPE worldwide. Has it changed the nature of your work, moving it towards health? Is this an area of focus for the future?

The answer is mixed. In one sense, the worldwide mission of HOPE worldwide remains very much oriented towards our grass roots philosophy, and we aim to respond to community needs and wishes. That will take different forms in different places, with health one of many areas where we work. And we have no other facility or hospital on anything like the scale of the Sihanouk Hospital Center of HOPE.

But the work with the hospital is our largest single operation and both the focus on it and what we have learned have shaped our organization in many ways. The venture has contributed in many ways to our thinking and approach. We ask often what we are trying to achieve and how. The Sihanouk Hospital Center of HOPE gives us many elements of an answer. It is a center of excellence, that serves those who come to it. It also serves as an example of what can be done. And the increasing focus on training of medical staff is another important element. It gives us a real chance to contribute to the nation and to the welfare of its people.

It is good to have the hospital as a focal point. But it is also good to have a diverse portfolio of projects. And seeing what can be done encourages us to be more ambitious in our goals.