Figuring out the economics here is hard. I’m used to the US where people work for money, and there’s no time left in a day. Here it’s completely different. Farm work seems to take half a day. The other half of the day is free. And that’s during planting season. The work gets even lighter between planting and harvesting.

Workload is cyclical. If workload is cyclical, income comes in spikes. Two big ones per year. Once in the summer and once in the winter. I imagine that means money is more valuable right before harvest, but only having been here when money is cheap, I haven’t observed this trend.

But what does one do with half the day free? Here you’d think that an ambitious person would just get a part-time job. Except that there are no part time jobs. There’s no McDonalds to work at. No paper routes. No secretarial work. So people spend it largely with other people and doing things around the town.

The concept of the hour, I am finding, is somewhat foreign. Certainly people know what an hour is, but it’s not how they think. I asked my Field Officers today how many hours this week they worked on Nuru stuff. The literally had no idea; they couldn’t even guess. It was two or three afternoons and a morning. How many hours was that? They couldn’t even estimate.

People work for free. Many people. I met a university grad in a rural village last week (which is very highly educated here; there might be 5 in our entire location). He was working in the lab at the health facility, not getting paid. Actually, he was subsidizing the cost of the tests to keep his skills sharp. There are many like him. There are teachers who work as ‘casuals’ in the schools who (sometimes) get paid $26 per month. But, being an agrarian society, they all have farms and so long as they do their farm work in the morning (4-8am), they don’t really need to get paid. The chance at a better job is good enough, it seems, to keep them somewhat motivated, at least for a while.

The value of money isn’t quite clear to me yet. The things people spend money on and the things they don’t perfectly line up. Two dollars is about the cost of a day’s labor. It can also buy you two full lunches at a restaurant, four Coca Colas, a motorcycle taxi from Kehancha (~15 miles) or ten days’ calories in flour. In the US, it would take closer to $50 to hire someone for a day (legally). With that you could buy 5 lunches, 50 Coca Colas, a car taxi about the same distance, and with frugal home cooking, about 5 days of food.

We gave out discount coupons to try to build the patient base at the local health center (it’s an internal competition for my Field Officers, each of whom were given 80 flyers with their name printed on them; the one who refers the most patients wins). The normal price is about $0.50 for a clinic visit and we were discounting it $0.25. A woman came in today with a deep gash in her leg. I was shadowing the in-charge. “When did it happen?” I asked. He asked in Swahili. “Ten days ago.” It was quite infected. Why did she decide today? I’m sure it was partly the increasing pain. But she proudly held the discount flyer. She’d deal with a festering leg wound if fixing it cost $0.50, but it just wasn’t worth dealing with it if $0.25 could fix it.

But even if one took this to be the value of money, it’s varies wildly person to person. Roughly half of our patients didn’t walk today; they took the motorcycle taxis. I’d crudely estimate that a quarter of them pay more in transport than they do in clinic fees.

That woman wasn’t the only one. There were 25 patients today, the first day of the promotion (the ‘sale’ lasts two weeks); last week we didn’t even have that many. Is that $0.25 price really such a barrier? Or is the perception of a discount that powerful? Are some people really paying $0.50 in transport to save $0.25 in medical fees? These questions and more are being actively pondered by your favorite Nuru FT3 Healthcare Program Manager.