The Auditor Cometh

This week, I experienced my first government audit.

Yeah . . . exactly.

Approximately half of our funding comes from the Office of Refugee Resettlement (ORR) which is a division of the Department of Health and Human Services (in case you were curious). In the mid 1990s, the United States was funding and training military groups in Latin America to fight communism. What was actually happened, however, was these groups used communism to oppress any union worker, Catholic, teacher, political figure, etc that spoke against the government. In effect, the United States had directly been funding torture in Latin America. As a result, the United States sets aside money every year for torture survivors.

Our funding is allocated by grants. Every three years, torture treatment centers apply for a grant from ORR and this grant accounts, again, for about 50% of our budget. The audit is the first for the center, and it was surprisingly productive. ORR is primarily concerned with accountability. They want to know that there money is being used as promised; in addition, they want to assess the success rate of the torture centers.

The first factor is completely understandable. I think government should be strict with money that is given out. All you cynics out there (like myself) will be surprised to know that the government representative did not miss a trick. She was a very smart woman and was very meticulous about every cent of government money that we spent. She was kind but harsh at times. She pointed out every problem she saw and lectured us for wasteful spending. The most shocking thing to me is the scale of money we are talking about. The grant being addressed is in the hundreds of thousands of dollars yet most of the government waste comes from lack of accountability in the billion dollars grants. While I think government accountability should be the norm, it surprised me that our meager grant (on the scales of things) was so meticulous picked apart.

The second aspect was on the "success" of our treatment plans. Torture treatments are very difficult because the idea of treating torture victims is only about a few decades old. In addition, cultural divides are often immense.

When our center opened its doors 23 years ago, we saw two groups of clients: Hispanics and Cambodians. Our initial staff was largely Hispanic so their treatment was fairly straightforward. However, the Cambodians were difficult to help because they did not care for the standard Western treatment: individual counseling. A lot of cultural problems arose--on one hand, Cambodians believe in reincarnation, and some felt that they deserved the torture because they were likely a torturer in their past lives. Furthermore, the staff discovered they could resolve their trauma only through group activity. The Kovler center used art and dance (called art therapy) and found great success. By symbolically representing trauma, it helped avoid the verbal difficulties of expressing it and empowered all the individuals of the group.

So back the audit...I brought up that story to illustrate the difficult of determining "success" in treatment plans. Success in medicine is often hard to quantify. We see this difficulty every day as Congress attempts to reform health care. They want to streamline the process using "proven methods" but how and who determines that? It's the same way with my center. I absolutely believe that some treatments are better than others and that poor treatment centers shouldn't be funded at the expense of a successful treatment center. But again, it's so difficult to determine success. They currently use a Harvard Trauma Questionnaire at Intake and Discharge in order to document improvement, but is that really the best way to do it? Is merely asking questions about anxiety the best way to provide accountability. Who knows? How do you quantify success for individuals that refuse counseling? Does art therapy fit into the Harvard Questionnaire?

All in all, the audit was successful because it made us much more accountable. The auditor pointed out weak areas in our system and provided a lot of helpful advice. I couldn't believe, however, how meticulous she was over our funding. I have a lot more respect for our government, but I wish they'd also focus their attention on larger sums of money that are allocated.