NEWSPOVERTY

I sat down early yesterday morning to brainstorm ideas for a new marketing video I’m helping to create for our Global Medical Brigades program. To get the the creative juices flowing, I started by reviewing promo videos from other non profit organizations I know of. During my search I found many videos that use the “shame” tactic to get you to volunteer. They give you the statistics then make you feel bad that you’ve done nothing. It started to make me think about all the ways in which people, especially Global Brigades students, are motivated to volunteer. Where some truly are passionate about giving, others solely do it to put it on their resume. My first gripe when recruiting students was that I only wanted the students who truly cared, the ones that didn’t need the “shame” tactic to get them to volunteer.

Coming across students who ask about their resume, about how much free time they’ll have, or whether or not they actually have to work always disgusted me. I would think that there’s no way I would want someone like that on my brigade. I even shared my thoughts with the CEO of our organization. His response was, “regardless of why they’re doing it, they’re still helping those in need in some capacity, and plus you never know how it could change them.”

So, reluctantly, I would recruit the resume builders to join. I would observe these students as they showed no real interest in the cause. But I couldn’t really complain, because just like those who were there out of “shame”, they were still there. They still took one week of their winter, spring, or summer break to be in a developing country.

As I watched these students, I noticed something different though, I noticed a gradual change. Slowly, day by day, over one week, they started to care a little bit more. So I started to realize, maybe they’re not here for the “right” reasons but maybe this brigade was all it took for them to realize there is another reason. Brigades truly do empower students, not to just help communities, but to empower students to become aware of the world around them, good and bad.

Now, I think, if I can just change the perspective of one more student, that’s enough for me. If it takes telling students that they’ll have a great resume, or if takes scary statistics on a promo video, then it’s worth it. One person can change the world for the better and you never know who that person may be. If I can increase those odds by just a little, then it makes this work worth it even more. Each day is a reason to keep striving for change and to never lose hope in those around us, even those who don’t see the world the same way we do.

We arrive at the community to a line of already 50 patients waiting to be seen. Some villagers walk to our medical brigades from hours away, knowing that it may be their one chance for medical care over the next four months or so. I walk down the line welcoming everyone as best as I could and my greetings were returned with grateful smiles.

Each station is set up as the villagers wait patiently. The intake station is stocked up with our medical intake sheets and our intake crew begin writing patients’ names on the sheets and handing them out to the patients to take to the next stations. Students proficient in Spanish set up the triage station to take the vitals of their patients to mark on the sheets to prepare for consult. In the consult station the doctors and physician assistants prepare to take patients to diagnose. Last, in the pharmacy station students start spreading out the medicine that they all spent hours the night before sorting and labeling.

After we begin seeing patients, I walk through the whole process. In the intake station, students and staff try to write down the name of each person on individual sheets, sometimes having to write down three or four names per person. I’m surprised to find that some don’t know how old they are. I stop for a moment to think about having absolutely no concept of time, years, yet alone age.

The patients then wait in another line for triage. In the triage station students are taking blood pressures, temperatures, heights, weights, and even glucose levels for the doctors and physician assistants. Patients describe various aches, pains, and symptoms that I try to decipher as I’m listening from a distance. The children have the same fear of thermometers and stethoscopes as those in the states.

Once again, after triage, the patients wait in a line to see a medical professional. The doctors and physician assistants are separated by specialty: children, cardiovascular, women, etc. The medical professionals see each and every patient, looking at the intake sheet, asking about symptoms, and finally prescribing the necessary medicines. I watch one of the physician assistants as he works with the children. You can see the passion he has for his work as he takes the time to make each child comfortable, tickling them, laughing with them, and showing them that doctors are not to be feared.

The patients then wait in their last line to have their prescription filled, which sometimes can take hours. This is the main backup in the process. Each patient gives the students their sheet signed off by a doctor. Some may have one or two prescriptions, whereas others can have up to seven. Everything from vitamins for malnutrition, abendazole for parasites, antifungal cream for skin rashes to even cardio medicine is handed out.

After watching this whole process for only a few minutes it is clear how much an electronic medical record system is needed. If patients were each given a medical identification card with a scanable barcode or even more simply, a serial number, it would provide each patient with a personal identification. Then if each station had laptops connected through a local server and an electronic medical system, each patient could be tracked paperlessly throughout the entire process. We could begin filling proscription right after the doctor hits enter, decreasing the bottleneck. But more importantly we could pull previous records for patients during their visits to track their health when proscribing medications. Also, once our CHW teams and clinics are in place, they too could have access to these medical records to track critical patients in the area. We would finally have the ability to track the progress of our communities.

We have already somewhat developed a data system for our medical records, but we need something more. We need something expandable, we need something that anyone could use and that has already been proven to work. Solution: open source medical record systems, more specifically OpenMRS. We have started researching how we can incorporate this software, now it all just comes down to configuring it for our specific setup.

A few little kids in Nicaragua always used to bid us farewell at the end of the day with the parting words "hasta nunca" which translates to "see you never." Oddly enough, these children would say that even if we were going to see them the next morning, but at the end of my month there, "hasta nunca" took on a different meaning... I may not see these beautiful children again.

I still think about my students and friends - Armando and Ulises, Tatiana and Lester, Gabe, Fabre, and Adrianna - all the time. I see them in the pictures up on my bulliten board and in my memories of my summer. I hope that I will return to Nicaragua in the Spring to serve with an Orphan Network trip and perhaps steal away for a day or extend my trip to pay a visit to our beloved barrio (village) where Manna Project is located.

For me, going into the trip, I knew I was going to get to know these communities and then in a month's time have to say 'goodbye.' Allthewhile, knowing who was going to carryon our efforts and mission - the same community of volunteers that had been doing a superb job for nearly a year before us. However, this week marks the end of Manna Project's 13-month program. The 8 year-long volunteers will be packing up their belongings, donating their stuff, finishing up their lesson plans, and handing over the reigns to the new team of year-long volunteers. What a difficult position to be in!

Indeed, service always does a great service to the volunteer. In stepping out to live for others, we inevitably get taught a lesson, have our lives changed, and feel touched by beautiful and painful experiences.

I commend these Manna volunteers for their commitment to the communities of Cedro Gallan, Chikilistagua and La Chureca for the last thirteen months. They have gone from being a new kid on the block who hardly spoke Spanish and couldn't drive a stick shift car, to the most beloved gringos that some of these Nicas will ever know.

And now they will be replaced; replaced by amazing and bright new volunteers but still replaced. Will they be forgotten? Is that okay? After devoting so much of their life to these people, can another gringo with the same rubia (blond) hair just swing in and take their place?

I really dont know if the people will remember them after a number of years...for now, the new gringos will not be able to compare to their dear friends who are moving on. Nothing the new group does will meet the standard they set, until everything sets into place and the communities become adjusted to one another.

Manna Project provides a truly amazing opportunity for average Americans to step out of their world and into another, not just for a week or a month, but for over a year. Through that year, both the volunteers and the Nicaraguans they are serving will grow to be genuine friends and confidents and will learn important and substantial lessons from one another. And then, at the end of the year, things will change. The Americans will return home and the Nicaraguans will be introduced to their new friends. Is it okay to continually take and place strangers into these people's lives? Can we ask young Nicaraguan children who don't understand what love is because their father walked out on them when they were little and their mother beats them, to grow cross to an young American, and then in a year's time, they too will be gone?

I don't know what the best system is, so I do not ask these questions to point out a problem or propose solutions. I simply ask these questions in reflection and challenge of pursuing a continued life of service.

Could you give it all up? Would you go and never come back?

I am so thankful that there are people in this world who would answer yes to both of these questions without second guessing. (And I'm thankful for those that second guess, and go anyways!)

For me anyways, I hope it's not 'hasta nunca' to these people. I'll be back!

Marmots once dug their homes in deep holes across the Himalayan plateau, helping turn over the soil and creating the grassland's most important water reservoirs. Now, they are being hunted for their skins. Piles of rocks speckle the mountainsides where marmots scratched futilely against the solid rock in an attempt to escape their hunters. The grassland moisture is drying up. The plains are becoming desert.

Yesterday, I wrote that rats ("grass rats" in Chinese) had infected humans here in Qinghai with the black plague. That translation was incorrect. The vector species were marmots. Currently, it is believed that the disease took two routes of transmission: (1) street dogs eating a dead marmot and infecting goats who later died from the plague and infected the man who buried them and (2) fleas transmitted from marmots to humans during poaching activities.

China has long been known as the breeding ground for the worlds' most dangerous and widespread diseases. Each year, the US designs its flu vaccines based on new strains found in China.  Why?

One possible answer is that China has a high population of animals and humans living in close proximity to one another, often with minimal infrastructure to restrict cross-transmission of diseases.

The Chinese government and NGOs have pumped a lot of resources into improving rural infrastructure. They have installed running water projects, built clinics, manufactured solar cookers, and distributed thousands of improved stoves. Despite these admirable efforts, W. China's rates of death and illness due to water and airborne diseases remain some of the highest in the world (with unofficial numbers likely to be much much greater due to the shear difficulty of getting health care out to China's rural masses).

Perhaps the solution does not lie in infrastructure development alone. China needs doctors to staff its clinics and  public health professionals to design preventative medicine programs. It needs engineers and locals to work together to design pollution management systems which break the cycle of disease transmission and it needs scientists who can help prevent the ecosystem imbalances which have been associated with so many disease outbreaks including historical cases of the pneumonic and bubonic plagues.

Humans worldwide need to reconsider the basic way that we interact with our environment, reduce our environmental pollution, and create healthy living spaces for ourselves as well as the animals and plants upon which we depend.

One Earth Designs (OED) was founded in 2007 by Catlin Powers and Scot Frank ( OED website; OED blog; OED facebook page; Twitter @OneEarthDesigns). Catlin will post on Mondays and Wednesdays. You can also find her on Twitter @CatlinPowers.

Qinghai, China - Unusually heavy rains drive rats and mice indoors. One dead and 11 hospitalized with Pneumonic Plague (bacterial infection by Yersinia pestis carried by rats; an advanced form of the bubonic plague which killed millions in Europe in the 1300s). Yushu and Golok prefectures are under quarantine.

The news is spreading through the villages by word of mouth. Villagers accross Qinghai are self-quarantining themselves (where official quarantines are not already in place). I just returned to the city areas. Other OED members and affilates are still in affected prefectures.

One Earth Designs (OED) was founded in 2007 by Catlin Powers and Scot Frank ( OED website; OED blog; OED facebook page; Twitter @OneEarthDesigns). Catlin will post on Mondays and Wednesdays. You can also find her on Twitter @CatlinPowers.

While Manna Project offered a variety of programs to get involved in during our month long stay in Nicaragua, we inevitably each began to invest ourselves more wholly in certain departments than others. My personal 'baby' of the month was Children's English. I adored the class with all that is in me.

Children's English was a relatively new program and there were about 8-12 students who would attend on any given day. Students were ages 7-11 and was composed of a bunch of cousins who lived in the same area at KM 13.5 on the Southern Highway and then other students from Chiquilistagua, one of our target neighborhoods. Each Tuesday and Thursday after Spanish Literacy a group of us Summer Volunteers would head toward 'The Land' (a community center in Chiquilistagua) and pick up a bunch of our students along the way, often piling 2-3 children on each lap.

During our first week in Nicaragua, the Summer Vols were invited to pick up a program and run with it. I had absolutely no formal training in education and teaching and thus was going into this with the motto of trial by fire! Lindsay, a fellow volunteer, and I set out to teach Children's English that first week. We looked through a couple of books aimed at their age group and compiled a 2-3 lesson unit on landscape vocabulary. Setting up this lesson plan meant forming the vocabulary list, looking up translations, creating worksheets with word boxes and exercises, and thinking up fun activities for during the class period to keep the students engaged and excited.

We were fortunate to be teaching a very energetic class. Usually by 4pm when class started, I was drained from teaching Spanish Literacy in the morning and playing with kids in between classes, but little Maycol, Marco, Lester, Rebecca, Tatianna, and Fredi (our regulars) always kept us on top of things.

Our first lesson was a hit!

What a success! We introduced these children to vocabulary words such as mountain, lake, river, ocean, beach, forest, jungle, etc. The list was a manageable size and by the end of the hour long session, I could hear them all utter the words under their breath, practicing as they did their final exercise. Could you imagine a bunch of young children showing up to an English class out of their own accord and motivation to learn!?  Their drive for learning and willingness to try new things surprised me each day, I don't believe I would have been so ambitious at their age.

In coming back to the United States and moving back into my apartment in Charlottesville, I have been met with many moments that throw me back to teaching my classes in Nicaragua. I think more conciously about my classes; what kind of planning is put into them?; how am I responding to a given stimulus?

Furthermore, one of my apartmentmates is a teacher's assistant for an ESL class for graduate students entering the University of Virginia. She comes home each day and I ask her about the lesson they taught thinking about how practical it is in light of entering a new culture and new language. Her and I recently talked about different pronunciations that are difficult for those learning English and I was once again thrown back to that first class I taught in Children's English when Lester kept saying 'Beeeesh' instead of 'Beach.' It's funny to think that 'ch' sound in the word is so difficult for native Spanish speakers considering there is a specific letter 'ch' in the Spanish alphabet. But then again, I conceed that English is a very difficult language to learn and again commend these students whether children, grad student, or my host mother in Nica for their conntinued efforts.

When you need a solution for your organization, is it better to do it yourself or outsource it to another organization that is already doing it? When does the efficiency of partnership out weight the power of ownership to shape something specifically for your organization?

With the political situation still unsettled in Honduras, travel to communities has been hampered on days of protest to insure the safety of our staff. When work in the communities is put on hold, it means being flexible to take on new projects and to rearrange our schedules to continue making a difference while in the office. This week, I took on a side project of reviewing a list of organizations that work in Honduras to find possible avenues of collaboration and discover best practices that Global Brigades may also benefit from.

Many people criticize the non-profit industry for continuously re-creating the wheel by developing more organizations that do the same work, rather than working together. The health work that we do in Honduras is not an exception to this. As I was reviewing the list and studying the websites of each organization, I realized that there are many other organizations doing health work in Honduras. I found that many are doing the same work as Global Brigades, but even more so, organizations whose programs would compliment ours. I began to wonder why we weren’t already working with them.

During the two hour drive out to our pilot community health worker village today, I sat in the back of our pick-up truck, sharing my thoughts about NGO partnership with a recent graduate from UC Berkeley. Together, I as a business student and her as a pre-med student, we used our experiences in each area to brainstorm and discuss why it is that many organizations don’t collaborate, and more importantly how we, as Global Brigades, can do more to collaborate.

Our main take away was this: everyone in the field agrees that we’re all working together towards the same cause, yet there is a disagreement on how this should be done and want the power to be able to do it how they think is right. With the joy felt in helping others, many feel a sense of pride that their work is making a difference, and with that comes a crave for ownership to continue doing it their way. Sure, all organizations want to learn more about how they can increase their impact and help more, but most often, organizations want to do it themselves once they learn how.

During this conversation we came to agreement that we need more specialized physicians to come on Medical Brigades to provide specific treatments to the health problems plaguing our communities. All it would take is another volunteer to be dedicated to recruiting more doctors, surgeons, etc. because all of the logistics and infrastructure needed is already in place. But the real question is: do we do it ourselves or do we work with another NGO that already only recruits certified medical professionals for medical work in Honduras? How do you get two organizations with completely different models to work together for the same cause? How do you convince someone that you are a collaborator and not a competitor?

As our group of summer volunteers spent more time in the communities and working with classes, we naturally began to feel strong connections to certain people and families. A group of friends that sat together at a table in the back of our Advanced English class included Gabriel, Norman, Fabricio, Adrianna, Elaina, and Aldo. They were all about our age, give or take a few years, and are eager and rather accelerated learners.

Usually we had a lesson planned and then had an alternate lesson for when this table finished the exercises. Often, however, normal conversation about life, language, and anything else that could come to mind would float into the mix. I sat at this table from time to time to help with the lesson and grew to really enjoy their company. Other summer volunteers also became quite close to them and soon they were frequenting our house to just hang out, get guitar lessons, or play catchphrase.

One afternoon this group of friends came over to tell us about a non-for-profit organization that they had started themselves in the Managua area. They call themselves 'Nicayuda' which is a portmanteau word combining 'Nicaragua' and the verb 'ayudar' for 'to help.' Nicayuda is an NGO composed of 7 young Nicaraguans who acknowledge a need for public preschools in their country.

There are a number of good private preschools in Managua but they are also immensely expensive. Thus, Nicayuda has opened a couple public preschools in which young impoverished children can begin learning. That week, after hearing these friend of ours talk about their NGO, a group of the MPI (Manna Project International) Summer Volunteers paid a visit to the preschools. Unfortunately on that day, the preschools were closed due to the swine flu scare. We did get to see the facilities a bit though and later I saw some pictures of Nicayuda's endeavors.

Much of what I have been learning from my time in Nicaragua is the concept of empowerment. We teach classes and work and give to the communities of Cedro Gallan and Chikilistagua not for our own gain and not to just provide classes but instead to provide a means for opportunity. By learning how to read and by learning English, people from this community might be able to use these skills to find open doors waiting for them. I have been asked again and again about whether NGOs should occupy a constant presence in developing nations. While I don't believe they should create too strong of a sense of dependence, if they are indeed doing good work then the good must continue. As I pondered this question, however, the ideal situation continues to come to mind: Nicaraguans serving Nicaraguans.

That's a hard concept to wrap one's mind around considering how poor most of Nicaragua is; How can the poor help the poor? Will we simply ask the 'not as poor' to help the 'dirt poor?'

Nicayuda fits perfectly into this model of Nica's helping Nica's. These young people aren't starting an NGO to boost resumes or merely because they are bored and have nothing better to do. These new friends of ours are putting themselves on the line and meeting a need with their own abilities. They are currently working on gathering resources and aid to improve the conditions of three preschools in the Managua area. If you are interested in learning more information, please friend Nicayuda Nicaragua on Facebook or email Norman at nicayudaconorg@gmail.com.

A woman in one of the slums that we visited offers chai to us.

A woman washing clothes in one of the urban slums that we visited.

What a typical neighborhood of a Sahayata client looks like.

A Sahayata client shows us her cloth shop, which she was able to expand through her Sahayata loan.

The non-profit that I am working with is an offshoot of the microfinance institution Shree Hari Fintrade Private Limited, which operates under the Brand name Sahayata. Founded only two years ago, Sahayata now has twenty-one locations in Rajasthan and is aiming for a total of three hundred branches throughout India by 2010. The six founders of Sahayata hold impressive resumes and bring a wealth of experience from working in multi-national corporations outside of India. The MFI claims to be adding more than 4,000 customers a month and expects even greater growth as it expands to more locations.

While Sahayata’s growth plan and execution are impressive (loan officers text collection figures from the field to a software that automatically compiles data from all branches and generates a report on excel), its focus on rapid expansion makes loan officers leery of lending to those at the very bottom of the income bracket. With huge targets to reach, the branch managers place their energy into increasing collection amounts. It is Sahayata’s policy to lend only to women who are married, own their own house, and have their own business.

When speaking of alleviating poverty, it is important to define exactly what parameters qualify as “poor” and what constitutes bringing individuals out of poverty. The initial aim of microfinance under Muhammad Yunus’ Grameen model was to help those at the very bottom of the income bracket, who did not have steady shelter or businesses, obtain loans. Though the women who receive the 5000-10000 Rs loans from still earn far less than the average middle class Indian, it is clear that Sahayata is not by any means a poverty-alleviating entity by Grameen standards.

Our supervisor says that Sahayata loans to women in the slums, but it is evident that the definition of “slum” varies significantly here. He unabashedly rejects the idea of lending to those living under tin roofs in the slums because he believes that there is a slim to nothing chance that women in the slums will pay back their loans.

“Sahayata lost money last year. We cannot afford to take on such high risk, When Sahayata expands and is able to make a lot of money, only then can we consider loaning to the poor. We must be able to stand on our own before we can help the poor. We can’t be expected to simply give out of our pockets forever.”

The assumption here, however, is that the poor are not going to return their loans and that the MFI will automatically lose money if it lends to these poor. Muhammad Yunus’ Grameen model has proved this wrong. Isn’t it precisely because normal banking institutions will not lend to these people that MFI’s were created? When I mentioned this to my supervisor, he explained that the Grameen model is viable in Bangladesh only because most of the population in Bangladesh is at the same level of poverty, so MFI’s there are forced to loan to the poorest of the poor. In India, however, where there are many different levels of income, MFI’s do not need to loan only to the poorest of the poor.

What he seems to be saying is that because there is greater profit to be made by lending to other income brackets, it is only natural that for-profit institutions will automatically favor lending to those women over women from the lowest income brackets and with the least amount of job security and stable housing. From a business standpoint, Sahayata’s decision to loan only to women who are married and own their own homes and businesses makes sound financial sense. As a newly established MFI, Sahayata suffered losses last year and is therefore unlikely to take on a large amount of risk.

Does the profit motive always lead to the neglect of the poor? In this profit-driven, growth-oriented approach to microfinance, the most disadvantaged group is again left behind. Is the profit motive and the fact that microfinance has become a lucrative business model detrimental to the original intent of microfinance as a way to alleviate poverty? Should MFI’s follow the rules of the free market?

Without government incentives for corporations to serve the poorest classes, it seems very unlikely that corporations will be willing to take on such initiatives on their own. The alternative to corporations that operate only to generate profit is what Muhammad Yunus calls the “social enterprise,” which has the twin aims of profit and social impact as barometers for success. As such, Yunus explains that, “A social entrepreneur will continue to be in the market for as long as his or her socially beneficial enterprise is at least breaking even.”

However, unless there are policy changes on the macro-level that provide incentives for the development of more such social enterprises or that encourage the adoption of double bottom lines, goodwill alone will not be enough to alleviate poverty. And until then, it seems unlikely that MFI’s will direct their efforts towards loaning to the poorest of the poor.

Before coming down to Nicaragua, we were encouraged to bring clothing donations with us. As I packed, I felt more secure in bringing a larger duffle bag, knowing that about half of its contents was donations. I was happy to be relieved of them when we arrived as well.

It wasn't until the very end of our time in Nicaragua that we saw these donations come to use. Manna Project International has a no donation policy- instead of straight up giving people handouts, instead MPI would rather teach someone the value of items and an honest days work.

One our group's biggest projects was to set up a 'venta' or store to be held on our final Friday working in La Chureca, the municipal city dump. The prices would be set low to attract people to come as well as to make the clothing more affordable for the patrons.

For a couple days leading up to the big sale, there were bags upon bags and a room full of boxes to search through and sort first.

At one point it seemed like a shipment of clothing from the 80's exploded in our house or that we had been transfered back in time. Some of the donations were quite fun to look through, including this cowboy boot vest (pictured below) and the 30 or so babies velvet onsies!

Eventually we got through all the piles and rebagged them to be taken into La Chureca. When we arrived at the school/community center we had to set it all up, which meant unpacking the bags, setting up the price lists, and figuring out an adequate system of getting people in and out in an orderly fashion.

The rhythm would be set to 10 people allowed in at a time, 15 items per person, 15 minutes. They flowed in one door and out the back door and people were allowed to get back in line as long as they would wait their turn. As the first group came in, our neat folded piles of clothing turned into disheveled heaps but soon enough the piles began to diminish and get smaller. The venta was turning out to be quite successful.

As an American consumer, who has paid a visit to the mall since returning to the states, it was amazing and awe inspiring to see a pair of American Eagle pants priced at $44 being purchased for 5 cordobas. With the current exchange rate, that amounts to a whopping $1! Now, that, is a steal!

Despite such amazing mark downs and the push to make these people feel a sense of worth in allowing them to be consumers, at times I could still hear people mutter under their breaths "No hay nada" (translation: "There is nothing").

This was shocking to me. There was clearly stuff. We had filled the bed of a pickup truck quite high with luggage of clothing. It's funny and sad that some of these Nicas, despite being given an opportunity to buy nice good clothing for cheap, still saw a need to complain.

Sure, it would be a whole lot easier to simply be given free stuff, but I remember feeling quite important and accomplished buying my first big purchase with my own money back in middle school. I hope that our donations, that old floral dress I used to wear, Michael's beloved striped polo, and even that oh so lovely cowboy-ish vest make it into appreciative hands and clothe the bodies of beautiful souls trapped in La Chureca.