Reflecting on cooperatives and economic deveolopment

Last week, the cooperatives in Duchity, Haiti had their second annual meeting. Last year, their group had 300 members and this year they're nearing 1000! Their elected president is a woman, and they have various other women in high ranking positions. In one much-anticipated election, a woman beat out five men to lead one of the committees. This marks huge progress Ina country with such distinct traditional gender roles. Cooperatives often provide women with economic solvency and help them to gain equal status in their communities.

I continue to be amazed at just how effective the cooperative model can be. So many foreigners come to Haiti to build schools and churches, often with great intentions, but the amount of money spent on these projects is incredible! If only people could think of investing in development and empowering Haitians to lift themselves out of poverty, they might start to see some amazing returns for their money. With hard work and cooperation, cooperative members are able to make money and support themselves.

Duchity announced at their meeting that they have purchased their own land. They already have plans to construct a training center, which will be used as a meeting space, a training center, and a community center. And because their cooperative is so productive and profitable, they aren't even asking for any loan money!

Yesterday, I met an international coordinator for the Canadian Pentocostal church. He told me about a community that one of his churches partners with just outside of Port-au-Prince. The priests at that church welcomed the partnership and keep asking money for bigger and bigger projects. For him, it all came to a head with a school that they wanted to build, which he refers to as the Taj Ma-Haiti. He tried explaining to their Haitian partners that any church in Canada would love to have a building like that, but they make do with much less, but Haitian priests were insistent that the school represented what the community needed. The Canadian organization had to take a step back. They hired a Haitian organization, productive cooperatives Haiti (pcH), to do a full community assessment. The Canadian Pentocostal church sees their role in partnering with a church as a commitment to partnering with the whole community and lifting all of God's children to a better standard of living. Now, with the assessment complete, they can approach their church partners with a better understanding of the community, its strengths, and its needs, and everyone can coordinate their efforts in the most efficient development projects. They anticipate doing agricultural training, using appropriate technology to help the fisherman increase productivity, helping the community to improve their access to clean water, and helping them to build successful cooperatives. Over time, each of these investments will make the community more self-sustaining, and then they can decide if their own money would be well spent on a Taj Ma-Haiti, or perhaps a more traditional school building.

Setback #1 & #2... and their conquerings

   As most of you may have noticed, my interest is in sustainable grassroots health improvement.  Seeing a bizillion patients a day is a nice idea, but won't help anyone after I leave.  So I decided to partner with FIDA, a grassroots, community developing organization... but apparently noone told them that.  They do have health promoters in the communities where their cooperatives are.  Betsy and I agreed that PCH could set me up to go work with them, but PCH (FIDA's Haitian arm) apparently didn't understand that idea.  They noted that they didn't have a health-arm to PCH, so they sold me out to another NGO.
  I showed up to my meeting this morning and got a schedule of all of the mobile clinics that I was going to staff.  At each clinic there will be one or two Haitian doctors, plus a slew of nurses and health agents.    I asked about the health promoters and they dodn't know anything about them (except that they exist).  They then brought me to a meeting at AME-SADA (African Methodist Episcopal- Service and Development Agency.
   SADA is NOT a community-based organization.  They're a big NGO with a fancy office who sends out mobile clinics.  They were thrilled that I was coming along, because that meant that they could see more patients... Their mobile group goes out regularly, whether or not they have guest-doctorers.  But the flaw in their plan is my lack of papers.
   Betsy emailed me a few weeks ago stating that the Haitian government has new laws.  In order to practice medicine in Haiti, they need a letter stating that I'm a doctor in good standing, stamped by the Haitian embassy.  Well, I didn't exactly have a weekday to go hang out at the embassy on such short notice, and I didn't plan on practicing medicine either.  We agreed that for what we had planned, teaching, I would be exempt.
   The big wigs at SADA had a cow.  They went back and forth for an hour and a half about how I needed papers and I can't see patients without papers and I can't work with them if I don't have papers and on they went.  They had me convinced that I would have to re-plan my whole trip.  But I found a break in the discussion and explained our misunderstanding, that I was expecting to work with health promoters and to teach.  Unfortunately, their organization doesn't acknowledge health promoters, but even if I were to work in a teaching capacity, I would still need papers from the embassy.  The conversation went on and on, and they concluded that they would have to ask Betsy to take me to the American Embassy when she gets here so that I could get some form of official papers. My translator suggested that Betsy might be busy, and I agreed, stating that I didn't want to twiddle my fingers until she had a spare moment.
   They then decided that I could go and essentially shadow the doctors and "correct" them.  I nearly fell over.  With all of my vast experience, I shouldn't be correcting anyone!  Stealing Cliff's analogy, I explained that if a foreign doctor came into my office/hospital and started telling us what to do, we might be a bit offended.  They agreed.  We concluded that I would go with the doctors, see what they do, learn about the community, make some suggestions (their idea), and learn something from them (my idea).  I'll meet with the medical team on Friday, and I'm really hoping to get an amicable introduction... if they introduce me as the fancy American doctor coming to right their doctor's ways, I might just cry.
   With their conclusion, my wheels started churning.  Out of earshot, I explained to my PCH translator that the reason I signed on with their organization is because they are community-based and they empower people.  We agreed that SADA doesn't empower anyone (but their doctors).  I've agreed to go visit these communities and observe the current systems, but in my head, I have bigger plans.
 
   The WHO has many variations of a health system model:

Health promoter --> doctor/ clinic --> local hospital --> bigger centralized hospital.

I still think this model could work with the FIDA-PCH-SADA health model.  I'm a few steps further from that then I had hoped to be, but I have hope.  If SADA has mobile clinics that visit these remote areas from time-to-time (once a month?  I've yet to find out) and there are health promoters in the community, then maybe I could still work with them.  This trip, I'd like to go out on these mobile clinic trips, get to know the community, hopefully meet some community leaders, and seek out a potential host family.  If I can do some networking, perhaps I can make some more specific suggestions to PCH about what I can do and who I might work with in August when I come back.  I'd love to meet their community organizers and have meetings with the promoters to see what they know.  I'm sure the Haitian government will never let them write prescriptions, but I'm certain they could use some hands-on skills, like learning to splint and suture, at least to hold people over until the mobile clinic comes along.
   I've also been talking with another group that's staying here at Walls.  Their organization (CONASPEH) is affiliated with a Haitian organization that ran a school for nurses.  Unfortunately the nursing school collapsed during the earthquake, killing 21 nursing students, and is a long ways from being up-and-running.  On my last trip, I met a pastor whose wife was an American-trained family doc, and worked at that school, training nurses to use Where There Is No Doctor and preparing them to function in communities without doctors.  I like their model, but I'm personally drawn to more rural areas (for purely selfish reasons, I like them).  The CONASPEH volunteers and I agreed that it might be worthwhile for me to someday partner with their organization, particularly once the school is up and running.  I could guest-lecture there, and perhaps even borrow some of their instructors to come out to more rural communities.
  Big dreams, man.  I have big dreams.  But I'm getting there.  They'll evolve.  Plans will change.  Dreams will morph.  And good will happen.

The new "main area" at the guest house... I slept on a mattress in a nice little two person tent, all by my lonesome.  Best night's sleep I've ever had in Haiti!  It was cool and breezy, with NO mosquitos.

 

Leaving for Haiti

Hi all!
    My trip to Haiti is fast approaching.  I can't believe I fly out in 2 days!!!  This trip I'll be working on a partnership with a really cool Canadian-based organization named FIDA and their Haitian counterpart PCH.
    Here's my understanding of their organization... supporting schools, building orphanages and adopting kids (often kids with living parents) are all really temporary fixes focusing on child poverty.  As Betsy puts it, "I don't believe in child poverty, I believe in adult poverty."
    By whatever mechanism, a community can be referred to FIDA-PCH.  They have an assessment team that goes door to door and asks families about their strengths, their cultural background, and their past work experience.  Then they synthesize all of their findings and make some recommendations to the community.  After the village chooses their own path, they can apply for grant money and make it happen.  For example, a farming community who had ceased to farm because of problems with the irrigation system applied for a grant to fix the irrigation system.  They got a grant, and FIDA hired local villagers to work on their own project (not outside volunteers, Haitians are fully capable of manual labor). FIDA helped them toward an agricultural cooperative.
     And then what happened?  Men started coming back from the cities where they were living in slums and looking for work.  Families started saving.  The community invested in their own schools.  Nutrition in the community improved.  Families didn't have to leave their kids in orphanages for them to get 3 meals a day.  And the community owned their success.  They did it.  By fixing the adult poverty, the child poverty disappeared.
   I spent a month at Walls Guest House last fall taking Creole classes and meeting with various NGOs to see who I might work with in the future.  But I never thought to work with FIDA-PCH.  Two days before I left, I met Betsy Wall.  (Her parents formed FIDA as their retirement project.  Her dad would work out in the fields with the cooperatives, while her mom ran the guest house as a fundraiser.  Now FIDA is a massive Canadian nonprofit and very effective.)
    As I was telling Betsy about my goals, she mentioned that their communities have health promoters and trained birth attendants who have been begging her to start a medical program.  I helped advise them on a really simple door-to-door health survey, which they've started incorporating with their field.   assessment.  And here I am packing to go down and do who-knows-what with them.  We'll start with an orientation, hopefully outline some goals and objectives, and then I'll get to meet the health promoters.  I'm hoping to help coordinate education and programming.  Maybe I'll teach on some topics.  They've also requested that I assist in developing a prenatal-care program.  (Haitian Ministries and Emily Smack were kind enough to pack me a HUGE bag of handmade baby blankets and other baby-related items for the midwives to hand out at their prenatal classes.)

(myself, my mom, & Enoch when we were in Haiti, 10/09)

  Anyhoo... I'll keep you posted as to my adventures.  Here's my tentative itinerary for anyone who's interested.  :-)
Peace, Becky

Leave Tuesday, May 4, 2010 American Airlines 837

Depart: 9:05am New York, NY (JFK), Arrive: 12:50pm Port Au Prince, Haiti (PAP)

Return Friday, May 28, 2010 American Airlines 896

Depart: 2:05pm Port Au Prince, Haiti (PAP), Arrive: 7:25pm New York, NY New York (JFK)

You will be working with our team here in Haiti, productive cooperatives Haiti. Pierre Richard is the coordinator and Jean Elto Vincent is the administrator.

1. They propose that you spend May 5 and 6 at the pcH office for orientation and planning.
2. You can spend May 7, 8, 9, 10 in Kenscoff.
3. May 11-14 you will be in Delis which is in the Chaine de Mathieau mountain range. Transportation will be provided and you will be returned to the guest house each night. There is no physical clinic building in this community.
4. You have a free weekend.
5. May 17 you will be at pcH office for planning.
6. May 18 is a holiday (Flag Day)
7. May 19-21 and May 24-27 you will be in Fon Batis which is in the Chaine de Mathieau mountain range as well. You will be accommodated there for the week days and will return for the weekend to the guest house. There is a building that was intended to serve as a clinic but there is limited supplies or equipment. There is no doctor or nurse but there are some health agents and trained midwives.
8. May 28 is debriefing at the office.
9. You will be provided a translator with medical knowledge.
10. Transportation will be provided to and from the field and to and from the guest house as well as accommodation and food in the field.
11. Supplies can be purchased in Haiti. As to what to bring, I have asked of the field can provide some advice.
12. You can fly directly into Port au Prince. You can arrange directly with Veniel for airport pick up and accommodation as per the above schedule. I unfortunately will not be around.