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.

Last night's dinner meeting...

Last night I had my final wrap-up meeting with pcH.  They took me to a cute little seafood restaurant in Petionville to discuss my month.  I was struck by how grateful they are that I am here, and I tried in every way possible to return that gratitude.

As we discussed my upcoming proposal, their wheels started churning.  pcH does not have a health care arm.  At first they suggested that I might be better off partnering with AME-SADA.  When we discussed that SADA does not have any involvement with the community, they agreed that their values are more in line with the type of program that I would like to build.  They then suggested that they might need to review their founding documents.  Their contract with the Haitian government states that they are an NGO that works in cooperatives, agriculture and adult literacy.  First they will speak with their board, then their lawyer, and then they may need to apply to modify their government documents.  They sounded very willing to do so but warned me that it might take some time.  I encouraged them to take as much time as they need, reminded them how impressed I am with their organization, and explained that I hope to work with them for many years to come.  We agreed that if the government won’t let me start a health program by the time I come back in August, then they will help me work on language skills and learning more about Haitian culture (and they might have me teach some English classes).

And then I opened up my line of questioning.  We discussed how health promoters might be selected.  Their communities already have health agents, midwives, and voodoo priests, all of whom practice some form of medicine.  However, I would like to use a term different from health agent, potentially health promoter, but we’ll discuss that with the communities.  Then we will ask the cooperatives.  I’ll explain to them what a health promoter will do, and then their community, through open space dialogue, can come up with their own list of qualities their health promoter should have.  After the list is generated, we will ask them all to vote on whom their promoters will be.

We also clarified that based on Haitian laws health promoters here will never be allowed to prescribe medicines.  Ironically, you can buy antibiotics, antivirals, and birth control pills in any market place, or even on the bus, but they won’t be allowed to write prescriptions… However, I reassured them that there are many many things that they will be able to do without prescribing, such as suturing, teaching how to make oral rehydration solution, and healing without medicines.  They got really excited and LeGran said, “They will save lives!” (His words, not mine J, but that is the idea.)

My language skills also need some help.  We agreed that I should have a helper, who I will call a partner.  I asked them to look for a few smart dynamic villagers who speak both English and Creole, who I can then interview.  I reassured them that they need no health care knowledge and they don’t need to be certified translators.  My ideal partner would be fun, animated, willing to try new things and culturally sensitive.  I explained that I need a local person to help me with Creole, but I also need someone who will elbow me if I say something that’s not culturally appropriate. (They agreed.) My proposal will include a stipend to pay this person, and a similar stipend to pay myself.  (I’ll donate it back, but that way they can financially account for my services.)

We also discussed about when, in the future (when my schedule isn’t based on a residency program), it will be best for me to come back, i.e. one week every two months, two weeks every four months… And they proposed that I come between planting an harvesting.  Ideally 2 weeks in January, 2 weeks in August, and 2 weeks between November and December.  I’m not sure how that spacing will fly with my future employer, but agriculturally, that makes a lot of sense.

Our meeting concluded with another round of appreciation.  They appreciate me, love my ideas, believe that our philosophies are consistent and are honored that I want to know Haiti.  I reiterated why I’m impressed with pcH, thanked them for their hospitality and generosity and told them how excited I am about coming back.

The best part, of the meeting though, was when LeGrand decided that since I keep coming back to see Haiti, Haiti and I have become lovers.  I made them promise not to tell my boyfriend.  J

Reflections after a weekend in Jacmel

Hey all!
     I just got back from a great weekend in Jacmel with Dom and his friends, Nesly and Natalie.  We drove past some incredible earthquake devastation on the way out, and Jacmel was a breath of fresh air on the other side of the mountains.  They have their share of quake damage too, but it's hard to shake the beach.  We drank Prestige, swam, and ate freshly caught fish under the palm trees.

Here's the dining area.

Nesly and Natalie

Dom learned to back float.

Sun setting... love the clouds

     Today we hung out at Leslie's house while Dom's car got washed and detailed, and then we drove back through new devastation.  The heavy rains last night flooded many of the main roads to Port-au-Prince and washed piles of trash all over the place.  We actually had to turn around at one "puddle" and find an alternate route.

Here's where we turned around

Going to Jacmel was great fun and an opportunity to reflect. 

Having been in Haiti for approximately three months of my life, I have nothing tangible to show for it.  It’s an interesting feeling.  The medical mission group who is staying at Wall’s saw 976 patients the other day (with a total of 8 doctors, in one day… that’s scary).   Another group built an orphanage.  Yup, they got their hands dirty.  Me, I’ve just learned a lot.

I first came to Haiti on immersion experiences, to see poverty and learn about the world.  Those experiences served as social justice retreats and powerful motivators.  In medical school, I came for a more spiritual retreat, to hang out on Jane Wynne’s organic farm and make recycled paper products.   I came last fall to learn Creole and to meet with nonprofits about long-term partnering, and here I am again.

Well, this trip, I’ve taken steps toward long term partnering.  Studying the rural medical system, learning more Creole, and having some fun are perks, but I think the relationships that I’m building are most significant.  Already committed to working here, I need to make sure that whatever I do is effective.  I’m making a big investment of my time and resources, and I’m expecting to see real returns someday.

I’ve fallen in love with participatory development, and I’m really looking forward to partnering with PCH.  They’re effective, and they’ve proven it again and again.  If I can assist them in adding a health care arm that is similarly empowering, while simultaneously saving lives, then all of my time will be well spent.

Thanks to all of you for your patience and support!  I'm so grateful.
love, becky

Are we really investing in communities?

            Yesterday was a great clinic day. I spent a second day working with Dr. Pierre, who speaks no English, but is good enough to repeat complicated words for me and even write them down.  She started asking me clinical questions, what would be my diagnosis of this situation.  Interestingly, her differential diagnoses are pretty slim.  A patient who presents for fatigue without fever is automatically diagnosed with nutritional anemia, after all her diet is probably poor.  Despite that many “field lab tests” available for checking hematocrits (ranging from spinning tubes which require electricity to simply comparing a spot of blood to standard color ranges), this clinic makes the diagnosis presumptively. 

           

            We saw this beautiful smiling baby in consultation.  Mom started talking about how she was sick, and the doctor took the baby, started playing, and reassured mom that she was fine.  (Apparently, mom really brought the baby in for the free sandwich.)  We each played with her for a bit and gave her back to mom, who then got her sandwich.  Then mom came back a little later, handed me a sleeping baby and ran off to do errands.  Yikes!  My first question was, “Eske ou pral returne, wi?”  (You’re coming back, right!?!?)  For all the talk of abandoning children around here, I had a right to be worried… 

            I think it’s really fascinating how much effort foreigners put into building and maintaining “orphanages” (a term which disturbs me greatly, because they have parents!).  Don’t get me wrong, I believe that children should be loved, schooled and fed, but wouldn’t it be nice if they could do that while living with their own families.  Haitian mothers and fathers love their children, just like we all do.  And I find it absolutely depressing that some of them feel so desperate that they feel the need to give their children away, thinking someone else can do it better.

            Fortunately, economically viable communities don’t need orphanages.  Communities that produce allow parents to raise their own children.  Wouldn’t it make more sense to invest all of that money into capacity building and training programs so that families could stay together?

            Needless to say, mom came back.  Her community, though it still has a few cases of malnutrition and struggles with various social problems, has a cooperative.  They have worked with PCH for a long time.  The people of Delis are productive, and they feel fully capable of raising their own children.  That’s pretty remarkable.

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.

 

After a delightfully uneventful flight...

     I’ve arrived in Port-au-Prince, and it’s not as bad as I expected.  I guess the media was only covering the wreckage, but I'm amazed at how life has gone on.  The regular airport is closed and has big cracks running down the walls, but the makeshift airport building functioned just fine.  The plane landed, I went through customs, and I got my luggage in about 20 minutes time.  No problems there.  I got a little cart for $2 and loaded it up with my 100 lbs of luggage, and I ended up giving $5 to the guy who helped me maneuver the cart.  Smooth as pie.

     On the way to Wall’s Guest House, we stopped to get me a cell phone.  I now have a bonified Digicel phone.  I still need to get a card for it, so I can’t really call out, but ya’ll can call me! 011-509-3889-0884.  I make no promises though, it might be expensive.

     And then we arrived "home" at Walls.  One of the buildings at Walls is completely collapsed.  The dining area has been moved into the garage, which still functions pretty well.  And the parking lot is full of tents.  I’ll be lucky enough to sleep in one of them tonight!  But I hear they’re cooler than the rooms and have fewer mosquitos.  Works for me!  I’m just hoping that Veniel can find a place for me to put all of my donations so I can actually reach my presently-buried personal belongings.  J

     This afternoon I got a welcome email from PCH, and I have two orientation meetings with them tomorrow, at 9:30 am and 10:30am.  I’m really looking forward to hearing what they have to say and seeing what they have planned for my month.  (Funny, I can dream up all kinds of goals and objectives, but none of them are worth doing if they’re not on the same page.) 

     I got to read a good chunk of Helping Health Workers Learn on the plane, and it’s a phenomenal book.  I highly recommend it to anyone who’s interested in teaching methods that empower and engage learners.  Regardless of what I actually end up doing, I’m hoping to put those ideals to work!

Formerly the main building of the Guest House