As an American health care worker I was in the midst of a crisis: there was no computer access, and I did not have the phone numbers of any of the patients to be seen the nest day. But the clinic was working perfectly: at the end of the day the last patients were picking up prescriptions and the doctor was writing final notes. The paper medical records on over 16,000 patients were organized in the rows of filing cabinets, and an outreach worker had visited at home all of those who would be coming in for free appointments with the volunteer doctor.
The Nueva Vida Clinic functions based on its relationships with those of the community they serve. One of the clinic buildings is set up with a laboratory and a dental office because people wanted these rather than a birthing center; the outreach worker knows who needs to be checked on because of news from the trained layperson Health Promoters around the neighborhood.
|Clinic at Nueva Vida (a neighborhood of Ciudad Sandino) operated by the Jubilee House Community.|
|Delegation at Work in the Clinic|
In back - from left to right:
Carl Thatcher, Becca Cooper, Dr. Dana, Claire Riggs
In front - from left to right: Pat, Mari Petzing
Of the international development work which I have seen and participated in, despair has come from the absence of reciprocity. An organization can come into an area that needs a medical clinic and build a building in 9 months, and having completed their project proposal call it a success and leave. This omits the evaluation and feedback of the people purported to be served: it denies a relationship.
The recipients of the service are the experts of what the impact of the project is on their community, and they are the ones who need to be heard.
It is only when those ‘receiving’ assistance have the opportunity to critique what has been done that there is the possibility to improve what is being done, and the only way for those ‘giving’ the service to learn if they are accomplishing what they actually intend.
Both the Nueva Vida Clinic’s outreach worker and Community Health Promoters are dramatic ways in which the health care that it provides is focused on the community, rather than on what the clinic thinks is needed. A woman spends her work days walking around the dirt roads of the neighborhood, and checking in at the homes of people experiencing health issues, and those too frail to travel to the clinic. She is able to give out “Bonos” for free care for those who are themselves unable to afford the small fee or volunteer shift and also lack family support to help them with it.
Community Health Promoters are volunteers who receive training in basic wound care and keep supplies like nebulizer and blood pressure machines in their homes, and are resources to their neighbors. Basic care can be provided.
Health care as I know it is professionalized, and remarkably inaccessible: one must go to the system. While I work with nurses, physicians, physical therapists and others who visit patients at home, potential patients must go through an intake process and be aided through a maze of billing to be seen. Even for basic care, formal channels must be followed. Shifting simple care to the community means strengthening the ties among neighbors, rather than removing individuals in need from their social supports.
I am encouraged by development work which have ten year reciprocal relationships with the community with which they collaborate, and by a vision of health care which bases its work both in and on people and their existing social ties.
Blog entry draft 8.27.2011
Visit to the >>>> Dump
What was the last thing I threw away today? It was probably an empty can of Del Monte Iced Tea this afternoon, left alongside some used napkins and other cans at a hostel picnic table. Though I didn’t think much further about it then, that can had a lot farther to go than that picnic table, or even the hostel garbage can. After our trip to La Chureca landfill yesterday morning, I can now picture a vivid place, with haunting faces, of where that can probably ended up. This dump went beyond a place where trash is contained; it is a scar on the earth, where disposable materials and people are left to be forgotten. Hopefully, not for much longer.
We all filed onto the bright yellow JHC schoolbus to take a windy trip through Ciudad Sandino to a place on the edge of Managua, passing all the normal little gas stations, tortilleras, and mechanics shops to a neighborhood consisting of brand-name car dealerships in bright, shiny new buildings. (Incidentally, many of the large international car brands represented there, including Toyota and BMW, and almost all of the beer and rum in the country, are owned by one wealthy Nicaraguan family, the Pellas). Then, we took a left, and were asked to close up the bus windows to avoid having burning trash smoke waft in. We immediately found ourselves in a low brick alley lined with mud, and semi-sorted piles of plastic bottles, sawdust, organic waste, plastic bags, cups, and wary eyes. In the small cross streets, there were lean-tos with people repairing bicycles with salvaged tires, or burning small piles of trash, very possibly cooking on those fires as well, while stray cats and dogs lethargically sift through the same detritus. These people are really the poorest of the poor, living in the dump and trying to make a living by collecting recyclables for bulk materials resale. They often get almost all of their food, clothing, and shelter from the dump as well, which means all the risks of spoiled meats and fruits, dirty, threadbare shirts, and small pieces of scrap sheet metal, wood, or plastic. As we passed block after block of these piles and people, the brick walls fell away to more shacks (even a snack shop selling soda and cheap carbs to dump workers and residents), and the cats and dogs were joined by cows and horses grazing on the trash, or hauling it on carts. Finally we rounded a muddy corner, and we could see the vast, layered expanse of trashed earth. However, this story could be heading towards a positive future, because this particular dump has mostly been filled in with dirt as part of an effort to find alternatives to a massive, open air landfill. The view from that muddy road, with trash-encrusted, packed earth mounds to our right, leading around a large cesspool to our left, led into a slum where that latent light of hope lay.
We parked and skirted along a path around the steep banks of the cesspool to enter the >>>>>>>>> Center, led by Bismarck, a community organizer for the trash pickers living in this dump. We traipsed through people’s front yards, back yards, and porches (solely consisting of dirt and salvaged materials) to a sturdy concrete building, built by an Italian NGO sponsor. As we congregated under the open air space with picnic tables, so did a growing number of young children, roughly between the ages of 4 and 12. Bismarck spoke to us, with a face both hardened and caring, of the plight of these children surrounding us, whose family’s lives had subsisted entirely around working and living in this landfill. He noted the desperate situation of their health, from contaminated water to malnutrition, and the quashed hopes of schooling for most of these children. He described the efforts the organization was spearheading in teaching the children to read and write, the provision of good meals for free, even mentioning a soccer team he coaches for them. After about 20 minutes of translation, interspersed by children kicking a ball into our circle, sitting next to us, staring into our faces, smiling, crying when they fell into a puddle, and generally keeping things from getting too adult-serious, we were allowed to get down to the real business: play! After all, when you are visiting a gargantuan landfill, and the people who live and work there by no choice of their own, for one day: what can you do? Make the trash disappear? Give them all food for a year? Nope. But, you can ask that little boy what his name is, and draw him a yellow tiger with blue stripes when he asks you to. You can also join in their chaotic game of mud-soccer. And, you can just give a damn about them, give their little bodies a hug, and realize that you are about to get on a bus out of hell in a few minutes, and they are not.
So what about that can?
First off, you can do your best not to support Del Monte products at all, whether in Nicaragua or in Oregon, where that company has a long history of labor violations, including quasi-legal deportations of their undocumented employees (see article here: http://www.oregonlive.com/news/index.ssf/2009/06/women_caught_in_fresh_del_mont.html). Next time, I’ll try and stick with something locally produced instead of a can of tea produced by misery.
Secondly, you can do your best to make sure that can gets recycled in a recycling plant, not by children in a landfill. In hindsight today, I should have brought the can back up to the hostel lobby, where they’d probably have a labeled container.
And third, and most importantly, make the mental connection between that can in the cooler and the landfill, or recycling plant, where it will inevitably go. It’s not about feeling guilty (that doesn’t help anyone, including yourself) it’s about being informed about what your choices do. Yep, it’s taking on a little bit of that first-world responsibility that we have to care, and help create better systems than we’ve done so far. Ultimately, we probably won’t be the ones who can make all of it happen, because we’ve created this massive mess in the first place. There’s nothing like a reckoning with a mountain of refuse created by us, paid for by the lives of other people.
PS. If you want to get a visual on what a massive landfill looks like in Latin America with some professional cinematography, great art, and a similar context, check out the recent Oscar-nominated film Wastelands (created with help from a friend from Brazil!)