March 19, 2012 by David Aday
Notes from March 6, 2012
Michael Cammarata ’12 (ourth project trip) is this year’s clinic coordinator and he has organized meds, worked with our medical providers, and helped to manage local logistics. He is deeply invested in the project and in the prospects for improving the delivery of medical services. Dr. Roger Martinez (our Nicaraguan doctor from the beginning of the project) and Dr. John Showalter (returning for the second year as a medical provider) have seen nearly 100 patients in the first day of the clinic, and in spite of the demands, their energy seems always to outlast our supply of medicine. In part, this is because we have not yet found the strategically appropriate way to organize our clinic efforts. As “Dr. John” notes, it does not make a lot of sense for physicians to see patients for whom they will prescribe, invariably, Tylenol, adult vitamins, and anti-parasite meds. We will meet with health brigadistas (volunteers appointed by the mayor to help coordinate health services in the communities) to discuss more appropriate ways of using our medical services. In the meantime, we struggle with the issue of who to see and how to see those who would benefit most from our medical services and medicine.
Working with Dr. Tellez from the Totagalpa clinic, we will take a field medical team into communities where we have not been for several years. Dr. John, Julie Sangimino ’12 (4th project trip) and Johnathan Maza ’15 (2nd research trip) head to Mojon Uno and Las Menas. The plan was to travel with a brigadista, but something went wrong. The team proceeds nonetheless and gets help along the way from a local girl who happily shows the way. The team sees, among others, an elderly woman with end-stage rheumatoid arthritis. Her husband apologizes the the inconvenience and says that he would have carried her to the clinic if he had been able.
The newest team members, Ambika Babbar ’14 (1st project trip), Stephanie Wraith ’15 (1st trip), and Carrie Perry-Hoyt (administrative associate in the Office of Community Engagement and Scholarship — more on that later) have spent the day in the clinic and have seen or the first time the operation and effects of our small medical program. It probably is clearer to them than before that our clinic is an important resource, but not the long-term solution to health and health care. They have seen the spirit and grace of the residents who come; the dignity and patience that belie the difficulty of their lives.
Daniel Fischer ’12 (1st year on the project) and Zander Pellegrino ’15 (1st year) have their first turn on the field research team and participate in focus group interviews with groups in the morning and afternoon. The focus groups are lead by Alex Ferraro ’12 (4th project trip) and Yardley Albarracin ’13 (3rd trip) — who are becoming master interviewers and group facilitators. They work together in seamless ways to invite, solicit, and nurture them in group members’ comments, and to articulate and express intersections of hopes and possibilities. I am moved by their skillfulness and their ability to express their affection and their dedication to the community, to the model of development, and to the possibilities for the future.
March 19, 2012 by David Aday
Still catching up. The following is taken from field notes on March 5, 2012.
There is so much water in the rainy season. Roads flood, water fills the quebradas and washes away roads and trails. So much of it could be captured, stored, diverted, retained to refill the aquifer. Last year’s efforts to repair and grade the roads and to build gutters and curbing have been undermined, apparently, by a strong rainy season. The road is nearly impassible in spots because of exposed rocky extrusions and ruts deep enough to conceal small children. And yet, the rainwater that was caught and stored during this time soon will be used up — well before the next rains come.
Clear-cutting the pine trees in northwest Nicaragua in the 1950s (by American and Cuban companies) has left the region a high mountain desert with annual flooding. The town where we spend our time, Ocotal, translates literally as pine tree and refers to the species that was abundant before the clear cutting. Some local citizens will share the irony of the name — if you are patient and encourage it. There are a few stands of pine now — mostly scrub — but the area is making at best a very, very slow recovery.
Over the last six years, we have seen the beginning of effective small-scale coffee planting. There are isolated farms that grow produce (pineapples, maize, coffee, mangoes) beyond subsistence. Plantains are increasing in number and produce.
In November, the mayor’s office (in Totagalpa, far removed from the daily lives of people in Cuje and Chaguite) partnered with an NGO to place rainwater catchment cisterns in each school in the region. The cisterns are 1000 liters. In Chaguite, the cistern diverts water from a formerly used cement container. The mayor suggested that the water could be used for a children’s garden at the schools — to improve nutrition. It is too small for that purpose and it is placed directly in the sun. The water will be too warm to use for watering or drinking, which in one sense is not too big a problem: the NGO folks didn’t provide a spigot or hose, or any way to extract water from the sealed cistern. The necessary parts were to be delivered in November. The cistern is full.
March 19, 2012 by David Aday
Catching up. What follows is from notes made in the field on March 4, 2012.
There is an old Calypso song that tells of a dialogue between a man and a woman. It begins with the man’s complaint about a hole in his bucket, apparently in response to the woman’s request to fetch water. The dialogue continues as the man laments his inability to solve compounding problems (the straw too long to use to mend the bucket, the axe too dull to cut the straw, and so on, back to the original): the inability to fetch water (to sharpen the axe, to cut the straw). Partnering with communities to take on complex and interrelated problems has a similar character.
They could have clean water by catching rainwater, if they had metal roofs. They could store the water if they had cisterns. The water could be purified if they had chloro in proper and dispensable form, and it could be stored for use during the driest season, if they had cisterns, and if the cisterns were large enough.
A similar story can be told about disposal of human waste, nutrition, and so many of the underlying problems of health. We try to understand from their point of view and to engage with them at strategic points.
Others with good intentions sometimes complicate our efforts. Imagine our friend with the holey bucket. A good Samaritan comes along and provides straw for the hole. Sadly, the straw is too long. Our friend can make it work for now, but the wrong-sized straw complicates the problem — and in time, that straw will give out as well. An NGO recently brought five cisterns (plastic holding tanks) to Chaguite. These were given to people in five households, with no apparent logic to the selection. It is possible that the NGO has a plan; that they will return with more resources; that they will work directly with people in the community to find equitable solutions that are forward-looking and sustainable. It is not apparent that any of this is the case.
One thing is clear: that some received this “direct aid” contributes to other residents’ sense of unfairness and expectation that a good solution would involve giving everyone a cistern. Seen from a different perspective, it is clear also that the cisterns are too small and that they do not contribute much to a sustainable or strategic solution. The 2500 liter containers provide enough water for less than one-third of the typical dry season. They provide a capability to catch, hold, and use a tiny portion of the annual rains.
We have begun to describe our proposal for building on what we’ve learned from the community: a strategy to bring all households to some minimum standard for access to clean water; a plan to capture more of the rainwater by using overflow techniques to direct excess water from individual cisterns into larger regional cisterns. It is yet to be seen whether our approach, focusing on the capacity of collaborative effort, will be a convincing alternative.
March 5, 2012 by David Aday
3.2.2012. The A team traveled through the community, meeting friends and notifying residents about the coming week of medical clinic. We stop at each of the schools to leave notes with the children, explaining how the clinic will work and inviting their families to come for medical consultation, and if needed, for medication. The roads are rougher this year; the colors more spring-like. It’s clear that the rainy season has been good; there is water in creeks and rivers in the lower elevations, and there is foliage. Dust from the roads doesn’t rise until late mid-morning. But the roads are rutted; there is clear evidence of erosion. Our nearly new Land Cruiser “Prado” lasted only one day. It’s possible that we (I) damaged the 4-wheel drive by banging the undercarriage on a deep rut. (I don’t think so, but the Budget Rental folks are less certain.) We will drive back to Estelli tomorrow to exchange the broken Land Cruiser for a different vehicle with 4-wheel drive. We need to be back for a meeting with the CPCs by 10 a.m., so we will need to be up and out early.
It’s been a good day. We have seen most of the CPCs that we want to meet tomorrow. Kristin Giordano (’14), Lester Chavez (’14), Alex Ferraro (’12), and Michael Cammarata (’12) spent time with an aging member of the community who talked about life lessons and showed them the results of years of labors of love, his house resplendent with expressions of his deep affection for place and home. They talk warmly about his reflections, and they quote him liberally.
March 5, 2012 by David Aday
We are greeted warmly—always and sincerely. This year, the people of Chaguite seem a little less surpised that we have, in fact, returned. It is gratifying to find our friends expressing and reflecting ideas of partnership more than appreciation. There certainly is nothing wrong with being appreciated—but to be trusted as a partner, to be invited into frank and open discussions about needs, hopes, and possibilities: this is the heart of our efforts. Alex Ferraro (’12; 3rd year with the project; 4th trip to Cuje) is a keen and sensitive observer, and she noticed the difference. Others of us sense something similar. At an arranged meeting with local community leaders (“CPCs”), we hear residents tell us that they value the fact that we are working WITH them; that we want to help implement projects that reflect their knowledge, their local wisdom. They are not parroting our model; they are describing the experiences they’ve had with us—and with others. We talk about a small cistern that the mayor’s office has installed at the schools throughout Totagalpa—and at the school in Chaguite. People came; they installed gutters; put in a pipe to direct the flow of rainwater into the cistern. There is no pipe leading from the cistern (promised in November), and there is no way to extract the water. The cistern is too small to use for a hoped-for garden project. No one consulted with community members. They appreciate this effort. They are want to partner with us.
March 5, 2012 by David Aday
3/1/12. 6:00 a.m. Next stop, Miami; then to Managua; then to Ocotal (ETA 7pm). The MANOS advance team will travel the last leg via the Pan American Highway, hoping to stop off in Paraiso, just north of Estelli, for dinner before settling into Ocotal in preparation for the team’s arrival on Saturday. No team has been better prepared or better organized. The 5-year plan is written and vetted, team members understand and embrace the concept of partnership, and everything is in order. I am blown away by the initiative and self-reliance of this team. They have their s*** (stuff) together. The newest team members are represented on the A team by Kristin Giordono. She and the other “newbies” are tuned in, ready to follow, prepared to step up and to step in. I expect great things for this week.
January 11, 2012 by David Aday
We returned from our seventh annual project week in the Dominican Republic on Saturday, January 7th, 2012. We had met our quota of hugs on Friday night; we had expressed appreciation to the cadre of fellow travelers and professionals. We looked at one another with comfortable and knowing smiles. What needed saying could wait. We lived it; talking about it would be nice but not entirely necessary. But I can never leave well enough alone.
First, to the entire SOMOS team: No team before you has been better prepared, has come to the week’s work as grounded, has worked as hard to understand what we know and what we don’t know in order to advance an agreed-upon model and method. For the first time, we were able to converse fluently in the language of the approach, and that allowed efficiency and coherence across a dizzying variety of events, questions, concerns, and issues.
We lived the mission.
I recall with mixed emotions a moment several years ago when issues arose during our time in the Dominican Republic and were met with confusion and uncertainty. Experienced members of the team sought to move towards resolution by referring to the project’s “model.” Newer – and some more critically thoughtful – team members were uncertain what constituted the model and how that provided any basis for resolution. We have come a long way from there.
Taylor Hurst and Kevin Salinas served us well as co-leaders, allowing space and offering encouragement for others to step up to organize, manage, and lead diverse and complicated pieces of our collective efforts. Among those who stepped forward from early in the semester are Joanna Weeks and Lindsay Schleifer. Alternately encouraging, chiding, insisting, and leading by example, Jo and Lindsay championed the motto: Get it done. They were – and are – brilliant.
Amalhyn Shek, quiet, dedicated, wise; she understands the approach in her bones. With no notice whatever, she can and does step into any situation to provide insight and guidance. She grounds us all, not succumbing to momentary flights of self-congratulation or giving in to the frequent frustrations or discouragement.
Rebecca Silverstein is our fountain of energy, determination, joy—and new ideas. She persisted in her pursuit of Engineers Without Borders with little or no encouragement from me. I thought it was premature. I worried that we would find ourselves doing the bidding of that NGO rather than engaging the community in bottom up efforts to understand the problem and to find viable solutions. Her precociousness and persistence made possible discussions with the community and others about short, intermediate, and longer-term strategies that were convincing if not compelling.
Jeff Rhodes and Kaveh Sadeghian shared an adventure that I would wish for each of you. It was an adventure of discovery that was more routinely a part of our experiences in the early years of the project—venturing into unknown areas to meet and learn directly from residents who showed and told us things that we did not know, had not heard previously. They saw back reaches of the river and cañada that we had not seen before—or had not seen for some time. They saw the country home of the Dominican Republic’s president’s wife. They met people whose family have owned property in the community for 200 years and who may be willing to allow the community to use the property for a center. And they learned basics of GIS mapping from my able and experienced colleague, Carrie Dolan.
Carrie, MPH and experienced international development professional, added measurably (pun intended) to our efforts and prospects in data collection. She will play a crucial role in helping us to transform conceptual visions into operational and empirically defined outcomes. If she wasn’t before, I think she’s hooked, and I appreciate more than I can say the opportunities that she brings to the future of the project.
Kaveh took on a role that is not typical for one so accomplished in leadership. He spent less time on this trip articulating a vision for the future, helping to shape policy and practice—and more time collecting and counting money. He stepped in where the project had an acute need: collecting money from 23 people to pay daily for bus transportation to and from the community and for groceries used by women at the school to prepare our lunches. It is a thankless and nettlesome task, and he did it with efficiency, effectiveness—and grace. It is a tribute to his dedication—to the project and to leadership.
Jeff and August Anderson proved to be exceptional additions to our base of language skills. I heard rave reviews from medical providers about both—their fluency and their graciousness in working as translators both in and beyond the clinic. Both share another quality that has enormous value for the project: incisiveness. Each demonstrated the ability to understand quickly and precisely complicated matters, and to work from that perceptiveness towards solutions that both resolved problems and advanced core pieces of our model and method.
Mel Alim, alternately serious, methodical, and whimsical, is a steady source of energy and compassion—ready always to laugh at herself and remind us all not to take ourselves too seriously. She is learning the hard and abstract concepts and methods of organizing, becoming a trained observer of process. She will make very significant contributions to our implementation efforts in the coming months and years.
Melanie Rogers was ready at a moment’s notice to contribute language skills and thoughtful questions about what we’re doing and why. Whenever I looked, Melanie was busy: engaged completely in whatever work needed to be done and, always, looking out for the needs of others.
We missed Galley Saleh and Bruce Pfirrmann. We thought about them and know that they were cheering us on. We will torture them endlessly with the stories that need to be told, assuring them and ourselves that we never really were apart and that our work together goes on, not missing a single beat.
Thank you all.
January 11, 2012 by David Aday
With apologies to my SOMOS and DASV colleagues, I begin this post with an excerpt from a letter I wrote to the team when we returned. There is a theme that I want to elaborate, and I hope to deliver on a promise to recognize the exceptional work done by SOMOS team members.
We struggled this year again, and we will struggle for years into the future with enacting partnership. What must we expect of ourselves? What can/must we expect from our partners? At a critical moment of confusion, there were suggestions that we should, automatically, defer—because we are “outsiders.” I beg to differ. We are partners. I’ve said before that we will never have an “insider’s” understanding of the lived experiences and culture of the community and its residents. But that’s not the goal; the goal is to understand as fully and empirically as we can what we need to know to be effective partners. Should we act on the suggestion of some in the community that a “wrap up” meeting is important at the end of the week? Or, should we defer to those who worry that they have no resources, that we have the resources and therefore we should get on with helping? Recognizing the difficulties and the inconveniences, we asked the community to come together for one hour on a holiday that was filled with other obligations. Seems like a small enough matter, but it was a noticeable step forward. We will struggle with decisions like these for years to come, in part from our good intentions to help and to respect. We must be careful not to allow our good intentions to overwhelm our guiding principles, in this case that partnership means commitment and effort on both sides.
Do not confuse this point of view with “tough love.” There is nothing accusatory about the idea of partnership. And this is not the usual notion of exchange: “I’ll do this if you’ll do that.” In some ways it is even simpler: “I can do this only if you will do that.” We worry continuously about “top down” strategies, about imposing our solutions on their problems—and it is right to do that. Those concerns sometimes can be paralyzing—not least because they mobilize dichotomies, almost always, false dichotomies. They reflect imagined objectivities that simplify and reduce—and distort.
In the usual objectivist way of understanding, there is no community mandate, no one most important problem, no singular preferred strategy. Rather, there are shared and shifting understandings about concerns and solutions. There are moments when there is sufficient presence among residents that the community appears to speak with some singular voice. Don’t be deceived: the singularity can be disaggregated by any number of variable forces. And, this is crucial: Recognize that our work has helped to shape that moment. When we speak of “community building,” we do so in part because our efforts to understand also shape what constitutes community and what constitutes understanding.
Does this belie the confidence we’ve put in community-building, in community-capacity, in community-based, participatory development? Not at all. No one said that this would be easy or that we would find and deploy the silver bullet. It is rather to caution against reductionist understandings and simplistic solutions. Partnering means sharing some vision of problems, goals, objectives, and strategies. We are engaged less in discovery than in construction. We ask questions, systematically, thoughtfully, and repeatedly, because we want answers to shape our understandings. In the process, our questions shape shared understandings among those who answer. It is the first step in partnership.
And so to the kudos: . . . . . next blog post!
January 11, 2012 by David Aday
Señor Wallace asks us to meet him at the school (where we hold the clinic) at 8:00 a.m. so that we can travel to the government office. He asks us to prepare a report of our work over the past seven years so that we can make clear to the officials that we are committed to improving health in Paraiso; that we are serious about long-term and sustainable change. (These are my words, not his. He says more simply: Write about the work you’ve done here so the officials will know.) It’s a short turnaround: pull together a summary of seven years of work with limited access to internet (and, thus, to files and data) and no immediate access to a printer. We believe that this could be a watershed moment and dive in willingly.
By Wednesday night at 10:00, we have a printed report, complete with data on the cañada, a Google Earth map with marked coordinates showing data points, and a concise summary of our project goals and strategies. We are eager to meet with government representatives even though we have seen before the limited impact that such meetings can have. Three years ago, a small contingent of SOMOS representatives accompanied Señor Wallace to the Mayor’s Office to express our concern about a bridge crossing the cañada. A resident of Paraiso had fallen when the bridge collapsed, and he was hurt seriously. We hoped to reinforce Señor Wallace’s plea for government repair. The meeting included high drama as the mayor insisted with various department heads that the repairs be made immediately. Months passed without result.
We are uncertain of our destination or our mode of transportation. We are told simply to be ready to travel from the school at 8:00 a.m. Concerned that we might not arrive by 8:00 a.m. (our bus transport is not entirely predictable), we called Wallace to get more details. He tells us that it will be fine; we should come to the school as soon as possible. We arrived at 8:30 to find Señor Pinto waiting. At 9:30 we call Wallace to check on details; there is no answer. At 10:30, we agree with Señor Pinto that we should walk from the school to the nearest bus stop and take a public bus from there to the meeting. We have walked perhaps a block when Pinto receives a call from Wallace: He will be there soon. He has arranged a police pickup truck to transport us. The truck arrived at 11:15; it’s a double cab with two officers occupying the front seats and enough room for three small people in the back seat. There are six of us representing SOMOS, Señors Pinto and Wallace, and a representative from a nearby junta who has come to express her support of our efforts. Señor Pinto, four students, our embedded photo journalist, and I climb into the pickup bed for a rough and sometimes unnerving ride to uptown Santo Domingo. There are curious looks from those we pass, seeming sometimes to say “Why are all those gringos going to jail?”
We had imagined that we were going to the Mayor’s office or to some executive branch related to that office. We were wrong. We arrive at about noon and unfold ourselves from the pickup bed in front of the Instituto Nacional De Recursos Hidráulicos—roughly, the national water resources institute. We didn’t have an appointment, but we wished to see the director. It was clear from the outset that Señor Pinto has been here before. It also was clear that we were not going to meet with the director. There were exchanges between the front door receptionist and Señor Wallace; armed security officers stood close and attentively by. We were asked to move back, ideally outside, while discussions continued. A friendly middle-aged man appeared and took charge of the discussions—and ultimately led us outside to talk on the walkway. There were ambiguous references to his office – “too small to accommodate such a large group” – and we found ourselves gathered in a circle some 20 yards from the entrance to the building.
The man is an engineer, perhaps a project director for the Institute, and he knows already what we want. He is polite, somewhat solicitous, but no, we cannot simply get equipment to dredge—even if Pinto knows how to use the equipment and has dredged before. Señor Julio understands the problems and concerns, but the equipment is in “the exterior” working on other projects. He will arrange for an Institute engineer to come to the community next week. If this engineer agrees that dredging would provide a reasonable short-term solution, the community will be able to use the equipment when it returns from the exterior. Clearly, Señor Pinto is not satisfied and we try to community off-stage with him to see if there are other efforts to make. I ask Kevin to say to the Señor Julio that we have been working in the community for seven years and that our clinical efforts will not succeed if people continue to become infected by the flood waters. We deliver our written report with some attempted ceremony, and Julio regards it briefly (earnestly?) for a short time.
It appears that we’ve had our audience, taken our shot, whatever its value may be—but Kevin discerns that Pinto is not quite done. Through a quick and hushed conversation among SOMOS team members, we decide to explore another effort to see the director before we leave. Kevin asks Pinto if we should return to the office to ask again to see the director. Señor Wallace, seasoned veteran of Dominican politics, thinks better of it and, in short order, becomes insistent that we’ve done what can be done. He says that he believes that Julio will send the engineer; with somewhat less enthusiasm, Pinto agrees.
Again, stay tuned.
January 11, 2012 by David Aday
In a post dated July 29, 2008, I posed that question after reading about a non-profit organization that was reportedly bringing electrical power and other basic necessities to communities in Africa. I wondered out loud whether all of the effort to research, build partnerships, and develop collaborative community efforts is necessary for successful social change. The news article seemed to suggest that an alternative approach works just fine: figure out what you think is the problem; get a couple hundred thousand dollars; and get on about remaking a part of the world.
More than three years later, I remain as unconvinced by the alternative as I was when I wrote the blog post. We have yet to implement a project that provides clean or cleaner drinking water or one that improves nutrition, or any effort to reduce the impacts of flooding of toxic water. Just last week, and after some very anxious and somewhat contentious moments, we arrived at agreements that may provide some temporary relief from flooding in one small community in the Dominican Republic. It will be some time yet before that strategy (making available a row boat to allow safe passage across a road during seasonal floods) is fully in place—and some time longer before we are able to evaluate its effectiveness and its effects on local social structure and culture. We know these things:
- it reflects both careful assessment of alternative strategies and local wisdom
- it relies on and helps to build the community’s capabilities for working together
- it fosters infrastructure that will be foundational for subsequent efforts
- it is part of a larger, integrated, and more holistic effort to solve flooding and other problems that undermine health in the community
Redux answer: Yes.