The line between help & handouts

Sometimes I get so wrapped up in the difficulties of developing countries that I forget poverty and hunger can happen in the U.S. too. And on a similar level. We watched a movie about Camden, NJ in my child health class on Tuesday and I left with my heart broken for a whole new set of kids. At the time of filming, 2005-2006, Camden was the poorest city in the country with some of the highest crime rates.  It was rated the most dangerous city in the US in 2009 and has been in the top ten most dangerous cities for the last ten years. While the population is just under 80,000 according to the 2000 census, there were 30 murders in 2005. (For some perspective, Portland has around 2,260,000 residents and there were 28 murders in 2005.) And these children see it all. Family members murdered, parents in jail, needles covering the public parks, daily food insecurity and overwhelmingly unstable and dangerous living situations. It was horrific to watch. I find it so easy to push those things out of my mind on a daily basis since there is so little I feel I can do from here. What would really help these kids? After the show aired on 20/20, people from all over the US sent clothes, toys, and books to give to the kids. They set up college funds for a few of them and a housing trust for one family. Extreme Home Makeover even build one family a new home. It all sounds great! We can all pat ourselves on the back for helping, right? But what will a college fund do if the child doesn't have enough family and community support to graduate from high school? And what will a housing trust do when the money runs out? Where will that family go then? All the toys in the world can't change a family in which the mom has a 9th grade reading level, the dad is in jail and they don't know where their next meal will come from. So I find myself at this line between help and handouts. Help being something that will effect long term change that will redirect the trajectory of the community. Handouts being things that are essentially band aids to a larger problem. And there is always a larger problem.

And then I think of a line from the Constant Gardener: "But these are people we can help." When is it better to focus on the little things you can do to help a family or an individual. Like giving out toys. Or giving them a ride home. Or a small part as an extra in a movie (which did happen in the 20/20 special). How do you make those choices? When is it better to address the end of the problem and not the beginning because you feel like the beginning of the problem is too big and too many steps back?

Delving back into developing countries, I am reading this book about health co-ops in Uganda and it is amazing. I talked about it a bit in my first blog post but I've read more now and it is again changing my perspective. The health care co-ops were a originally a product of the Land O' Lakes dairy c-oop in the mid-western US. The dairy co-op decided it needed a better way to get healthcare for dairy workers and the workers needed more control over and connection with their health care. Using the co-op form, they created HealthPartners a locally owned and operated health care co-op. The dairy farmers were better able to negotiate drugs prices and premiums and keep the administrative costs incredibly low. In this time Land O' Lakes had been asked to go to villages in Uganda to help dairy farmers set up co-ops similar to those in the US. They were amazingly successful. Forming a co-op allowed the Ugandan farmers to pool their resources for veterinary care for their livestock and negotiate fair market prices for the milk their cattle produced. The most important part of the co-op was that the Ugandan people ran them. The Land O' Lakes people came in for advise and direction, not to run the program for the people.

After the success of the dairy co-op, HealthPartners was approached by one of co-ops in Uganda about starting a health co-op. HealthPartners was hesitant because it was a huge long-term commitment and they didn't want to give the people false hope but they sent a team down to do research and find out if starting a health coop was even feasible. In Uganda HealthPartners held meetings with the dairy coops and towns to see the interest level in a health coop and to gauge the commitment of the people. The Ugandans had a high level of commitment as long as the Americans weren't giving false promises so HealthPartners decided it would be doable. It wasn't fast or easy but using the dairy co-ops as a natural place to start health co-ops, HealthPartners began advising the dairy farmers on ways to begin organizing. Again the most important part of these co-ops was being self-sustained, self-supported, and long-term. The goal was for no one from the US to have any position in the Ugandan health care co-ops aside from providing advise and direction. Because these co-ops were community based, each community where a co-op was started had their own meetings and voting process to come up with guidelines and regulations for their co-op. This meant the community had to decide on everything from premiums to what was covered to what constituted a family. There were issues unique to Uganda like the fact you can't bill people for services there and there were issues which are faced in the US like how many children do you cover in a plan before you have to pay an extra premium. The book is fairly technical in explaining how they worked out all of these issues but the point is, they changed a system. They didn't just pay for one families health care. And they didn't give handouts. As painful as it was to not just purchase an x-ray machine for the clinic one co-op ended up building, if HealthPartners had, they wouldn't have been sticking by the principal of the clinics being self supportive. I appreciate that attitude in many ways.
Then the Paul Farmer side of me jumps in and would beg, barrow or steal an x-ray machine for a clinic in Haiti because those are the people I can help.

I find the HealthPartners model to be fascinating and clearly more sustainable then many programs since their main goal is to let the Ugandan people make their own choices. At least from what I saw of being in Haiti and seeing so many aid organizations, it seems that these organizations eventually get stuck in a rut. When you go into Haiti, especially after the earthquake, you see need in almost every direction. Your organization shows up there wanting to say, feed the displaced families. So great you ship in some imported rice and chicken and feed some people. And then you are there for a few months and get involved in the community and realize they really need homes. So you build some houses. And then you realize they need schools. So you build some schools. And then you see they need clean drinking water so you build a well. And then you can't stop looking for need. And you can't leave because you are an aid organization and in order to get donors to keep money coming in to pay employees and administration costs you have to show you are doing things. And there is nothing donors like more than seeing there money go into a school or an orphanage. So you keep doing these things and pretty soon, even though you had the best of intentions when you got there, you are stuck in this cycle. In the mean time, nothing in the community has changed. Yes, it is important people are fed and have clean water and homes and schools. But it is more important the community can do it themselves. And has the confidence to do it themselves. Every aid organization's goal should be to become obsolete. To get in, teach a community to form a dairy co-op or a health care co-op or sustainable farming practices and then LEAVE. You have to leave. And I don't mean leave as in abandon, I mean leave the work for the people and be available for further advice and direction.  Believe me, I would be over the moon if I could spend the rest of my life living and working in Haiti. But do I want it to be because the community I am in can't do what I am doing themselves? No.

There are a thousand more things I want to say on these lines but this post is probably already long enough and I feel like I should make some attempt to list my goals for the week.

• Finish The Resilient Child
• Call Alisa's mom to plan the day for the baby shower!
• Make an appointment with the career center
• Write cover letters (yes, I have been putting it off)
• Finish online homework on Saturday so I can have a free Sunday and not feel guilty

More attainable goals. Also 3rd season of Archer premiers tonight. And that's how you get ants.