Ma’jo’n is the Tzutujil word for ‘there isn’t any’ and this week it’s been the most common word I’ve heard at the centro de salud.
Coming from the US there are things that I don’t understand immediately about health care here. The centro de salud is a government run organization, and every week sends its requisition forms in requesting the medicines that they need. But they don’t actually always get them. In fact, a good percentage of the common medicines we give out daily we are currently out of. We have been out of albendazol syrup (for treating parasites in kids too little to take pills) since I arrived. This week we ran out of amoxicilin pills, trimethoprim pills and syrup. In fact the only antibiotics we have are donated amoxicilin syrup, donated cipro, and a few courses of a cephalosporin. We ran out of folic acid last week (which we need to give to every pregnant woman) but were luckily able to get some donated.
The donations come from private organizations such as Save the Children, and I honestly don’t know what the centro de salud would do without such donations. But running a clinic with donated medicines has its problems. For one thing, the doctors never know what they have to offer. For another, there coordination between supply and demand is far from perfect. While we have very little in the way of antibiotics we have quite a lot of alka selzer, zyrtec and osteo bi flex.
I want to share something that made my day. The mail a few days ago carried a letter and a donation (fairly standard for our growing non-profit) - what took all of us by surprise was the source of this very generous donation.
Two third grade classes, from Cresskil, New Jersey held a donation drive to support our partnership work in Ecuador. Ms. Regan and her classes held a penny donation drive as part of their community service work:
“One small penny can change the lives of many”
So 3rd graders, thank you for your generous donation - we know it will change the lives of many in Yambiro, Ecuador. Further, I’m sure your community service will change your own lives. We’re all proud of you and the global citizens you are becoming; we all have something to learn from your hard work….
So after 10 houses and 3 kids vaccinated it almost time to return to the centro de salud. We stop at one more house and a woman standing nearby sees us, takes off running and returns running, pulling behind her a very reluctant 4 year old. He digs his heels in, but his mother prevails delivering him and his vaccination card to us with a flourish. The nurse takes care of him and then does something remarkably resourceful. Frequently after they get a vaccine kids will have a slight temperature, part of the body developing an immune response as it is supposed to. But to keep them comfortable its generally recommended that they can have tylenol. Now this mother did not have any tylenol so the nurse I was with took the sterile wrapper from the syringe she had just used, dropped 2 tablets in it, folded it over and had a clean bag of tylenol to give the mother. I was impressed.
So as we head from house to house spreading the joy of vaccines to the small children I learn a few things about the public health system here in Guatemala.
First off, unlike in the US, vaccination here is not an obligation. Rates of vaccination for polio and measles are in the 50-60 percent range in this district. (The WHO estimates that for all of Guatemala the numbers are closer to 91 percent for measles and 85 for polio). In contrast, in the US rates are around 92 or 93 percent.
So in a country where the government sends people door to door to give vaccines and balloons out I am surprised when a few of the households we stop at state that they do not want the vaccine. I ask why expecting an answer that involves government conspiracy, or as at home, fear of long range developmental side effects. But the nurse I am with says that no, the families just think the vaccines cause fevers and they do not want them.
This, she says, is a population we need to work more with.
Today when I arrived at the Centro de Salud, the nurse who has taken me on said that today I could come with her on a vaccinating trip. Which was very exciting. Every day 1 or 2 of the nurses from the Centro go literally door to door through the town of Santiago Atitlan to vaccinate children who are behind in their vaccines. Here is what happened:
The nurse, who is wearing traditional dress for Atitlan, and an assistant put on their outfits from the Ministry of Health which consist of a bright orange hat and navy vest emblazened with the ministry seal.
And then we set out, we walk a few blocks from the Centro de Salud to the spot where they had left off that morning. We walk down an alley-way which is barely wide enough for one person and the nurse knocks and yells “VACUNA!” (VACCINE!)
The door opens and inside are a man, a woman weaving and a now very scared looking 5 year old boy. The next part of the conversation takes place in the Tzutujil language, but clearly the father says to the boy “Do you want a vaccine?” and the boy says a very definite no. The nurse holds out an uninflated green balloon that he’ll get as a bribe, and so (unlike children we encountered later), he didn’t run away, or scream. He just put on his bravest look until it was over and he safely had his balloon.
And then we continue on down the street, offering Vacunas and having children eye us suspiciously, like the opposite of the ice cream man.
An age old conundrum for any young person is how to get experience when experience is required in order to get experience. The challenge of experience is even greater for young people who want to go into international fields. Opportunities are few and are often expensive. The model of the IHF has many strengths, such as working through collaborative, long-lasting partnerships and supporting the implementation of solutions to community’s self-stated needs. I think another strength of the IHF is that it provides young people with the chance to gain experience in international development while contributing to real change. In many organizations that do international development work, proficiency in a second language and experience living abroad are required even for entry level positions.
Through the IHF, students and volunteers work together in campus chapters and with partners in developing communities to implement projects that have tangible benefits. They are able to gain skills in project planning and management, cross-cultural communication and teamwork. They are able to do this with the support from their chapter members, their partners, and the IHF Central Officers who are always available to provide guidance and training. They also work together to fund raise through local and national efforts to make it possible for many to work in the field with partners. No matter what IHF members move on to after their undergraduate education, they will be able to use the skills they have gained.
The work of the IHF is not all about the chance to gain experience- it is also about working with partners to improve the lives of others. IHF members have worked to bring smokeless cook stoves to villagers in India, provide scholarships for students in Guatemala and increase access to health care in Costa Rica. The benefits that community members receive from these projects are also long lasting and will make a real difference in people’s lives. IHFers do receive experience from the work they do with the IHF, but what really drives them to take the time out of their busy schedules is because they truly want to work with partners to make a positive difference in the lives of others.
In the first post in this series, I took a look at some of the successes the IHF model has achieved in its first five years. I’d like to turn now to an important question for any organization - new or old, large or small - namely, “what can we do better?”
When looking back at our first five years, two major areas of improvement jump out.
Working with an all volunteer staff presents some apparent challenges, most immediately for the IHF’s capacity. Our volunteers work incredibly hard, and the work they do is invariably of high quality. But there are limits to what a group of volunteers can accomplish – at least if they want to sleep at night! At various points over the past five years we have had to pass on opportunities to benefit our partners due to a lack of capacity. At certain points, some of our volunteers have had to make unfair sacrifices to meet our obligations to our partners. Over the past year, we have increasingly felt the pinch of how many hours our volunteers can work as we have grown. We have been lucky to increase the number of volunteers. And we have been very lucky to benefit from the leadership of our Executive Director Heidi Jutsum, who is able to dedicate an amazing amount of time to making sure all the IHF’s volunteers are working in the right direction. This oversight is particularly important to our student volunteers – both to their growth, and to ensuring that they make meaningful contributions to our partners. But the IHF is at a point where full time staff are needed to effectively manage our volunteers and fulfill our obligations to partners.
This leads to the next significant challenge facing the organization - unrestricted fundraising to support our capacity growth. We have traditionally spent less than 2% of revenue on administration and overhead. We have not focused on raising funds to cover administration or overhead in the past. As stated above, focusing donations on the needs of our partners is one of the IHF’s central tenets. We have thought very deeply about whether we want to commit ourselves to funding a staff position.
But a full time staff position would roughly double the hours spent on IHF management and administration. More importantly, it would give this person the freedom to focus entirely on meeting our partner’s goals and fostering our volunteers’ growth. It would both expand our capacity and improve the quality of our work. With a relatively small investment, the IHF could take on new partners, work with more students and better support all our stakeholders achieving their goals.
We exist for our partners. We believe an investment in a full time staff person is consistent with our mission and model. It will present challenges, but also opportunities – and it is essential to the ongoing success of the IHF and the work we do with our partners and volunteers.
I’ll be following up next week with the last post in this series. Keep an eye out…
The IHF was founded more than five years ago to make a difference – but to do it differently. We saw ourselves as different in three ways:
- Focused on communities’ goals: we feel that putting communities in the lead on setting goals and executing projects would increase the sustainability of the IHF’s projects.
- Minimizing administration: we send donations directly to our partners abroad, and with volunteers contributing the vast majority of our labor, our administrative fees are lower than two cents per dollar – which means more resources for those who can best use them.
- Creating new leaders: by giving college students and young professionals experience with grassroots approaches to development, and giving them leadership opportunities within the IHF.
All of this sounded good on paper when the IHF got started. And it still sounds pretty good today. But how has this approach worked out on the ground?
What have we done well?
Reaching its fifth birthday is significant for any organization, but particularly for one that takes an innovative approach. The IHF’s continuous growth has been driven by three factors. First, all that we have accomplished is driven by the incredible hard work of our volunteers in the US and abroad. Second, our ability to learn and execute well has supported our ability to carry out an increasing number of increasingly complex projects. And throughout this, adherence to our model – what makes us different – has led to success on the ground.
Some numbers begin to tell this story – 300 families who don’t have to worry about indoor air pollution in India, two dozen Guatemalan kids who can attend school, a clinic in Costa Rica and dozens of graduates with exposure to grassroots development work. Working with the IHF has been genuinely life changing for many student volunteers who have gone on to focus on public health and economic development. We continue to influence students to take on the challenges of development in partnership with local communities through our work at Dartmouth and Haverford, and now at Brown.
So, there is much that we have done well. But where can we improve? More on that at the end of the week…
Working with partners is hard. It can be very difficult for a group of volunteers to find the time to come together, unite around a common vision and work effectively together. To have that group of people extend their work out and create a meaningful relationship with a whole other group of people adds on new layers of challenge and complexity. It can be tempting for organizations to say they can accomplish their goals on their own and think they can move forward faster if they don’t have to take the time to develop partnerships. However, despite the challenges, work in partnerships brings much more benefits than working alone if the time is taken to build strong, lasting relationships. This belief is a core foundation of the IHF model.
Can you imagine sitting in your house on a Saturday when you hear a knock on the door? You open the door and find someone who is obviously not from the community who is there to tell you that they can see a real problem in your community and they are here to solve it for you. They tell you to come to a meeting they are having about improving the hospital in town so you don’t have to wait as long to see the doctor. You go to the meeting and listen to all of the great things these people are going to do to improve the hospital. Things seem to get better in the hospital over the next couple of weeks, but then the strangers leave and things at the hospital go right back to the way they were before.
This scenario is often the case when groups of students travel to other countries to do projects. They come with really good intentions, and they may see some improvements for a little while, but without their continued presence, the improvements don’t last. However, if projects are done in partnership, the chances are better that improvements will last. Both because it is more likely that someone will be there to follow up and make sure the project continues, but also because it is more likely the project will be something the community actually wants and needs, making it more likely to be supported. The university students in IHF chapters only have a limited time available when they can be physically present in the communities they partner with, so in order to make sure the IHF projects are sustainable and have a lasting impact, it is essential that the work be done in partnership with a local organization.
The IHF was founded after a group of college students decided they wanted more out of the volunteer experiences they had abroad- they wanted to be able to continue the relationships they had established and the work they had started. They also didn’t want to be seen as people who were here today, gone tomorrow. From this foundation, the IHF has grown to have established partnerships with organizations in five countries. This growth and the benefits that have come with it are all the result of our firm belief in the power of partnerships and our willingness to nurture them.
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