On a public health mission I went to the town market with two municipality officials and one of the centro de salud staff to see what recommendations we could make. Santiago´s market appeared to me fairly typical for a market in Central America. Crowded, full of people sitting on the floor selling fruits, nuts, crabs, fish, fish heads, and pretty much anything else that you could need. 
But on this trip, we focused on the stands that sell food. Picture a booth at a carnival or farmer´s market where you can buy a plate of tortillas, beans and rice. Or soup and a soda.
The town of Santiago is starting a new program in improve the sanitation of the market so our task was to go from stand to stand and make suggestions to them about how they could prepare food more safely. At every stand we asked to see their official permit allowing them to sell food, and the ‘Tarjetas de Salud’ (health cards) which every employee is supposed to carry stating that they have tested negative for TB. And at almost every stand people told us ‘Oh yes, we have those, but we keep them at home.’ I was actually surprised at how many store owners told us honestly ‘No, we don’t have those.’
The other recommendations were pretty basic. My major contribution was to point out that no one had any real way to wash their hands (definitely needed my master’s to notice that one) and that maybe the best place to store the vegetables wasn’t on the ground.
But here is the really funny thing: When I got back home I realized that the stands we visited probably weren’t the main threat to public health in the market. A much greater nidus for infection and vermin is probably the unrefrigerated fish, fruits and vegetables sitting on the ground. And those are the poorest vendors, who don’t pay license fees and who couldn’t afford to if they were charged. So I wrote my notes up for the centro de salud and in it I explained this, but it is a hard line to walk because on the one hand I don’t want suggest taking away the livelihood of the poorest people in the market, but reforming the rules for who can sit on the floor and sell without doing so would require money from somewhere.
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.
So today was the end of my first week volunteering in the Santiago Centro de Salud (government run clinic) here in Guatemala. My Spanish is a bit rusty, and there is a whole new system of documentation to learn so I was surprised when as soon as I arrived the nurses said they had a big job for me.
Apparently they get donations for the clinic, mostly from the US, and the boxes are all labeled in English. Nearly everyone who works at the clinic is bilingual in Spanish and the native language T’zutujil, but hardly anyone speaks enough English to decipher the boxes. So my first big job was explaining for each box and tube, “Tylenol PM-tiene acetaminofen y benadryl tambien.” 
Over the weekend I’ll be putting together a list of medications in Spanish and English for the clinic to keep. But from now on when I bring or process donations in the states I’ll make sure that they are labeled in the language of the country they are going to. Such a small step to go from a meaningless and potentially dangerous action to a useful donation.
Travelers to Asian cities (or much of the developing world) know the site (and smell!) of the ubiquitous ‘Auto-rickshaw’ — a three wheeled taxi used for short trips around typically urban areas. Delhi, Mumbai, and dozens of other uber-urban are swarming with 2-stroke, 4-stroke, natural gas, and diesel models:
The Auto-Rickshaw - a staple of daily life in South Asia.
Imagine my surprise when I landed in Guatemala to find the streets of Santiago filled with Auto-Rickshaws! Here they’re called Tuk-Tuks and bear more than a resemblance to the Auto-Rickshaws on the other side of the planet:
Both are made by the Indian company Bajaj - a massive company whose distribution network extends from India to Central America, South America, Asia, and Africa. Most of the Global South seems to be Bajaj’s market - an icon of one upwordly mobile nation is becoming that of many more…
Good or bad, pros or cons, globalization is happening. Of course the streets here in Guatemala are filled with Toyota Trucks made in the Americas, Toyota sedans from Japan, US made school buses, Hyudais and Nissans from Asia, Fords from up north and even some BMWs and Mercedes from Germany. As the Chinese and Indian economies evolve I think we’ll see more Bajaj products around the world, and it won’t be long before we see the $2500 car, the Tata ‘Nano’, here in Central America.
I think it also won’t be long before we see Guatemalan products in India - what do you think? Do you know of other similar stories of a shrinking planet?
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…
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