Letters from Nica Part 2: Burning Questions
‘Sup SGHE,
Upon arriving in the small, very hilly village of La Pimienta (literally the Pepper in Spanish), our caravan was greeted by a poster proudly declaring that this was the site of multilateral health initiatives. I didn’t recognize many of the 10 or so NGO’s and Government Agencies listed except for two: Save the Children and USAID. Seeing this signpost in such a strange land compelled me to ask the community members about their history with public health initiatives.
What I found was a bit surprising to me. A group named Provadenic built La Pimienta’s community health center about 30 years ago. For a short period of time, Provadenic was able to provide La Pimienta with all of its most basic healthcare needs. But soon enough, Provadenic lost all of its funding, and La Pimienta was left with an empty community health clinic.
After years without access to basic care, La Pimienta was discovered by the great people at USAID. Hearing about this excited me. But that was only for a moment. Unfortunately, as I had found out, USAID came with vaccines one year and was gone the next. Yet another sadly short-lived story.
It was at this time that I wondered, in the midst of all of these unsustainable or unlasting health initiatives, if La Pimienta would ever have a way to provide their own basic health needs. I asked. And all I got in return was complete and utter silence.
Listening to the traffic bustle from my cozy cafe seat, I wonder about the real effectiveness of our projects as Students for Global Health Equity. What I gather from La Pimienta is that things have been stagnant for the past 30 years.
And now here comes the flood of questions, ones I think are necessary to ask before we dive head-first into our projects for Global Change. Are we really for changing the situation of the impoverished, for those who lack access to care? If so, what makes our programs any less of a crutch for the communities we support than a one-time intervention by USAID? And also, how do we know that we will not go out of business in the next thirty years like Provadenic in La Pimienta? Lastly, if we do reach our hands out to communities like la Pimienta, communities without any safe or easy access to urban health amenities (namely pharmacies and hospitals), when will we ever be able to put them back down?
Until Next Time,
Dev
Insightful and honest post Dev! You describe a very real challenge for the grassroots approach to improving health that many students here in the US often forget — that even though the communities that our projects serve see positive change, there are tons of other communities that haven’t been lucky enough to be adequately engaged by organizations. While the incredible strength of grassroots initiatives certainly must not be ignored, a significant challenge is ensuring that all communities are served, rather than the select few that happen to be engaged by partners. What the grassroots approach requires are multiple horizontal relationships between individual communities and partner organizations. Because the scale and complexity of resources, logistics, and communication increases dramatically as more communities and organizations become involved, we see an upper limit for the number of communities that can benefit from this grassroots approach.
Nevertheless, it is clear that the grassroots approach has been able to successfully bring together resources, maintain strong, sustainable relationships, and tackle unique problems in communities that are often unnoticed or ignored by top-down approaches. Real change is occurring at the communities that we work with. But at the same time, examples such as the abandoned (and forgotten) health clinic in La Pimienta are stark reminders that many communities do fall through the cracks in the grassroots approach. We are seeing an unprecedented level of passion and resource mobilization in developed countries aimed to help impoverished communities. Yet, the challenge of finding the right model that delivers these resources efficiently and effectively to as many communities as possible still remains to be solved.
Thanks Ron for the reply. This is a question that I think won’t have an answer until we spend more time trying the grass-roots approach. But I wonder if there are things that the government can do instead of supporting large umbrella organizations who are spread so thin that they often don’t make much of a dent at all. Maybe what we need is more of an umbrella fund (something like what the Global Fund does but with small NGO’s like the one we’re working with here in Nicaragua) that could provide successful grassroots organizations with funds to increase their benefits for more communities. Just a passing thought, feel free to rip it apart as necessary…