The global health worker's constant question

May 17, 2011 part A

Warning, I'm about to spend the rest of this post in philosophical musings, but first: my store in La Esperanza (with the actual Kendra of La Esperanza),

and a delicious pastry by the central park fountain:

My year of global health classes has left me with more questions than answers about development and aid work. I now find myself constantly asking, “What’s the exit strategy?” and “Is that sustainable?” which often leaves me feeling pessimistic about projects. Even when it comes to my own research project I feel like I’m perhaps not going about this the right way. I chose this project because it seemed like what the kids need the most – better dental health. I’ve had two conversations with Regino since then that have made me think there are other things they need more.

The first conversation was about the water supply. As far as I can tell, about 5 of the communities in the co-op have piped water. These communities also sometimes chlorinate the water. They have this option because the water comes from a single source – a spring or river-fed tank somewhere up the mountain. The water that comes to the tank may or may not be contaminated year round, but contamination is generally worse during the rainy season in May and June. Regino tells me that if the water is chlorinated this prevents the contamination from causing diarrhea. That’s great, but some of the communities cannot afford the chlorination. The Ministry of Health or the co-op helps to arrange chloride delivery, but they don’t pay for it. It costs 2,400Lempira to pay for a container of the chlorination solution that lasts 18 months. That’s about $130 for a container or $7 per month for the whole community. Regino told me that there are 20 families with piped water. At about $0.35 per family per month, Las Mercedes still can’t afford it (please for give the excess of math here). I assume they cannot afford it because of the upfront cost. I know for a fact that families in the community spend more than that on candy every month.

Just thought I'd show you the candy since it's part of my survey: bombones, confites, chicle, and a mix of chicle and confite

(lollipop, hard candy, gum, and hard candy covered gum)

I think this maybe a more pressing issue to the community because when I talk to Regino about the possibility of fluoridating the water his face tells me that chlorination is a higher priority to him. There are some questions to be asked here particularly when addressing the overall problem of diarrhea. What is the incidence of diarrhea and how bad is the problem really? Who has piped water? How often is that water contaminated? If they don’t have piped water, where do they get their water (wells, river)? And do they boil it? Who has latrines? If they don’t have a latrine, where do they go to the bathroom? How prevalent is handwashing?

I saw the local community health worker collecting water samples so I know that the Ministry of Health regularly tests the water for contamination. There is a clinic in San Nicolas where information on the incidence of diarrhea could be collected. At least some of the communities are already collecting money monthly to pay for the water system. El Cacao residents pay 20Lempira (~$1) per month for piped water, and I think that includes chlorination (a resident of El Cacao told me their water is always chlorinated). It would be beneficial to the community and a good project to find out what the water and sanitation needs are in these communities and to help organize a way for the communities to collect the money to finance water chlorination.

Another major priority that isn’t being addressed came up in an awkward conversation last night. I have not been very successful at arranging to go out to the communities to do my surveys. It’s been a combination of me not being assertive enough about needing to go, the language barrier, and the fact that Regino has actual work to do beyond chauffeuring me around to the communities. I realized last week that if I wanted to get everything done in time I would need my own transportation. I think I’ve figured out how to go about buying a motorcycle in La Esperanza and I’m going tomorrow to do it. Last night I was talking to Regino about my schedule, and he asked me how much the motorcycle cost. I hadn’t been intending to tell him, but since he asked point blank I wasn’t going to lie. He was polite about it, but I could see a strained look on his face. Then I realized that it would cost a third of that to put his daughter through her next year of school. He had asked the medical team in April about the possibility of paying for her continued education because he does not have the money.

Oscar, the teacher in Las Mercedes, laughed when I asked him if any of the kids from Las Mercedes went on to 7^th grade in La Esperanza. It just costs too much between tuition and room and board. I asked Gustavo, the community health worker if students from other communities in the co-op went to school in La Esperanza, but he said only some of the students from San Nicolas are able to afford it. San Nicolas has a school that goes to 8^th grade, and some of the fathers from the town are working the US and sending money home. He estimated that it costs about 15,000 Lempira to pay for school, supplies, and room and board for a year of school. That’s about $800.

Filomena reading fairy tales on my iPad. She does this pretty much every night after finishing her homework.

Apart from once again reminding me what a spoiled brat of an American I am, this encounter also pricked at one of the issues that has been bothering me with regard to working in Global Health. It has occurred to me that, while it may be admirable to want to do medical mission work, the ultimate solution is to have local health workers. There will never be a nurse or doctor from Las Mercedes if they cannot move beyond the 6^th grade. Although it would take some thought to decide how they should be awarded, scholarships would probably be a very good investment in this community.