Hospital de la Matanza

There were dogs in the hospital. I counted three. There seemed to be more but the same ones simply moved from one floor to another as they pleased. No one there really noticed. But someone in our group did and asked the social worker giving us a tour about them. She was embarrassed.

One belonged to a man who lived at the hospital, in the waiting room just outside the maternity ward. He had nowhere else to go so they let him stay there and keep his dog with him. Our guide was very proud of the room. It had been built recently so that people would be comfortable while they waited for their babies to be born. Looking in, I could not tell which person was the resident, and to me it did not seem like such a bad place to stay. You would see so much joy from this glass walled room… one of the most beautiful experiences of life happening over and over again.

The patients and visitors seemed to like the dogs as well. The dogs had a calming presence, sleeping in corners and strolling casually, unaffected by suffering of such a place. They made it feel more like home and less like an institution. The floor and walls were a bit dirty, but so too where the homes and skins and clothes and of the people of the campo who came here for help and for solace. Perhaps there is something to learn from this… that the little things that make strange situations more normal can bring great comfort to those in pain.  Some broken rules do more good than harm. 

Death and Sunlight

The stench of rotting flesh unearthed and caskets cast aside. Spiderwebcracked glass doors and rusted padlocks let eternity rest. Who comes to care for the remains of loves long lost? Some. Not all.

How many children went hungry so that mausoleums could be built and strangers could admire the colored light of stained glass ceilings reflected upon floors out of reach? Salvation and adoration. What legacy is left in the corners of Cemetario de la Recoleta? What secrets buried.

Look into the life lines of your palm and see ancestors. Strength and sacrifice.

Cats sprawled across certain stones seem to be missing parts of their stomachs and their souls. The vacancy is more frightening than anything else here. Broken drawers reveal open coffins and steps leading to depth. Let them wander.

In circles las Madres de Plaza de Mayo search for their ninos desaparacidos. Many in silence. Simply walking, with white scarves to show resistance to the evil that exists and never can be undone. Tourists gather and flash cameras at their weathered faces and at those of their children, their grandchildren-- at the black and white pictures that the women string from their necks with names and dates written below and the men hold up on picket signs. The prints are old and scarred by the sun and their hands shake under the strain of the banner but still they walk. With respect, with resilience, with reason that we cannot begin to understand only looking on.

Across the busy street lies the body of one man who fought for the freedom of Argentina and carried its flag across the Andes. Two soldiers guard his coffin and four marble maidens. Outside the cathedral a flame burns for his bravery y that of the soldado desconocido de la independencia. Saludalos! the wall tells us.

And thus some lives are revered by all who pass and others by only those with great strength and greater sorrow... but still so many go unnoticed and are truly lost.

Shit Matters

Today is World Toilet Day but there is not much to celebrate.  

Diarrhea kills at least two million people per year, according to experts from the World Health Organisation (WHO). It can be prevented and treated, but we are not doing enough to address this critical global health problem.  

UNICEF’s 2012 Progress Report, released last month, showed that diarrhea is the second leading cause of young child deaths worldwide (responsible for 11% of deaths, following pneumonia which causes 18% of deaths). Although diarrhea’s death toll has dropped by a third in the last decade, this progress is insufficient for a disease with simple, proven, cost-effective interventions.  

As the causes of and conditions for diarrhea are inextricably linked to desperate poverty, many interventions require meeting the most fundamental human needs. Deaths can be easily averted through practices such as breastfeeding; providing adequate nutrition, safe drinking water and vaccinations; and maintaining basic sanitation such as hand washing with soap. 

Open defecation, which is practiced by over a billion people worldwide, remains a major contributing factor to diarrheal disease. I have seen children in the poorest slums of Kenya, India and Central America run barefoot in streets where feces flow freely. They play in garbage and draw pictures in the dirt, running their little fingers through sewage then have no water or soap to wash up.

The United Nations has committed to reduce the number of people without access to safe water by half, and many of our big-hitters in global health are working to address this, but expenses are considerable. The Gates Foundation recently launched a “Reinvent the Toilet” competition, challenging researchers to leverage new technologies to design models that function without sewage output, water or electricity, yet the cost of winning prototypes may initially be as high as $5,000 (though this drops with commercial production).  In many ways, meeting critical needs and implementing infrastructural changes presents a far a greater challenge than other intervention techniques to treat the symptoms of this illness.

So what can we do to stop this shit? 

First and foremost, talk about it. The Community-Led Total Sanitation (CLTS) method, used by the World Bank, Plan International , UNICEF and The Gates Foundation among others, begins with communication. If we can raise awareness for the potentially deadly problems caused by open defecation, we can actually stigmatize it and encourage people to change their common behaviors.  According to the CLTS approach, this awareness is a critical first step to trigger a community’s desire for change, propel them into action and encourage innovation, mutual support and appropriate local solutions, thus leading to increased ownership and sustainability.

Next, we must keep talking. The dialogue must extend beyond the impoverished communities where children are dying from diarrhea. There is an incredible dearth of private donor-driven funding for this cause; by talking about it here, in the U.S., we can spread the awareness, so people will understand the gravity of the issue and support the treatment of the disease. Here, we must remove the stigma associated with diarrhea, so that people will be willing and wanting to publicly help prevent it.

Three key interventions can successfully treat diarrheal disease: administration of oral rehydration salt (ORS) solutions to prevent life-threatening dehydration (the main culprit of diarrheal deaths); continued feeding; and zinc supplementation. These low-cost treatments remain inaccessible for the vast majority of the world’s most vulnerable people. Oral Rehydration Salts alone could prevent about 90% of child deaths from diarrheal dehydration, yet less than one third of diarrhea- infected children receive ORS, and there has been only a 2% increase in this access over the last decade.  ORSs have been criticized as a “Band-Aid” in places where safe water and sewage systems do not exist—only providing the most superficial treatment rather than addressing the underlying causes of the disease. But the fact of the matter is that they save children’s lives, and it’s better to bandage a wound then let it bleed dry.

Oral Rehydration Salts cost about 10 cents each. They can even be substituted with a homemade mixture of sugar, salt and water. If only more mothers were aware of this treatment and the treatment was more widely accessible, many, many lives would be saved.

The technology is here; the effect is proven; the cost is negligible; and the services are available.
So let’s all be potty mouths. The time has come to start talking about diarrhea, why it matters, and what we can do to stop it.  

the scenic route

home is a matchbox and pocketknife

buried in the cargo pants that don’t change.

everything carefully categorized, compressed and cleaned

before departure,

now crammed into corners just out of reach

from the driver’s seat.

single key on the chain.

two sets.

but no one to hold onto the spare.

stream of horizontal lines empty cans  diesel signs

ticking away the odometer.

radar enforced but not controlled.

the cracks on the windshield slowly spread.

wonder if they’ll find each other

somewhere in the heartland.

and whether the engine will make it

from this coast to the next.

bet your life

on nothing but liability coverage.

keep your eyes on the road

not the rearview.

Getting and giving

What do you do?

I used to hate this question because I thought it was a set up for passing judgment. I refused to ask it—even answer it for long time. When forced to fill out forms that required I list my occupation, I often wrote nomad, hermit or astronaut-ballerina. But now I don’t mind it so much. I have an answer. I work with nonprofits. Several actually, but primarily as director of development for a small organization called Give A Child Life (www.giveachildlife.org). We help children under the age of six in urban slums of developing countries.

Over the last two years, I’ve seen the defining characteristics of desperate poverty-- struggle, resolve, hope, resilience, sorrow and gratitude. And by connecting with the children we are trying to save, I’ve experienced these emotions myself.

On my first trip to the slums, we found a three-year old boy who was HIV positive and so malnourished he weighed only seven pounds. I paid for his taxi to the hospital. I thought I’d helped save his life. He held on for a little while then died a few months later.

But the child I that meant the most to me was Cecilia. She never stopped holding my hand. She’d been abused and wanted love so badly. We spent only one afternoon together, but I decided to become her sponsor and make sure she grew up with a real future. Shortly after, gang members with guns burst into the shack where she lived, and she and her mother fled to the forest. I wanted to fly to El Salvador and save her—crazy as it was. I could do nothing but wait… until a few weeks later her mother finally contacted our program coordinator. Cecilia was safe. But they could never return home; it was too dangerous. I may never see or hear from her again. Yet I’ll always love this little girl, wherever she is.

It’s easy telling people what I do, because it’s important and I want others to know about our work. But it’s hard, because I’m not there. I feel so helpless, so far away in my little Montana attic. It’s even worse when I forget about the children’s suffering and get wrapped up in my own world… And then, another story is delivered to my inbox, and I remember there are others struggling desperately to stay alive. 

Reading these stories gives me gratitude for what I have and perspective about what’s important. Sometimes I feel powerless, because I know we cannot eradicate all poverty or help everyone in need. But each of us has the ability to make a difference in some way—even if it’s small. And because we were born with incredible resources, we also have great responsibility. 

Winston Churchill once said, “We make a living by what we get, but we make a life by what we give.” So, what do you do?

Mercy

In Psych 1, we learned a theory about social intervention. It posited that the farther away you are from suffering, the easier it is to ignore and the less likely you are to intervene.  The chances diminish exponentially as you move across the street, the town… the world.

But the phenomenon of globalization is pulling us all closer and closer together, and problems that were once out of sight and mind are now in plain view. For me, they’re delivered almost daily, directly to my inbox from the field—slums in Kenya and El Salvador. Each case is heart wrenching, but the most recent one especially so. It comes from Kiandutu, a desperately poor community outside Nairobi …

Some might consider Mercy Wangare a lucky mother. Nearly every time she gave birth, she had either triplets or twins. But for someone living on a razor thin margin of survival, this was devastating. She was sick and weak, and struggled desperately to care for six children, all under six years old.

After she gave birth to the twins, she bled so much that she became anemic. She was in and out of the hospital until she passed away last June.

Two days after her husband buried Mercy, he gave the three youngest children away to strangers. He kept the older three, who could assist with household chores though they were still only five years old. Relatives found out and immediately went to collect the children. Mercy’s sister Martha took them in. She has five children of her own, is unemployed, and only went to school through the sixth grade.

Two of Mercy’s children are malnourished and at only 18 months already suffer developmental delays.  They cannot walk, can barely crawl and have delayed speech. But Martha is determined that these children will not be raised by strangers while she is still alive. She says she will fight for them like her own… with or without resources.

Martha heard about Give A Child Life’s program in Kiandutu and approached the village elders for help. GCL provided her with emergency food and instructed her to take the infants to the hospital for medical treatment.

The email from our Project Coordinator ended, Let me have your thoughts. I sat at my desk, sipping tea, and staring at that line for a while, then out the window.

When we travel to these places and see the incredible hardships, we step back from our own lives for a moment. We embrace a broader vision and a gratitude for the gifts we have. When we return, I again wrap myself up in my own problems. Until the next email or call reminds me that there are others out there concerned only with the most fundamental challenge of all: survival.

Many of these people are children, not yet old enough or strong enough to fight themselves. They must rely on others for help. Including people far away, who may not see or hear their cries.

Cindy and Cecilia

Cindy Julissa has a round figure, cropped hair and bushy eyebrows. Her only child, Cecilia, is five years old and incredibly affectionate. Cecilia constantly seeks attention and affirmation from her mother, her teachers and me. Our Program Director Carlos says that she is always looking for love because her father abuses her, like so many others here.

Cindy’s husband works very much--“to help people,” she says. Cindy does beadwork herself, but only sells her jewelry at parties.They often do not have enough to eat. They usually spend the money he makes by the 15^th of the month. Right now, they have only beans and powdered milk for the Cecilia. No one will lend her food, but sometimes she can share with her mother.

Before they had this house they rented another one, farther away. When Cecilia began to study at the Center they moved here. The house is very small and cluttered. The edges are crowded with mounds of clothing and plastic bundles. The small television is showing static to a tattered chair and couch when I arrive. There is a two burner stove in the corner and a shelf covered in dishes. Laundry hangs in the half open adjoining room: men’s jeans and little girl’s panties. Piles of garbage. Piles of wood. Piles of wet and dirty clothes. A pit latrine in the back. Cindy is embarrassed. She would have tidied up if she’d known earlier that I was coming.

They have no water. It costs $150 to buy the rights to use the nearest tank, then $3 for use each month. They sell water at a nearby school for 10 cents per container—clean water. Cindy shows me a large blue vessel she carries the water in. Several blocks. About ten times per day. The family has had several problems from drinking contaminated water: bronchial infections and problems with parasites. Cecilia was premature, born at 7 months, so she has a compromised immune system and gets sick often.

She has two books, about women’s rights and domestic abuse from a workshop she attended. One has been partially eaten by a rat. “There are rats,” Cecilia interjects. A moment later she points to cartoon rats running across the television screen. They’ve put on Lady and the Tramp. It was my favorite movie when I was her age.

Cindy says the biggest problem in her life right now is making sure Cecilia’s education is taking care of. She does not want her daughter to end up like her. Also, sometimes her husband works and sometimes he does not. If she could do some work from home, it would be much better for them. It’s very hard for Cindy to find work because she doesn’t trust anyone to watch her child.

When Cecilia was only three years old, she got lost for a long time. Cindy had left her with her father. He brought the girl to his mother’s house. But the woman didn’t watch her closely and the girl ran away. Cindy was very frightened. She called the police. Eventually they found her—a woman was watching her—but it took a long time. Cindy trusts no one with Cecilia now. Not her husband. Not her stepmother. She leaves her alone only at the Center.

Cecilia wants to be a teacher. I ask why. Because you like people, right? says her mother. No. Because she likes to drink milk. But she doesn’t like school because she has to get up early and can’t sleep in. She shows me her toys: a box with soiled plastic tea cups, an off-white bunny, and a baby doll with one foot. She is very proud of these things, which are hers alone. She holds my hand and asks me to stay. She sits on my lap, and we watch the movie together.