Journey to India

by Uli Heine, PCI staff

When I traveled to India eight years ago, I witnessed a world I had not encountered before, but whose memories have been in my mind and heart ever since. I had never been to Asia and did not have any children yet. I was impressed with the obvious differences between India and what I considered “the western world”. The dichotomy of poverty, pollution and the constant noise level of the city that is Delhi contrasted with the beautiful women in a sea of sarees, children’s smiles, and gracious hospitality. However, most of all it was the humble nature of the people I met that stayed with me.

So, how did my recent trip to India compare to the one in 2000? The main difference for me was that I now have children of my own (two boys - four and seven), and that I easily identify with every mother who is pregnant, nursing and trying to care for her children. For me, this just heightened the way I experienced everything I witnessed on this trip because I kept saying “What if this was me or my child?”.

This time, a colleague and I accompanied seven women, five from San Diego, one from Kentucky and one from London to India's Golden Triangle. While we did visit some sites (Agra's Taj Mahal most notably) and enjoyed local markets, our main activities centered around visiting a shelter home for boys and our polio immunization program just outside Delhi as well as our micro loan program for women entrepreneurs in Jaipur.

At the shelter home, we talked to 40 boys who formerly lived as street children at the Delhi train station - a very unsafe place. It was so rewarding to see them well clothed, fed and educated. Of course, it is always heartwarming to visit kids - they truly tug on your emotions as you realize that they have the same wants and needs as our boys and girls - and the same potential when given the chance! It was inspiring to listen to the boys as they stood up and professed their dreams of becoming doctors, teachers or engineers! It really proved to me that we are not just helping them survive but truly thrive and provide them with opportunities they could have never dreamed of.

The second visit was to a village where we conduct polio immunizations. We all know that this disease is very preventable and unnecessary but nevertheless India is one the countries with the highest number of polio cases. PCI provides access to about half a million polio vaccinations a year by mobilizing the community to get the word out about its importance. We even work with religious leaders who act as messengers to the community. The most touching moment took place when a polio-afflicted young man, propped up by his crutch, talked passionately about his role in getting people immunized. I admire his courage and will never forget his face!

The third program visit involved a group of about 30 women in Jaipur who had received micro loans (about $100) from us to start their own business (saree making, weaving, cow herding etc.). We currently work with about 2000 of these women in 93 villages in our loan program and the repayment rate is close to 100 percent. We actually have made loans to more than 7,000 women in total, benefitting their whole families. In their own words, this really has changed their lives as they are now able to feed and clothe their children and send them to school. It was of great interest to me, as well as to the travelers, to be accompanied by one of India’s Qualcomm representatives. Qualcomm is partnering with PCI to strengthen the women’s ability to be financially successful by using Internet technology to bring their wares to the marketplace in the most efficient and effective way. The highlight of that visit was that some of the women travelers literally gave out four more micro-loans to women who had already replayed their first loan.

It's hard to pick which of these program visits was more impactful. They all provided wonderful hope in the midst of great poverty that we saw along the road. The experience really proved to me that PCI is changing the world - one village at a time, and that I am so very proud to be part of it together with all our staff and donors.

Community-Based PHC: So What's New??

by Janine Schooley, PCI Staff

Sometimes I get the question, "So what's new and innovative in CBPHC?" The answer is that there isn't anything new, and that's the point! We already know what we need to do. We have the bullets, as someone said, but the gun seems to be elsewhere or malfunctioning. I think it isn't that we don't have the gun. I just think we have misplaced it, or it needs some tinkering to get to work, or we need to remind ourselves how to pull the trigger. I really dislike this analogy for it's militaristic and violent connotations, but I couldn't come up with anything better..So, to continue this horrible analogy, we have several bullets and they are inexpensive, tried and true. We know the power of exclusive breastfeeding, good antenatal care, immunizations, long lasting insecticidal nets, good nutrition, and other low cost, low tech interventions in terms of saving lives and improving quality of life. We've been talking about this for decades, not just amongst ourselves, the practitioners in the field, but at the highest policy levels. As the September 13-19, 2008 Lancet reminds us, a major milestone, the Alma-Ata Declaration, was issued 30 years ago. So what's new isn't the need for what the Alma-Ata Declaration so eloquently calls for, but perhaps it's the realization that we still haven't gotten there. In other words, we don't need innovation. What we need is inspiration and, as Nike so aptly puts it "Just do it!".

It is easy to get a tad depressed when thinking about these past 30 years. Millions upon millions of dollars are being invested in the vertical diseases of HIV, malaria and TB. This is as it should be. These diseases deserve the world's attention. However, our investment in fighting these scourges should not be at the expense of what the bigger killers are and I'm talking about diarrhea, pneumonia, malnutrition, poverty.It can be very frustrating to know what we need to do, to know it is relatively inexpensive, and yet to know that we aren't doing it. Why?? Is it because it isn't "sexy"? Is it because it doesn't have a built-in corporate interest (and in fact, in some instances, bumps up against corporate interest as in the case of exclusive breastfeeding)? Is it because it is so process-oriented and diffuse that policy makers can't wrap their heads easily around it? Is it because we are too busy trying to do the work that we haven't figured out yet how to advocate for it, how to sell it? Is it because its primary constituents, women and children, are so disenfranchised that their voices can't be heard? Is it because the keys to its success are just so simple and basic that it's hard to get excited about them? These are the questions that can make you quite discouraged, especially since it seems that, with the world food crisis, the HIV/AIDS pandemic, the world economic crisis, global warming and other global trends, we are losing precious ground rather than gaining momentum.

But there are reasons to be optimistic and one of them happened this past Saturday at the APHA pre-conference workshop on CBPHC. The workshop featured work in advocacy, social mobilization and behavior change being carried out by Project Concern International and others as a way of injecting new life and on-the-ground examples into the discussion on CBPHC and the evidence for its importance. The group of 25-30 participants seemed far from discouraged. They were interested and energized and many of them were willing to volunteer time and energy to move the CBPHC agenda forward, in some cases adapting the very same approaches we discussed as working in our programs in the field to our own work as advocates and agents of change. However, in this case, the change we are bringing out is in the visibility and implementation of CBPHC approaches to scale.

As one of the facilitators of the workshop, it was gratifying to feel the energy in the room, as walked together to lunch, over lunch, as we walked back, and throughout the day. The group buzzed with ideas, passion and commitment. I know I can easily become discouraged about the fact that we have such good models and ideas and yet the funding seems to be elsewhere and so many opportunities missed. But on Saturday I was far from discouraged. I've been even more excited by the fact that the momentum continues as evidenced by blogging, the ongoing buzz and commitment that we are hearing and feeling. Unlike so many workshops, there actually has been residual impact. In fact, I'm so encouraged that I even more strongly feel that the quotation on the front of the recent Lancet, "Health for all need not be a dream buried in the past" is quite true and that this "timely reawakening of interest" in PHC will be the beginning of a new era, an era where we invest our not insubstantial global resources in the right way, on programmatic models and approaches that are cost-effective and that will save and improve the lives of the world's most vulnerable people. If the workshop this past Saturday is any indication, we do have something to be optimistic about.

The Inauguration of a Community Water System in Rural Nicaragua

By Katherine Selchau, PCI Staff

At the elementary school in the community of Loma Alta (located in the northern department of Jinotega, Nicaragua) the community gathered to inaugurate a community water system (made possible by PCI), which is serving 45 families in this isolated community. The water system is a gravity fed system that brings water from a large tank located up the mountain to a water point at the home of each of the 45 families, and then to the school, so that the community will have access to safe, clean water over the next 20 years. The water source was generously donated by a local community member who owns the land in proximity to the source. With the contribution of construction materials and labor, latrines were constructed at each home in the community and families were given training in their proper use and maintenance.

At the ceremony, the Mayor of Pantasma (the local municipality) spoke about the critical problem of deforestation in the region, its negative effect on the protection of water resources, and the need for the community to be vigilant in preventing illegal wood gathering. He also urged the community to advocate for greater support in ensuring the protection of local natural resources in their community and others like theirs. Children read poems and gave dance and theater performances illustrating the importance of water and the protection of natural resources.

Linked to the construction of the water system is education about the proper use, maintenance and management of water, latrines and local resources, as well as improved hygiene and sanitation practices in the household to ensure associated health benefits reach every level of the community. Just inside the school entry a poster describes each instance of proper water use represented by small cartoons on the poster: “Wash your fruits and vegetables.” “Always boil water for drinking at least 5 minutes.” Wash your hands after touching animals, using the bathroom, and before cooking.” It was truly inspiring to witness a seed of change being planted that will affect so many different levels of society in this community for years to come.

A Different World: My Trip to Nicaragua

by Derek Twomey

Two four-hour flights from Los Angeles and I find myself in a different world – a world I couldn’t even believe existed; houses that are mere cubicles, dogs that are skinnier than the cardboard that holds the houses together, families living in these shacks without water and electricity. I was appalled at these living conditions. You see something like this and you cannot help but want to make a change in the world.

I have been fortunate to be involved with an organization, Project Concern International (PCI), which establishes projects in developing countries to give those in need a chance for a better life. In a world full of suffering there must be some sanctuary that can help to shield off the effects of poverty and a way to bring hope to those in need.

While I was in Nicaragua, I saw parents who filled hot stuffy schoolrooms to learn from PCI educators on how to purify their water to avoid disease and keep their children healthy. I heard beneficiaries explain how they were given worms to grow so that they could fertilize the soil and, in turn, teach others in the community how to grow crops more successfully. PCI gave us a tour of the health clinics that they had built so that trained doctors could treat the sick. Many villagers were able to build outhouses and makeshift stoves through the generous support of PCI donors. I was surprised to see how well these small rural communities are organized so that they can work together for a common good.

Through the love of sports, I have found a way to help others, a way that allows young children and teens to find some happiness. With the help of PCI and athletes in my community, this summer I collected and distributed used baseball equipment to the children living in the poverty-stricken villages of Nicaragua. Through the shared love of baseball, I was able to form bonds with these kids and bring smiles to their faces. Though there was a language barrier, there was always the sense of the universal languages of sports and hope.

I have never personally stared into the eyes of starvation, never spent a night shivering on the streets, and never been forced to live a life with a single parent or no parent. I have always had a roof above my head, food on the table, a bed to sleep on, and most importantly, a family who loves me. I have been blessed, and I am grateful.

My family has always taught me an important goal in life – to make the world a better place. Whether it is small acts of kindness or traveling across the globe to third world countries to help make a difference, it all has the same effect. There are those people I see on television, read about in books, or hear about in my community who are involved with creating programs to enhance our world and make it a better place to live. I want to be part of these groups, to do all that I can to create a chain reaction so that no child will have to live in such poor conditions.

Zambia’s Most Vulnerable

LIFE ON THE STREET IS NOT ALL THAT EASY
By Robert Chisha, Former Street Child & Current Outreach Worker for PCI’s Africa KidSAFE

A lot happens on the street.

There is stealing, sexual abuse, robbery, fighting and drinking. The most common and most dangerous are drug abuse and sexual activities. I involved myself in these, along with the rest of street children who take drugs to remove the shyness from begging and help keep their bodies warm during the night. It helps to remove the fear of stealing and the fear of the places where we sleep. It allows us to just not care.

It is not the wish of street children to be on the street, it is due to circumstances. It’s due to loss of parents, mistreatment from their family, step mothers or step fathers, peer pressure, poverty, stigma, and discrimination. If the parents of the child died with HIV/AIDS, you find that people in the community treat the child as if he or she also has HIV - as a result the child will end up going to the street.

In the street there is stigma from passers by, or society at large. They look at street children as though they are not responsible people, forgetting that it is society that has denied these children. It is society that has not been responsible to them.

This is another reason why street children take drugs - to cope with the environment and to forget whatever people say to you. Society should accept that the future of children lies in their hands and start acknowledging children who are on the street as children who need our love, care, attention and support in order to become responsible adults.

People need to come together to look for solution on issues concerning street children and speak one language in order to help to reduce the number of children living in the street. The problem of street children needs attention from all angles: government, NGOs, community leaders, concerned citizens, local donors and international donors in order to improve the living standard of children in the country and to help to improve and promote the rights of children. Once all these things are put in place and the needs of children are being identified by society, then we can begin to see change.

Where’s the “N” in PreveNtion?

by Janine Schooley, PCI's VP for Technical Services & Program Development

August 7, 2008
Mexico City IAC

Well, actually there are 2 “Ns” in prevention so you would think that nutrition and food security would be considered in more discussions about HIV prevention at the World AIDS Conference this week. It is certainly gratifying to hear so many people now talking about food and food security in connection with treatment, care and support, but I did not hear one person mention the role that food and nutrition security (FNS) plays in prevention! When I was in Bangkok last year at a regional meeting on HIV and Food, several participants flat out told me that there was no link between food and prevention. I was astonished!

Starting with prevention of mother to child transmission, when done right in countries with infant mortality rates above 25 per 1,000 live births, PMTCT must involve the promotion, protection and support of exclusive breastfeeding to 6 months followed by clean, safe, affordable and nutritious complementary foods. Exclusive breastfeeding is the first defense against food insecurity (among other things) and is critical for child survival and the fight against malnutrition, as well as HIV.

Then there is the link between ART adherence and food. Yes, this relates to therapeutic feeding and treatment, but it also relates to prevention in the sense that people who do not have food, or do not have access to services/medication because of the high cost of food and household food insecurity, will be more likely to abandon treatment, have poorer immune status, adopt a fatalistic attitude about their health, and may adopt more risky behaviors as a result.

Livelihood security is an important part of FNS and, as such, must be linked to prevention in that households need to have sufficient funding to buy food, medications, condoms if not available for free, etc. Women, girls and boys may resort to risky sexual behaviors in order to put food on the table for themselves or their families. This does not have to result in full out commercial sex work, but sexual favors in return for help with household expenses, including “sugar daddyism” and other similar relationships could lead to infection. I once asked a sex worker in Addis Ababa why she didn’t practice safe sex and she said that she would “rather die a slow death from AIDS than die of hunger”. Hunger can make people do things that they would never otherwise do, particularly if you are a mother with hungry children.

FNS and OVC of course must go together and it is critical that children are well nourished so that they can study in school, have a full and healthy life, free from as many of the risks that lead to HIV as possible. Luckily there is more understanding of the links between children and maternal and child health/primary health care, including nutrition, but it is seldom placed in the prevention context.

Positive living and empowerment are not concepts that only apply to PLWHA. They apply to everyone and are essential for keeping people virus free. Empowerment comes with health and good nutrition, as well as with livelihood security and the ability to grow and/or buy sufficient food. There are likely even more linkages between FNS and HIV prevention, and clearly this needs to be the topic of more discussions and analysis, particularly as the cost of food rises and the world food crisis deepens. I hope that at the next meeting I go to on HIV/AIDS I will hear about a few of them.

¿Y como encontró la TB? Notas sobre la Conferencia de SIDA 2008 # 3

Había un chiste que decía –“estaba una persona en un restaurante comiendo cuando llega el mesero y le pregunta: cómo encontró su filete, señora? A lo qué la comensal responde: pues así, por accidente al mover una papa.”

La XVII Conferencia Internacional de SIDA que se lleva a cabo en la Ciudad de México entre agosto 3 al 8, se caracterizó por muchas cosas buenas, novedades, mensajes inspiradores, conferencias de tinte político, activismo admirable y la oportunidad de conocer más, compartir y regresar a casa (o al trabajo más bien) con renovados bríos y las mejores intenciones. Dentro de los cientos de conferencias, sesiones, pósteres, y etc. lo que hubo muy poco fue el tema de Tuberculosis. No obstante que la Tuberculosis es la principal causa de muerte en personas positivas, donde esta es endémica, el tema de Tuberculosis, o co-infección más bien brilló por su ausencia.

Contadas fueron las presentaciones oficiales que incluían el tema. Unas cuantas más que durante la presentación hacían tal referencia, pero incluso cuando se repetían mensajes importantes, el tema de co-infección fue rara vez mencionado.

Moviendo varias papas por decirlo de alguna manera, pude encontrar materiales, uno que otro póster, y unas cuantas referencias durante las presentaciones. Hubo incluso el día 7 de agosto, una manifestación por activistas que abogaban por el acceso a las pruebas de TB, por quimioprofilaxis y por supuesto por mejor coordinación entre programas. Había un stand de un laboratorio que vende también pruebas de TB. Y estaba afortunadamente el módulo de la Secretaría de Salud con información del programa nacional de TB.

Por qué esta ausencia tan marcada? Durante el trabajo del proyecto SOLUCION TB en 13 Estados mexicanos, en los acercamientos con programas y organizaciones que trabajan en VIH/SIDA, hemos constatado que es poca la colaboración existente, que en algunas agencias incluso es bajo el conocimiento sobre TB (aún que traten, apoyen y aboguen por personas positivas). Encontramos en la realidad las mejores intenciones de colaboración, guías prácticas, documentos, y normas que indican cómo debería ser la realidad aunque esta todavía no sea como debería de ser por el bien de las personas afectadas por TB y por VIH. En las áreas donde trabaja el proyecto, como en otros países, la mortalidad en personas con TB está fuertemente ligada a la co-infección.

Cuáles son las alternativas? Además de dar seguimiento a las normas que contemplan una respuesta para esta problemática, existen cada vez más, aunque todavía en etapa incipiente, iniciativas de Abogacía, Comunicación y Movilización Social encaminadas a esta temática. En cuanto a la abogacía de políticas programáticas, la iniciativa de las tres “Is” para el control de la TB en personas positivas incluye –Infección, control de; Intensificar la detección y la Isoniazida como terapia preventiva. Se imaginarán que la iniciativa surge en inglés por eso la redacción un poco forzada.

Nos queda mucho por hacer, pero eso hace también interesante el camino. Empecemos por la mejor coordinación, por la detección, y la dotación de Isoniazida profiláctica. En materia de abogacía, tenemos un amplio margen de mejoría. Quienes trabajamos en TB, vamos a sentarnos a la mesa del diálogo y la planeación coordinada con los programas de VIH/SIDA. La TB es curable, su tratamiento es gratuito y podemos evitar muchas muertes innecesarias. Abogacía para la Acción YA! Busque información sobre la publicación ‘Think TB in peoplw with HIV” en www.aidsmap.com.