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.

Conoce tu Epidemia y Actúa YA! – Nota sobre SIDA 2008 # 2

Para alguien que trabaja en Prevención, el mensaje a través de esta conferencia fue claro. Algunas ideas previamente conocidas:

Conoce tu Epidemia –Una y otra vez, líderes y expertos/as mundiales aclaraban, recomendaban, exigían hasta el cansancio la necesidad de que la prevención vaya siempre de acuerdo a la realidad. Es decir, se necesita saber dónde existe la necesidad de prevención, quienes están siendo afectados y afectadas, para actuar precisamente ahí, donde más se necesita. En el caso de muchos países de América Latina, la prevención no es generalizada sino focalizada y o de baja intensidad. Tal es el caso de México al menos. Una gran mayoría de personas afectadas corresponde a hombres que tienen sexo con hombres y a personas con conductas de riesgo, más evidentemente, trabajadoras y trabajadores del sexo comercial. De primera instancia el mensaje es: trabaja con estos grupos vulnerables y atiende sus necesidades ahora! Esto es por supuesto condición necesaria para un bien planeado y ejecutado programa de control y prevención de VIH. La lógica así lo indica, pues evidentemente no solo se prolonga la vida y se mejoran las condiciones de las personas afectadas sino que potencialmente, se previenen nuevas infecciones (bajan las cargas virales, se conoce el estatus, la gente puede decidir protegerse más y proteger a otras/os etc.).

La epidemia no se acaba a condonazos. Más frecuentemente de lo que quisiéramos los programas preventivos se centran en la distribución de condones, y sólo en eso. Se piensa que ‘distribuir cientos y miles de condones en las personas con prácticas de riesgo acabará o disminuirá en gran medida el riesgo de nuevas infecciones’. Bueno, muchos/as de nosotros sabemos que la problemática no es así de sencilla –si lo fuera, ya hubiéramos controlado la epidemia hace mucho tiempo. Repartir condones sin trabajar en otras necesidades de salud y sociales es un esfuerzo tal vez bien intencionado pero de poco impacto. Las personas con prácticas de riesgo son personas multi-dimensionales, que enfrentan una problemática compleja y generalmente no atendida. La manera de ayudarles a protegerse debe ser también multi-dimensional.

Los mensajes ya conocidos pero poco reconocidos incluyen:

“No podemos salir de la epidemia sólo con tratamientos” (la traducción literal sería “no podemos tratar nuestra salida de la epidemia). Es decir, no es suficiente con mejorar y asegurar el acceso a antiretrovirales para las personas positivas y evitando sus muertes como vamos a acabar con la epidemia. El punto es, se necesita hacer más y mejor prevención. Mucho más de lo que estamos haciendo.

La prevención que funciona y que tiene impacto es aquella que es ‘integrada’ es decir, que ofrece diferentes servicios, que conjuga diferentes programas, y abarca los diferentes aspectos de la vida de la persona afectada -- Una prevención basada en la persona. El mensaje de integración, si bien no es nuevo para quienes conocen de y trabajan en VIH/SIDA es frecuentemente olvidado en los programas, públicos o muy medicalizados principalmente donde se separa a la persona en ‘sistemas’ y ‘departamentos o programas’ que sólo ven al ‘cliente’ o ‘paciente’ como un órgano o sistema, y no como un ser humano integral, afectado igual que su familia.

La prevención integrada e integradora requiere asi mismo de la conjunción de diversos sectores, no solo del sector salud, sino de empleos dignos, de vivienda, de educación y acceso a información, de justicia social y de reconocimiento de derechos humanos.

Finalmente, otro mensaje poco reconocido es el de la necesidad de ver a las personas afectadas como sujetas de derecho, y no como objetos. Ni de estudios, ni de investigaciones, ni como ‘beneficiarios’ de programas, sino como personas con dignidad, sentimientos, emociones, complejidades y sobre todo derechos humanos, de salud y de reconocimiento.
Desde mi personal trinchera, envío un saludo especial y una felicitación a los colegas de ONGs que trabajan incansablemente en la lucha por los derechos de las personas afectadas, y que hacen hasta lo imposible por apoyar de manera integral, sus necesidades. Mi respeto a todos y todas.

Gender Based Violence

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

“It’s important to shoot for the moon; Even if you miss, you will still be among the stars…”
-- Anonymous

It has been very gratifying to see so many presentations that mention or focus on the need to address gender-based violence as a growing social driver of the epidemic, particularly in a country such as South Africa. Not only was this featured in President Clinton’s keynote address, including his announcement of support for a UN agency dedicated to women, but it was discussed during several mainstream panel presentations. PCI and others have been focusing attention lately on developing an effective social mobilization approach to changing norms that fuel gender-based violence. While this approach is comprehensive and not prescriptive in the least, it struck me, when listening to some of the presentations, that we should more proactively include a few additional elements into our thinking:

1) Involvement and engagement of groups that work with men and boys. Although of course our approach engages men who are police, policy makers, media influentials, among others, and targets men as part of general society through social change amplification campaigns, perhaps we could be more overt in our promotion of an ethic of responsibility among men and boys by engaging groups already involved in this effort. There are male-oriented civil society groups in South Africa, for example, who are fighting against “risky masculinities” -- dangerous conceptions about what it means to be a man and how manhood should be proven. These groups will have much to offer to the process of changing social norms.

2) Women aren’t just victims; they are key actors in social change. Rather than think of women as being a somewhat passive ultimate beneficiary of our social mobilization work against gender based violence, we should think of ways of empowering women to be active agents of social change. One way of doing this would be to incorporate an economic empowerment component into the process so that their self esteem is increased and their ability to engage actively in the process of social change is enhanced. It’s not enough to modify the attitudes and behaviors of all the social actors and processes that influence behaviors that impact women; the women themselves need to be mobilized.

3) There is a critical subset of women that deserves some special focus. Hate crimes against certain women are apparently on the rise in much of Southern Africa. This includes horrific acts of violence against lesbian girls and women, sex workers, and others. Many of these women are imprisoned and then raped (“state violence”). Many suffer a double stigma of being HIV and lesbian or sex worker. Many suffer psychological violence/abuse as well as physical. This is clearly a small, but increasingly ugly subset of vulnerable women and there are undoubtedly key groups that work with and on behalf of these women that we could partner with.

Why Do Pendulums Have to Swing?

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

August 6, 2008 :: Mexico City IAC

For every 2 persons starting anti-retroviral therapy (ART), there are 6 new infections. Clearly we cannot treat our way out of this epidemic….

At the first World AIDS Conferences, the discussions were all about prevention because, well, there wasn’t much else to talk about. There was no ART; there were no vaccine trials; there was only prevention. Then for years the focus became almost exclusively on treatment. At this year’s conference however, there is a lot of talk about prevention and, more importantly, there is a lot of talk about there being no one silver bullet, about the need for an integrated, comprehensive approach. Peter Piot, Director of UNAIDS, was philosophical about this development. He said that paradoxically perhaps we had to go through this process of veering from one to the other before we could finally come back to the realization that we need it all. He said that we left prevention in the dust of treatment, but that perhaps we couldn’t truly do what was needed in prevention until we had figured out the ART side of things. I don’t know about that (smacks a bit of a rationalization to me), but the change sure is welcome.

Not only are people this year talking about the need for both treatment and prevention, but thankfully, they are talking about something called “combination prevention” which means the kind of prevention that works on multiple levels, using multiple strategies, with none of them working in isolation – a larger, more systematic response that effectively combines biomedical, behavioral, and structural interventions and matches that combination to the particular situation and nature of the epidemic..

Oversimplification is out and context, finally and thankfully, is in. A new paradigm for monitoring, evaluation, and documentation of evidence will be needed and there must also be a realization that social change is messy and takes time. We need to focus more on the “how” and less on the “what” and we need to take into account the interplay between treatment and prevention. New partners in social and behavioral change will need to join the rank and file of HIV/AIDS combatants. In addition, prevention must be seen not as stopping something, not as preventing something, but actually as something more positive, allowing hope and sexuality to flourish and bringing out the best inour humanity and in our protection and promotion of health and wellbeing.

This theme of integration is winding its way through discussions about prevention of mother to child transmission (PMTCT), the need for family-centered approaches to care and support, and the need to focus on good primary health care and social protection when addressing the needs of vulnerable children. This is all music to my ears and is in keeping with my tongue-in-cheek suggestion of a new definition for the acronym PMTCT: Promotion/protection of Mother Together with Child Total health, as opposed to just stopping vertical transmission of one virus.

Someone joked that if we think in more integrated terms, perhaps we will all have less meetings to attend. There are of course many more compelling reasons why this pendulum swing is most welcome, not the least of which is that it means that we will finally have a good chance of making a dent in this still raging pandemic and do so in a way that is as cost effective and lasting as possible.

La Importancia de la conferencia Internacional SIDA 2008

by Blanca Lomeli, MD (PCI's Regional Director of North America Programs)

Son las 5:00 am del día 4 de la Conferencia, escribo esta nota por la necesidad de compartir, mientras pienso en cómo haré para empacar todos los papeles, folletos, documentos y etc (si, algunos souvenirs) en mi pequeña maleta. Muchas cosas para compartir con los colegas que no pudieron acudir.

Pensando en la importancia para México de esta conferencia: Los ojos del mundo puestos en México:

• Indudablemente el país ha sido analizado en diferentes niveles, y con diferentes resultados, respecto a la pregunta que se hacen muchos/as (sobre todo gente de México) de porqué fue seleccionado. El estigma y la discriminación, la homofobia son prevalentes. La epidemia es de ‘baja intensidad’ (comparada con otros países) o concentrada, y el acceso a los antiretrovirales es aún muy limitado. La prevención ha sido durante los últimos años casi inexistente.
• La conferencia ha servido para que el Gobierno preste más atención al problema, de primera instancia, para hacer cambios cosméticos y superficiales y poder ‘aparecer’ como un país más comprometido de lo que está, con la epidemia. El Secretario de Salud, por primera vez en la historia (y su historia) participó en una marcha contra la homofobia, caminando al lado de personas que seguramente no forman parte de su círculo profesional y/o social muy frecuentemente.
• La cobertura de los medios nacionales y locales ha sido diaria, con diversas notas y frecuente. A pesar de que ningún tema se toca tanto como las próximas olimpiadas, la Conferencia, las protestas de la sociedad civil, temas como derechos de trabajadoras sexuales, de niños y mujeres se han cubierto con una intensidad nunca antes vista. La gente piensa en SIDA y piensa en Derechos, al menos al escuchar o leer las notas periodísticas.
• De manera importante, el presidente Calderón inauguró la Conferencia y además anunció que se abría el mercado para explorar la producción o venta de medicamentos antiretrovirales ‘genéricos’ y se ha negociado una baja del costo de los precios con 5 de 7 laboratorios que los producen y venden en el país. Este es un cambio importante, substancial que ayudará a que el país pueda adquirir y asegurar el acceso a medicamentos a más personas durante más tiempo.

La conferencia SIDA 2008 en México ha sido principalmente, la razón que 25 mil personas, científicos/as, activistas, miembros de la sociedad civil, visiten la Ciudad de México por unos días, escuchen lo último sobre los avances, el progreso y el futuro de la epidemia. La energía continúa siendo impresionante. Las conexiones humanas, y las baterías de todos y todas recargadas, lo mejor de todo.

A million deaths is a statistic; one death is a tragedy

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

“Imagination is more important than knowledge”
--Albert Einstein

There are many statistics being presented here at the Mexico City IAC 2008. They are presented via power points, through poster presentations, in graphs, in pie charts and in handouts galore. But somehow all these facts and figures keep going in one ear and out the other, not really sticking and not really bringing the HIV/AIDS epidemic to life.

Fortunately there are a few other ways that information is being presented. For example, in the entrance to the grand exhibit hall, there is an old shack made up of roofing materials, cardboard and other miscellaneous junk. Hanging on the outside of the shack are large photos of people living with the co-infection of TB and HIV. A brief story is written in their own handwriting below their photo. If the handwriting is in a language other than English, then there is a translation into English written in magic marker below the photo and story. People can enter the shack and walk through the small living area, the smaller bedroom and out the other end.

For those of you who have been to Tune Town in Disneyland, it is kind of like walking through Mickey or Minnie’s houses, but not really. This house is filled with additional photos and stories, and none of them are cartoon character happy and peppy, although there is hope and dignity in this house. Even in the shabby furniture (the sofa is an old car or truck bench seat, the tables and chairs are mismatched and look like they were taken from a land fill) there is hope and dignity. There is an old wheel chair in the corner and various personal items here and there. It feels real, almost too real to bear. It looks like so many of the homes we have been invited into around the world, only this one echoes with the stories and voices of many families, many people living with these mutually reinforcing diseases, making it even more powerful.

There are many positive people here, like the 16 year old young woman who moderated a session I attended, introducing the scientific/medical presenters from around the world. She has been HIV positive since birth and she thanked all of us for the chance to express her pride in being HIV positive because, in her native country of Australia, she cannot be so open because of stigma and discrimination. She also brings the issues of HIV/AIDS to life in a way that all the power points in the world could never do.

And finally, every once in a while during a presentation filled with statistics, filled with the problems we are all here trying to address, someone will make a statement that makes us all sit up pay attention just a little bit more. Last night that statement was about the new phrase that the presenter has been hearing recently in Haiti to describe the terrible food crisis there. I don’t speak French so I won’t get that right, but basically it was that people have coined the term “Clorox hungry”, meaning the level of hunger that feels like they have been bleached dry, bleached of everything. I had heard about the riots in Port Au Prince and I had seen the statistics about the cost of food and the rising levels of malnutrition in Haiti, but somehow just the fact that this new term is being used made my blood run cold.

Statistics are important of course, but when this conference is over, it will be these and other such memories that will stick with me, will go in both ears and stay in my mind, probably for a very long time.

How Big is Too Big?

Reflections on the Mexico City IAC 2008
by Janine Schooley, PCI's VP for Technical Services & Program Development

This conference is huge! I’ve never been to such an event. They say there are 25,000 people here, but it feels like more when you are trying to make your way anywhere in the conference center, buy a sandwich, use the rest room, or get on a shuttle bus back to one of the hundreds of hotels participants are using all over this huge city. It is rainy and grey here in Mexico City, but the conference participants don’t seem to mind. There is an energy and a critical mass-ness about such a large group of people all coming together for a common purpose, to Stop AIDS Now!

But is the meeting too large? It’s so gargantuan that they can only hold it every other year. In 2 years it will be held in Vienna. Two years ago it was Toronto. The logistics are mind boggling and so I choose not to boggle my mind with them, simply thanking my lucky stars that it isn’t MY job to organize this monstrosity. The program book (and that’s without the supplemental program which is quite large itself) is the size of a good sized city’s phone book.

But it is the World AIDS Conference and the world’s eyes are upon us. The size and scope is a good thing when you have President Clinton speaking and the paparazzi’s cameras buzzing, sending images and messages around the globe. This conference may be too big for me, but it isn’t too big for the topic of HIV and AIDS. HIV and AIDS needs a meeting of this size to attract the attention of the media and the politicians. The energy and the scale of the conference is helping to ensure that this unprecedented humanitarian crisis does not go unnoticed, does not fall off the headlines, and does not fade from the consciousness of the planet.

So is this monstrosity too monstrous? NO! It is just the right size for the job, the job of helping us all tackle HIV and AIDS, raise awareness, keep the funding flowing, keep the folks in the trenches motivated and uplifted, and keep us all reminded that size does matter, particularly when the dragon we are trying to slay is as huge and monstrous as it is…

Let’s just hope Vienna is big enough for IAC 2010!

FOCUS! The Girls at Risk on the Streets of Zambia

The Africa KidSAFE program (a PCI-led effort to provide a safety net for Zambia’s vulnerable children) faced challenges in addressing the needs of female street children, specifically, which remains a common obstacle in global efforts to help street children.

This is primarily because of the unique experiences, motives and problems that street-active children face when female, including escalated verbal, physical and sexual abuse, increased vulnerability to HIV/AIDS and other STIs, exclusion, and the turbulence of pregnancy.

This greater trial and tribulation paradoxically makes female street children more resistant to aid from outreach workers and shelters, and there is a higher incidence of female street children leaving the structured care of temporary and permanent shelters. In an effort to revise our approach to increase success rates, the Africa KidSAFE Network has recognized a need to specialize care. To do this, we have increased facilities directed specifically towards female street children, including exclusively female shelters, staffed by female professionals, shelters for new and expecting mothers, and assurance of high-quality care within shelters and for outreach worker training.

These efforts will serve to foster trusting relationships and provide an environment conducive to addressing the emotional, mental and physical needs of female street-active children. The network plans to improve these facilities in close consultation with the girls’ feedback and further research and negotiations are being pursued this quarter to maximize services provided exclusively to girls.

Building Back Better

Earthquake Resistant Housing for Peru’s Rural Families

Nearly a year ago, an earthquake measuring 7.9 on the Richter scale rocked the Peruvian regions of Pisco, Chincha, Alta, Ica, and Canete, leaving more than 90,000 families without homes. Since then, PCI has been working to create long-term, forward thinking solutions to help people in Peru deal with these kinds of disasters by building earthquake-resistant housing.

In partnership with Food for the Hungry, PCI has convened some of the world’s foremost experts in earthquake resistant building technology, non-governmental organizations, government officials, and international donors to pioneer an effort to help families rebuild with earthquake resistant adobe.

PCI is hosting visits from government officials of surrounding communities and other organizations, in hopes of expanding and developing the program. The vision is to create a local effort based on this technology to ultimately benefit tens of thousands of Peruvians.

Easing Burdens for Orphan Caregivers

Goats Provide Nutrition and Income

Ethiopia has one of the largest populations of persons living with HIV/AIDS in the world and, as the number of children losing parents to HIV/AIDS increases, an enormous burden is placed on extended families to meet the needs of these children.

Lack of food is often a major obstacle to improved health and nutrition, as well as recovery from tuberculosis and other debilitating infections for adults living with HIV/AIDS. For children, the lack of food leads to greater health problems due to weakened immune systems, poor school performance, and diminished quality of life.

With funding from Alternative Gifts International, PCI is providing HIV/AIDS-affected and vulnerable families in Ethiopia with goats and sheep to ease their burdens, help avert their deteriorating nutritional status, and generate income.

Goats are considered optimal for families affected by HIV/AIDS because they are small and can be easily handled by the sick, young, and elderly. The milk from goats is improving the quality of children’s diet and can also be sold for $0.44 US per liter to generate vital income for families. As of June 30, 2008, PCI expected to distribute over 2,500 goats and sheep to 1,700 caretakers of orphaned and vulnerable children.

PCI is Changing Lives

Project Concern International’s work is making the most critical of impacts: changing lives for people living in poverty around the world. Reducing maternal mortality in high-risk areas of Latin America, providing goats as a source of income and nutrition for the caregivers of AIDS orphans in Ethiopia, and offering women in India the means to start their own business are just some of the ways PCI is ensuring people rise above the debilitating circumstances of poverty and disease.

The heart of PCI is change – lasting change, self-empowered change. Our goal is to help communities and individuals become stronger and self-assured and to provide people with the means and tools to create the transformation they want to see in their own lives. There is no exact formula for this kind of work, it requires listening to the needs of each individual community, working together with common vision, and ultimately helping people reach their goals to build a world of health and hope one child, one woman, and one man at a time.

We invite you to take this opportunity to learn more about the individual ways we are reaching people in Asia, Africa, and the Americas – read their stories and share in their success. PCI is proud of the different paths we take to assist people in obtaining better health and personal empowerment throughout each part of their lives and say thank you to all who are helping support our mission.

Read more in Changing Lives, PCI’s enewsletter >>>

Sexual Violence and HIV/AIDS

By John Berman, PCI's Senior Director for HIV/AIDS Policy & Program Development

When we think about HIV/AIDS, does rape come to mind? If it doesn’t it should.

Getting infected with HIV is closely linked with sexual violence. It’s inseparable. And in places like South Africa, where up to a third of women first have sex as the result of rape or other forms of coercion, it’s driving the epidemic.

In several ways.

First, every act of forced sex is an additional, unplanned risk of infection.

Second, a recent study from South Africa showed that men who commit violent acts are 50% more likely to be HIV positive than those who are not violent.

Third, you can be sure when a woman is raped, a condom is rarely involved. She’s exposed.
Fourth, pervasive level of sexual violence lead to situations where women do not feel safe, let alone empowered, to say no to a man’s advances.

So if there are all these linkages between sexual violence and HIV infection, why don’t we hear more about it? Why don’t we do more about it? Part of the answer is that sexual violence is often seen more as a social issue, or perhaps a criminal issue, than the health issue. As a result, “health” programs draw an artificial line about what can and cannot be done.

That has to change.

Health programs need to address underlying social factors that drive the HIV epidemic. Sexual violence, and gender inequity should be right up there at the top. We could do this by helping to mobilize communities to change destructive social norms such as pervasive sexual violence. We’ve got to work with people everywhere – men and women - to bring an end to the violence. It’s the only way we’ll ever really stop the epidemic.

Water Is Life: A Glimpse of Life for Martha in Tanzania

Story provided by PCI/Tanzania staff

A woman named “Martha” in Bubu village of Babati District described how she spent five hours per day, from 5 a.m. to 10 a.m., drawing water from the river bed, competing with cattle owners and other women, in order to get four buckets of water per day (20 liters each). The women in Bubu village have formed a group to promote the development of their community, but Martha and the others find it very difficult to achieve results with this group because of the amount of time spent on collecting water. Martha shared that if she had a water point nearby, she and other women would have time to dedicate to working in this group. With more time, Martha said she would begin growing and selling vegetables. And if she were able to generate money this way, she said it would help her improve her house and her children’s education. When asked how she chooses between collecting water and selling vegetables, Martha simply responded “Water is life.”

Martha went on to describe how children help in water collection, primarily in the evenings and on weekends. But collecting water in the evenings is dangerous due to hyenas, and it negatively affects their school work. Even the teacher’s work is negatively impacted by the lack of water, as she too needs to spend hours collecting water for herself.

Standing in queues and carrying water back and forth to the house for five hours per day can create a lot of tension. Martha said that improving access to water would improve harmony in the community, as the tension over water during the dry season results in fighting and hatred.

Martha finished saying that if this [PCI’s] project becomes a reality, the improved access to safe water will have a positive impact on all these aspects of her life.

What Aceh Has Taught Me
By Allison Zelkowitz, PCI Staff in Banda Aceh

The 2004 Indian Ocean Tsunami killed nearly 167,000 people in Aceh alone. Since that time, hundreds of international organizations have worked to repair the devastation and help the survivors rebuild their lives.

Much has been written about reconstruction progress and the impact of international aid on communities in Aceh. Thus, I’ve decided to talk about Aceh’s impact on me, and the simple but important lesson Aceh has taught me: we can recover from anything.

As a Communications Officer, part of my job has been to interview and write stories about people involved in PCI’s livelihood, health, water, and sanitation projects. One of the questions I always ask is, “What happened to you when the tsunami hit?” Every person I’ve interviewed has had an incredible story to tell, and each has told it calmly, without self-pity. Some were knocked unconscious by the terrible wave, carried for miles, and awoke in a tree or on a hill. Others just barely escaped the tsunami’s force, running for their lives and climbing onto rooftops. Each of them was an exception, one of a small group of survivors—in many villages, sixty to eighty percent of the inhabitants were killed.

Everyone in Aceh has lost family members, friends, and neighbors. I’ve spoken to mothers who had their infants dragged from their arms, grandfathers who outlived their grandsons, and children who, in a few short minutes, became orphans.

I remember the day I truly realized the strength of the human spirit. It was a Sunday, and I was sitting on the beach near Banda Aceh, the same stretch of pristine sand where, three years ago, thousands had perished. I’d come to the ocean because I needed to think, to mull over a personal problem that was weighing on my mind. While gazing at the water, I noticed a middle-aged man playing with a toddler on the beach. A few minutes later, he walked over and sat next to me, setting the little girl in his lap. He explained that she was a child from his second marriage—his first wife, and all four children, had died in the tsunami.

My own problems never seemed smaller.

Encounters like this are a common occurrence in Aceh. As the rehabilitation phase nears completion, I continue to feel blessed that I’ve had the opportunity to meet these resilient people. Although they have suffered incomprehensible losses, they are rebuilding their lives with courage, determination, and dignity. Their strength is an inspiration.

Global Focus: Poverty & Hunger

In a world that houses 6.55 billion people, almost half - three billion people - live below the poverty line, earning less than $2 a day. Among this group, 800 million people are suffering from hunger and malnourishment because they cannot afford to provide themselves and their families an essential daily need: food.

Hunger can manifest itself in many forms besides starvation and famine. Most poor people who battle hunger suffer from chronic undernourishment and vitamin or mineral deficiencies, which can result in weakness, delayed fetal development, stunted growth, and greater susceptibility to illness.

Malnutrition is the single most important risk factor for disease. The more malnourished a person is, the more vulnerable he or she is to disease; and the sicker a person is, the more vulnerable he or she is to malnutrition. In addition to the impact on health, the constant search for food consumes valuable time and energy, causing less time for people in poverty to work and earn much needed income.

Better nutrition is a major key in ending poverty and provides the foundation for achieving better quality of life. Healthy children have the capacity to learn better. Healthy people are stronger and more able to create opportunities that gradually break the cycles of both poverty and hunger.

With countless countries facing food shortages around the world, a global food crisis is upon us. This “silent tsunami” threatens over 100 million people. Addressing the core issues of poverty and hunger is paramount – and the time to act is now.

So do what you can to effect change – whether it’s spreading awareness of the issue or donating to a charity involved in this international work. Each of us has the capacity to make a difference. And together, we’ll have the momentum to plant a seed of change for the next generation to escape a fate of suffering caused by hunger and malnourishment.

Maji Na Usafi Kwa Maisha Bora!
("Safe water for a healthy life!")

By Janine Schooley, PCI Staff

Water has been on my mind lately. This is not only because I am here in Tanzania for PCI’s new Starbucks/Ethos-funded water and sanitation project, but for many other reasons as well. PCI, with its implementing partner, ADRA/Tanzania, and its collaborating partners, WaterAid Tanzania and the Babati District Council, have come together to officially launch and plan for our BAHEWASA Project. (By the way, BAHEWASA stands for Babati Water for Health in Swahili.)
So, what else is making me think a lot about water these days? Water is running through our planning for the project of course. We are learning a lot about the need and demand for water; clean water for drinking, but also water for livestock, for cooking, cleaning, growing food, and overall survival. But it’s not just that. It’s the fact that water here is a microcosm of the contradictions that are Africa. I’m sure you are wondering what I mean by that. I mean that water is both scarce and abundant, important for the poor as well as for the privileged, a symbol of tradition as well as a symbol of our modern times.
Here in Tanzania it is the "wet season". It has been raining almost every day, almost all day sometimes, since I arrived in Tanzania. Sometimes it comes in sprinkles and passes quickly. Other times it pours like I’ve never seen water pour, from the sky, and runs in raging rivers through a town or village.

On the other hand, when you ask anyone in the village of Vilima Vitatu (3 Hills), one of the 11 villages selected for BAHEWASA implementation in Year 1 (total population approximately 31,000), what they most want or need, the answer will come back a unanimous: "water!" Some villages have less than 1 water point per 1,000 population. Imagine what that would be like: have 5 bathrooms and a kitchen in my house in San Diego. That adds up to about 12 water points, not counting the taps outside for the garden hoses. It is mind boggling to think of the difference between that and what the families of Babati are living with.

So, water is critical for the people of Babati who live in villages, as well as for the people who depend upon the tourists who come to the game preserves. Water means livelihood for the cattle herder as well as for the safari guide. It is a common thread running through the traditional societies and the first world visitors who flock to see the elephants of Tarangire in their khaki vests and hiking boots. Water is definitely on my mind.

The World Food Crisis

On April 17th at a joint White House news conference with President George Bush, the Prime Minister of Great Britain, Gordon Brown, stated that the globe is facing a worsening food crisis unseen in over 30 years.

The World Food Program (WFP) has recently identified at least 30 “high risk” countries from around the globe that they consider vulnerable to the rising international prices of basic food commodities such as rice, wheat, and corn, commodities which have currently soared in the world markets and, in some cases, jumped to an all-time high at the wholesale level.

The Food and Agriculture Organization of the United Nations reports that 21 countries likely to be directly and adversely affected are in Africa where food-related riots have already been reported in Egypt, Cameroon, Burkina Faso, Senegal, Cote d'Ivoire and Haiti. The WFP has characterized this as the ‘Silent Tsunami” warning this may lead to potential catastrophe.

Executive director of the WFP, Josette Sheeran, said this week, that the rising food prices are “threatening to plunge more than 100 million people on every continent into hunger.”

Though the long-term impact is still unknown, there is a way to help support those who will be severely impacted by this crisis. Through PCI, you can help provide not only nutritious meals, but economic opportunities that will enable those living in poverty provide for their families and communities. Learn more at www.ProjectConcern.org/FoodCrisis.

PCI and the Three Bears….

by Janine Schooley, PCI Staff

When people ask me about PCI’s annual budget, or whether we are a small or large organization, two thoughts come to mind: 1) It’s all relative; and 2) Goldilocks and the Three Bears. By “relative”, I mean that, in comparison to many grassroots or local non-profit organizations, we would be considered large, with a $22 million dollar a year cash budget and over 600 employees worldwide. On the other hand, if you compare us with our major competitors, organizations like Save the Children, CARE, or World Vision, with whom we compete for funding in the areas of child survival, HIV/AIDS or food security, we are definitely the “little guys,” working with organizational resources that are a fraction of what the “big guys” are able to muster.

Sometimes we are told “you’re too big,” when we apply for grant resources designed for smaller or local/indigenous non-profits. And yet we have also been told “you’re too small” by funders who are looking for a major, multi-country contractors with the obvious ability to manage multi-million dollar awards. This is where Goldilocks and the Three Bears comes in. We aren’t too small or too big; we are juuuuust right. Well first let me say that we aren’t exactly quite “just right,” yet. We would like to be bigger and better and stronger and more able to bring our programs to more people. But rather than try to be a larger organization, we strive to be the best medium-sized organization we can be.

Why, might you ask? Why not become as large as possible? Well because our particular size allows us to be responsive, nimble, innovative and yes, scrappy. We aren’t burdened by a large bureaucracy. We have systems, structures, and capacity that enable us to effectively compete and manage programs with the best of them, but we haven’t let them get unwieldy or cumbersome. While we can effectively compete for multimillion dollar awards through PEPFAR, for example, we are able to be more integrated and cohesive in our technical/programmatic work than otherwise. In some organizations, the HIV staff and the food & nutrition security staff, for example, are so large and so departmentalized that they don’t even talk to each other, let alone collaborate on integrated programming. Our technical officers interact with each other and actually seek out opportunities to collaborate. Because we aren’t attempting to spend large pots of funding in a relatively short period of time, we tend to seek out opportunities to meet the needs of smaller pockets of people who are particularly isolated and vulnerable. This “off the asphalt road” approach means that we can reach people in great need who otherwise might be overlooked. Our “just right” size also contributes to our ability to stay grounded and grassroots, working with and through local community-based organizations and networks because we don’t have our own large organization to draw upon. Our mid-size helps ensure our “in the middle” position whereby we effectively link the field/communities on the ground with global policy, research, technical resources, etc.

Of course, we must grow in order to stay viable and to expand our impact, and grow we will. But just like Goldilocks, we have been able to appreciate our mid-size and middle position in the meantime. This will help ensure that we retain what is best about our current size while expanding its impact as far and wide as possible.

The Continued Struggle Against Polio

By Dustin Wright, PCI Staff

During the 20th century, medical advancements helped take the offensive against the polio virus, which has plagued and crippled people since the days when Egyptian pharaohs were erecting pyramids. The polio vaccine made its debut in 1955 and was soon distributed in an oral form which made administration of the vaccine easier. People in even the most remote regions were receiving the life-saving treatment.

According to the World Health Organization (WHO), the last remaining polio endemic countries are Afghanistan, Pakistan, Nigeria, and India, with the later having the highest number of confirmed cases. Already in 2008, India has confirmed 82 new cases of polio, adding to the 864 cases the country logged last year. The second highest endemic country, Nigeria, has confirmed 18 cases this year, with 286 reported last year.

Obviously, poverty and poor education are main factors that contribute to the tenacity of the virus in these countries. In Nigeria, for example, some Muslim communities have resisted polio vaccination because of the belief that Western countries are using the vaccine to inject Muslims with chemicals that will reduce their fertility or infect them with HIV/AIDS.

War and conflict aren’t helping things either, especially in Afghanistan, Pakistan, and even non-endemic countries like the Democratic Republic of the Congo and Chad.

With the largest number of infections, India is the focus of many eradication campaigns. The northern state of Uttar Pradesh experienced a polio outbreak last year and PCI India responded by increasing its presence in the region. Volunteers were dispatched door to door to ensure that local families were taking part in available immunizations. Community leaders were contacted to spread the word and local mosques made announcements. After a century of technological advancements in the fight against polio, spreading the word may well be the weapon that ends the war.

A Glimpse of Life "Behind the Pearly Gates"

By Laurel Kirkland, PCI Staff

I was originally introduced to Project Concern International (PCI) by a new friend upon moving to San Diego. At the time I was looking to get involved with an organization like this. As a matter of fact I was hoping to find one EXACTLY like this. Fortunately enough I applied for and was accepted into an internship with the Program Development department allowing me the opportunity to familiarize myself more with the International NGO world.

I was immediately given projects that conveyed a confidence in my ability and intelligence. Instantly I found myself immersed in the non profit organization lingo, what I think should be termed, Acronymian. As I swam in a sea of acronyms, research, and editing projects I had a chance to learn PCI’s different strokes. I tried to be friendly, helpful and make connections with people from all departments in the office (which isn’t difficult, they are a welcoming bunch). I worked hard and asked lots of questions. Not long after my internship began, approximately one month, a position as Office Assistant/Receptionist opened up and I jumped at the opportunity to get on board this fine ship. I knew this was my chance to get a foot in the door and was given a lot of encouragement to do so.

Now I am continuing to learn more about Project Concern International and am eager to stick with the organization with hopes of moving up. I have had a glimpse of the incredible group that is the machine Project Concern International. I am convinced that every one of the people working here has good intentions. We are a wonderful family who celebrates together by having potlucks and lunch outings. Our VP for Technical Services and Program Development, Janine Schooley cleverly creates appreciative farewell songs for those that leave us which we all sing in unison at a farewell lunch. For Valentine’s Day we all drew Secret Valentines and came in to discover something special in our cubicle. For Halloween we dressed up and trick or treated around the office. We work very hard but there’s always room for a little fun around here too.

PCI from the insider’s view is probably just as amazing as it is from the outsider’s view, this is no mirage folks. These people are dedicated to making this world a better place. We are progressive, innovative and compassionate in our overall work and within our individual office.

PCI Fights for Clean Water in Tanzania: The Babati Health Through Water & Sanitation Project

By Janna Smith, PCI Intern

“We shall not finally defeat AIDS, tuberculosis, malaria, or any of the other infectious diseases that plague the developing world until we have also won the battle for safe drinking-water, sanitation and basic health care.”

Kofi Annan, former United Nations Secretary-General

Lack of immediate access to water can have adverse effects on the health and development of a community, and especially affects the women and children of the community. In many parts of Tanzania, women and children spend an average of 6-8 hours per day accessing clean water. This can prevent some children, especially girls, from attending school, since water is usually collected by girls. Traversing long distances also leads to more danger for women and girls- including sexual assault, and rape. Children also frequently miss school due to illness, stemming not only from water-borne diseases, but also from walking long distances without shoes.

PCI has been working for many years in the area of water, sanitation, and environmental health. We have found that freeing up time for women and girls who spend hours each day collecting water positively impacts their health, education, and overall well-being, which in turn leads to positive community development and capacity building.

We firmly believe that community involvement is crucial to the success of our programs. Collaborating with community leaders is an essential part of the process to assess local needs and make decisions that would best benefit the local people. To this end, PCI has teamed up with the district council in Babati, a region in north-eastern Tanzania, and another community-based organization called ADRA/Tanzania to implement our newest water and sanitation project, called the Babati Health Through Water and Sanitation Project, funded by the Starbucks Foundation-Ethos Water Fund. This project will provide safe water for at least 30,000 people in the Babati region of Tanzania, as well as education programs for better sanitation and hygiene practices to mitigate the incidence of water-borne diseases. The project will also build rainwater harvest systems in schools within the area, so that children will have access to clean water while they are in school.

PCI has carried out successful water and sanitation projects in Central America, India, and Indonesia, and hopes to add Tanzania to the list of sustainable water projects in which women and children especially reap the benefits.

WATER IS LIFE

Access to basic water supply and sanitation services are increasingly acknowledged as fundamental for health and development, and are being increasingly accepted as a fundamental human right. In observance of World Water Day on March 22, 2008, I thought I’d share some interesting facts about this basic necessity that can help translate the global problem into terms that are a bit more easily digestible:

• A person can live about a month without food, but only about a week without water.


• A human being needs about .5 to 1.5 gallons of drinking water - which weighs from 4.5 to 11 lbs - per person per day to maintain health. Imagine carrying enough water to meet your family’s needs every day.


• Did you know the average girl/woman in Nicaragua spends 6 hours a day obtaining water? By bringing water to her household, 10 years of her life (6 hours day times 365 days times 40 years) can be freed up to be much better spent on other things such as education, economic development, and improving health.


• A third of the Earth’s population lives in “water-stressed” countries and that number is expected to rise dramatically over the next two decades.


• We use an average of nearly 40 gallons of water per person each day in our homes; our great grandparents managed with under 5 gallons.


• Many people in the world exist on 2.5 gallons of water or less each day. Our toilets can use that amount in one flush.

So what can you do??? Here are a few concrete ways you can immediately get involved:

• Join PCI and other organizations to participate in the Walk for Water that will take place in LA, Seattle and NYC on Saturday, March 22.


• Join the Virtual Walk for Water and your name will be included in a symbolic water jug to be carried by a participant in one of the local Walk for Water events.


• Create a Water Advocate page and tell the world why the cause matters to you.

Over one billion people on the planet lack access to clean, safe water. Let’s take this opportunity to effect change and make a positive contribution toward addressing the problem – one family, one village, one community at a time.

A Grandmother Finds WORTH in Zambia

Maweta Tembo sits among her four small grandchildren in the village of Chiwala, part of the Chongwe District outside of Lusaka, Zambia. A 72-year-old widow, Maweta has already raised six children of her own but now must care for her grandchildren, whose parents were killed by AIDS.

Before the PCI-led WORTH program, each day was a struggle for the grandmother. With little money, her grandchildren often went without food and she could not afford the fees required for them to attend school. But now, there is hope for Maweta.
In the Chongwe district, there are currently 5,000 women enrolled in the WORTH program. Combined, these women provide care for 11,550 orphans and vulnerable children. WORTH empowers these women by providing them access to literacy classes and economic training. With help from local organizations, women are encouraged to form self-managed community groups and taught how to manage and save money. The savings are used to create village banks that can provide local women with microenterprise loans.

After attending a WORTH community orientation, Maweta began mobilizing women in her village to form a group. After nine months, Maweta has learned how to read and write and gained basic math and accounting skills.

In January 2007, Maweta sold mangoes and managed to save $60. She used the money to buy school requisites for her grandchildren so they can continue with their education. She also received a loan from the village bank in order to start a business. Maweta is currently buying fast selling food items and re-packaging them into smaller and affordable sizes for her customers. The profit realized from the business goes towards meeting her grandchildren’s basic needs and she no longer feels the worrisome financial burden she once did.
"If WORTH had been launched years back in my area I would have been rich and my own children could have been educated!" Maweta said.

For more information on PCI’s work in Zambia, visit http://www.projectconcern.org/site/PageServer?pagename=Responding_to_the_AIDS_Crisis_in_Zambia.

Teaching by Example: The Story of Mariel

Like every morning, in a warm sector of the municipality of Santibáñez in Bolivia, anxious students of the Luís Guzmán Araujo School sit outside and wait happily, expressed through their small smiling faces. It is the beginning of a new school day and the boys and girls of the fourth grade, with their typical childhood curiosity, anxiously await the beginning of the day to learn more about the problem of environmental contamination, which days before their professor, Norma Cabas, taught them, using the knowledge imparted on her by Project Concern International.

Mariel Rodríguez Antezana, a lively and highly observant nine-year old girl who attends this school daily, tells us that her greatest aspiration is to become a teacher. With her high level of intelligence, she was quick to realize the harm that the plastic bags and bottles strewn about her community were causing to the environment.

Conscious of this harm, Mariel quickly learned to recycle this material and converted herself into a teacher's helper, telling her classmates to transform the same harmful material into pretty and useful crafts, like beautifully knit tablecloths, placemats, and bags.

This young but great teacher, with hope lighting up her face, now works laboriously together with her classmates that consider her their leader in the war against plastic.

Upon asking her what would be her greatest wish if she could have anything in the world, without a doubt in her voice Mariel answered, "I want to keep studying."

Just as it does in the Luís Guzmán Araujo School, PCI works to promote the recycling of plastic bags in more than 1,200 schools in Bolivia, and has educated to date many children like Mariel, who learn to take action in order to care for our environment.

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To learn more about PCI's work in Bolivia, please visit http://www.projectconcern.org/site/PageServer?pagename=Combating_malnutrition_and_poverty_in_Bolivia.

Project Concern and the International Year of Sanitation
- Katrina Lee
As an intern for Project Concern International, I’ve noticed that many of the topics on this blog deal with predominantly poverty and health issues. A topic that really interested me of late was PCI’s involvement with the UN’s International Year of Sanitation. Backed by the UN’s Millennium Development goals, member nations will report back to the UN on May 2008 to update on their progress in improving areas such as access to water, adequate drainage systems, housing quality, and waste management.

Access to clean water and adequate sanitation for developing communities is a major aspect of PCI’s programmatic focus and is a critical component in improving overall health for families in need. Since 2004, PCI has been implementing in a project called CASCADA, which promotes the creation of regional and national water sanitation systems that work to improve sanitation in some of the poorest areas of Central America. In Nicaragua, CASCADA has helped reorganize the country’s National Water and Sanitation Network and created four additional networks as well as community-based sanitation organizations such as community water boards.

While Project Concern International operates various other programs, I believe that CASCADA is unique in its ability to address sanitation issues at the government level while fully involving the local community. In a greater context, I believe that the International Year of Sanitation is one of the most significant milestones in progressive development. Today, simple issues such as the availability of clean water and waste removal seem far-fetched to many because of the reaches of modernization. It is important to realize that many communities to this day still lack these basic amenities.

We at PCI are committed to providing access to these basic needs, and look forward to seeing increasing progress on this front during 2008, the International Year of Sanitation.

A New Year Bring New Challenges, New Opportunities

Most folks tend to begin a new year with the best of intentions, feeling hopeful and optimistic, ready to take on new personal and professional challenges. It’s often a time to take stock and identify those lingering (and sometimes annoying) things we’ve pushed aside for one (usually good) reason or another and tackle them head on.

Well, the same feeling applies to life at a nonprofit agency – especially PCI, an organization near and dear to my heart.

There is so much to be excited about if you’re a supporter of PCI’s work. Because we’ve been recognized for all of our important work addressing the HIV/AIDS pandemic, we’ve established new programs in two more African countries, Botswana and Malawi. PCI has also expanded its role in responding to crisis situations around the globe. Last year, we helped communities hardest hit by floods in India and Mexico, Hurricane Felix in Nicaragua, an earthquake in Peru, and the Southern California fires. And PCI continues to adopt an innovative approach to its core philosophy of helping people help themselves with microcredit and other economic development programs in impoverished communities around the world.

One exciting way we plan to spread the word about PCI’s efforts in the coming year is through our Seeds campaign (www.ProjectConcern.org/Seeds). The heart of this awareness effort is a simple pledge: "You have the power to change the world. By adding your name to this pledge, you'll be joining Project Concern International in planting seeds of change to help thousands of children in need escape generations of poverty."

We think and believe that collectively, we can change the world. PCI’s programs are planting these seeds of change to create a new life and to empower individuals to be self-sufficient, healthy, and hopeful. We have the resolve to effect that change – one child, one family, one community at a time.

And now that we’re at the beginning of a new year, there’s no time like the present!