After weeks of weeding through surveys and doing data entry and analysis, I had been looking forward to finally travelling in Zimbabwe. My last weekend here me, Patrick and Danielle (another IRD intern) went to Great Zimbabwe, which is a UNESCO world heritage site and it’s known for being the largest best preserved stone wall city in Southern Africa.

One of IRD’s country staff Mr. Charles Ncube’s family stays in Masvingo City which is near Great Zimbabwe, and he generously offered to drive us down to Masvingo which is south east of Harare and put us up at his home for the weekend as well. After driving for about 4 hours we finally got to Masvingo which is really a quaint little city with one main highway that goes straight through the city. We were warmly welcomed into Charles’s home by his wife and children, who were all impeccably dressed and patiently waiting for Charles to come home so that they could go to church.

Early Saturday morning we went to Great Zimbabwe where we met our guide who showed us all around the magnificent city for a whopping 3 hours. We started by climbing up to the Hill complex where the King and his immediate family lived. The views from the hill were absolutely stunning and then we ventured down to Great Enclosure which featured the main wall that was 36 feet high. There we watched a traditional shone dance. Most of the people we come across said that once you see Great Zimbabwe you have seen Zimbabwe. At first I doubted that statement, but once we got there and heard the history of the place it become apparent that Great Zimbabwe really influenced present day Zimbabwe, even the country’s name was taken from the site.

After visiting Great Zimbabwe we went to Lake Mutirikwe which was formed in 1960 to provide irrigation water to farmlands in the region, the scenery itself was quite beautiful and peaceful and we spent a few hours just taking in the views with Charles’ children. On Sunday I probably had the most memorable day of the whole weekend. It began early at 8:30am, I went to mass and, to my surprise, they were having a wedding or renewal of vows where the bride who was 78 yrs old was dressed in a full white gown and veil and made an entrance into the church compound accompanied by a whole troupe of singing church ladies and lots of flower girls. Her husband, to my delight, also got baptized. At 80 years old he repented and wanted to join the church– obviously there is no age limit when it comes to letting God in your life. The whole mass was so enjoyable because it was obvious everyone in the congregation was hysterical, a premature kiss between the couple resulted in the whole crowd erupting in joyous laughter. I have never been so entertained in mass. After mass we then went to a National Park to see the wild animal and after driving around for about 3 hours we finally saw 2 white rhinos that had stopped right in the middle of the road but quickly ran off when we approached them. We finished Sunday off by having a braai (barbeque) with Charles’s family and a quiet evening talking about everything we did the whole weekend, his wife is probably one of the most kind hearted women I have ever met, the hospitality we received from her was incredibly sweet and made the whole trip worthwhile.

Back in Harare, it was back to business. Patrick and I had about 5 days to finish all the necessary data analysis and write up a final report, which sounds pretty simple but we had quite a few bumps down the road and we probably spent a lot more time trying to clean the database than we expected. On Thursday evening we hosted a going away party for me and Patrick. It was so great to see people say such wonderful things about us and wish us well. The feelings were mutual on my side as I will be forever grateful to everyone at IRD Zimbabwe—Willard, the driver, who taught me a Shona word everyday , Ziggy, a mobilization officer for PROOF, who warmly greeted me everyday and even gave me a lift to church a few times, Tinashe, Kuda and Theresa who were always there to listen whenever I was having a bad day, though there were very few of those to begin with, and most importantly Themos, the country director, who offered up invaluable advice and guidance. I will miss Zimbabwe dearly and hopefully I will come back soon.

To everyone who has followed my blog entries I am extremely grateful and I hope my experience has shown you what a great country Zimbabwe is.

Nutritionist, Luis Mayer, checking-up children at the office

One of my main interests in studying theology is political theology.  Political theology, that is, the practical and the theoretical visions of what theology could be, is an attempt to reconcile theology with other academic disciplines and socio-political infrastructures.  In doing so, one is better apt to understand theology in the context of history, society, politics, economics, health, business, education, etc.  In short, the question of what it means to be a religious human being in the world is addressed more adequately.

The world we inhabit is neither secular nor religious.  Entities such as national governments, international institutions, multi-national corporations as well as the Church (or another religious institution) help form people’s conceptions on the world.  The world is both secular and religious.  It is a difficult concept to grasp as a theology student, though, since it is a dogmatic truth (being a Catholic!) that the Church is one, holy, catholic, and apostolic.  I believe that anything different from this view is false.  But, as global citizens, Christians must understand that to live in the world, participation in civic events, the local and global economy, national politics, as well as the Eucharist, is not only necessary, but inevitable.  Even non-religious persons must encounter religious language that pervades modern society, albeit many times negatively.

IRD’s work, and most developmental and/or humanitarian work, whether it is non-governmental, not-for-profit, or religious, is therefore a natural extension of the concern and respect one human ought to have for another (and his or her beliefs), labor, and history.  As social beings, our communication must be planted on fertile ground.  But, we can never forget the past: events such as genocides, slavery, civil wars, religious/racial/LGBT discrimination, terrorism, colonialism, etc.  These issues force us at all times to react positively or negatively.  Not to take into account any of these issues as religious concerns—let alone as human concerns—is to negate the existence of foolish hatred and gruesome injustices that still plague the world.  Not to take into account the existence of any of the aforementioned issues leaves one in fantasy.  A Christian is not immune to the harsh realities that face the world’s population.

My work in Colombia necessitates knowledge of history that has positively and negatively influenced the living situations of people’s lives.  In this regard, I am in no sense qualified for the work and analysis required in Florencia’s regional office.  But, after multiple conversations with IRD beneficiaries (on distribution days, institutional events, or house visits), I have a better idea of the deprivation, anguish, and hopelessness displacement causes.  Grasping the experience of being kidnapped to the jungle, separated from family, losing everything (homes, farms, jobs, money, education, etc.), and forced to live in unbearable conditions (as is common for displaced persons), is unfathomable.

Since my site of work for Contextual Education II is the Basilica of the Sacred Heart, I expect my work with IRD has prepared me sufficiently to dialogue, work, and learn with the Latino immigrant population of Atlanta.  Immigrants come from somewhere.  Immigrants almost always leave their respective countries of origin due to domestic hardships (lack of income, education, health care, domestic violence, etc.), public matters (armed conflict, political exile, insecurity, etc.), psychological instability (fear, anxiety, no sense of belonging, trauma, etc.), and lack of religious freedom.  There are motives for peoples’ immigration, and they are not always negative (drugs, gangs, etc.).

A mother and child at UAO al Barrio in El Timi

So, as I look forward to my work at the Basilica of the Sacred Heart, I wish to take into account the situations facing the difficult decision to immigrate.  Meanwhile, it is just as significant to understand the social, political, economic, and religious tendencies of afflicted persons and families unable to immigrate, since their situation is so deprived of resources.  Taking both populations into account for Contextual Education II—immigrant populations in the United States and afflicted populations in their respective countries of origin—by means of religion and theology, will be a descriptive exercise that hopefully indicates trends for why people immigrate, namely Latin Americans to the United States.  I encountered numerous displaced persons with dreams to go to the United States for a better life, but it is not that simple.  Why the United States?  Why immigrate?  Is it necessary for one to immigrate to the United States for a better life?

New Catholic church in El Timi

Working with grassroots organizations to promote social and community empowerment, like IRD, is an example how local entities can support strategies that promote brotherhood and sisterhood among afflicted persons so that immigration is not necessary.  The good life does not happen in the United States alone (if at all), it can occur anywhere, and should occur everywhere, but it requires more socially, politically, health-oriented, and religiously charged persons to bring about better livelihoods.  We must not leave this work to a single Church mission or a single non-governmental organization, we are all responsible for the damages humans have caused in the world, therefore we must all work together to attack the aforementioned issues that, although they may not affect us, nevertheless harm others.  Everyone must participate to overcome the fears and injustices that still plague our world.

The voice of the displaced persons and communities is crucial for growth to ultimately blossom.  We conduct surveys every distribution day; there’s a survey with every house visit; the displaced population is present at all the events concerning the IDP situation in Florencia.  The attention and initiative is certainly there!  But, sometimes, the interactions seem artificial as one simply jots down or clicks away at the answer to a question.  The surveys must be that way, though, so that there are numbers and figures for IRD to measure the quality of the work being done.Development, in all senses of the word, requires progression.  Progression always entails a beginning and an end, a past and a future, as well as a stimulant that nurtures that growth.  For International Relief & Development in Florencia, development is nurturing.  Nurturing internally displaced persons and communities through health, education, and empowerment allows IRD to support families’ and communities’ progress from a bleak and anxiety-ridden past toward a more stabilized future.  The growth IRD hopes to see in beneficiaries is not one divergent from one’s past—and one’s identity—but one moving beyond one’s former troubles by re-establishing oneself through nutritional, social, and political integration.

Me during a survey on a distribution day

The surveys must be that way, but the whole interaction with the displaced persons doesn’t have to.  So, whenever I’m in charge of conducting a survey, a house visit, or meeting with members from La Mesa de Desplazados (“The Committee of Displaced Persons”), I look back in time to my days at the Gateway Center for Contextual Education I.  The Gateway Center is a homeless services center in Atlanta, which makes my comparison nearly ridiculous.  Atlanta is a thriving urban center whereas Florencia is a small city surrounded by huge patches of green.  However, all my knowledge concerning the art of dialogue and listening is based on my formative interactions with the homeless persons of Atlanta.  Simple things yielded great trust in those exchanges: being present, being patient, being an active listener, creating space for the dialogue to flow, not acting as if one should always give answers, which made way to life-learning experiences.  I practice these same techniques in my interactions with the persons seeking support from IRD.  As a “chaplain” at the Gateway Center, being present and attent allowed the other person to know I was there for them.  And, by being there for them, I too, was in a position where the other was there for me.  The art of dialogue is the art of listening and the art of communication.  It’s not always about giving answers or responses.  Many times, if not all the times, it’s about what one receives, hears, and understands that makes listening crucial for someone’s development—for the other and for me.

Development also consists of reaching a goal, of reaching justice cooperatively.  The historical progression of one’s woes and thoughts must be confronted.  Everything must hang, that is, everything that frustrates, scares, enjoys, and saddens one, must be brought out for true justice and reconciliation to be reached.  Facing that which confronts us causes lament, but, in turn, peace and justice might be reached.  IRD does a good job to let the people know who they are; they are victims of heinous crimes, but there’s a light at the end that can be reached with support from others—neighbors, international organizations (IRD, International Red Cross), national government (Acción Social), local government, etc.  IRD wants to hear what bothers people.  As a chaplain one also wants to hear what bothers people.  That story (or stories) might contain more information than one at first notices (generative themes, as we’ve learned them).  By delving into these loose strands one finds that the other person may be trying to get at something deeper.  Afterward, one is better equipped to confront the situation together with the person seeking support.

One of the members from La Mesa de Desplazados indicating some necessities of displaced elders

Reinaldo (the psychologist) and I met with members from La Mesa de Desplazados (the grassroots initiative begun by representatives of displaced persons in predominantly IDP barrios or invasiones) one Saturday morning to write a document for the mayor.  The document consisted of bringing forth the needs of the displaced population in Florencia.  We sat down and conversed about the lack of services for the youth and older adults.  We talked for hours and finally came up with a decent document.  The needs are great, but the motivation for a solution is great too.  The grassroots initiatives, such as working with La Mesa de Desplazados toward creating events and documents to make the displaced population known in Florencia, are terrific ways to make issues known.  For example, an event named the Golombiao will take place in August (which I helped plan with Reinaldo), which will involve at least 250 persons from eight different barrios.

Reinaldo speaking before displaced persons in the town center

In all my experiences with underrepresented persons, I learned that change and development takes time.  Proper development doesn’t occur willy-nilly nor does it happen fast.  Proper development requires human evaluation that begins with hearing another’s history up to that point of contact.  Any attempt to develop the social and political re-integration of displaced persons in Florencia requires the voice, thought, understanding, and cooperation of the displaced persons and communities.  This type of development necessitates acute hearing, concentrated focus, total expression, and a reconciled approach toward justice.  The other thing I learned was to remember that the other, no matter his/her situation, always has something to offer: the communities, the barrios, the invasiones always have assets (whether it is the youth, cooperation, skills, etc.).  This is something, as a chaplain, I needed to learn to be an active participator in someone’s life—and allow the other person´s life in mine.  Although I am not representing a religious body during my internship in Colombia, I am certainly making my internship represent a stage in my religious development.

This past week I went to the nutritional recovery center for the last time to check in on a little girl that we referred there a couple of weeks ago.  While the nurse was taking the information we needed, I saw that one of the babies was not in a crib, but in a basin on the floor lined with blankets. Her skin was splotchy and she had an intense look on her face and I went ahead and picked her up.  After holding her for a few moments I noticed that her hands and feet were severely disfigured.  Instead of palms her hands and feet were sort of like a V coming off of her ankles and wrists with two fingers at the ends.  She can sort of stand, but will never walk normally (or possibly at all). I had never seen that and I asked the nurse what it was and whether it was genetic or a disease.  The nurse told me that the disfigurement is caused by the chemicals that the government uses to fumigate to coca crops in the fight against drugs.  The chemical gets into other crops and the water and there are apparently a lot of children with the same condition.  I was thinking more about it and I am curious about what chemicals are used to fumigate the fields, who manufactures them and who pays for it.  Mostly, I wonder if American anti-drug money is being used to buy these chemicals that are having such a negative effect on the population.  When I thought about the situation and the chemicals being used, the image of the “Made in USA” label on the canisters of teargas that were used to quell the Egyptian riots flashed in my mind.  It also highlights (in fact my whole experience in Tumaco highlights) how easily whole populations are affected and discarded byproducts in the war between the armed drug cartels and the military.

Last week we did our first trial with the household surveys.  Overall, I think it is a good survey. It was a success and we got good information.  We need to do a few adjustments, but overall I think it is going to be a useful tool for IRD.  I am a little concerned about it though.  As we were going through the survey one of the mothers got upset and started to cry a little.  I think she was embarrassed of her home and possibly thought that we were judging her. I tried to soothe her worries and explain why we were taking the survey (to improve the data on the subject and hopefully improve services down the road), but it left me feeling bad.  The survey is tricky: on the one hand, it is an incredibly useful tool that will provide data where there is currently a gap and hopefully lead to projects to fill those gaps, but on the other hand, the surveys are very personal and could be seen as an invasion of privacy.  The people that we are surveying say they want to participate and we hope it is a sincere desire to participate, but we have to wonder if they are participating because if they don’t they think they may lose the assistance we provide.  I don’t know what to do about it yet – the nutritionist and I are discussing some strategies to address this and hopefully we have some kind of answer by the time I go. I think we have to make the survey voluntary and clearly explain that they won’t lose any help if they don’t participate.

I am spending this weekend painting the educational materials with the nutritionist because he will be out of town next week.  It’s my last week in Tumaco. I want to thank everyone for reading.  I also want to thank Dr. Jenkins and IRD for sending my here – this has been an incredibly useful internship and learning experience. Every day I learned something new and I’m taking home a ton of lessons that I hope to apply in my future public health career.  I think I’m ready to go back; I’m definitely looking forward to sleeping in my bed, seeing my friends, picking fruit, and eating pie. And, though I’ve learned that I can happily live off of seafood and fruit, I am looking forward to some vegetables in my diet. At the same time, leaving Tumaco is bittersweet because I’ve met some wonderful people here, most of whom I’ll never see again. I’m learning that comes with the territory in this field.  The IRD team here was wonderful and saying a small goodbye to a few people on Friday was more emotional than I expected it to be.  I’m going to miss working with them and I’m going to miss Tumaco. I hope to return one day, but in the end, who knows? I feel lucky that my experience here was positive and I won’t forget my time here anytime soon.

Yesterday the day started with the nutritionist at IRD asking if I wanted to go to the nutrition center. I said yes, thinking it would be great to see how Lady was progressing and see what was going on there. I knew that there was some tension between the center and IRD lately –a case had gone poorly (a baby girl had died) and there is an ongoing investigation and the center was getting a lot of heat and they thought it was because of IRD. I didn’t know we were going to the center to hash it out. We got there and received a frosty reception (though I did get to see Lady and she is back to a healthy weight and eating like a fiend) and were ignored for 20 minutes. Then we went into an office, sat in a mini circle while the doctor and three other employees at the center chewed us out for 20 minutes. I thought it would only be a couple of minutes, but he kept going and going and he told us about how the center’s name was being dragged through the mud and how a mother had heard they had killed a child and wasn’t letting them take her child and how the doctor was being personally investigated. It was awkward and all we could do was sit there. I had some idea of the background, but did not know that it had gotten so bad for them and they had every right to be upset. Then the nutritionist talked and told the IRD side and showed documentation showing that IRD had not done anything improper and how IRD had also documented from the start that the center had not done anything wrong (they never even saw the girl because they couldn’t – she had developmental issues that they are not prepared to handle so we could not even refer the child to them). He also promised to support them in the investigation and made everyone feel like things were going to be okay because IRD and the Center had done nothing wrong – there were just a lot of rumors floating around that needed to be cleared up. It was pretty amazing to see the situation go from toxic to good in the 20 minutes the nutritionist talked. I was impressed. It is also interesting to see how the two organizations worked together to fix the issue. There was a lot of talk about lessons learned from this experience and a discussion about how to improve the relationship to keep something like this from happening again. In the end, the whole situation will make the both organizations a little smarter and ready if something like this happens again.

In the afternoon I went on some home visits with the IRD nurse. The first house was one of the houses built on sticks on the water. Walking out to the house we were warned that the plank path to the houses was wobbly. It was a gross understatement. I am a pretty confident person when it comes to walking on wobbly things, but the whole thing shook and swayed with every step. It seemed like the thing would collapse at any moment. It was lot more precarious than I had imagined. Then, the house would move slightly every time I took a step and all I kept thinking was that the water below was filthy. I looked for fish and didn’t see any – I figured I would see something because it is on the ocean, but there was nothing but trash and swimming kids. It’s hard to describe – well, not hard, it’s a terrible situation and I feel bad that anyone has to live in those conditions. I know that not everyone lives in the best situations and I have been to some poor houses, but there is nothing good about these houses. The only thing separating people from filthy water is a thin board. And it’s not just a few houses or one neighborhood in Tumaco, it is thousands of people, thousands of families and lots of kids.

We talked to the mother about nutrition and weighed her child and went to the third house of a woman with a malnourished child that we wanted to refer to the center. She was nervous and understandably did not want to give her child up for a month. We started to talk to her about how great the center was and I showed her pictures of Lady and the progress she made in two and a half weeks (it was really a hard sell) and we finally took her to the center to check it out. They were very happy to see us in the afternoon and were welcoming to the mother. She is taking her child there tomorrow and I know in less than a month she is going to be a lot healthier.

Last week I was riding with Richard in the truck and we were talking about our upcoming trip to Barbacoas. I have been looking forward to it because it’s a chance to drive into Colombia more and see something besides the coast. The trip to Ricaurte, though terrifying, only had me more excited. Richard was telling me that I shouldn’t tell anyone that I’m American, that on the trip I was going to be an Argentine because it might be unsafe as an American. I noted it, but didn’t take it too seriously. Then today, the boss in Tumaco told me that I wasn’t going to Barbacoas because it’s unsafe and there have been some kidnappings lately. Shoot.

I think that when it comes to the relationship between people from other countries and the United States, Americans walk on a very thin line and we have to work hard to impress and not mess up because people are wary and looking to have their suspicions about the US confirmed.

Yesterday, the nutritionist and I went to the IRD warehouse to take inventory of all the supplies that were donated from the Comfort.  There were 10 full pallets that we had to sort – 6 from the Church of Jesus Christ of Latter Day Saints, 2 from Project Cure and 2 others.  We spent all morning and part of the afternoon going through the LDS materials and documenting everything. I was impressed by how much stuff they donate, the quality of the packaging, how well it was labeled and how easy it will be to distribute even though it is a ton of stuff. Then we moved to the Project Cure pallets and it was a lot of different kinds of boxes (a lot of Barnes and Noble boxes) that were poorly marked.  There are probably 80 big boxes we have to sort through (we did 30 yesterday).  We opened the first one of catheters and I noticed that they were all expired.  As we started sorting through the boxes, 80 percent of them had expired equipment (and not expired in 2010 either, expired from 2008, 2009) or things in open packages or used stethoscopes wrapped in gauze.  I was very upset and disappointed and then the nutritionist said, “Americans, they like to pass off their useless things to developing countries because they don’t care.” I know where that sentiment comes from, but it stopped me cold, because it crystallized for me how difficult it is for Americans to improve their image. Here we are in a warehouse full (and I mean stuffed) with free, new, donated American goods representing the goodwill of many organizations in the US and these two pallets (that represent 2% of the goods) from Project Cure wipes all that good away and the image people are left with is of thoughtless Americans giving developing countries their leftovers, their scraps.

On a brighter note:

Last Sunday Richard invited me to his house for lunch to meet his family.  I loved it – I love when people open their homes and share their lives with me.  It was my favorite thing to do in Uganda and I think that it is the most welcoming gesture that one can make to a foreigner.  I hope to pay it forward in Atlanta and in the future.  Richard has a great family and an adorable three year old. He came and picked me up on his scooter (which is not bigger than mine) and all 400 pounds of us rode across the two islands to his house.  On the way I took time to appreciate how much people can fit on the back of their trucks and motorcycles, and I like the chances people take.  It makes me feel like we are chicken in the US to test how much we can tow (or are scared to break a law).

I have two weeks to go and now we are working on the projects that I hope to leave behind.  I did not want to leave here knowing the housing was such a big issue and that I didn’t do anything, so we are using my public health training and have created a survey for the home visits.  I figure that IRD should be collecting data about the housing on the home visits that will give a stronger (quantitative) voice to the problem and that one day can be used in a proposal that can address the problem.  The survey is based off the international SPHERE standards and my hope is that it will show how big a problem the housing is here in Tumaco.  Then the Peace Corps volunteer in me is pushing better, simpler teaching materials for the mothers and trainers (based on the Mango Tree model – I have to give them a donation for using their ideas) and I also want IRD to start a soccer team sort of based on the Fugees Family organization in Atlanta.  I think it would be great to start a team of displaced kids to instill a sense of community and tie it to education and tutoring.  People in the office like the idea and now we are trying to sell it to Bogota because it probably would not be cheap (though, if I were a Peace Corps volunteer I could probably do it for close to free).

On the way to the office on our first day in Bogota, the operations manager was telling me how excited she was because the Comfort was coming.  She spoke softly and I didn’t catch it all, but I knew that it was a big deal.  It wasn’t mentioned again so I forgot about it until I got to Tumaco. Here, the office was getting ready for the Comfort and they knew something was going to happen, but they didn’t know how IRD was going to be involved. People thought that we were going to go to the ship, maybe help unload medical supplies (the IRD supplies were actually airlifted by helicopter and delivered by truck to their storage facility).  Then, last week, there were a lot of emails back and forth between a nurse on the Comfort and the office in Bogota, with me being copied because I speak English and would serve as a translator. As I wrote last week, the emails asked us to organize a group of midwives for training. We asked about covering transportation costs for the midwives, but we never heard back.  I got a final email last Friday asking me to forward the list of midwives to another person on the boat, which I did.  Then I waited.  Monday was a holiday, Tuesday we did distributions.  I had heard a rumor that we were going to the boat on Thursday, but Wednesday passed and we heard nothing.All this time, the medics and nurses from the Comfort had taken over a school and were providing medical care for people here in Tumaco.  There Navy doctors and nurses provide medical care for difficult cases and surgeries. The school has military security all around it and dozens of people waiting outside the door hoping for the promise of American medical attention.   I guess I don’t like the idea that this boat shows up for a few weeks, does a few surgeries and takes off leaving everyone wondering why they were left out and not really knowing what goes on behind those walls (admittedly, I don’t know what’s going on back there either – it’s all rumors and people think that the miracle they need is just on the other side of that wall).  I guess it is good publicity for the US (which is needed here) with them swooping in, saving some people and leaving with the promise of coming back (there is a billboard in front of the school that says “Comfort and Colombia, a promise kept” with a picture of a Navy officer, a Colombian army person and a Colombian in a hat).  I wonder what kind of work they are really doing and (now I’m not a doctor) how they follow up with patients when they are only here a couple of weeks, especially when they deal with difficult cases.  I guess that I’m more comfortable with work that is built up more slowly and has a chance to continue making an impact afterwards.  But then again, these Navy doctors are doing work that can’t be done locally and they are saving lives and that is good also – another one of those situations that is difficult to really come down on one side or the other.

On Thursday we went on a field visit to Ricaurte and around 3 pm I got a call from the office telling me that the Comfort called and on Friday I was supposed to meet the midwives at 7am for a training at 8.  I had to be at the school and ask for a nurse and if I couldn’t find her, ask for another guy.  I didn’t have their last names, it was disorganized and felt rushed and all I could say was “sure.” I read the email that the nurse sent and she went on and on about how this training was essential and would save lives and how excited she was.

On Friday morning I took a motorcycle to the school. I got there and met the midwives and we were sent to the training entrance and the whole thing went surprisingly smoothly.  It was decided that the Comfort people would pay for the midwives transportation, but they only had dollars and were going to give all the women a dollar bill.  I thought that was silly, so I collected the 35 dollars and went to get it exchanged to pesos.
The training was about what to do when a baby wasn’t breathing and it was okay, but the nurses were training very qualified midwives (8 of the 20 women had delivered over 4000 babies) and asking them to use a hand respirator called an ambu.  None of the women had one of these and in the end the nurses gave away a few, but the ambu was the most important part of their training. Another nurse told the midwives that when a baby dies the mother should hold the dead baby because, in America, studies show that it is better for the mother.  She went on to explain that in other countries sometimes they did not let the mother hold the baby because it is taboo and how that was bad.  I’m not a big fan of telling people that their culture and traditions are bad and I wanted to say that, but it wasn’t my place.  In the end I talked to a few of the midwives and they told me that they learned some things, so it wasn’t all bad.

Last week the nutritionist and I sat down to try to create a short nutrition survey so he can get a better idea of the nutritional situation of the displaced population here in Tumaco and teach to the gaps.  I was doing some background research to see what kind of questions we wanted to ask when I came across a World Food Program report about Colombia.  They had looked at nutrition in several other provinces but not Tumaco and their first question was how long the family had been displaced. They didn’t really go into it a lot in the report, but the question got me thinking.  They divided people who were displaced in displaced 1-3 months, 4-9 months and over 9 months, but then did not explain differences in diet among the groups.  I wondered if after a year the diet of displaced people is generally better or worse.  My gut reaction is that if you were to do a food survey after a year the diet would be better than when they arrived because they have lived in their new community for a year and know the markets and are “settled.” But then I started thinking that, at least in Tumaco, for the first three months, people who are served by IRD get a ton of free food. Then the government provides free food for the next 6 months (which coincidently lines up with the WFP timeline) – how settled are people really? How well do they know the markets? How much did they learn about nutrition in those 9 months both from programs and by seeing what was distributed? Did that change their buying habits? I could imagine a scenario where, after a year, people are actually eating worse than they did during the first nine months.

I would love to know because I think it raises a lot of interesting questions about whether or not the aid that IRD and the government provide is actually doing any good in the long term.  Again, my gut reaction is that giving the food is a good thing, especially for the kids who show signs of malnourishment much more quickly than adults and the aid in the short term can prevent that.  I do worry about long term distributions and creating a culture of dependency – but then what is the right amount of time?

I was at dinner with a personwho is working with disabled people in Tumaco.  We were talking about the displaced population in Tumaco and he asked if I would rather live in a village in Uganda or be displaced in Tumaco. I was surprised by how quickly I knew that I’d rather live in Uganda.  To be fair, I am comparing two completely different situations.  The situation for displaced people in Tumaco is that of a continuing complex humanitarian emergency. The people who live in these neighborhoods have moved there recently and come from different places, where in Bududa families have lived there for generations. That means that the displaced population here does not have the same established sense of community because people are constantly coming and going.

I just can’t get over the living conditions (I know I’ve written about this a lot, but I’m stuck on it). The man at dinner was telling me how one of the guys he interviewed that week broke his back when he fell through one of the wooden plank walkways and now he’s paralyzed and spends most of his days in on a mattress in the corner of his mother’s house alone a lot of the time.  I was thinking how in Uganda, things aren’t always great, but at least there I had an idea where to begin, or you can see where if some changes were made (albeit big changes) then schools could and health facilities could be improved.  But in Tumaco, I don’t have any idea where to begin (another reason of course is that I have only been here a month and spend my time in a hotel instead of being in the community).

I was thinking about the kids and how good the schooling of a displaced child is.  Yes, there are laws and procedures to get them into school, but there is constant moving and stigma when they do go to school and I am sure that a lot of them do not go to school.  It just seems like the rest of Narino (the province that Tumaco is in) is bleeding into Tumaco and it is bad for the families and it is bad for the town, which does not have the resources and capacity to handle over 120 new families a week. This is why you get the poor housing, sick and malnourished children, and higher rates of violence and disease.  The whole system in Tumaco is overburdened and there is no end in sight. I guess this is why they call it a complex humanitarian emergency.

I was also thinking about IDP camps.  Colombia has the second largest internally displaced population in the world, but, unlike Sudan, people here do not live in IDP camps. They have to find their own homes and services.  I immediately compare the situation to the camps I saw in Uganda and I think that I would rather live in a camp (and I know I would rather work in a camp). Now, again, I don’t know a lot about camps. I visited a few in Uganda and drove past many others. The camps in Northern Uganda are over 20 years old and are more like towns.  But I do know that when people are in camps it is easier to have an accurate count of people (though the numbers are hardly ever accurate as we have learned over and over) and to distribute goods and services, because everyone is centrally located.  In Northern Uganda several camps were built by schools so the kids could still go to school.  It just seems that here in Colombia it is easier to lose track of families or even ignore people because you don’t know where they are.  At least in the camps there is a sense of accountability. The UN establishes the camps and there are minimum standards for living (which are not always met, but there is at least something to build towards). It seems like it is harder on both sides – there are many families here that do not receive services because they do not know what is out there and don’t even know their rights as displaced people (I think that educating people of their rights is one of the most important functions that IRD carries out) and it is harder for NGOs or the government to provide services directly (some of the neighborhoods here are too dangerous to enter).  Then again, I wouldn’t want to be forced to live in a camp – so, like everything else, it seems I can’t really come down on one side or the other.  I just see that people are being ignored and the situation is not good and getting worse and trying to think of where to start.

We went on a home visit today in a neighborhood I hadn’t been to yet.  It must be a newer neighborhood because the wooden walkways between houses haven’t been built (but they seem like older houses).  This neighborhood is on water and when the tide comes in people are forced to stay in their houses or wade through the water. Like other neighborhoods, they use the water below as their toilet with the thought that the tide going out takes away all of the filth.  The house we visited was one of the worst houses I’ve seen so far.  It was two rooms, the door had no lock and the hinges were made of string.  There was a big hole in the floor (big enough for the baby to fall through for sure) and one bed where the family of three (mother 18 years old and 2 kids- 4 years and 2 years old) slept.  The kitchen had a small area for the plates and there was a board on the floor with two bricks and the part of the stove you put the pots on (I don’t know what it’s called) lying across them to cook on.  They build a fire underneath the bricks, in the house to cook.  I asked about the bathroom and she told us about going in the water and letting the tide take it. We asked if her kids played in the water and she said of course.  I asked where she got water and she said “en la llave” or the tap.  I went outside to look for the tap and did not see one.  I asked a neighbor and she pointed in the direction of the tap.  I walked and didn’t see anything and she said, “right there.”  I looked and looked around and didn’t see a tap and asked where and she pointed to a small tube sticking out of the ground. I couldn’t believe it – it almost seemed inhumane to ask people to drink water from this hose.  It was surrounded by trash and is definitely underwater when the tide comes in.  I asked and they said the water has been out for the last 8 days and I swear that is the first time I’ve ever thought that a lack of water was a blessing.   Going to this house today makes me wonder if a camp is really worse.

As we were driving to the second house I was talking to the team and telling them that I could not live like that and how I am still struck that this is a choice and that this option is better than where people are fleeing from.  The nurse told me that this morning they had gotten a lady who just arrived in Tumaco after she was told she had 10 minutes to leave or they would kill her.  I asked the driver how long these neighborhoods had been around and he told me that they started being built in the mid 1990s and before it was all beaches. There have apparently been efforts to get people to move out, but as soon as someone leaves another family moves in. The houses are worlds away from what is in Bogota and also worlds away from the rest of the (not displaced) population in Tumaco.

IRD’s mission is to close humanitarian gaps in Tumaco.  I think they do an amazing job at what they do – they get people in the system and provide direction and orientation within the system while also providing aid.  I think what they do is important and there is a need for it and the people in this office work incredibly hard.  But I look around these houses and neighborhoods and living situations and wonder how to put a dent in that problem, how to make the lives of displaced people here better.

It’s been three days since I’ve been back to the IRD office in Gnommalath town.  I’m sticky with dried sweat and still a little groggy from waking up at 5am after going to sleep after midnight.  But, we needed to have enough time to leave Talong village in Boulapa District and arrive in Hainoua village, Mahaxay District, before everyone went to the fields for the day.

After conducting the assessment of the First Aid Kit in three villages so far, our team now has a pattern.  As the IRD Health Officer begins with the assessment questions, I turn and begin an inventory of the contents of the first aid box.  What medicine and materials have been used the most?  Which medicines are about to expire?  Have any of the medicine or materials been replaced using community funds?  As I look through the box, checking off each roll of gauze or packet of paracetamol before replacing it, I notice a bottle of pink pills.  The pills are in a bottle marked “Berberine” but they are definitely not berberine.  When I ask the community volunteer what they are- chloroquine- I’m surprised.

South East Asia was the epicenter of the emergence of antimalarial drug resistance to chloroquine.  While only one strain of malaria, P. falciparum, is resistant to chloroquine, it is widely believed to be the most dangerous.  And the only ways to differentiate between strains of malaria are too expensive and difficult to perform in rural communities like Hainoua village.  With another wave of antimalarial drug resistance emerging close by on the border between Thailand and Cambodia, this time to artemisinin, it’s more important than ever for communities to be aware of the dangers of drug resistance.

“But why does chloroquine not work now, when it’s worked in the past?”  asks the community volunteer responsible for the first aid kit.  I pause for half a minute, wondering how to explain the development of drug resistance in English words and concepts simple enough that the IRD administrative assistant will be able to effectively translate for the community members.  Eventually I explain “Every time malaria meets a drug and survives, it learns how to survive a little better.  When drugs are not chosen or used correctly, malaria learns more quickly.  Chloroquine has been used for over fifty years- malaria has had a long time to learn how to survive against chloroquine.”

Even though the community had purchased chloroquine to treat malaria in a chloroquine-resistant part of the world, I was very impressed with Hinoua village.  The entire Education Development Committee had come for the assessment meeting, and their dedication to and ownership of the project was evident.  Aside from successfully developing a plan to continue financing the first aid kit, they had decided as a community what medicines were truly needed.

The chief’s wife in Pah Panang village, Boualapa districtm clears away the dishes from dinner- steamed fish, fish soup, and sticky rice.  Night has fallen while were eating, and community members have quietly slipped in during the meal to join us on the floor.  Soukasien, the IRD Health Officer, and I are here to assess a small first aid program.

A little over a year ago, remote communities with limited access to even their local health clinic were chosen from the 150 communities that IRD currently serves.  A volunteer within each community was identified, provided a large first aid kit, and given a three day training to learn how to diagnose and treat common illnesses and injuries.  While the community volunteer was, of course, free to treat other community members, the priority was providing basic care to children attending school.

The village chief and the community volunteer take turns answering questions as it gets later and later into the night.  With enthusiasm, the community volunteer describes how the community developed a plan to sustain the first aid program once the donated medicine and materials in the first aid kit run out.  Every child at school is charged Kip 5000 for the year (about 60 US cents)- a fee every family can afford.  The funds are pooled and are available when new medicines and materials need to be purchased.  This way, the chief states, “No sick person is charged.”  If you are injured or ill, you don’t have to first wonder if your family has enough money to be treated.

The first aid program has already had a significant impact on the school children in Pah Panang.  Before, a teacher had to walk a sick child home and wait for the parents to come back from working in the fields.  The child (and teacher) missed the rest of the school day.  But now, the child can be given a little medicine, allowed to rest for a half hour, and can then rejoin their class later.

While the most common illnesses the volunteer treated were stomach aches, toothaches, and fevers- he wished he knew more.  Sometimes, he said, he is not sure when an illness is serious enough to refer the patient to the local health clinic- he is eager for more training to help his community.