And the work continues . . .

I am sitting in the Lima airport awaiting my return flight to the States. This is a flight I have made many times – and yet, I always feel a bit anxious about the trip. Perhaps my anxiety is born from the feelings I have leaving Peru and in the recognition that there is a great deal of work that needs to be done in preparation for my next trip.

This has been a really “full” trip – with the First Annual Arequipa Connect Conference, many meetings to plan an upcoming research project, preparations for the Second Annual Alto Cayma Healthcare Conference and Training Symposium (in April) and our outreach campaign to Carabayllo. Next week, a group from Affinity HMO in Appleton, Wisconsin will be visiting the Mission of Alto Cayma to work with Dr. Bob Gehringer and Nurse Karen Falkenstein to determine ways that the Mission Clinic and the Affinity group can establish a collaborative partnership to advance healthcare services to the people of Alto Cayma.

On Tuesday afternoon I flew back to Lima for a series of meetings with critical HBI in-country partners. These meetings are important to the on-going work of HBI as they help to establish the connections that make our work so valuable. In addition, the meetings afford a tremendous opportunity to brainstorm about future programs and projects.

Speaking of future projects - I am excited to get back to Portland to prepare for an important upcoming collaborative project in Arequipa with the University of North Carolina Wilmington School of Nursing. In early March, HBI and UNCW will be partnering on a community assessment research study to evaluate healthcare access, utilization and satisfaction amongst people of the Alto Cayma communities.

Our hope is that this Institutional Review Board (IRB) approved study will help to bring greater attention to the needs of impoverished peoples in the periurban communities of Alto Cayma and help to direct future interventions. HBI will be posting more information about this study in the coming weeks.

On a separate note - I have recently learned of a change in U.S. law that makes it easier for people to donate to non-governmental (U.S. 501 (c)(3) registered) organizations like HBI.

The U.S. Congress has passed legislation that allows those over 70 1/2 years of age to forgo their required minimum distribution for the calendar year 2009. They have also extended the legislation that allows those 70 1/2 years of age to make contributions directly to a charity. The benefit of giving from your IRA, is that you do not have to take the income on your 1040. This is a major benefit for those who use the standard deduction rather than itemizing. Should you wish to donate to HBI - please see our website for details: http://www.hbint.org/donate/money.php

As always, thank you for your support of HBI and our on-going work of serving the poor and building bridges for sustainable change.

Valle Sagrado Outreach - Photos

Photo: The Playground

Photo: A case conference

Photo: The walk home

Photo: Waiting for the doctors

Photo: Dental care

Photo: Dr. Juan - a true healer

Photo: Nurse Karen and friend

Photo Credits: All of the photos posted in this BlogSpot are courtesy of an HBI volunteer Daniel Bachhuber. Daniel is working in Peru through the month of March and will have frequent photographic updates posted to his Flicker site at: http://www.flickr.com/photos/danielbachhuber/

Daniel is an extremely talented young man with an amazing ability to capture the true essence of a situation in his photography. HBI is very proud to partner with Daniel on a variety of collaborative projects.

The Sacred Valley

What a great day! The day started as an uncertainty and quickly became a real meaningful experience for every member of the team.

After loading the bus in Miraflores (a toney neighborhood in Lima close to the coast and well known for the “gringo” amenities) we started the 2-plus hour drive to the community of Valle Sagrado in Carabayllo (and area that one of my close colleagues once described as “the end of the earth”).

Ironically, the community of Valle Sagrado is named after one of Peru’s most sacred and revered areas – the ancient and historic valley of ruins near Cusco. Once you get past the nomenclature reference – there is very little in common between the Sacred Valley of the Urubamba region (see: http://www.cusco-peru.org/cusco-surroundings-cusco-sacred-valley.shtml) and the Sacred Valley of Carabayllo.

Our “clinic” for the day was the home of Sra. Torribiya – a woman who has been a defacto community leader for the people living in extreme poverty of this region. Torribiya’s spirit and commitment to organizing a better “tomorrow” for her neighbors are inspiring. She never fails to greet our teams with a huge smile and a lovely sign (see photo).

After a quick, and very purposeful, set-up – we started to serve a sea of patients. The line seemed to grow and grow and grow. By the end of the first hour of clinic it was apparent that we would not be able to attend to the masses of patients awaiting our clinic providers. As such, we triaged the line and took a firm interest in providing the most comprehensive care possible to the patients we were able to serve.

As our goal behind this clinic was to evaluate the needs of the people in Valle Sagrado regarding their access and utilization to healthcare services – we were very focused on ensuring that our Peruvian nurse Raquel had an adequate environment to ask the detailed questions in our assessment survey. This “adequate environment” did not last long – as the droves of patients waiting to be seen pressed into the small clinic space.

Not one to be deterred, Raquel pressed forward and managed to complete almost 20 surveys (little did we know that each survey would take so much time to complete). However, by the time Raquel completed the last question on the second survey we all knew how important this information would be to the development of a comprehensive care plan for the community.

I write this BlogSpot update from the comfort of my first class bus seat as we embark on a 15-hour drive back to Arequipa. As such, I have not had a great deal of time to systematically review the data we gained in the survey – but, a cursory review has my jaw dropping. Many of the respondents described incomes at less than 300 soles (approximately $100) per month; and this is for a family of 5. Additional data revealed the depth of poverty enveloping the community: of the 20 respondents not a single family has access to indoor plumbing or water, many of families described 6 or 7 day work weeks with 12-hour days for little more than 15 Soles ($5 USD), most of the families surveyed said that they knew “where” to get medical and dental care – but could not afford the cost of transport and prescription medications. The most revealing data we retrieved pointed to a barrier that few studies have discussed – the opportunity cost of receiving care.

Raquel told me on our drive back from the clinic site to our hotel that she was very surprised at the number of people who were enrolled in the government’s SIS program (analogous to a Medicaid program for the lowest socioeconomic strata) who were unable to utilize the program due to the “cost” of missing work to attend a day long waiting game to try and get an appointment. She told me that person after person described the extreme hardship of not being able to utilize the services of the SIS program – because of the “costs” (time off work, transportation, etc.) of accessing care. By the end of our clinic day I felt that I had gained a sufficient enough understanding of the needs of the people of Valle Sagrado to help shape a proposal for expanded care delivery to one of our in-country partners.

You can only look into the eyes of child who is suffering from extreme poverty with significant empathy and deliberate intention. The pain and loneliness their eyes express speaks volumes to their needs. The goal of HBI is to help develop a collaborative response to the extreme poverty of Carabayllo and to begin to build the bridges that will allow all of the children of Valle Sagrado the opportunities of education, healthcare, and the unlimited hopes of tomorrow.

Stay tuned to this BlogSpot for more info regarding our collaborative work in the Sacred Valley of Carabayllo.

Be Flexible!

It does not seem to matter how much I travel to Peru – I have a hard time remembering that the best of any plans will often be changed.

Our team has just arrived to a hotel in Miraflores after a 14-hour bus ride from Arequipa. We are a bit sleep deprived and in desperate need of showers – but all and all, we are in really good spirits and excited for our outreach project to Carabayllo tomorrow.

That is until we were slapped in the face with a big dose of reality.

The purpose of our outreach campaign to Carabayllo (in the Northern Cone district of Lima – a sprawling peri-urban slum of over 1.5 million) is not to deliver medical and dental care, but to support the development of a sustainable outreach project to the area through a collaboration with the Anglican church of Peru’s non-governmental health care outreach program. We planned to spend the better part of 5-hours surveying the needs of the community through an administered questionnaire and through observational evaluations obtained by a team of Peruvian physicians and dentists during a small clinic outreach.

When we arrived at the hotel this afternoon we were told that there is a “political power struggle” going on in the area – and that it may be too dangerous for us to go. It seems that elections are going to take place in three of the small communities that make up the area know as Valle Segrado in Carabayllo. The officials seeking leadership positions are angry that “and America team” is coming down to make the official of another community “look good.” Through telephone conversation the leaders have alerted one of our in-country staff to this “issue” and requested that we not conduct the clinic.

Daniel Bueno Rojas, HBI’s in-country lawyer and “go-to-guy”, is traveling up to Carabayllo (a four hour round trip) to try and sort out the issues and help to smooth the way for our clinic in less than 16-hours. He seems to think that he can convince the powers that be - that everyone can “win” from the clinic and the community assessment. He is, however, concerned about the potential for violence if we show up for the clinic and we have not fully discussed our intentions with all of the elected/nominated officials.

His parting words to me as he left the hotel for Carabayllo were – “we will need to wait to decide yes or no for the clinic until around 11 pm tonight.” Alas, we are in a state of pause awaiting our next steps. Perhaps the most difficult aspect of this whole “waiting game” is that we need to get back on a bus for Arequipa tomorrow night for another 14-hours of transport.

Arequipa Connect Conference: Photos from the event

Taking Notes: A group exercise designed to create a coalition building experience

Group Exercise: Building a coalition

Presentations: Collaboratively strategizing on solutions

Meet the Press: Helping to extend the connection

The Devil is in the Details

Day two of the Arequipa Connect Confernece and our fears of a transportation strike never truly lived up to there dreaded expectations. Rather, our start time was delayed by a an hour and we were forced to talk over the cacophony of protesting marchers bounding their drums and blowing their whistles just outside of the conference hall. That was only subtle distraction to the tremendous work that went on between the conference participants on day two of our Arequipa Connect event.

Our day started with a presentation from Mr. Daniel Bachhuber about the data gathered at the end of day one of the conference. Mr. Bachhuber described the overwhelming interest that conference participants expressed in furthering the concept of a coalition (89% of conference participants submitting a completed survey indicated their interest in creating further collaboration). The data from the survey also supported the strong feelings on the part of the conference participants to share their resources - with 100% of the surveys reporting interest in resource, equipment and professional sharing. Surprisingly 41% of the survey respondents indicated that they would be interested in meeting monthly, with another 24% interested in quarterly meetings. All and all Mr. Bachhuber's report gave great credence to the need for a coalition building conference.

Following Daniel's presentation, the group listened to a report from Mr. Brian Piecuch on a small independent study HBI and MMI commissioned to determine patient’s satisfactions with health care services in the Arequipa area. Mr. Piecuch's presentation and accompanying video were very elucidating to all of the conference participants - as many of the stereotypes commonly held about the Peruvian Healthcare system were not identified as problems by the 150 randomly questioned for the surveyed. In fact, the number one complaint patients had with the healthcare services they received (we collapsed the services into 3 categories - MINSA, EsSalud and private clinics and providers) was the "wait time" necessary to receive care. Less than 5% of the patients polled felt that costs or poor equipment and facilities was an issue for their receiving services.

The report from Mr. Piecuch helped to structure the context of the conversations in our morning conference sessions. Our morning workshops focused on identifying the issues and challenges facing the organizations represented at the conference. The goal from this level of discussions was to chart out a set of common concerns that were endemic or critical to the needs of NGOs working in the Arequipa area in the healthcare sector. Remarkably - everyone seemed to share a common set of concerns: issues with customs, issues attracting and retaining volunteer providers (Peruvian, North American and others) and the poor communication amongst other organizations working in the healthcare sector.

Our afternoon sessions were moderated by Mr. Ken Kraybill and built on the exercises from day one of the conference. During a 2-hour session participants were asked to break into groups of 5 people and to identify a problem, strategize around a potential solution to the problem and then identify the critical steps necessary to the actualization of a solution. The exercise required that the groups work within the "consensus model" of decision making (see: http://en.wikipedia.org/wiki/Consensus_decision-making) and that they follow a few prescribed steps - identifying a facilitator for their discussions, designating a time keeper, and appointing a note taker. After the groups worked on their projects for a little under an hour - we reconvened the entire conference to process the exercise.

It became very clear early on in the discussion session that conference participants were excited (almost anxious) to begin the formal process of developing a coalition. With a vote and the appointment of a facilitator for the next meeting - a coalition of NGOs working together in the Arequipa area was born.

The "Groupo Connectado Arequipa (GCA)" will convene their first formal meeting on 09 February 2009. The next steps for forming the coalition will be firmly in the domain of the newly developed GCA and will more than likely take shape in the next couple of months. HBI and MMI will continue to provide technical support with help in meeting facilitation and oversight in the development of an on-line communication tool (Mr. Daniel Bachhuber has graciously offered to spearhead this project); but the new coalition strongly belongs to its new member constituents.

One thing is for certain - when you put a group of spirited, passionate and creative people into a room together for two days . . . GREAT things happen. Stay tuned to this BlogSpot for ongoing updates about the new Groupo Connectado Arequipa coalition and their burgeoning process of development.

HBI is proud to have partnered with MMI on this historic event. We look forward to future conferences that work to create bridges between groups and organizations bringing desperately needed health and social services to the poor.

FANTASTICO!

In a word - today’s conference was . . . FANTASTICO!

The First Annual Arequipa Connect Conference had over 60 participants from various organizations in the Arequipa area. The bulk of the time in today’s conference was spent allowing participating organization to discuss their programs - including their challenges and triumphs. Each NGO had 5-minutes (we were really lenient with the time keeping) to discuss the "Who, What and How" of their NGOs and to reach out to the other conference participants.

The afternoon was focused on coalition building and was amazingly facilitated by Mr. Ken Kraybill. The participants seemed to really enjoy the discussions and were excited by the opportunities for interaction and problem solving. Ken led the conference group through a series of exercises designed to everyone thinking about the concept of a coalition and the ways that they might develop a coalition.

The day’s events ended with a few more agency/organizational presentations and a "cocktail hour" for mingling and informal networking. It was a very successful day and a great start to our two-day conference. Our hope is that the strike called for on Tuesday never materializes. This maybe a fleeting hope - but we are still planning to carry-on with our plans.

The conference is a partnership endeavor between HBI and MMI - and we had a marvelous opportunity to demonstrate the power of our collaborative effort when the press arrived. Mr. Brian Piecuch and I took turns speaking to the press (almost 20 press personnel showed up for the event) about our visions for the event and our hope for more cooperative efforts toward serving the poor. To see a brief interview that was conducted on Peruvian Television, go to the following URL: http://vimeo.com/2888021

Thank you for your on-going support of HBI and our work in Peru. Stay tuned to the HBI BlogSpot for further updates on the conference and our outreach work in Carabayllo this weekend.

Arequipa Connect Conference

Plans are almost complete for the First Annual Arequipa Connect Conference. For over a year HBI and Medical Ministry International (MMI) have been planning and strategizing to bring together a broad base of non-governmental organizations working in the Arequipa area to discuss ways to collaborate and share resources. The planning has finally ended the conference beings on Monday, 19 January at 8 am in Arequipa.

The past two days have been slam packed with preparing for the conference – with meetings, last minute shopping runs and final document preparations. At this point the only real road block for the event is . . . well . . . a literal road block. Rumor has it that the labor organizations in the Arequipa are calling for a general strike (if you have not been in Peru or Bolivia for a “general strike” – think absolute shut down; nothing goes on the roads and the day-to-day life of the community halts).

The strike is planned for Tuesday, 20 January – the second day of our event. Alas there is little to nothing we can do at this point but send out good thoughts and a bounty of prayers. Hopefully, the strikers will decide that the “First Annual Arequipa Connect Conference” is far too important an event to hold up with a mass protest. Only time will tell.

Stay tuned to the HBI BlogSpot for updates and pictures. In the interim – keep those good thoughts coming.