Friday, January 22, 2010

Humility

Photo: Luis Enrique, the Peruvian volunteer that introduced us to
Hogar de Vida and one of the children from the home.

This afternoon I had the privilege to visit a small non-government organization (Hogar de Vida) that focuses their services toward HIV+ children and their mothers.

Sitting on the dirty sofa in the practically empty living room of the home, I watched child after child run around and play. The house was filled with mother's and their kids. The Director told us that the house reaches maximum capacity at 21 women and children - but that they routinely take more and have them sleep on the floor or wherever they can fit.

She told us that the organization works with practically nothing. They receive a small amount of food from the government programs - but this food is never enough to feed the more than 70 HIV/AIDS women and children that come to the house everyday for food (this is in addition to the 21 families in the house).

She asked if we could help them to purchase a "milligram" scale so that they could accurately measure the medications they needed to provide to the children every day. She told us that they had been struggling to use the old scale because it failed to provide accurate readings - and "getting the right dose for the child is very important."

She told us of her struggles to gain the financial donations to send all of the children to school. For, although their tuition to school in the public system is free - they needed to pay the extra expenses to keep the children in the schools. She told us that the cost for one child is not great - but when compounded by 21 children, the task becomes almost impossible.

As we talked with the Director a few of the children came to the sofas where we were sitting. They instantly gravitated toward Christina (a wonderful young Peruvian-American woman who volunteers to help translate for our work). They hung on her arms and affectionately hugged her chest.

Watching the little girls made me realize that there is so much more that we can do. It made we realize that the work we are seeking to accomplish will never end. It made me realize that ever little child deserves the best care, love and compassion we can possibly offer.

Sitting on that couch today with two little girls who are both HIV and TB positive - was really humbling.

A Little Vitamins . . . and a lot of love

For over 3-years, HBI has been helping to sponsor a young girl and her family living in one of the poorest areas in Lima. I went to visit Ines and her mother this afternoon - and, well . . . she looks great.

Certainly, the skin condition that plagues her entire body is not completely gone; but, she is living her life now. She has had special orthopedic shoes made that allow her to walk without continuously traumatizing the soles of her feet (setting up the cascade for horrific blistering and unbearable pain). Her mother tells me that she absolutely loves school and is a little "Chatty Katy" when she gets home every afternoon.

The money that has been donated to help with the "Medical Fragile Children" program has gone to purchase medications for Ines, to supplement her nutrition, to help defer the costs of schooling and to help the family carve out a better life for themselves.

It is really amazing what came happen to a child when she is given the basic materials to grow and prosper. It is really amazing to see "life" flow through her beautiful little body.

Our hope is that we can help to structure a program that will expand the work of advocating for the needs of medically fragile children living in extreme poverty. And, today I think we got one step closer to that hope.

I am forever humbled by the little souls of this world that persevere in the greatest of lifes challenges and circumstances. I am forever touched by the love of Ines.

Thursday, January 21, 2010

Vida Peru

I spoke with a group of some 100+ physicians and dentists tonight at the annual volunteer appreciation event for Vida Peru.

Vida Peru asked me to speak about the work of HBI and the concept of volunteerism. Mind you, speaking to a group of 100+ people at 5:30 p.m. on a Thursday night is never an easy task - but that task was made a significant degree more complicated when you consider the fact that I was speaking in English with a translator. Thank you so much to Reverend Pat Blanchard for her fantastic idiomatic translations.

By the end of the talk only 2-3 people in the audience were snoring, and only a half a dozen or so others had their eyes closed. Not too bad. No, seriously. It was a real honor to be the "key note" speaker for our partner agency's event. I am really excited by the turn-out and more excited by our partnership with Vida Peru. I see a real future for our collaborative efforts to get more Peruvian health professionals volunteering.

I will be meeting with Vida Peru and our staff lawyer (Dr. Cesar Daniel Bueno Rojas) tomorrow morning to discuss the development of a conference for Peruvian providers in September. We are talking about promoting a conference to educate Peruvian healthcare professional working in impoverished areas about the "primary care approach to diagnosing and treating diabetes." We plan to have a one day intensive CME conference and a one day clinic in an impoverished clinic.

Stay tuned for more details on this upcoming project. We will be seeking volunteer presenters (any endocrinologists out there want to come to Piura - in the North of Peru?) for the conference in the coming weeks. The work never ends - and boy, it sure is great (even if I have to be away from my lovely wife and our beautiful Little Alex).

Sunday, January 17, 2010

The Need is Great

Like many of you, I have been closely following the media accounts of the tragic earthquake (and the horrific aftermath of human suffering) in Haiti. It seems almost overwhelmingly to fully comprehend the level of tragedy.

HBI has been receiving a number of inquiries as to our potential involvement in Haiti. I have been in e-mail and telephone communication with a number of people who are looking for a mechanism to help. I completely understand the need to help, and . . .

The "and" for me is this - now is not the time for a rush to action in Haiti by HBI. The critical response to Haiti and the needs of the Haitian people is best facilitated by organizations that focus their efforts toward disaster situations. What Haiti most needs right now are teams that are well-equipped, well-trained, fully supported to work in chaotic circumstances.

Military, government and NGO teams are working together to develop viable mechanisms to deliver basic supplies (food, water, medicine, hygiene equipment, etc.) to people suffering in the desperation. Search and rescue teams from around the world are using their honed skills to locate survivors trapped in the rubble. Doctors Without Borders/Médecins Sans Frontières is desperately working to bring their expertise into the country to facilitate triage hospital services and "front line" care delivery. The Red Cross is putting together delivery mechanisms to get food and water to isolated areas of the island nation. And organizations like Partners in Health continue to delivery high quality care in makeshift clinics and hospitals.

Our support should be focused on helping these wonderful efforts. Now is the time to donate to the numerous emergency response efforts that will save lives and decrease suffering.

In the future, as the need for "bridge building" efforts become the focus of the needs in Haiti - HBI may be involved. The mission of our work is to support in-country organizations and efforts. The best way that we can do that is to shine the spotlight on the work of the organizations that are making a difference in Haiti today. In my opinion, the best thing that HBI can do at this time is to encourage our supporters to donate to organizations like Partners in Health and the American Red Cross.

There will be a time for organizations like HBI to get involved in supporting Haitian efforts to rebuild their country - but until then, we will support those organizations that are fully equipped to meet the immediate needs of the people of Haiti.

Monday, December 14, 2009

Change - Yes we can

It is possible - really possible, for us to change the world. How? It has got to start with a massive level of committment on the part of everyone.wwd_world2.jpg

If everyone in the United States committed to volunteer one day per month - imagine the change that would happen. Here is what I am proposing - suppose everyone in the United States spent 4-hours each month volunteering with some organization, project, or program.

The key would be that the volunteer experience must be focused on making a difference in another person's life. This could be working with the Humane Society helping to create greater adoption options to find good homes for abandon animals or helping with a local Food Bank to inventory their stockroom. Whatever the volunteer experience - it must be about stepping outside of yourself. It must be about giving a part of yourself to another through service.

Imagine the possibilities. We really could (scratch that word) - we really CAN change the world!

Saturday, December 12, 2009

Creating Change - real, lasting change

For a long time I have had some very fixed ideas about creating sustainable change. For most of my career I have envisioned change (true, lasting change) coming from a "bottom-up" vetting process. Change - empowering, confirming, life altering change - I have held, would be a part of a bigger paradigm shift that would come when people were provided the basic tools they needed to "actualize" a new existence. This of course happens when we work together to help one another. It comes when we willing and able to provide caring, compassionate help.

Okay, don't get me wrong. I still believe that true change must come from the "bottom" and penetrate into the bastions of our societies. I do, however, think there might be another way to look at how we are involved in helping to create that change. I am going to make a small modification to my belief. My change of attitude comes to me by way of a wonderful movie that Lee and I watched recently.

The movie, The Blind Side, is based on the true story of Michael Oher and his incredible rise to the National Football League (NFL). The story is the tale of a powerful relationship that developed between Michael Oher and two extraordinary people (Anne and Sean Tuohy). Central to the story is the movement of Michael from the impoverished projects of Memphis to an upper crust private school and a starting position on the high school football team. The controversy comes into the story by way of a strong relationship that develops between the Tuohy's and Michael.

Their relationship is built from a simple need - Michael was a young, economically disadvantaged, homeless adolescent with few options. The Tuohy's were a wealthy, well-positioned, socially established family who were alumnus of the University of Mississippi. Eventually a series of steps take place that move Michael from a life of homelessness to the Tuohy's home, and eventually to a full scholarship with the University of Mississippi and a career with the Baltimore Raven's of the NFL.

These steps, simple movements really, are the focus of my "shift" in thinking regarding the help that we can provide to others. What I took from the movie was this - it doesn't really matter what drives our desire to help . . . we simply must help.

In the long run, if Michael was the "product" of the Touhy's desire to develop a top notch NFL prospect who could go on to play for their alma mater Ole Miss; or if the Touhy's were simply carrying out their Christian (the Touhy's were involved in the development of one of the largest Evangelical Churches in Memphis, TN) mandate of being their "brother's keeper." It does not matter!

I now really, truly believe, that change is more important than the "motives" that lead us to help others in the process of sourcing change. Okay, please do not get me wrong, moral and ethical rules still apply; but it seems to me that providing help (opportunity) is the critical piece of the change equation - not the reason that a person is compelled to help in the first place.

Okay here it is - the boilerplate statement: we can only change the world by accepting that fact that we are all a part of that change.

Sure, some people out there will be driven to help from the ethos that percolates in every aspect of their beings. But let's be honest, many of us will be motivated by a bit more self-interested reasons. In the end, if fewer children go to bed hunger, if more people have safe, affordable housing to build their lives, if more people feel safe to express their sexuality without concern for societal reprisal, if more opportunity is available for people to leverage a new life experience - then the reason we are engaged in creating that change is not that important.

So - let's get out there and help . . . regardless of the reason we are helping (yeah, yeah - all moral and ethical precepts held in consideration). Let's create a better world that will ensure that EVERYONE has an equal opportunity to become who they are really, truly meant to be.

Thursday, December 3, 2009

We Truly Can Make a Difference - By Modeling Behaviors

The following article appeared in the NY Times on-line edition. I found the article to be very compelling. It states that our desire/ability/propensity to help other may be innate.

This is extraordinarily encouraging and gives drive to the work of NGOs and faith based groups who are seeking to "model" (through the work of compassionate service) the age old adage of "becoming our brothers [and sisters] keepers."

It seems that we are really driven to make a difference and support others in the world - maybe all we need are the opportunities to continuously engage those inner drives.

Read on -

December 1, 2009

We May Be Born With an Urge to Help

What is the essence of human nature? Flawed, say many theologians. Vicious and addicted to warfare, wrote Hobbes. Selfish and in need of considerable improvement, think many parents.

But biologists are beginning to form a generally sunnier view of humankind. Their conclusions are derived in part from testing very young children, and partly from comparing human children with those of chimpanzees, hoping that the differences will point to what is distinctively human. The somewhat surprising answer at which some biologists have arrived is that babies are innately sociable and helpful to others. Of course every animal must to some extent be selfish to survive. But the biologists also see in humans a natural willingness to help.

When infants 18 months old see an unrelated adult whose hands are full and who needs assistance opening a door or picking up a dropped clothespin, they will immediately help, Michael Tomasello writes in “Why We Cooperate,” a book published in October. Dr. Tomasello, a developmental psychologist, is co-director of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.

The helping behavior seems to be innate because it appears so early and before many parents start teaching children the rules of polite behavior. “It’s probably safe to assume that they haven’t been explicitly and directly taught to do this,” said Elizabeth Spelke, a developmental psychologist at Harvard. “On the other hand, they’ve had lots of opportunities to experience acts of helping by others. I think the jury is out on the innateness question.”

But Dr. Tomasello finds the helping is not enhanced by rewards, suggesting that it is not influenced by training. It seems to occur across cultures that have different timetables for teaching social rules. And helping behavior can even be seen in infant chimpanzees under the right experimental conditions. For all these reasons, Dr. Tomasello concludes that helping is a natural inclination, not something imposed by parents or culture.

Infants will help with information, as well as in practical ways. From the age of 12 months they will point at objects that an adult pretends to have lost. Chimpanzees, by contrast, never point at things for each other, and when they point for people, it seems to be as a command to go fetch something rather than to share information.

For parents who may think their children somehow skipped the cooperative phase, Dr. Tomasello offers the reassuring advice that children are often more cooperative outside the home, which is why parents may be surprised to hear from a teacher or coach how nice their child is. “In families, the competitive element is in ascendancy,” he said.

As children grow older, they become more selective in their helpfulness. Starting around age 3, they will share more generously with a child who was previously nice to them. Another behavior that emerges at the same age is a sense of social norms. “Most social norms are about being nice to other people,” Dr. Tomasello said in an interview, “so children learn social norms because they want to be part of the group.”

Children not only feel they should obey these rules themselves, but also that they should make others in the group do the same. Even 3-year-olds are willing to enforce social norms. If they are shown how to play a game, and a puppet then joins in with its own idea of the rules, the children will object, some of them vociferously. Where do they get this idea of group rules, the sense of “we who do it this way”? Dr. Tomasello believes children develop what he calls “shared intentionality,” a notion of what others expect to happen and hence a sense of a group “we.” It is from this shared intentionality that children derive their sense of norms and of expecting others to obey them.

Shared intentionality, in Dr. Tomasello’s view, is close to the essence of what distinguishes people from chimpanzees. A group of human children will use all kinds of words and gestures to form goals and coordinate activities, but young chimps seem to have little interest in what may be their companions’ minds.

If children are naturally helpful and sociable, what system of child-rearing best takes advantage of this surprising propensity? Dr. Tomasello says that the approach known as inductive parenting works best because it reinforces the child’s natural propensity to cooperate with others. Inductive parenting is simply communicating with children about the effect of their actions on others and emphasizing the logic of social cooperation.

“Children are altruistic by nature,” he writes, and though they are also naturally selfish, all parents need do is try to tip the balance toward social behavior. The shared intentionality lies at the basis of human society, Dr. Tomasello argues. From it flow ideas of norms, of punishing those who violate the norms and of shame and guilt for punishing oneself. Shared intentionality evolved very early in the human lineage, he believes, and its probable purpose was for cooperation in gathering food. Anthropologists report that when men cooperate in hunting, they can take down large game, which single hunters generally cannot do. Chimpanzees gather to hunt colobus monkeys, but Dr. Tomasello argues this is far less of a cooperative endeavor because the participants act on an ad hoc basis and do not really share their catch.

An interesting bodily reflection of humans’ shared intentionality is the sclera, or whites, of the eyes. All 200 or so species of primates have dark eyes and a barely visible sclera. All, that is, except humans, whose sclera is three times as large, a feature that makes it much easier to follow the direction of someone else’s gaze. Chimps will follow a person’s gaze, but by looking at his head, even if his eyes are closed. Babies follow a person’s eyes, even if the experimenter keeps his head still.

Advertising what one is looking at could be a risk. Dr. Tomasello argues that the behavior evolved “in cooperative social groups in which monitoring one another’s focus was to everyone’s benefit in completing joint tasks.”

This could have happened at some point early in human evolution, when in order to survive, people were forced to cooperate in hunting game or gathering fruit. The path to obligatory cooperation — one that other primates did not take — led to social rules and their enforcement, to human altruism and to language. “Humans putting their heads together in shared cooperative activities are thus the originators of human culture,” Dr. Tomasello writes.

A similar conclusion has been reached independently by Hillard S. Kaplan, an anthropologist at the University of New Mexico. Modern humans have lived for most of their existence as hunter gatherers, so much of human nature has presumably been shaped for survival in such conditions. From study of existing hunter gatherer peoples, Dr. Kaplan has found evidence of cooperation woven into many levels of human activity.

The division of labor between men and women — men gather 68 percent of the calories in foraging societies — requires cooperation between the sexes. Young people in these societies consume more than they produce until age 20, which in turn requires cooperation between the generations. This long period of dependency was needed to develop the special skills required for the hunter gatherer way of life.

The structure of early human societies, including their “high levels of cooperation between kin and nonkin,” was thus an adaptation to the “specialized foraging niche” of food resources that were too difficult for other primates to capture, Dr. Kaplan and colleagues wrote recently in The Philosophical Transactions of the Royal Society. We evolved to be nice to each other, in other words, because there was no alternative.

Much the same conclusion is reached by Frans de Waal in another book published in October, “The Age of Empathy.” Dr. de Waal, a primatologist, has long studied the cooperative side of primate behavior and believes that aggression, which he has also studied, is often overrated as a human motivation. “We’re preprogrammed to reach out,” Dr. de Waal writes. “Empathy is an automated response over which we have limited control.” The only people emotionally immune to another’s situation, he notes, are psychopaths.

Indeed, it is in our biological nature, not our political institutions, that we should put our trust, in his view. Our empathy is innate and cannot be changed or long suppressed. “In fact,” Dr. de Waal writes, “I’d argue that biology constitutes our greatest hope. One can only shudder at the thought that the humaneness of our societies would depend on the whims of politics, culture or religion.”

The basic sociability of human nature does not mean, of course, that people are nice to each other all the time. Social structure requires that things be done to maintain it, some of which involve negative attitudes toward others. The instinct for enforcing norms is powerful, as is the instinct for fairness. Experiments have shown that people will reject unfair distributions of money even it means they receive nothing.

“Humans clearly evolved the ability to detect inequities, control immediate desires, foresee the virtues of norm following and gain the personal, emotional rewards that come from seeing another punished,” write three Harvard biologists, Marc Hauser, Katherine McAuliffe and Peter R. Blake, in reviewing their experiments with tamarin monkeys and young children.

If people do bad things to others in their group, they can behave even worse to those outside it. Indeed the human capacity for cooperation “seems to have evolved mainly for interactions within the local group,” Dr. Tomasello writes.

Sociality, the binding together of members of a group, is the first requirement of defense, since without it people will not put the group’s interests ahead of their own or be willing to sacrifice their lives in battle. Lawrence H. Keeley, an anthropologist who has traced aggression among early peoples, writes in his book “War Before Civilization” that, “Warfare is ultimately not a denial of the human capacity for cooperation, but merely the most destructive expression of it.”

The roots of human cooperation may lie in human aggression. We are selfish by nature, yet also follow rules requiring us to be nice to others. “That’s why we have moral dilemmas,” Dr. Tomasello said, “because we are both selfish and altruistic at the same time.” (Copyright 2009 The New York Times Company)