This past week a group of American
medical providers came to La Croix. Sunday we went around the clinic and
planned out our week. Sunday moves pretty slowly, so I went with a few doctors
to the clinic, they looked at the few patients there, and then we went outside
and drew up plans for a garden around the clinic. As I was measuring out
distances and trying not to step on the chickens wondering around (there seem
to be chickens everywhere) I felt like we were wasting our time. I was with two
seasoned providers, a nurse and doctor, and we were measuring out a garden. We
weren’t curing any diseases, we weren’t setting bones, we were trying to figure
out if we could plant over a septic tank. Sure the clinic was having a slow day,
but we’re in rural Haiti, we could have gone a mile in any direction and found
someone who needed medical help. Wasn’t this a waste of our time
I started to intellectualize
this, thinking about the opportunity cost to putting in a garden at the clinic.
How many people were we not treating by spending time on another project? I
didn’t get too riled up because the opportunity cost theme continued in my
thinking. The clinic is fully functional and sees many patients on a regular
basis. Everyday when I see Dr. Abel (one of the doctors in charge) he tells me
about all of the babies he delivered that day. When we went out into the
community, one of the focuses was on preventative care. Part of what Shelly
(the nurse serving with me) objective for public health is to distribute at
home birthing kits. Most women in La Croix deliver their children at home. I
thought that Dr. Abel delivered most of the babies in the area, but even though
he sees a large number of babies, he only addresses a small portion of mothers
because most deliver at home.
Women deliver at home for a
multitude of reasons; some don’t have the money to go to the clinic, some go
into labor before they can get to the clinic (they only way to the clinic is by
foot or by taxi, and I can’t imagine a woman going on a taxi after she’s gone
into labor), and sometimes women don’t feel very welcome at the clinic. This
isn’t because the doctors are nasty or the clinic is poorly run, the clinic is
one of the best run clinics in the area. The clinic is however further away
from some of the communities, the landscape around is fully of briar bushes
whose seeds stick to you and cut up your legs, and it doesn’t feel as familiar
as home. If I were a woman in La Croix, though the clinic may be more sterile,
I am sure I would feel more comfortable giving birth in my own home. Since many
women are uneducated on issues cleanliness, the sterile nature of the clinic
might not factor into their thinking, and unfortunately it might give the
clinic an even more uncomfortable vibe. The opportunity cost of delivering her
baby in the clinic versus delivering at home is something to consider.
As I considered this, I realized
the value of planting a garden at the clinic; it would make the clinic a nicer
place. No, it wouldn’t directly save anyone’s life, but might make a few more
people come by. Right now there are nasty weeds outside of the clinic whose
seeds stick to you when you go by. My legs were all cut up after marking off
the area, I can’t imagine how they might make an expected mother feel. These
weeds are a minor issue, but they are giving women incentive to stay at home
and deliver at home. If we planted a big garden, we would make the community
feel al little warmer about the clinic, and maybe encourage a few more mothers
to deliver at the clinic who otherwise would not. This garden would open up the
clinic to the community more.
This type of dilemma highlights the
difficulty with community development. In order for places like Haiti to
develop, they need to have strong community institutions like clinics. The
stronger these clinics are, the better off the community is. Part of
strengthening these clinics is having competent doctors, but another part is
having nice gardens outside welcoming people in. This type of community
development work might sound good but is extremely difficult to put into
practice. Sure everyone knows that a clinic is necessary to a community, but in
order for a clinic to function it needs patients. If a medical team goes out
and addresses all the issues in the community for free, there won’t be any
patients to go to the clinic. This means sometimes not giving people care in
the communities and forcing them to go to the clinic, which is really hard to
do. This also means that we sometimes have to plant gardens instead of treat
people. Community development is not only a shift in actions, but it is an
entire shift in perspective; we have to stop thinking “how much good can I give
these people” and start thinking “what is my part in this community”.
Many times the result of community development
is quite boring and anticlimactic. Setting a broken bone in rural village is a
thrill, making a clinic look nicer is a bore, but which supports the greater
needs of the community institutions? When we do work out in the communities, we
have to think about how we affect the permanent community institutions. The
needs of the community are usually pretty mundane, but the only way for Haiti
to move forward is for Haitians to build themselves up. American doctors can
only cure so many people in one visit, but a community clinic can treat the
community indefinitely.
Many people will come to Pastor
Pierre saying “I’m starving, why can’t you give me food”. If he sees that they
have a cell phone, he’ll tell them to sell their cell phone before he can give
them food. Even though this is better for the community as a whole, This is
extremely difficult to do. It is no fun for Pastor Pierre and it creates a lot
of resentment. Pastor Pierre would love to help as many people as he can, but
if he gives food out freely to anyone who claims to be hungry, he’ll be feeding
everyone, and anyone selling food will go out of business. He will give some
food away, but he gives away very little, and won’t give food away if people
can get it for themselves, even if that means selling their cell phone.
Though this may seem like a
depressing topic, the result is a development in its finest form; clinics
promoting public health, schools educating the next generation, and communities
paving a new way forward. There are few days in pastor Pierre’s work where he
can see a dramatic change. Much of what he oversees is pretty mundane, painting
a school, purchasing a bus, planting a garden. That said, his commitment to
community development over the past thirty years has created seven schools
teaching over 3500 children, two fully functioning clinics, and a La Croix that
improve itself.