Going Upstream

There is a parable that is often told in public health circles to illustrate why it is so important when trying to remedy a problem to look for the root of the problem and fix it rather than focusing all effort on the numerous results of the problem. The parable goes like this:

You come upon a fast-flowing stream and you see a toddler struggling to stay afloat. You jump in and save the toddler. But no sooner do you get ashore than another baby comes floating down the stream on the verge of drowning. Each time you get to shore the same thing happens and you aren’t able to save some of the babies because it’s just you. So you start calling for help and townspeople come and start helping as well. Some have good ideas about how to save more of the babies, like placing a net across the river or making a chain of people to pass the babies back to shore. Meanwhile, one person thinks to walk upstream to find out why so many babies are coming down the river. It turns out that 50 yards upstream, the fence guarding the shores has fallen and the toddlers are wandering into the stream unknowingly. The townsperson fixes the fence and you all get together to celebrate over a Gallo (the local beer).

I’ve been thinking a lot about where I am in this stream lately. I’m treating a lot of scabies, URIs, LRIs, fungal skin infections, GI parasites, and malnutrition. On any given day, I meet at least one person whose story really compels me and I think “I’m going to sponsor this person. I have the money and they really need _____.” In the blank might be school fees (one mom told me in confidence that she’s been crying a lot lately because her husband says the four girls they have, oldest being 12 years, can’t go to school anymore because there’s no sense in wasting money educating girls), money for a continuing education class (the head health promoter wants to take a social work class for $150/mo to improve his ability as a lead health promoter; another health promoter was orphaned at 4 years of age to his 80-year-old grandfather when his mom, dad, and two other siblings were killed by the army but has since showed himself to be a very bright and dedicated health promoter with a great deal of understanding about natural remedies and a desire to take some classes on the subject), money for asthma medicine (a 2-year-old girl with bad asthma has been being treated with very frequent two or three day courses of IM gent and ampicillin by local pharmacists for her resp exacerbations because her family doesn’t have the money to bring her to clinic when she gets sick or buy her inhalers). Anyway, literally every time that I have my mind set on where I’m going to put my money, I find myself stopped in my tracks by the reminder that the money I have could make a much bigger difference if I could get further upstream.

The Parrochia makes is 100% clear that their belief is that as upstream as you can get is buying people land. People will never escape the problems associated with poverty if they don’t own land. In addition, by giving them something they can use for a variety of things: build a house, cultivate coffee, open a corner store, you have given them dignity and self-determination. I buy into this notion and found myself more recently thinking that when I leave here in June, I will donate towards purchasing more plantation land to be allotted to those still living under a system of indentured servitude. The idea of land purchase is really appealing when you see the beautiful new communities of Totolya, Tierra Santa, Por Venir, and Nuevo San Andres. All are peaceful communities supplied with electricity and water in with each family has its own home as well as a front and back yard.

But this week, when we visited Vicente in Quixaya, I started to doubt that this was the ultimate solution either. Vicente’s own father had been given land by the Parrochia many years back as part of a similar resettlement. Now that parcel of land is split between Vicente and his 4 or 5 siblings and their spouses and children. Each lives in a tiny house, kids and parents sharing beds, no free land for growing fruit or vegetables (they have a couple of potted vegetables). As the numerous grandchildren grow and get married, the property will be even smaller and I have to wonder if some will return to living on a plantation, renting land they can’t afford and ultimately return to the same destitute state they came from generations before. Of course, the land grant was important and valuable and makes them so much better off than they were before but now I’m thinking that further upstream is the issue of family planning.

If people continue to have 10-12 kids, despite wanting only 2 or 3, poverty, overcrowding, and disease will continue. I’m sure, I will come to think even further upstream than this over time but right now I’m feeling like funding a program that disseminates information on family planning and makes the methods accessible is the most valuable thing I could do with my money.