Transition

Time has flown by! I can’t believe it’s April already but I’m quickly wrapping up my second and last year hear at Columbia University. My experience here is definitely ending on a high note as I’ve had the opportunity to get envolved with a couple of neat projects, had time to take more public health-based classes and even worked in the time to explore New York City a bit.

I can honestly say that the Peace Corps was the slowest experience of my life and graduate school has been the fastest. But, I’m taking my own advice with a grain of salt – as I’m only 26. Now, I’m looking beyond graduate school and figuring out “the big plan,” which to say the least – still eludes me. I often think about career paths and find that one or several would make me perfectly happy – it will most likely come down to a time and a place. I’ve tried not to think about it too much as I’ve wanted to get the most out of graduate school. My work with the New Media Task Force has wrapped up (our competition was an awesome success!) with some (or really, most) of our winners and competitors developing their ideas into reality. I had a great time listening to my fellow classmates share their ideas and learned a great deal from the judges feedback. I’m still working as a program assistant for the MPA-DP program – it’s been a blast. I’ve met with many a prospective student and I have to say that the information sessions are my favorite part of the job. Listening to people say why they want to join this program (or are considering it) reminds me of why I’m here and where I’ll be going.

I’ve been trying to find time to read novels and get out in the city as well. I’m discovering all of the wonderful historic spots here (I thought we had plenty in VA but NYC has got it made) and listening to my new favorite thing: The Bowery Boys podcast. I have to throw some publicity their way because it is honestly the funniest, best compilation of short stories I’ve ever come across. Check ‘em out.

Oh, and I’ve discovered the Farnam Street Blog – which has become addictive. I’d recommend it if you’re into exploring new literature, articles and ideas about the how’s and why’s of people and organizations. He gives great summaries that will get you on the road to learning new, awesome things. I’ve also got a long list of books piling up from BrainPickings.Org that I look forward to reading.

Finding that Academic Rhythm

It’s hard to believe that I’ve been back in New York for a little over a month now. Work with Haiti is almost all finished now – a couple more reports to write, presentations to give and meetings to have but otherwise, I’m moving onto (and sucked into) school.

I have one year left here at SIPA and I’m planning to make the most of it. I feel like my experience in Haiti gave me the time and the opportunity I needed to analyze my interests and put together a comprehensive picture of where I’m going (or rather, where I’d like to go). Now, I’m just further exploring what I’ve determined to be my future career and trying to learn the ins and outs of the business. This involves quite a few internet searches and informational interviews alongside some great old-fashioned networking. All of this in conjunction with my classes, job, work with student groups and an internship! Whew! I’ve been keeping busy.

If you’ve been following along over the summer, you’ll note that I’ve become more and more interested in behavior change for social good. I would like to branch out from WaSH and work in all areas of public health including nutrition, chronic diseases and gender policy. To that end I’m taking a course on advancing health literacy at the Mailman School of Public Health and have, happily, started to intern with a great entertainment education organization, PCI-Media Impact. They work in over thirty countries world wide alongside local organizations and governments to produce radio/TV shows on public health, conservation and community empowerment. I’ll be supporting both the partnerships department (learning how to write!) and programming for Latin America. They have a long history in L.A. and are doing some really great things there. I’m glad to have the opportunity to learn from and be a part of their team.

I’m also working quite a bit with New Media Task Force . We are planning a great competition, Innovating Mobile Technology for Development, for students to explore the ICT4D space. We’re inviting students from all universities as well as people from the “field” (I always think of green pastures when I say that) to join in, compete and network. Teams of up to four students will be presenting innovative ideas to a panel of judges for the chance to win prizes. There are many competitions like this out there (MIT has an intense one) but they are usually limited to those with a software background or professionals already in the field. This will be an opportunity for students to get creative, meet other people interested in ICT4D and network with professionals. It’s going to be on November 2nd and I’m really looking forward to it! We also have quite a few great speakers and skills workshops lined up for the semester. The other group I work with, the M&E student society is bringing in a few great speakers as well. Hopefully, I’ll be leading a workshop on participatory M&E approaches this semester for them.

I’m still digesting my experience in Haiti – but I’m sure I’ll be weaving stories about my work there into other posts throughout the year!

Community Driven Initiatives

One theme throughout this summer has been the feasibility, functionality and sustainability of community initiatives. When international aid funds fall short, as they have been, and when the outlook of future aid looks dim, many organizations turn toward community based, voluntary initiatives. Community based initiatives are fantastic but I’m worry about the extensive emphasis on voluntary community based organizations. Voluntary community health workers, voluntary water system management committees, etc. Voluntary work that, in developed countries, the government pays people to do. Luckily, for the sake of local community development, good and talented people are willing to take up this work –it’s only unfortunate that some communities don’t have such driven leaders and those that do often lack support, capacity development, and direction.

My next activity will be to develop a concept paper regarding a community driven water quality monitoring system. It is imperative that the person carrying out this work is either a volunteer or incorporates it into a job that he/she already gets paid to do. In this area though, there are few (if any) people who have paid jobs in water system management. Many of the water systems here were originally built by volunteer committees called CAEPAs (Comités d’Aprovisionnement en Eau Potable et d’Assainissement) and are free water points that are not maintained. It will be a challenge (that’s not really the right word – perhaps, a trial in error) to find a solution that benefits the local leaders to such a degree that they might carry out a long term monitoring program.

The basis of the concept paper is how to promote, implement and manage a community driven initiative based on data collection.

So far, I have some initial thoughts on what might be important when setting up a community driven process and what might be potential roadblocks and limitations in the case of water quality monitoring.

The most important aspect of a project of this sort is of course, who is involved. Without good leadership, a project with little supervision has no chance of success. And while every locality has good leadership in some capacity, the leaders also have to be invested in the project you are proposing. The question of how to find the right leaders and get buy-in is perhaps the most essential to the success of any initiative.

The second most important question is how to communicate a common vision and make sure that all parties are benefiting from the project. In an initiative where the chief objective is data collection (for monitoring purposes) – this is often very difficult. I have some ideas on how the community could gain more from water quality monitoring but have not yet determined how they might be implemented. My utmost concern is that when a community realizes that their water is contaminated, continues to test and the water remains contaminated, they may stop testing entirely without taking any action. Of course, if the water tests come back clean – the community has more incentive to test their water frequently to make sure that it stays clean. There are also ethical questions regarding whether one should promote testing that might lead people into a false sense of security as their tests come back positive or solely focus on household water treatment. That would be an entirely different post and one you might be treated to next week!

Information mapping

One of the activities we do in our focus groups is participatory information mapping. During our first week here in Port a Piment we met with one of the local doctors who advised us that what would be beneficial to map out how new health information is disseminated throughout the watershed so that organizations could choose the most effective means to reach the population. To that end we thought a good starting point might be to incorporate a visual mapping activity into our hygiene committee evaluation.

After some quick research we came across NetMap, a tool developed to plan projects and measure influence. I particularly liked the influence idea and although getting our hands on little things that might stack sounded difficult – we do have the luxury of multi-colored paper clips that my co-worker brought down from the states. We worked with the university students to make actor cards that included words and pictures (we did not know literacy levels within the watershed) for participants to use. We thought this might speed up the process and make the activity more visually appealing. The only draw back to these cards I’ve seen so far is that we cannot leave them on the table (or else it would prompt people to just use all of them) and holding them out of the view of the focus groups feels a bit secretive. We made maybe 50 different cards and included a few blank ones for actors we hadn’t thought of as well. Our only other supplies included a large piece of paper and markers.

Each participant places three paperclips on an image of their choice: pink for high influence, green for medium and blue for low. At the end we tally points for actors and share what the collective importance of different actors is for the community. We only had one focus group that after tallying up points a woman exclaimed that it was all wrong. The hospital had not received any paper clips. We explained the instructions again and re-did the exercise but the hospital didn’t fair much better. It seemed that although everyone collectively thought the hospital was important, they had more important sources of information individually.

 

I’ve felt that this activity has been just as rewarding for the community as for us. We plan to compare results between the committees and community and give the feedback with specific recommendations for each hygiene committee on how information is disseminated in their region.

The role of media in behavior change

Over the last month I’ve been reflecting on what works in hand washing. What really makes people wash their hands in different cultures and contexts, in poor and rich communities? What do WASH programs in the development field really accomplish?

In extremely poor communities, I think that largest barrier to hand washing is access. If there is not a lack of water it is a lack of soap. And if there is water and soap, it is a lack of visual queues (a sink outside the bathroom, etc.) that help people form habits. Basically, hand washing requires convenience. But on top of convenience, it requires constant reminders. How many of us have read the sign above public sinks, “all employees must wash hands” and had that influence their decision to take those few extra moments to wash their own? (At least, I hope we all have!) 

What I think many WASH programs lack is that media centered approach to washing hands. I think if you have the right message that will reach all age groups, hand washing will happen. I would love to become more involved in activities that work more on creating habits rather than teaching them. Perhaps I’ve listened to one too many talks on when you should wash your hands this summer.

Most people here in Southern Haiti feel that hand washing is purely an economic barrier. If they had the materials (a sink, soap, time) they would wash their hands – the benefits are clear. But how does a WASH program create an environment where families can obtain these materials outside of providing them? Many argue that there is a lack of desire to spend extra income on soap and that a WASH program creates that desire – but how? Should we all just switch over to business promotion? (Just imagine my sarcastic tone there…) Or should we just do a very simple cost benefit analysis to prove that even though buying soap may mean less maize, it means more maize eventually in your stomach (due to improved nutrient retention). I always tried this approach in my work in Peru and feel like it may have some effect here in Haiti but haven’t seen it promoted at all.

For all of these reasons, I love behavior change. I love WASH because it is something that is so simple, yet so complex. In rural environments of developing countries, bacteria and deadly bacteria are much more rife than in the sanitized environments of industrialized countries. I often find it ironic that development workers from these sanitized environments go to places like where I’m working in Haiti and try to improve hygiene habits that are extremely poor in our own countries.

Over the next year, I’m hoping to delve further into the use of media for behavior change in public health and learn more about how information campaigns can change consumption and behavior patterns in developing countries.

Getting Going

So, after a few weeks of being stuck in the incredibly dull office – we’ve finally got back to working again!

Our next project, if you’ll remember from a previous post, is an evaluation for CRS. In the past few weeks we’ve been doing a literature review and designing questionnaires to use with focus groups and household visits in order to assess CRS’s Health and Hygiene Committees.

These committees (there are 14 in all) were started by CRS in February in rural areas of the watershed to monitor health and disseminate information. The committees are made up by a number of people from different sects of the community. Every committee has a traditional birth attendent, a community health care worker, members of a maternal mortality surveillance committee and local community leaders (priests, principles, community organization leaders). The only people excluded from participating are any politically affiliated persons. (Politics are too volatile here)

So far, the committees have been trained on health, nutrition and hygiene, adult education and maternal health. They plan to train the committees on infectious diseases (TB, HIV, malaria) and disaster mitigation.

The committees complete auto evaluations every three months (starting in June- the first will be completed this August) where they report how many latrines or tippy taps were constructed in their area. How many education sessions they did. How many people were taken to the hospital. How many maternal deaths there were. If anyone left the committee – among other details.

Knowing this, we designed the evaluation around focus groups and household spot checks. In the focus groups we hope to learn about the administration of the committee and committee health knowledge (with questions based on what they should know). With community members, our focus groups will concentrate on perceptions of the health and hygiene committee and knowledge of health and hygiene topics. Both focus groups will look at priorities and where health and hygiene rank. The household spot checks will look at how many houses have bathrooms and tippy taps and the general “sanitation situation” of each home. We’ll also be asking more individual questions during these visits – questions about child health and their perceptions of how children become ill and the actions they take when their children are unwell.

We’ve already done two focus groups with committees as well as three household spot checks. We’ve used these opportunities to flesh out our questionnaires and make them as applicable as possible. We also used the opportunity to see how our partners do with conducting focus groups and interviews. Currently, we’re working with three university students from American University in Les Cayes who are on their summer break. They’re all agronomist students but welcome the opportunity to practice their English and get to know their communities better. They’re all fantastic, very good at interviewing and hopefully excellent in conducting focus groups.

The whole evaluation will be conducted in Kreyol and we’ll be reporting our findings to CRS in about another month.

It’s all very good news – we’re glad to be working finally and getting involved in the community. Below is a picture of one of our first focus groups – near Rendel.

A short update

This week was pretty slow. Some more school visits and a bit of desk research on participatory evaluations of rural community projects. Next week we’ll get more into the evaluation, so that should give me some more material for the blog. The hydro team will also be here from New York to do some work and teach us how to use a new water testing system for testing e. coli contamination – so I’m looking forward to that – and devising a plan to reach the whole watershed.

Some pictures to hold you over:

Our home.

Mia and Meroney on one of our hikes to a school. This week we had a hike that took us across the river several times. It had rained the night before and the water was nearly up to our waists (with a nice current to go along with it). It was an enjoyable walk – except for one  brief section where we literally had to scale a rock. I failed miserably and was following a woman with a gigantic container that she was carrying on her head full of some type of flour. The women here are marvelous at their ability to scale mountains and cross rivers without holding on to the goods they carry! Perhaps I could learn a few things about having grace.