Is Doing Good Bad?

This post is a little different than others.  It has to do with the ethical questions of what we are doing here in the DR--or with any outreach or mission venture, really.

I recently read a book called Toxic Charity:  http://www.amazon.com/Toxic-Charity-Churches-Charities-Reverse/dp/0062076205    

 

The book had a profound impact on me as I wrestle with the question of whether these kinds of trips and work are a good thing.  Who are the trips for?  Who do these trips really benefit?  As the title of another book suggests, how do we go about alleviating poverty without hurting the poor or ourselves?

You might think:  "How could I possibly be hurting other people by going down and doing medical clinics and bringing them clothing and things that they can use?  How could I possibly hurt other people by sharing ways of doing things that are better than what they are currently doing?"

So let me address the first of these questions:  How could I possibly be hurting other people by coming down here to the DR and doing medical clinics and bringing them things they can use?

One of the public health clinics

The clinics that we do here are a wonderful thing in many ways.  We bring a variety of medications that are often not available here in the local clinics.  While the government health system does have a series of clinics all around the country, even in the rural communities, these clinics often do not have a steady supply of medications.  So patients come to the clinic, receive a consultation, but then leave with a paper prescription because the pharmacy in the clinic does not have the medication in stock.  The majority of people we see at these clinics cannot afford to buy these medications at the local pharmacy--if there is one. So we come and are able to help by providing medications that these people may need.   While we may only provide a 30-day supply of a medication, and that patient will then still run out and have to go without.  Is that doing more harm than good?  Many would answer with a resounding "Yes."  Why start something you can't possibly finish nor sustain?

So at one of the clinics we did this past week, we saw a woman who had recently had two of her toes amputated because of uncontrolled diabetes.

This woman had to have her last two toes amputated three weeks prior to her visit to our rural clinic as a result of uncontrolled diabetes.

While I am sure that those of you reading this blog and seeing this picture are a bit queasy at the moment at the sight of this foot, these are the harsh realities that exist here.  I held this woman's hands while she buried her head in my shoulder as the doctor took Betadine-soaked gauze and cleaned the wound.  He then prescribed a stronger antibiotic and a stronger medication to manage her blood sugars.  We were able to give her three months of the medication. Did we do a good thing?  Most would answer again with a resounding,"Yes."  

So what is the difference between these two situations?  I struggle with knowing how much should be done.  And I have to find a way to answer these questions if I continue to come here and work with these great people.  

In both cases, I think something good came out of the clinic we provided.  In the case of the hypertensive who receives only one month of medication, we provide a small amount of education, a great deal of encouragement, and a sense of hope.  We also probably provide this person with 30 days of lower blood pressure, less severe headaches, and perhaps slightly greater productivity.  We haven't cured the high blood pressure.  Nor have we managed to create a sustainable change such that when we leave, the good that we have done can continue on.  It can't.  Without a steady supply of medication, this person's high blood pressure will certainly return.  While we haven't created a lasting change medically, we did impact this person's life in some way.  I guess I can only hope that doing so is a start.  As for the woman with two fewer toes--I think this is a great example of how these kinds of clinics can do good.  This woman received some antibiotics that could prevent a potentially deadly infection--and she received enough to help her get through the healing period that has the greatest risk.  She also received three months of a stronger med to control her blood sugars.  By managing her blood sugars, even if only for a short 3-month period of time, she has a chance to heal.  If her blood sugars remain completely out of control, her healing would be impeded.  Our presence potentially could have provided life-saving interventions for this woman.  In this case, we can't provide long-term sustainable care, but we may have just managed to get her healed to the point that she can survive and continue working to make sustainable change.

So what in the world could be bad about these trips, anyhow.  Isn't handing out toothpaste and toothbrushes to those who don't have any a good thing?  Isn't giving people who have worn out shoes a new pair a good thing?

A recent chain email going around posted this commentary:

The food stamp program, part of the Department of Agriculture, is pleased to be distributing the greatest amount of food stamps ever. Meanwhile, the Park Service, also part of the Department of Agriculture, asks us to “Please Do Not Feed the Animals” because the animals may grow dependent and not learn to take care of themselves.

 

Despite the fact that this post is incorrect in saying that the park service is part of the Department of Agriculture (It's actually under the Department of the Interior), the idea remains the same. Do we create the same situation when we simply give people things rather than teach them what they might need to survive over the long term?  As a parable in The Bible notes, if you give a man a fish, he eats for a day.  If you teach a man to fish, he eats for a lifetime.

One thing that is important to me is the idea of doing "sustainable aid."  What do I mean by that?  I mean avoiding "drop and run" efforts and focusing on doing something that will continue to make a difference once I am no longer here doing what I did.  How do I come and provide a source of assistance that will last longer than a 30-day prescription or a pair of shoes?  

Providing education about microbes and disease prevention.

One thing that is really important to me is educating people so that they have working knowledge.  I understand that just because someone knows what to do doesn't mean that it will happen.  But without knowledge, there is no real chance of making change.  We have a collection of "stuffed microbes"--stuffed animals shaped like microbes--that we can use to help educate people about causes and preventions of various diseases.  We provide some education and dialogue about Botulism, Cholera, Typhoid, Cold/Flu, Dengue Fever, and Giardia.  We get the people involved in the conversation and try to make the education visual and fun.  My hope is that they will think back and remember the funny nature of a bunch of Americans trying to explain the dangers of these microbes and what they can do to prevent them.

I try to provide solid information about nutrition and health issues.  But what information is necessary to impart to do good, and what might I be saying or teaching that does harm?  So now you might ask, How can providing information do harm?  The people here in the DR have a special and unique culture.  There are some things that they believe and do that runs counter to my own culture.  I try to think about whether what I teach is trying to impose my own cultural viewpoint and values or if it is really something that impacts their health and well-being.  Let me try to provide an example.

Today I went to visit a friend whose wife just had a baby.  There is a prevailing belief here among Dominicans that a new mother and baby should not leave the house for 40 days.  That's nearly 6 weeks.  To me that seems extreme.  Where I come from, moms and babies are out and about at a young age.  Is that a piece of educating that I need to try to emphasize?  What major good can come of trying to change a basic custom and belief here?  This belief is a part of their culture, unique to them, and it's something that works here.  Why change it?

On the other hand, there is a practice and belief here that one needs to add sugar to milk in a bottle so that it's sweet for the child, or else the child won't drink it.  There are several issues with this practice.  For starts, children get to a point where they will not drink unsweetened milk.  If one doesn't have sugar handy, then the milk is turned down.  Yet milk is very important for a child's health and well-being.  Feeding kids excess sugar is also providing empty calories.  In a world that is increasingly battling obesity--even in developing countries--taking steps to avoid that can be important later in life.  This country has a strong prevalence of Type 2 diabetes.  Maintaining healthy eating habits can curb this risk later in life.  This is a belief I would want to challenge and change.

But there is a fine line between what I believe is the "right" way to do things and what is culturally desirable and not threatening to one's health and well-being.  I think than many times when we try to help others, we try to impose our own notion of "what is best" and as Americans, we often think that we indeed do know best.  I have to be careful to remind myself that I don't always know what's best, and my way may be a disaster.

Some of the students from the first week of my August trip to the DR.

So here I am with a group of students who want to "do good."  Not a one of them would intentionally do harm.  And we all need to be thinking about why we are here and what we are doing.  Our presence, our communication, our actions--all impact the people here in some way.  We are also impacted.  But in the process of experiencing wonderful things for ourselves and enjoying a beautiful trip and feeling good about the things we are doing, we need to be ever mindful of the impact of our presence, communication, and actions on the people with whom we work.  We must always remember that WE are the VISITORS in someone else's country.  We need to learn from them probably more than they need to learn from us.  

A couple of ONU students with their new Dominican friends--learning from the kids and sharing themselves.

Just a little food for thought the next time you volunteer to HELP in some way.  Is your "doing good" really good?

A Day in the Life of a Rural Dominican

Dominican children with jugs getting ready to go collect water

I have been asked to share a little bit about the average day in the lives of the Rural Dominicans.  Doing so is much like asking me to chronicle the average day for an American.  The Dominican people are diverse people with a variety of activities and jobs that make up their world.   Nonetheless, I will try to share some of the more common elements of life here for many of these people.

I have been talking with a lot of different community members, asking questions that will help guide my thesis in my Public Health program at Wright State.  I am learning a great deal about the customs, beliefs and practices of these people.  So I will start with meals and food-related information since that is what I am most directly working with in my thesis project.

This woman is outside her home cooking in her "kitchen" under the tarp.

The average Dominican eats twice a day with no real snacks in between.  The first meal is some sort of breakfast.  Usually breakfast is coffee with lots of sugar, and if people can afford it, bread or plantains.  Eggs, ham, salami, cheese, and other more substantial foods are generally not readily available because of the cost.  Eggs cost 5 or 6 pesos each.  The exchange rate is $1 = 38 pesos.  That means that a dozen eggs costs nearly $2.00.  The second meal of the day is usually mid-afternoon.  This is the big meal of the day, and the staple here is rice and beans.  People eat more rice and beans than any other food.  It is readily available, reasonably affordable, and most of all--it fills you up.   Today I spoke with a woman who said that they eat mean in their family "sometimes."  She bought a skinny chicken yesterday, so they had meat last night.  The chicken cost 135 pesos ($3.55).  There are 11 people who live in her house, so 11 people had to share that one chicken.  No one gets much meat that way, that's for sure.  Even today when the Dominicans brought lunch for the Dominican members of our team, there was no meat.  Whenever possible, they try to provide meat, but today there was none--only rice and beans.

I talked to a woman yesterday named Chandra, who lives in Ana Patria.  She is married and lives with her husband and 5 children, ages 12, 10, 9, 5, and 9 months.  Her husband is in the army and earns 5,000 pesos a month.  That is about $132.00.  I was interested in learning about their meals and eating habits.  The most common meal is rice and beans.  I asked her if they ever ate meat, and she said “sometimes.” When I asked how many times a month she ate meat, she said, “twice.”  I asked if they ate eggs, and she said they did not.  When asked why, she said they were too expensive.  I then asked if she had chickens.  They have two, but they are too young to lay eggs at this point. And if the people do have financial resources to buy food, they are limited as to what they can buy. Most people only have access to local vendors or colmados.  Below is a picture of a colmado and what can be purchased:

A colmado and the limited items available to most people in rural communities.

As you can see, there is a limited number of options, even if you do have money available.  There are a few canned goods, some bread, rice, beans, oil, spices, and some snack foods and candy.  If you don't buy your food products here or grow your own, then you buy from locals who sell their goods.

Vegetables for sale alongside the road

Crucita and two of her 7 children.  She is the person I spoke with today who bought the skinny chicken.

I asked the woman I spoke with today (above) if she grew her own vegetables.  She told me that she didn't have a garden because it didn't rain enough.  Water is a dear commodity here.  We passed a house yesterday that was particularly nice--it was concrete with no cracks, had a concrete floor, had a garden, and had a water tap outside.
One of the students remarked that it is sad that the way one can measure some degree of wealth in the DR is by whether they have water on the property or not.  That standard seems to be so minimal.  Yet the standard is so real. 

Today when we were in Estancia, we were in a school on the main road, and there were houses across the street that were quite nice.  They all had gardens and nice homes and some had cars.  One family -- all three generations-- were sitting on the front porch shelling guandules (pigeon peas).

Three generations shelling guandules

This family lives on the main street, and immediately behind them is a running water source that comes from further up the mountain.

Water source running behind the houses on the main street in Estancia

Most of the crops in this region failed this year because of a lack of rain.  With no water source, there is no way to garden.  Those people who do not live with this water source passing through their property must walk quite a distance to get to water.  You cannot just cross someone's property to get water.  As a result, they must lug that water (as in the first photo).  The family pictured here shelling guandules is most fortunate because they live on the water way and were able to prevent their crops from failing as a result.  Water really is a key to wealth, and this community really demonstrated this aspect of life here.

For many Dominicans, there is little available work.  In the barrios where we have been working, the majority of people try to make a living through agriculture.  There is a high level of unemployment here.  Crucita (the woman pictured above) has been unemployed for over a year.  She had worked in a store and in a club, but both businesses failed, and now she is out of work.  There is very little industry here, so there is not a lot of opportunity for work.  If a person is able to afford to send a child to high school or a child is able to go to college, then there are greater opportunities for people.  But since so few people have regular jobs and income, many people are simply unable to go to high school or college.  And because this is an island nation, there is not much manufacturing.  Exporting products is extremely expensive. The largest industry here is tourism, and that tourism and money is limited to the coasts. 

The Dominican Republic is listed as a Medium Developing Country by the United Nations.  The reason for that is because of its GNP level.  Its GNP is skewed by the extraordinarily wealthy landowners and resort owners.  Because there is so much wealth in the tourism industry, it skews the picture of what the rest of the people in this country actually make and have available to them.

A Dominican Home in a rural barrio.

Many of the rural Dominican homes are much like this one or much like the outdoor kitchen under a tarp above.  These homes have dirt floors.  They leak terribly.  They are miserably hot because they are made of tin and wood.  They are structurally unsound.  This is the reality of life in the Dominican Republic for so very many.

One thing that many students and foreigners notice is that a lot of Dominicans "just sit around" outside doing nothing.  These people are usually unemployed with no prospects for work.  The temperatures are hot and make working outside difficult.  If there is no water to drink or places to cool off, then not exerting oneself in these conditions is actually a healthy thing to do.  But rest assured, they are not doing "nothing."  They are creating a sense of communion and community that is so crucial to survival and happiness here.  While the Dominicans have little in terms of material goods, they are so wealthy in relationships and spirituality.  We in America have so much and want more and are miserable because we don't have what we want.  The Dominican people have so little and are so grateful for what they do have.  Maybe there is a lesson to be learned from these people.

So that's what I can say about a day in the life of a Dominican.