Community-driven change: Part 2

by Ayesha Khan

“The more I see, the less I know for sure.”John Lennon

Perceptions can be faulty. We should try to base the work we do on data and evidence, not just what we see as a need.

It can be difficult to assess what is most needed when you set out to work in a low and middle income country (LMIC). Need is subjective and our perception is colored by our own biases. Too often, we let perception influence the direction we take with our projects.

As I mentioned before, Haiti received $13.81 billion dollars in aid after the earthquake, most intended for rebuilding. Yet 360,000 people remain in tents after losing their homes to the 2010 earthquake. Where did that money go? You may think it was lost to the corruption of the government, but actually only 1% went through the Haitian government.

Most of the funding went to NGOs, and just like people, NGOs are not all the same.NGOs have their own perceptions – sometimes true needs, sometimes only perceived needs based in the “mind” of the NGO. NGOs answer to board members that may not be on the ground, and much of the money donated to NGOs post-earthquake went to groups already in Haiti pre-earthquake. Many of these NGOs had costly plans in areas far from Port-au-Prince and didn’t redirect funding to match the changing needs of the country.

To ascertain if local need matches your perceptions, find some data. Data collection is often difficult in LMICs, but available in some form if you need it.

In Fort Liberté, we went to the hospital and asked the hospital director, Dr. Deacom, if she had any data on deaths and patients that come in to the hospital. She took us to a room with piles of paper charts thrown every which way organized only in the mind of a man named Fritz. Somehow Fritz extracted 2,000 charts for us that had all emergency visits between the years 2009 and 2010, one year prior to the earthquake and one year after. Collecting data from charts is possibly one of the most tedious tasks known to mankind; tedious, yet essential. (All research was reviewed and approved by The Human Subjects Committee at the University of California, Berkeley.)

Our tedium discovered that there are 5 times more emergencies in Fort Liberté than HIV, malaria and TB cases combined! Yet these three diseases are funded 225 times more. What’s more, the median age of visitors the Emergency Room in Fort Liberté is 15 to 29 years old.

Moving beyond the perceived need of help for HIV, malaria, and TB, evidence shows us that people with preventable emergency death and disability in Fort Liberté are in the most productive years of life, and disability in this age group is particularly devastating. There is an urgent need for emergency care in Fort Liberté.