In my previous sentence, just before I wrote the word “experiences,” I paused to consider what adjective might be appropriate to describe the last two months.  None seem to fit correctly.  Even in the now 34,000 words I have written about these past nine weeks, I know that things have been lost in communication – that there are things that I will never be able to answer to the casual “How was Kenya?” that I am so often asked.  It is interesting to visit a place with the intent not only to appreciate what it is but to also explore what you can do to change it.  Almost like getting to know a person, I have come to both admire all that Kenya has to offer and at the same time appreciate and understand her flaws.  At times during this trip, I was elated, depressed, optimistic, frustrated; I taught and learned, I spoke and I listened, I took and I gave.  There is no adjective I know to describe that.

I am grateful for the opportunities that both Duke Engage and the Foundation for Sustainable Development gave me.  I am grateful for the graciousness with which I was welcomed into the Iguhu District Hospital and the home of Mama Joyce, and I am thankful for the support I received from friends and family at home and colleagues of mine in the field.  Without any of these, the experience would not have been as fulfilling as it was.  To be able to walk away after two short months and know that a difference has been made is a true gift that I have no words to give thanks for.

I think now would be an appropriate time to summarize my projects at the hospital and to identify our accomplishments.  At the beginning of my internship, I conducted a collaborative needs assessment out of which came a list of development objectives from virtually every hospital department.  While a final workplan was being composed, I began a project to enhance the exterior landscaping of the hospital which was quickly taken over by the grounds staff.  I then designed and implemented a patient wait time survey for the hospital by which average patient wait times for each department could be measured.  Along with the hospital secretary, I compiled and analyzed the results to produce a report on the project findings and submitted the report to senior hospital administration.  I then began a four-week training program in which I trained both medical and non-medical personnel on basic life support skills and the use of emergency medical equipment which was generously donated by sponsors from the United States.  A thorough set of training materials documenting everything covered during the program was left at the hospital for future trainings.  Simultaneously, I networked four computers at the hospital and designed and implemented a database program for the hospital to use.  Iguhu District Hospital is the first hospital in the Western Province of Kenya to have acquired a system capable of completely computerizing patient records.

When I began my internship and designed the project to train hospital staff on basic life support skills, it became obvious that the hospital and I lacked the resources to complete the training because we would be unable to teach the staff how to use critical medical equipment since the hospital lacked this equipment and had no ability to acquire it.  As such, I turned to friends, family, and supporters in the United States to provide funds required to carry out the project.  I asked for $1,000, and my request was exceeded by the hospital’s extremely generous donors.  With the $1,100 that the fundraising campaign raised, the hospital and I were able to purchase medical equipment for the hospital and facilitate medical training among its staff.

Donations to this project were unique from donations that are generally given to organizations working in the developing world.  The equipment that we were able to purchase using donated funds was used in training and thus empowered the community to drive its own development.  Far from solving the hospital’s problems for it, the donated money gave the hospital the tools it needed to address the issues it had by transferring skills to the people themselves.

These skills are inherently useful because they can be used to provide higher quality healthcare to the citizens of the area.  However, the potential for development as a result of these skills extends far beyond this obvious benefit.  Armed with the knowledge of how to use basic equipment in emergency medical situations, the hospital staff is now better positioned to petition the Kenyan government for more equipment and can make informed requests of their government concerning the exact nature of equipment they need.  Furthermore, since extensive training materials were left at the hospital, the staff can now travel to other facilities in the area and repeat the training sessions to further disseminate the skills they have.

I hope I have been able to demonstrate the full ramifications of the donations the hospital and I received and explain why a donation to a sustainable development project is far better for the community than simple aid.  I sincerely hope that your donations in the future to developing countries support projects that emphasize long-term community empowerment rather than more temporary solutions.  I want to again thank my donors profusely for their generosity and interest in my work at the hospital, without which this project could not have been the success that it was.

The other major undertaking at the hospital was networking the five computers it has, creating a patient database, and beginning to computerize patient records.  Interestingly, this huge project required the least amount of money, since the Ministry of Health Services had been sending the hospital computers for quite some time.  Unfortunately, the computers came with no training and no instructions on their use.  After three weeks of learning how to use Microsoft Access and developing a database system to fit the hospital’s needs, the hospital now has a customized patient records system, allowing access to patient histories, more accurate record keeping, and more efficient report creation.  The network and the resulting ability to completely computerize patient records in the government-run hospital is the first of its kind in the Western Province of Kenya and might even be the first of its kind in the country.

As it turns out, there was great hesitance to adopt the computerized system since the paper record system was seen as far more dependable and less prone to error.  Even in the short time during which I was able to oversee the use of the database, I noticed the hospital staff having difficulty giving up their previous methods of recordkeeping, and frankly, I expect that many months or even years will pass before the network and/or database will be used at the hospital to its fullest potential.  I stood and continue to stand by the project, however, because of my strong belief in the use of modern technology to develop institutions in developing countries.  The network and database have opened the door for future development workers to build upon the existing infrastructure, and the system has great potential to vastly improve the efficiency of the facility and even reduce costs.  For example, in the two months that I was there, the hospital purchased a second printer to connect to another one of its computers.  With the network in place and simple printer sharing enabled, only one printer need ever be purchased and/or serviced at the hospital.  The network also opens the door for future workers to implement other projects, like automating the patient wait time survey to occur without any effort on the part of the staff.

This blog will likely see more commentary on international development work in the future, but I felt this closure was necessary for the end of the Duke Engage trip and my experiences in Kakamega, Kenya.  Thanks for your interest in international development, and I hope you’ll continue to occasionally check this blog and maintain involvement in development work across the world!

Joseph Ambani, the hospital administrator, had not previously received any medical training at all and was unprepared to organize the hospital in a mass-casualty situation. Thanks to donations to the emergency responsiveness project, Mr. Ambani has received basic medical training and is ready to lead the hospital in an emergency.

Betty is the hospital secretary and had never received any medical training. Using donated funds, we were able to purchase medical equipment and train Betty on its use. Betty can now help deliver basic medical services in an emergency and can even use her skills to improve the hospital’s efficiency during normal operation.

Charles Aluvisia is a volunteer in the Comprehensive Care Clinic and counsels HIV patients. He has never received medical training. Here, Charles performs a primary trauma assessment on a patient who is lying on a stretcher made using donated funds.

Dr. Bomji, the Clinical Officer In Charge at the hospital whose staff is better prepared to handle emergency situations and can help him improve the quality of healthcare delivered at the hospital.

REFLECTION

Only one week left!  And as exciting as that is, it’s also pretty terrifying, because I have a LOT left to do.  Sleep is now a low priority.  I have to finish the patient wait time survey write-up, finish the training materials for the emergency responsiveness project to leave behind at the hospital, finish up the database, get the network connection working, set that up, and write a final report for FSD.  Most of this must be done before Wednesday.  Now you can understand why I haven’t blogged for the past week.

I’m really excited about the patient database, because it’s something that I think has great potential not only to help the hospital immediately but also for future interns to come and tweak to make even better.  Aside from making reports easier to create and keep track of patient histories in a more effective way, the network will also help because it will prevent the hospital from having to purchase huge amounts of official record books from the ministry.

This project, like all of the things I’ve been doing in the last couple of weeks, is primarily designed and implemented with a “ball’s in your court” attitude.  I began these projects obsessing about the community buy-in and how receptive the staff would be to using the network or retraining others in the community in emergency responsiveness.  Lately, though, I’ve come to realize that my conscience is clear if I give the community all the tools and resources it needs to be able to sustain the project.  I can’t control whether they choose to or not.  Why should I beg them to use a computerized network?  After all, it is designed to help them, not me.  I feel like my moral obligation ends at setting up the network, designing an easy-to-use database, and instructing them on its use and how it can make their life easier.  After that, I can rest easy knowing that I did everything I could to make their record-keeping more efficient, accurate, and useful.  It’s up to them whether or not they want to use it.

As much as I’ve loved my time here, I am looking forward to going back home.  This final week will hopefully provide some closure over the many ideas, projects, and realities I’ve had and faced over the past two months.

I’ll try to keep up blogging, but as you must understand my list of to-dos is extensive, so I make no promises.  What I DO promise, however, is that all my generous donors will soon have a full description of exactly what their money provided to the community and how thankful the community is for these donations.

RECAP OF THE DAY: Woke up, went to training, people were late, talked about trauma patients, handed out the handout, left, went home, went to Kakamega, met with the carpenter who is going to make the stretcher/backboards, saw him make one, went and got different wood because the first one I got was too weak, tested it, it looks good, Damaris is helping me get belts to fix patients down, got foam to make temporary splints, went for a run, got caught in the rain, waited forever for the matatu to leave, we had to switch matatus halfway, only problem was we transferred into a matatu that was full, I had to stand up and lean over four people, got home really late, worked on budget for meeting tomorrow morning, going to Kisumu tomorrow to check prices and buy stuff, sleep.

REFLECTION

Today was a really productive day.  After training, I went into town to oversee the making of the first of six stretchers that will be given to Iguhu Hospital after the training ends.  The carpenter is really professional and very good at what he does.  I was pleasantly surprised by his understanding of my vague hand motions and terrible drawings – by the time I got there, he was almost done with one of them, and he took the changes I wanted to make in stride.  I was even foolish enough to doubt him at one point – we had a debate over the strength of a certain piece of wood – and I was proved wrong.  I can’t tell you how good it feels to leave a pretty important job with someone here and be assured that the person knows what he’s doing!

We have a meeting with Angie tomorrow morning to discuss the budget for the online fundraising.  I’m thrilled to report that the project raised $1,100, which is beyond what I asked for.  Thank you to everyone who donated!  I’m going to make sure the money goes to life-saving equipment that is complemented with thorough training.  It’s a wonderful feeling to know that so many people are willing to put so much of their own resources into developing this community with me.

Some of the money is going toward the construction of six stretchers/backboards.  They’re kind of a hybrid between stretchers and backboards, so I’m thinking of pursing a patent and calling them strackboards.  Unfortunately, judging from the multitude of pirated DVDs available here, I don’t think intellectual property is respected at all in Kakamega, so my patent will probably be useless.  I have some pictures of their construction posted below.

I’m a little nervous about tomorrow, because I announced today that I would not be there at the training and instead have asked my co-trainer (Charles from the CCC) to handle the training.  I left him with all the materials and briefed him on what should happen.  I really hope the training (a) still actually happens, and (b) goes well.  Given that a huge part of this project is the reproducibility of the training, it’s vital that Charles is able to effectively train his peers.  I anxiously await his report on Monday.

I’m off to Kisumu tomorrow to check the prices on Ethernet cable.  I need tons of it, because I want to network the five computers at Iguhu to form a patient database.  I’m still trying to get a handle on Access – my “fiddling around” with it yesterday didn’t go very well – but tonight I’m just going to focus on getting my budget done and working on the textbook I’m trying to write about emergency medicine.  I figure that the whole network project can’t happen if the Ethernet cable isn’t cheap enough, so I shouldn’t spend any more time trying to figure out Access until I’m certain that the network can actually happen.  If it can, guess what I’m doing this weekend?

Building the backboards/stretchers

The carpentry shop

Making Supports

RECAP OF THE DAY:  Woke up late, ran to work, did a review for the training today, went home, got ready, headed to town, had lunch with Poe, visited a bunch of shops, checked out some prices, went to Yakos, headed back to Iguhu, got permission to use the hospital vehicle tomorrow to go to town and get wood and stuff for the construction of backboards, went home, started working, made movie from the team retreat, read up a bit on Microsoft Access, prepared for training tomorrow, eat, sleep.

REFLECTION

The mid-term retreat was last weekend, which is why I was unable to blog.  The entire team went to Hell’s Gate National Park, and it was a lot of fun!  I think we definitely all needed a break, and it was cool to be able to regroup as a team, discuss what we think about our internship so far and where we want to take our internships in our remaining time.

The park itself is phenomenal.  The first day, we woke up early to go rock climbing and then biked across the entire park to go to a large gorge.  The park has wild giraffes, zebras, ostriches, water buffalo, and more just walking around it, so we literally biked through herds of zebras and the like as we made our way across the park.  I was actually cut off from my group as a herd of zebras crossed the path in front of me.  It was a very unique experience.  The gorge was also amazing; words can’t do it justice, so check out the pictures I’ve posted below.  We also filmed a movie in the gorge, and I spent the majority of today editing it, but unfortunately the speed of my internet connection prohibits my uploading it until after I return to the States.  Stay tuned, though.

I had an opportunity to have a very long and very interesting discussion with Angie, our project coordinator, about her ideas regarding development in general and development in Kenya.  I wanted to talk to her about this because us interns have many discussions about the theory and practicality of what we do, and I figured that given she has done development work for many years now in several different parts of the world, her opinion is one that matters more than most.  I want to discuss her thoughts here, and just so you know, I asked Angie if I could blog about our conversation, to which she agreed.  But because this is a secondary source, I want to make sure that no one draws firm conclusions about Angie or her thoughts based on this recollection of a conversation.

We started out with a general question.  If you had complete control over everything in Kakamega or in Kenya, what would you do?  Angie would remove every foreign aid presence in Kakamega, because aid in any form creates a sense of entitlement and wrongly teaches the local society that foreign presences will always be there to step in and solve their problems for them.  From there, societies should be forced to supply in-kind contributions to any development program that is implemented.  Interestingly, Angie seemed less interested in ideas of sustainability and more concerned with instilling in the people the concept that they must work hard for their own development.  In fact, she said, there has to be a balance between aid and sustainability.  Yes, we should encourage the proliferation of sustainable solutions which require people to use their own resources to solve their own problems.  But when the people lack the resources or have the wrong resources, sometimes you have to bring in the resources through aid in order to achieve the long-term development that you are looking for.

This is an interesting way of looking at it, but one that makes a lot of sense.  In fact, every sustainable development project has within it an element of aid that plays a critical if not pivotal role.  In my very own project, for example, the time and knowledge that I offer the staff at Iguhu can be considered direct aid that is involved in a longer-term project of enhancing emergency responsiveness.  Why is this aid – a donation of my time, free of charge – necessary?  Because in this situation, the resource that was lacking – namely, trainers – needed to be supplied in order to get the development the hospital sought.  But what is important about this aid, though, is that it is only supplied given a significant in-kind contribution

We then spoke at length about the political situation in Kenya.  We’ve all noticed that people are in general very cynical about their government, that corruption is rampant, that people feel out of control of their politics, and that the government itself is plagued with tribalism.  Emily, Liz, and others have stressed the fact that they feel that a top-down political reform is absolutely required for development, since the current government is fractionalized, inefficient, and corrupt.  Mama Joyce has told me about campaigns to get elected – how politicians literally hand out money to people, which is a sign of power and wealth that is taken by the people and results in election.

Angie added onto this by saying that it was in fact the youngest generation – including (if not especially) those who have university degrees – who are especially prone to voting along tribal lines, a fact that is startling, especially given that I have generally assumed that education is the key to incite a bottom-up political reformation.  (As I understand it, Angie did her Masters degree in Kenya, and part of her thesis included an exploration into these political questions.)  The reason for it is that when university students graduate with degrees, they often cannot find jobs and end up loitering at home doing nothing.  Therefore, they tend to vote for politicians of the same tribe as them, because they are led to believe that the politician will take care of his own and offer them jobs.

While that may go to say that economic development will be critical in eradicating tribalism in Kenyan politics, Angie has another interesting idea.  She says that many of these problems arise from people feeling too far removed from their government, and that political apathy due to a highly centralized government often manifests in tribalism, since ethnic divisions are the strongest ones that exist.  While more personal government exists in name, it is virtually powerless.  Angie says an interesting idea to toy with would be instating a far more federalist state, with local, state, and national governments having clear and distinct objectives and jurisdictions.  In this way, people can begin to be divided along lines other than tribes, and people might start to take a far more interested role in their local and state governments, since they would be closer to the people themselves.  In national elections, people might start feeling united by their locations and by extension their common problems instead of solely by their tribe.  Finally, decentralizing the government might also have the effect of giving people more direct control over their day-to-day problems instead of depending on a massive, inefficient, central government.

We also touched briefly on two other interesting points.  Angie has a unique perspective on Kenyan politics because she was here during the post-election ethnic violence following the last election, where ethnicities collided with massive force while politicians fought over seats of power.  Angie said that the sheer length of the violence and the unwillingness of politicians to budge despite the high death toll were telling to the people – telling that their leaders actually did not care about them, and that governmental reform was necessary.  She went on to say that violence like that, though devastating from a human rights standpoint, may have actually accelerated or incited a political questioning of leaders, which in the long run can lead to powerful political reform.

We talked about democracy itself and its role in Kenya.  Angie had a really interesting point – she said that post independence, land and property owned by the British were sold in bulk to whoever had money because the British did not have the time or the will to allocate it more fairly or give custody of it to the government itself.  Therefore, the resources owned today in Kenya by Kenyans are lopsided and very unequal, and it is not a result of fair competition through years of capitalism.  Perhaps a different form of government, and perhaps temporary, might be effective in redistributing resources to the people in a more fair manner that encourages fairer competition.

Lastly, we talked about globalization in Kenya.  I’ve talked briefly before about my views on globalization – I go so far as to say it is the ultimate “goal” of development work in Kenya and around the world.  And though Angie agreed that globalization was a good thing, she also cautioned that there are some aspects of globalization that inhibit the Kenyan people from tackling their own problems, because in an increasingly globalized world, Kenyan issues become everyone’s issues.  The example she cited was the post-election violence, which she said could have been a powerful force for political reform.  The forces that stopped the violence were foreign, which stopped the political movement in its tracks.  Why did foreign forces intervene?  Because Kenya is a critical trade route in the region, so problems in Kenya have economic implications elsewhere.  By stepping in to resolve the situation, these foreign powers reinforced the heavily-ingrained idea that foreigners will come in to solve all of the problems in Kenya, and that Kenyans themselves have a smaller responsibility to work for their own betterment.  Thus, we have an example of when globalization can actually slow down development work.

We then wrapped up the discussion with Angie telling us about one of her professors and a term he used called “revolutionary patience.”  All of us interns, I think, are increasingly frustrated with the slowness with which everything works, and with the feeling that our small contributions in single organizations scattered across Kakamega won’t actually make a difference.  Angie told us about her same sentiments she experienced during her three-year tenure in Bulgaria with the Peace Corps, and how a professor she later had told her that she must have “revolutionary patience” – meaning that revolutions take time, and revolutionaries must have inhuman patience to wait for them.  As we struggle for the change we seek with the fire of revolutionaries, we must remember the long road ahead and recognize the place of the step we are taking down that path.

A long conversation, but a fruitful one, I think.  Liz was about to kill me afterwards and maybe Angie was too – no way to be sure.  In any case, it gave me a lot to think about, and it definitely changed my perspective on the work I’m doing and development work in general!

REFLECTION

With online fundraising going well (donate here!), I’m looking forward to how the project shapes up!  We started medical patient assessment today, and I think it’s going pretty well.  It’s exciting to see how all of the skills we have gone over so far are going to come together.  Another bonus is the fact that we got all of our regulars to show up today – yesterday, for some reason, not many people came, which was kind of worrisome.  I’m hoping it was because I advertised that we were doing blood pressure, and so people who already knew how to do blood pressure chose not to attend.

Tomorrow is the mid-trip retreat at Hell’s Gate national park.  We leave at noon, so I’ll have to go to training in the morning before leaving for Kakamega to meet up with the others.

I learned today that the hospital was recently delivered four new computers.  I’m really excited about this, because it means that I can try to make a patient database using Microsoft Access and connect all of the computers to make a network over the hospital.  Trouble is, I’ve never used Microsoft Access, and for it to be successful here, the program has to be basically flawless.  I’m giving it a shot, though, and if ANYONE out there has any experience with making databases using Access, please help me out!

Liz and Emily both had interesting blog posts yesterday that I want to talk about a little bit.  Emily in particular found a girl working at ACCES who has a medical issue that she is worried about.  What Emily discusses was whether the idea that “we can’t help everyone” was realistic or whether we were just assuming that.  It’s an interesting question – I think most agree that long-term development, capacity building, and emphasis on sustainability is a good thing, but why is helping individual people when we can a bad thing?  In other words, if Emily were to pay for the girl’s medical tests and treatment out of her own pocket, while that may not be a sustainable solution, how could it hurt?

In response to Emily’s question, I think that we absolutely can help everyone, but doling out money is not the way to do it.  As I’m sure many agree, it should be the responsibility of those involved with the girl and her concerns – her family, her hospital, her community, her school, her government, and most importantly, herself – to address the problem.  When people like Emily step in to provide direct aid to the girl by paying for her medical tests and treatment, what they actually do is free the involved people and organizations of their responsibility over the girl’s medical issues.  When too many people like Emily start to provide such aid to girls like the one Emily discusses, the dangerous consequence is that communities are very quick to transfer the responsibility of care over girls in such situations to people like Emily.  In effect, when a lot of aid is given, it quickly becomes Emily’s responsibility to provide assistance to the girl.  When Emily stops, she will be blamed for the girl’s poor health.  When communities see people like Emily giving what they do, there is a sense of entitlement that is created – a sense that Emily as an institution, not their community or government, should be giving this aid, and so there is no pressure, no motivation to attack the correct institutions at play.

A good example is HIV anti-retroviral treatment, which is currently provided free for all Kenyan citizens who are HIV positive.  As Liz points out in her blog post, most of the ARV treatment is provided through direct aid by the American and British governments.  The ARVs that are supplied support tens of thousands of patients in Kenya and many more throughout Africa.  But now, imagine if that aid were stopped.  Thousands would suffer and die, and who would be blamed?  You can bet that fingers would be pointed at the American and British governments for stopping their life-saving donations.  The Kenyan government – and governments all over Africa – has escaped in a major way from the responsibility of managing the epidemics that sweep the country and the continent.  The same goes for malaria – the free mosquito nets given out at hospitals are donated by an NGO – and even water – the same NGO is the major source of water purification solutions.

So while you might want to help girls like Emily’s, consider carefully how you do it.  Direct, one-time aid is not only meaningless in the long run; it is actually detrimental.  Teach the girl how to advocate for herself and those around her.  Talk to government officials about people like the girl.  That is what “making change” means.

RECAP OF THE DAY: Woke up, went to training, came back, worked out, took bath, got a call from Angie, Kirsten and Erin are at Iguhu for a meeting, meet with them, get the official rejection letter from FSD (flashbacks from college app days…), talk about stuff, go home for lunch, come back, work on computer, go home, take a long nap, dinner, sleep.

REFLECTION

Today was pretty uneventful.  I read exactly what FSD thought was wrong with my grant.  I’ve posted both my grant and the letter I received today below.

Grant:  Khanna_Grant

Letter:

June 19, 2009

Dear Arjun,

Thank you for submitting your grant proposal titled Iguhu District Hospital to the Foundation for Sustainable Development.  The FSD Grant Fund receives many proposals for great projects like yours from Latin America, East Africa and India each year, and due to our limited resources we are only able to fund a portion of the proposals we receive.  Unfortunately, at this time your project has not been chosen to receive funding.

Your proposal was well written, and the evaluators felt that your project has a lot of potential.  But we want to offer some suggestions on how the proposal could have been strengthened:

Providing a Government Service: FSD is careful to avoid providing services that the government should be covering.  While we understand that it’s frustrating when the government does not provide the necessary services, it’s important not to set up a parallel system and thereby free the government from their responsibility to their citizens.  While we felt the overall project concept was good, we would have liked to see a stronger advocacy component.

I hope that you will choose to submit your proposal to other funders, pursue independent fundraising, and/or explore creative ways to achieve your project’s goal with available resources.  Your grant packet includes a list of international grant making organizations; also, many of our interns have had success with sending project proposals to their friends, family and colleagues back home.  Your site team can provide you with more information on the process of receiving donations from friends and family for your project work via FSD.

Within one week, you will receive a detailed evaluation of your grant proposal.  We hope that the feedback provided in the evaluation will help you to hone your grantwriting skills, and will aid you and your host organization in developing and writing future proposals.

We wish you the best of luck with your project.

Sincerely,

Caitlin Drewes

International Programs Officer

Foundation for Sustainable Development

June 19, 2009

Dear Arjun,

Thank you for submitting your grant proposal titled Iguhu District Hospital to the Foundation for Sustainable Development.  The FSD Grant Fund receives many proposals for great projects like yours from Latin America, East Africa and India each year, and due to our limited resources we are only able to fund a portion of the proposals we receive.  Unfortunately, at this time your project has not been chosen to receive funding.

Your proposal was well written, and the evaluators felt that your project has a lot of potential.  But we want to offer some suggestions on how the proposal could have been strengthened:

Providing a Government Service: FSD is careful to avoid providing services that the government should be covering.  While we understand that it’s frustrating when the government does not provide the necessary services, it’s important not to set up a parallel system and thereby free the government from their responsibility to their citizens.  While we felt the overall project concept was good, we would have liked to see a stronger advocacy component.

I hope that you will choose to submit your proposal to other funders, pursue independent fundraising, and/or explore creative ways to achieve your project’s goal with available resources.  Your grant packet includes a list of international grant making organizations; also, many of our interns have had success with sending project proposals to their friends, family and colleagues back home.  Your site team can provide you with more information on the process of receiving donations from friends and family for your project work via FSD.

Within one week, you will receive a detailed evaluation of your grant proposal.  We hope that the feedback provided in the evaluation will help you to hone your grantwriting skills, and will aid you and your host organization in developing and writing future proposals.

We wish you the best of luck with your project.

Sincerely,

Caitlin Drewes

International Programs Officer

Foundation for Sustainable Development

RECAP OF THE DAY: Woke up, went to town, worked out, went to the market, went to Yakos, bought a bunch of DVDs to watch, came home, relaxed, talked to everyone at home, watched a chicken get slaughtered, feathered, cut up, and cooked, I was still hungry, ate it, work, sleep.

REFLECTION

First of all, I’d like to thank profusely the donors to my project that have already showed overwhelming support for the emergency responsiveness program.  I assure you, your donation will make a difference, and I’ll be sure to keep you updated about what is happening at Iguhu District Hospital.  For those who would like to donate, a project description and online donation link can be found here.

Second order of business – my grant decision came back on Saturday, and unfortunately it was not funded.  As promised, a detailed evaluation has been filled out by the grant review committee, and I am scheduled to meet with Angie tomorrow to look over this evaluation.  I’ll be sure to post it here.  Moving forward, though, this makes my online fundraising even more critical.  The original $500 fundraising goal has been raised to $1000.  Every bit counts – again, a dollar goes a long way here – so anything you can contribute would be extremely helpful.

Because the grant decision came out negatively, I’m also in the process of deeply re-thinking the project and re-assessing the needs of the hospital.  Perhaps you can help me; I’ll talk about my dilemma here.  The original project was designed to train Iguhu staff on all the major practices they need to be trained on in order to respond to emergency situations, so the ultimate goal was to leave Iguhu with at least one set of trained staff ready to respond to either trauma cases (like a car accident) or medical cases (like chest pain).  As it turns out, most of the equipment required for trauma cases is much cheaper than the equipment that medical cases require.  My dilemma is whether to go ahead and purchase these things for the hospital and train them on their use or to just focus primarily on trauma cases.  The reason why this is a debate, in my mind, is because your normal 911 system whereby people can call for ambulatory assistance from their home is at least 10 years away, given the massive shortage of monetary and human resources.  That means that what the hospital is really going to be seeing will be trauma cases (and specifically, car accidents).  So is it worth it to buy supplies for medical cases?

This question is complicated when you consider some of the other needs that could be fulfilled in the hospital.  I’ve talked about the admirable CCC staff before; they need a laptop to log patients electronically, especially if I succeed in my mission of getting them permission to use hospital vehicles for village visits.  So, nebulizer to treat severe asthma in an ambulance, or laptop for CCC use?

I think what this goes to show is that it’s difficult to focus on the long term (10+ years) when you see so many short term needs that could be filled.  What I’m leaning towards is biting the bullet and doing everything for the emergency training, because I feel like it’s unfair to me to judge whether the capacity to handle medical cases is needed by the community before the capacity itself is there.  It’s one of those things where you’re never really sure how many people would call an emergency vehicle from their home in response to a medical condition until people have the option of calling such an emergency vehicle.  While there might be other needs – just as pressing, maybe – that could be filled, focusing on one task and making sure the hospital is equipped for the long term is in the best interests of everyone involved.

But I’m still not sure.  I need to write up a new budget for my online fundraising by tonight, so hopefully I’ll have it figured out by then…

Now I’d like to turn to a highly controversial, ongoing discussion in international development work.  I’ll take this time to present the topic here, because I think it’s something that everyone involved or interested in international development should think about.  Most of all, I’m greatly interested in what your opinion is on the matter.

The origins of the issue stretch as far back as the first (and sometimes the most offensive) question:  Why is it that we citizens of “developed” countries should care about or be motivated to act upon the conditions in the “developing” world?  When we read about hunger, poverty, AIDS, or malaria, why should we do anything about it?  What makes these things our problems, and why should we feel the need to send some of our own resources to the developing world to alleviate them?

Answer this question for yourself – it’s more difficult to articulate an answer than you might think!  Most of us take this question for granted and consider it too horrifying to even consider.  “Of course we should help,” people say.  But why?

There are two answers that I’ve heard to this question.  The first is based upon human emotion.  When we hear about millions of people dying of starvation of malaria, we are outraged.  Given that there is something we can do about it, we are motivated to act upon these problems by the idea that every human deserves some basic level of freedoms, and among those are freedom from hunger and freedom from disease.  It’s a valid point.  The roots of our desire to alleviate these problems stem from a belief in charity – we say that since these people are unable to help themselves, we should help them because doing so preserves the sanctity of life and maintains the human rights that we believe should be afforded to everyone on the earth.

The second answer is virtually the same as the first but adds that we have the obligation to perform development work because all we are really doing is undoing the detrimental effects of colonialism; in other words, given that many countries in the Western world played a large role in slowing or stopping the infrastructural growth of developing countries during the colonial period, it is only fair that we now help build the infrastructure that we prevented from sprouting.

Both of these responses fall under the umbrella of the concept of a “moral obligation” to help.  We have a moral obligation to assist and sponsor development work, so we do.  And up until now, everyone is basically on the same page, including myself.

But the question I would like to leave you with is this:  when does our moral obligation end?

A big example is the HIV epidemic.  Even after setting up free testing centers and offering free ARV treatment to those individuals found positive, we find that people still choose not to get tested for a variety of reasons, all of which center around a cultural stigma associated with the disease.  Jonny Steinberg, in his work Sizwe’s Test (2008), says, “When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people.”  Steinberg searches for this “miscalibration,” and makes for key realizations:  The first is a reaffirmation of Edwin Cameron’s conclusion – that people are scared of getting tested for HIV because of the stigma associated with having the disease (see Witness to AIDS, 2005).  Second, he finds that this stigma is greatly exacerbated by the fact that this stigma is applied onto you by people you know very well.  Third, he realizes that hesitancy to be treated sometimes springs from a feeling of cultural humiliation associated with adopting “white medicine.”  Finally, he discovers that procreation plays a critical role in the religion and culture of many societies, and that HIV is feared and ignored because it undermines a man’s virility and thus his spiritual success.

Sure, these findings are significant and elucidate many interesting aspects of the epidemic in Africa, but here’s the million-dollar question:  What should we do about it?

So here’s the question to ponder – after setting up free testing centers galore, offering free ARV treatment, having testing caravans go to individual villages, and urging the incorporation of HIV education in schooling, if we still find people refuse to get tested and deal with the disease, is there more to be done, or have we fulfilled our “moral obligation?”  Steinberg, Cameron, and many others have uncovered the real roots of the problem, which are largely cultural.  Addressing this problem at its roots will require a complete overhaul of the culture itself.  Is it our place to do such a thing?  Is it our responsibility?  Is it our obligation to do something about the “miscalibration between institutions and people?”  What if those institutions are Western constructs, and the people are locals whose culture and beliefs are unlike anything we know?

The more I think about it, the more circular the discussion becomes.  Yes, we have a moral obligation, and yes, we have set up institutions all over Africa (testing centers, counseling, ARV distribution networks) that we believe would work.  If they don’t, we have done everything we know to try and address the issue, so maybe our obligation ends there.  But what if we got the institutions wrong?  What if the institutions we established are badly “miscalibrated?”  Is it our obligation to rethink them?  If so, how can we redesign them to fit a culture different from anything we know or truly understand?  And how can we rely on people of a culture in denial about HIV to invent these institutions, if we must have them do it for themselves?

Essentially, the question is this – if an aspect of a culture needs to be changed, who should change it?  Is that a change that needs to come from within, or are our efforts required?

I’m terribly interested to hear what others think on this issue.  It’s important to answer these questions because the answers have massive implications in foreign policy around the world and might serve to point developing countries in the right directions in terms of long-term development.  Be sure to comment on this post to dish out your opinions!

REFLECTION

Waking up in the middle of the night because something is crawling on you is the worst feeling in the world.

In other news, my online fundraising campaign is up and running!  The link is here and the project can be read about here.

I’m going to spend this whole blog post talking about why you should donate to this project.  The most important reason I think you should donate is that this project focuses heavily on the concept of sustainability and skills development rather than just aid.  This idea is the cornerstone of FSD and is one that is exemplified by this project.  It focuses intently on training the staff on emergency medical practices and much less on donating anything.

The training has actually started, and it’s off to a fantastic start.  We’re getting great turnout, and trainees are really excited about what they’re learning.  Keep in mind that the training incorporates not only doctors and nurses but also non-medical personnel such as registration desk attendants, drivers, and security staff.  Given the limited human resources that the hospital has, it is extremely important for everyone to know how to respond if an emergency does arise.

This opportunity to donate should also excite you because you know exactly where your money is going and what it will be doing.  Have you ever wanted to do something for a developing community but hesitated to donate to a huge NGO for fear of your money getting lost in the bureaucracy?  Do you want the satisfaction of having hard evidence – pictures, personal interviews, and more – that your donated money actually made a difference?  If you donate to my project, I will make absolutely sure that I follow up with you personally and tell you exactly what your money is doing and how it is positively affecting the community here in Iguhu.

If you have any questions, concerns, or suggestions about the project or what your donation will do, please don’t hesitate to ask me by commenting on this or any blog post.  I don’t want anyone to blindly donate anything; please take the time to scrutinize the project before you decide to give.  I’m confident that you’ll end up feeling the same way I do about what Iguhu needs and how to empower the community itself to satisfy that need.

Again, the link is here, and you can read a little bit about the project here.

Thanks a lot for your time, your consideration, your donation, your reading this blog, and your commitment to development in this amazing community.

One last thing – just so I can keep track, if you choose to donate, I would greatly appreciate if you would shoot me an email at arjun.khanna@gmail.com letting me know who you are and how much you’ve donated.

REFLECTION

Emily and I still anxiously await our grant decisions!  We understand how difficult the decisions must be, given the large number of summer interns that must be reviewed.  What we don’t understand is why it’s taking so long for online fundraising requests to be processed.  I didn’t think it would take two weeks for my request to appear on the website, but it’s still not up yet.

Emily and I headed off to Kisumu today to purchase necessities for our projects after an hour of training this morning on artificial ventilation with the hospital staff (the training’s going well).  We drive over and reflect on how nice it is to be sitting at a comfortable distance apart from each other and not have to be cramped in a tiny matatu with thousands of people crammed in.  Once we arrive at Kisumu, the ride gets less nice.  Neither of us have any idea where our shops are, and Kisumu is a huge place.  We drive around aimlessly for about an hour, kind of hoping that a giant textile depot will suddenly appear in front of us.  The odd thing, though, is that we repeatedly called the owner and handed the phone to our driver (Ken) to talk to him and find out where we are going.  Each of these conversations lasted about five whole minutes, and after each of them Ken hands the phone back and says “we need to ask someone” whereupon we ask a random person on the street where the store is.  They all stared back blankly at us, and spoke to Ken for another five minutes in Swahili.  The result?  “We need to ask someone else.”

Emily finally demands that we drive to a major landmark (the New Victoria Hotel) and asks someone to come get us from the store.  As it turns out, it is basically right across the street.  Embarrassed, we enter and then proceed to purchase items necessary for pad-making.  Yeah, they thought we were pretty strange after that.

I go to my medical supply stores, and through some clever manipulation involving forced direct competition between the two stores, I walk away with medical supplies at half price and a huge smile on my face.  Emily and I then drive over to the Green Gardens restaurant and have pizza, boneless chicken, and this mint lemon drink.  A phenomenal break after daily ugali, let me tell you.  We drive back and have a deep conversation about development in Kenya.  When we arrive in Kakamega, we call Guillaume and Liz and ask them to meet us in the middle of town to hang out.  While we wait for them, we meet a Massai and Emily freaks out.  She’s asking him all these questions, and he’s demonstrating how he can pull on the giant hole in his ears and it doesn’t hurt.  We meet up with Liz and Guillaume, and the girls want to shop for skirts or something, so Guillaume and I decide to get haircuts.  We find a barber and go for it.  Are we nervous?  Absolutely.  Thirty minutes later and we’re both sporting cool new haircuts that cost 30 shillings.  Yes – 30 shillings.  Two haircuts cost less than a US dollar; we were thrilled.

We walk around some more when it begins to rain.  This is the third time I have been in Kakamega and it has started to pour; aside from the discomfort, it is inconvenient because matatu prices seem to escalate dramatically when it is raining because they know you just want to escape from the downpour.  Fortunately, I asked a group of guys how much it would be, and one of them (obviously a newcomer) actually told me that it was 50 shillings.  The others started yelling at him as I happily hopped into the matatu and had an extended conversation with a man who had the worst breath I have ever had the misfortune of smelling.  Apparently, he is Obama’s cousin.  I’m pretty sure everyone here thinks they’re Obama’s cousin.

I head home, then, and start working on tomorrow’s training session.  I’m also excited because Charles has invited me to attend some HIV counseling sessions.  I’m starting to organize the CCC data for them, and beyond that, I’m looking forward to being able to see firsthand what goes on behind these closed doors.