Overview
We have worked with the people of San Jose creating interventions to address their 5 self-identified leading causes of ill health: water, nutrition, education, health care, and poverty. The most important goal for all interventions is being self sustaining whenever possible. Almost any structural problem can be fixed with enough money, but once the external support ends can the intervention continue operating? We focus on low cost, low technology solutions. Sometimes these solutions may only work part of the time or reach only a portion of the population, but these realities are better than other options in extremely resource-poor environments. Below are some of the interventions that are working well at this time. We have tried many other interventions that did not work well, which we have listed in a separate page. We accept the reality that if 10% of interventions succeed we are doing well and if 20% of interventions work the first time tried, we are highly successful!
Our Approach
We do not belief in top-down solutions or in hand-outs. The people of San Jose know the challenges they face better than anyone else. If listened to, the causes for the identified problems are often self-evident. We just have to listen, then explore possible solutions in a collaborative way. Sometimes solutions are found that are possible with minimal external funding and ideas. Other times, the solutions are beyond what is possible structurally or financially at the present time. Delivering water to homes is a great example. When there is a source of water above homes (natural springs), designing and constructing piped water projects is relatively straight-forward. We have helped 5 communities install piped water, even when the piping runs over 4 miles. One community has no water source above it for many miles. This presents significant challenges, technical and financial. The costs and the technical skills necessary to maintain such a water project are not possible at this time. We must explore other options. In the mean time, partial solutions are put into place.
We do not believe in hand-outs. All of the interventions discussed below require that the recipient put in resources and/or labor. We find people respect the intervention more and are more likely to benefit from the intervention. Additionally, they are usually more able to correct problems that arise during the operation phase of the project because they helped create the project.
Interventions/Projects
Water
Access to any water and access to potable water are the biggest challenges facing the people of San Jose. Given “Water is Life” this problem is huge. In the dry season, many people have to walk more than 2 hours to reach a tiny basin of water and that water is not safe to drink because it is so contaminated. Ill health results from limited water, low quality of water, extra calories burned getting water, and the time expended getting water. Here are some of the interventions we have ongoing.
Nutrition
Improving a population’s nutritional status is complicated. At the most basic level the goals involve increasing the amount of food, increasing the variety of food, reducing food distribution problems, and reducing calories lost performing non-productive work (such as carrying water and firewood). Our most successful nutritional interventions to date address reducing caloric expenditure by reducing the time and energy spent collecting firewood and transporting water. Due to the paucity of water in the region fish farming is limited to a select few home. Those that have a fish farm have experienced a significant increase in their protein intake. Agricultural interventions often take years to realize the benefits and are closely tied in with poverty reduction.
Education
Improving the educational status of a population can greatly improve long term health of that population. Many early interventions focused on improving the resources available to grade school students and increasing the teaching approaches teachers used. When we arrived most schools lacked basic supplies such as paper and pencils for students. Teaching was primarily focused on rote memorization with very little effort directed towards creative and analytical thought. By far our largest education-based interventions involve scholarships so needy students can attend school beyond the government-required 6th grade.
Health and Dental Care
Given we are physicians by training we have always offered curative medical and dental care. We also provide fluoride treatment to children as an effective preventive intervention reducing the rate of tooth decay. Twice a year while in San Jose we hold medical and dental clinics. Early in our time in San Jose we assisted two women to be trained as Community Health Workers (CHWs). They operated the San Jose clinic while we were not there. Due to low visit volumes we decided to end this program after three years. Years later another group placed a CHW in San Jose. Their intervention ended with the same results we experienced. When we are not in San Jose, medical patients travel to San Marcos clinic, about 1-2 hours walk away. Patients with dental problems really have no options in the area for dental care.
Poverty Reduction
Reducing the poverty of a community is challenging. The causes of poverty are multi-factorial and these causes often extend well beyond the boundaries of the community. Except for education and health care jobs, there is no formal employment in the area. Most people are less than subsistence farmers and rely on infrequent day labor. The families doing the best generally have a young person living and working in the US as an illegal immigrant who send money back to Honduras to support their extended family.
Poverty reduction interventions involve a multi-pronged approach that can take years to achieve meaningful improvements. Education of the population may be the best long-term investment. Educated people are more likely to find work, even though it may not be in the area. Most of the San Jose inhabitants lack formal education and have no specialized training. Presently, we are searching for methods to bring more money into the area from outside the area by selling unique goods or services. When one neighbor sells eggs to another neighbor and that neighbor sells back bread to the neighbor selling eggs, there is no increase in the wealth of the population. Money must come from outside the area to improve the financial status of the target population. Consider visiting the Interventions Tried page to see some of the prior activities we have tried.
Other Projects
Solar Systems
We are installing simple solar PhotoVoltaic systems in the San Jose area.