Monday, June 30, 2008

When 2+2 != 4

My team project is to work on a healthcare infrastructure for the Quichua community on the upper Napo River in Ecuador. After flying to Coca, Ecuador, we took a 2-3 hour canoe (gas-powered) ride to Sani Lodge, one of the only indigenous-owned lodges in Ecuador. Sani Lodge is owned by the Sani Quichua community who has a community center about 30 minutes away from the lodge. To get there, we need to paddle a few minutes to a stream, then gas-power to a station where we switch to a larger canoe/boat and go a bit further to the community center. A cooking area is in the center with a school, building for community meetings, community clinic, and futbol (soccer) field complete with bleachers around it. They are in the midst of building a new structure to start producing chocolate. The clinic itself is small and was funded by an oil company when they made a deal with Sani to fund several projects in return for digging to see if there was oil underneath their land (but not to drill for it). The clinic was also given money to purchase medications and supplies which the community deposited into the bank and used the interest to extend the period of time they could purchase supplies. While basic supplies are covered solely by this fund, many of the medications are paid for by the community as it is used. However, Sani has all but run out of the funds to purchase supplies and cannot afford to stock up on medicine (as seen by the sparse and only cabinet in the center in the photograph to the right). The medications are sold at a cheaper price for about 2x the stock amount (versus 10+ x) by a Spanish-founded nonprofit group called Sandi Yura. Sandi Yura offers courses on healthcare to "los premedores de salud" (health volunteers) on different areas.

Jess and I brought Sani's promedor de salud (Blanca) medical supplies which we got donated by Wound Technology Networks (based in Hollywood, FL, USA) and backpacks for easy portablity (remember! Sani is in the Amazon and a lot of healthcare is done via backpack medicine - traveling quite large distances through the jungle or via canoe to the patient). We were pleased to discover that the promedor already knew how to use most of the supplies (all wound care, mostly first aid, supplies), but saddened to discover that her volunteer work was strained by lack of additional manpower, money, supplies, and knowledge. She explained that although Sandi Yura gave some courses, they were not enough for what the community needed, and pregnancy/maternal care and good sexual education/puberty education for children were greatly needed. We decided to talk to Sandi Yura directly about why they did not offer these courses and what we could potentially do to help, but when we had the chance to speak to the Spanish president, we found contradicting information. We were told that classes on maternal care, pregnancy, youth education on washing hands, sexual education, and teaching children on puberty were already in practice and that Blanca had already taken the courses and should be teaching them. She became very defensive and said that Sandi Yura was doing all they could and we needed to work with them. We asked what we could do and how we could help, but instead of giving us an answer, she replied that whatever programs we wanted to do, we needed to run by them first. We thought that working with an already established organization would be a good plan, so we agreed to contact one of the people she suggested (she did not want to talk to us about it herself). As soon as we ended our conversation with her and walked out of the building, however, a large group of the Sani community and leaders of other nearby Quichua communities (they had just had a meeting), approached us and had our guide translate the following. They explained that Sandi Yura did NOT in fact provide those courses and had a very very large fund which they received to help the Quichua but that they did not, in reality, see. Asking us for our help, and telling us they needed the projects we had spoken to them about directly, they expressed their concern about Sandi Yura and how they did not see any of the money.

Now from the above description, it seems pretty obvious that Sandi Yura was a corrupt organization. However, it is not that simple. Sandi Yura is a nonprofit group that provides all their services for free. A lot of their work is dependent on the promedores doing their jobs as well. As they train select individuals from the communities who are then responsible for teaching the rest of the community, a hiccup can occur anywhere along the way. In addition, a lot of the teaching the promedores do occur at town meetings, which Sandi Yura's president explained were often cut short due to impatience and not wanting to listen. As a result, it is possible that Sandi Yura is doing their job, but there is a problem in their delivery. In this situation when 2+2 does not equal 4, what are we to do? Our next step is to ask Sandi Yura for their budget, annual report, and exact programs they offer. Hopefully they will also have statistics on the number of promedores they train on each topic as well so that we can deduce where the failure of the program is occurring.


Gonzalo Miranda said...

Hola... por esas misma fecha estaba acompañando a la asociación de promotores Sandi Yura y tengo documentado un taller de capacitación, puedes verlo en:

Gonzalo Miranda said...

Uno de los problemas que se tiene en las comunidades kichwas es que se asocia proyecto con construcción de infraestructura y donación de medicinas gratuitas, Lo que hace Sandi Yura es Promoción de la salud, , no tiene jefe extranjero, solía contar hasta septiembre de 2008 con un asesor, cargo que ya nadie ocupará. Su principal logro es el trabajo en incidencia en políticas públicas y lograr que el ministerio de salud llegue a las comunidades e incorpore al promotor de salud como parte de los equipos de salud. No es una ONG que da regalos a los Kichwas , es una asociación de los mismos promotores, mediante el acceso a algunos proyectos de cooperación han logrado mantener una capacitación mantiene en la actualidad más de 70 botiquines de salud y más de 90 promotores de salud permanente capacitados si bien consigue algunos fondos es muy difícil la manutención de una asociación de esas características la vialidad por la geografía de la zona hace que el costo de su funcionamiento sea muy elevado. Sandi Yura busca lograr el enfoque intercultural en el modelo de atención, poniendo énfasis en la recuperación de prácticas tradicionales de salud que aportan mucho. La atención en salud en Ecuador es una obligación del Gobierno y un derecho de la gente. Pero Al ser Orellana una provincia relativamente joven está en proceso de implementación un sistema de salud local. Sandi Yura tiene más de 10 años trabajando en la formación y equipamiento básico de los botiquines comunitarios de salud, también un trabajo con las escuelas en prevención de enfermedades, un trabajo en la concienciación para prevenir la violencia intrafamiliar y un apoyo con microcréditos comunitarios para la crianza de pollos y peces en las comunidades donde hay botiquines de salud, es un trabajo integral que busca el fortalecimiento de la participación comunitaria.

Un saludo...