By: Jeff Hoover, Field Coordinator, CARE USA

On my final day in Ayacucho, Peru I had the opportunity to see CARE’s maternal health programs firsthand.  We drove 3.5 hours through terrain seemingly created for Avatar to the town of Vilcashuaman (aprox 10,000’ elevation).  The distance and terrain alone illustrate some of the issues already facing expectant mothers in the region – namely access to health care. 

In collaboration with the Ministry of Health and the regional health center, CARE implemented a program called Foundations to Enhance Management of Maternal Emergencies (FEMME) and the results were astounding.  The program led to a 46% increase in women who had access to maternal care and a 49% decrease in maternal deaths.  The FEMME program proved to very successfully address cultural and religious sensitivities that led to rural women not getting the maternal care they desperately needed.  The program also contributed to the development of national protocols which were replicated throughout the country.

Najarro with her baby and a health worker

We met with a group of women who received care at the local health center.   The first, Najarro, 17, had a (relatively) smooth pregnancy.  She talked about how she had been born at home, learned about the center from her family and wanted a safe place to have her baby.  Najarro was very determined to return to school and took advantage of the health center’s offer of free contraception.  Najarro talked about how she wanted to share with others the benefits of the health center and to promote family planning to women who were currently in school or working.

Marcelena with her youngest child

We then met Marcelena, 30, who had recently delivered her fourth child and had many complications.  She dealt with bleeding, high blood pressure and a urinary tract infection during delivery.  Luckily she was referred to the larger hospital in Ayacucho city and delivered a healthy girl.  While the system established by the FEMME program saved Marcelena’s life, and the life of her baby, she clearly faced a number of other challenges.  She spoke about facing domestic violence and abuse from her husband and in-laws because, in her words, she was poor.  Our visit was a sad ending to our time in Ayacucho and was a stark reminder that even after saving the life of a person there is a great amount of work to do to ensure that cultural norms are inclusive and supportive of the woman’s role within a family.

The work we saw in Peru was extraordinary.  It was particularly eye opening for me as it was my first trip to see CARE programs.  I was struck by a number of things.  Many of the programs we visited had ended, but they were still gaining strength and influence.  It was clear in the starkest terms which areas were heavily influenced by CARE’s work and which weren’t.  People who received CARE training were healthier, had improved their economic status and enjoyed an overall better quality of life.

Our advocates in the U.S. have heard from opponents of foreign aid that it’s unsustainable and ‘we can’t do it forever’.  Many opponents of foreign aid also think the help we provide is a ‘blank check’.  This could not be further from the truth.  The success of every program we saw was entirely incumbent on the locals’ participation.  For these programs to work, the residents of the Ayacucho region needed to be invested for the impact to be long-term and sustainable, and that’s exactly what happened. 

To help us continue successful, cost effective investments in U.S. foreign aid, please send a message to your Members of Congress letting them know that you support investments in these types of programs! 

To learn more about you can get involved in the CARE Action Network, you can also contact your local Field Coordinator.

I wake up my second day in Kisumu, feeling slightly like time and space have become somehow irrelevant. I’m seven hours ahead of everyone I know and love (soon to be eight due to Daylight Savings), sleeping under a mosquito net and feeling the creepy crawly tug of jetlag grabbing at my heels. And as I soon find out, Kenyans have their own sense of time and space all together. A 10-minute drive takes 45, an 8 am pickup means give or take an hour, a mile could actually be five. You get what I mean. It’s all extremely well intentioned however, and actually fits perfectly in with their “Hakuna Matata” attitude, so I quickly adjust, accepting that Kenya works on its own operating system.

Our first stop is an hour drive outside the city. We pass the equator along the way, oddly enough sponsored by the local Lions club. Everything in Kenya is branded. Coca Cola, Bic, Safaricom. I see it on security gates, cars, housing complexes in the city, tin stalls in the rural areas.  In so many ways, it seems everything is for sale.

We pull up to the Malanga Health Center and are greeted by the two nurses that manage the center, Paul Malawa and Alice Nangumba. There is a sense of pride with which they show me their modest facilities, describing in detail the purpose of each room. What interests me the most is the way they compare and contrast everything as before CARE and after CARE. And it’s not in a “Somebody’s-here-from-CARE-we-should-talk-them-up-type-of-way.” Like their sense of time (or lack thereof), Kenyans also are known for their frankness.

The results are tangible. Mosquito nets for the maternity recovery ward. Medical equipment that helps the staff determine PMTCT risks (prevention of mother to child transmission). Clean water systems to replace the rusted tank that sits in the front yard, the previous source of water. New maternal delivery beds (previously mothers had to give birth on wooden benches). Even chairs for patients and a clock for the nurses to determine the timing between contractions. CARE’s contributions seem to be everywhere.

But the thing that I hear again and again, is what CARE has given that can’t be seen. CARE has built capacity. Capacity is one of those words, that as a member of the communications team, we try not to use. Media view it as to “wonky,” the public gets confused by it. But the truth is whatever you call it, capacity building is what we do. And it’s what we do best. We’re not handing out fish; we’re teaching people how to fish. Capacity building is the entire approach behind CARE’s work:  educating and investing in the community leaders and practitioners that are on the ground really making the changes. It’s strengthening competencies so that Paul and Alice can be more effective in their work. It’s job training, education, utilizing community networks and resources. And it’s serving as a true partner to the Malanga Health Center. “There has been no particular NGO that has been around consistently in this facility,” Alice told me. “It’s only CARE.”

We walk over to the Comprehensive Care Unit. We pass a rusted bicycle, aka the old emergency obstetrics transport vehicle.  Easel paper covers the walls remind clients of the pillars of safe motherhood, the top ten diseases. We pass a chalkboard that serves as the mortality record. In June of this year, there were 2 births and 8 deaths, two of which were under five.

The Care Unit is packed with visitors. Noah, the only paid counselor on staff, says he sometimes sees up to 50 clients a day, usually on the days the Anti-Retroviral Therapy medicines arrive. Trained volunteers known as peer educators spend much of their day helping other clients. As clients themselves, they are too well aware of the health challenges that face their community. Paul tells me about how common “deserters” are. Deserters are clients that find out their status and then disappear; the stigma of having HIV is too high. Peer educators track them down, trying their best to convince them that taking their medicine is best for both their own health as well as preventing the spread of the disease to their partners. Sometimes they succeed. Sometimes they don’t. It’s a tough conversation to have. I will learn at my next stop how CARE is using some exceptionally creative ways to approach such a challenging subject.

Our next stop is just a few miles down the road. It’s a program I’ve wanted to see for some time. Kenyans are a people meant for performance. It’s not uncommon to hear singing while walking down the streets; meetings are often started with a dance and a song. So it only makes sense that when talking about some of these more complicated issues—family planning, domestic violence—Kenyans would choose to express themselves through drama. The Participatory Education Theater group uses an interactive style of theatre to engage its audiences in critical discussions. And it seems to be working.

A group of 40 or 50 people has gathered at the local Chief’s homestead, waiting for the performance to begin. Men, women and children alike are sitting in the grass, laughing with their neighbors, catching up since they’ve last met. Several of the women are members of the House of Nannies, a CARE group that supports caretakers of HIV/AIDS orphans. One such caretaker walks over with a curious boy named Obama. There are lots of Obamas here. And lots of Clintons, Rhoda of CARE Siaya tells me. Kenyans tend to name their children after important visitors. If I’m lucky and I meet a woman who gives birth in the next week or so, there may be a “Niki” running around too.

After awhile the performance begins. It’s all in Kiswahili so CARE staff lean over occasionally to translate. The first performance is on balancing religious beliefs and family planning. A mother approaches her husband with her very sick child. She wants to go to the hospital. The father refuses, saying they will pray. The child later dies and a fight ensues. During the course of the performance, the audience jumps in with suggestions, both men and women expressing their views on what the parents should do. A deeply religious people, Kenyans often have a hard time reconciling where prayer needs to be accompanied with medical interventions. Performances like these allow the community to discuss and accept that such interventions don’t have to go against their religious beliefs. 

After the performance, a CARE staffer facilitates a discussion. Some of the opinions expressed are long-held, deep-rooted. It’s amazing to be able to witness such frank dialogue between men and women. Other performances address the rights of children and birth spacing. The dialogue goes on and on. Auscar, who facilitates several of the discussions, tells me they have to cut off the dialogue at some point. They could sit and discuss these issues for hours. People are truly engaged. I may not speak Kiswahili, but the animated hand gestures, the facial expressions and the back and forth conversations are proof enough for me. This is a forum for conversation that is working.

It starts to rain and five or six of us crowd in the CARE truck for a debrief. Kenyans love the debrief. How do you feel? What did you think? What could we have done better? They are innately curious and we spend an hour or so discussing a range of topics. They are open and honest and I finally get to ask some of the questions that are still lingering from my car ride with Refa. And they ask me questions back. It’s an intimate exchange and I feel like I have learned immensely in my short time with them.

As Refa prepares to drive me to the airport, Rhoda pulls out a small gift from the Siaya office. It’s a beautiful traditional wrap that Kenyan women wear. Along with the CARE logo, it reads the slogan of the Village Savings and Loans Group, “Grow Together.”  I am deeply touched and give each of my new friends a sincere and heartfelt hug. I have experienced so much, and my trip has just begun. I can’t wait to see what else awaits me. 

Have you ever encountered a kindred spirit? You know, a person that you meet and somehow, within minutes, swear you’ve known for a lifetime? That perhaps you met in another life? Well, I have. Kind of. I have a kindred country. It’s Kenya.

I have wanted to travel to Africa since I was eight years old. Not on safari, but to really see Africa, experience life as so many Africans do. During my elementary school career days, I was the one that wanted to be in the Peace Corps or an aid worker while my friends all wanted to be lawyers and fashion designers. It has been a lifelong love affair.

When I found out I’d be traveling to Kenya with my job at CARE, I was overwhelmed. And to be honest, a bit anxious. What if after all these years of anticipation, Africa didn’t feel the kinship back with me? What if I was not strong enough to handle such a life-changing experience?

The purpose of my trip is twofold. One, to capture the work that CARE does on the ground in our programming through stories, videos and photos and share it with the wider world back home. And secondly, show an NBC journalist our work with the Sports for Social Change Program. I’ve been itching to see CARE work since I started all of four months ago, but the fact that my first trip with CARE would be to Africa felt like a dream come true. After what felt like a 75 hour flight, I finally landed in Nairobi. I found an ATM, took out what I later found out was the equivalent of six dollars and headed to my hotel. As it was night, I saw pretty much nothing heading out of the airport. But I could feel the energy. Whether it was that of the city’s, or just my own head rush, it felt palpable in the whizzing car.

Kisumu and Siaya
The next morning I woke up at 5 am, again missing Nairobi through the darkness. I flew out to Kisumu, a mere 40 minute flight from Kenya’s capital city, where Refa, a broad and quiet CARE staffer met me. Finally the sun had risen and I got my first real glance at a land I had wanted to see for so long. I was breathless.

Kenya is a paradox. In the two hour ride out to the Siaya District, I saw both incredible beauty and absolute heartbreak. New to the whole development world, I sat mostly quiet, asking Refa more about himself and his background than the questions that really were running through my mind: “Do people actually consider that a habitable structure?” “Why is a country where the tin roadside stalls lining the (loosely defined) roads named things like ‘Praise Jesus the Lord Electronics Shoppe’ have such issues with domestic violence, rape and gender inequity?” “Are there any traffic laws here?” (There are some pretty crazy traffic scenarios with motorbikers, bicyclists, rickshaws, walkers, peddlers, schoolchildren, buses, and trucks all competing for the right of way.)

But in between these questions, my jaw would drop. The landscape near Victoria Lake was lush and dense and green, almost like a Hawaiian island. The women were stunning, poised and graceful, carrying things on their head that I couldn’t manage in a shopping cart. Little children, shouting “White Girl” in Kiswahili and “How are you?” in English smiled at me with faces that shined with a tangible inner glow.

When we finally pulled up to the CARE office in Siaya, I was greeted with hugs and handshakes that made me feel immediately welcome. The work done in Siaya, a rural district in Western Kenya, is nothing short of astonishing. They touch so many different areas, and I saw throughout the day, they are thoroughly integrated into the community.

The Family Planning Results Initiative
After a quick briefing with the team, we headed to the Siaya District Health Center, a facility that CARE partners with as part of the Family Planning (FP) Results Initiative (RI). In a country projected to have a population of 50 million by 2015, population explosion is a major threat to human development in Kenya. Utilization of FP services in Kenya are low, some 39 percent, while the unmet need of FP services is high at nearly 25 percent.

Launched

Launched in 2009 with support from USAID, the initiative seeks to increase sustained and consistent usage of FP services in the Siaya District by not only using traditional programming, but by also incorporating social change efforts. FP is much more than using preventative measures. What really impressed me about RI is how comprehensive the approach seems to be. It involves building the capacity of the community to challenge social norms and practices and improve gender inequity by confronting long-standing behaviors and practices. Kenya in particular faces the tough reality of traditional gender roles and discrepancies for women when it comes to accessing services, including health care. Often times a women doesn’t even realize she has choices when it comes to planning her family. RI is doing some great work to make sure that reality, along with local attitudes around FP, changes.

With a full day planned, we headed next to Awendo to meet with a group of elders, the Provincial Administration, who represent the government at the local level. We pulled up to a circle of men sitting outside in plastic lawn chairs of varying sizes. One thing about the Kenyan people is that they are overwhelming gracious in their welcome. They greet me like an American movie star. After hearing at the health clinic about the difficulty in breaking through ingrained gender roles, I am amazed at how frank and open the Administration is with me. They explain how CARE has educated them about the importance of open dialogue around difficult but critical issues, such as maternal health, HIV/AIDS, and family planning. It was evident how successful the partnership has been just by how candid they are with me, a complete outsider, and a female to boot. It’s one thing to say that I work for an amazing organization, one that really focuses on the root causes of poverty and teaches communities how to empower themselves. It’s another to go half way around the world to hear the people that are served by CARE reiterate the same thing. I will later find I hear this again and again.

As captivated as I was by the discussion I couldn’t help but notice a small boy standing on the outer edge of our circle. Eyes wide open, I could tell he was incredibly curious about me. After our meeting, I slowly walked over to him and greeted him in my (very) limited Kiswahali. He stared at me in amazement and then broke into a big grin. Before I had a chance to blink, I was surrounded by a dozen or so kids, all of them in absolute wonder and gratitude for the smile and hug of a stranger.

Men Leading a Women’s Movement
At that moment, choked up as I was, I realized something. In America, there are ton of compassionate people, people that work for those who have less, the unfortunate, the poor. But in Africa, there is a level of poverty that is hard to come by in America. I would venture to say it doesn’t even exist. It’s easy when separated by an ocean to think that developing countries have nothing to do with us. We have enough problems of our own, after all. I could argue about how investing in foreign countries through education and improved health care for the extreme poor is a matter of national security. Desperate people are more likely to take desperate measures, after all. But at that moment, seeing how a 6 year old girl reacted to a smile made me feel it was much simpler than that. I’m not saying we shouldn’t care about our problems at home. What I am saying is that this little girl has the right to a future too. By partnering with CARE, local communities throughout Kenya are making tremendous strides so that she can shape that future for herself. In Awendo, she is growing up in a community where the male leaders are learning to value women’s roles and opinions. By the time she’s a teenager, perhaps she’ll have more options because of that shift in thinking. It’s a pretty powerful thing to imagine.

Ligega’s Village Savings and Loan Program
By this time of the day, I was exhausted and emotionally drained. Adding to my weary state was the fact that I had gotten a total of four hours of sleep over the past two days. But we had one last stop to make before heading back to Kisumu for the night. And I had been looked forward to it for weeks. So we drove to Ligega to talk with the women of CARE’s Village Savings and Loans (VSLA) program.

CARE’s VSLAs are unique in that they are able to penetrate extremely poor and rural areas, places where people live on less than $.50 a day, places traditional microfinance organizations have been unable to reach due to high costs and access issues. By pooling small amounts of funds (a few cents to a few dollars), women in VSLAs are able to use joint savings in case of emergency health situations or to buy supplies to help their businesses (fertilizer, for example). By becoming part of a tight knit group, these women begin to be able to discuss critical issues that are harder to do in more restrictive societies, as well. Issues like family planning, HIV/AIDS, maternal health and domestic violence.

The road to the health clinic where this particular VSLA was meeting was a rough one. We were several hours behind schedule and I felt awful that this group had been waiting around to meet me. As we pulled up, windows down, I heard a soft chant, and as we got closer I realized there were about 45 women who, on seeing the CARE truck, had started singing and gently swaying. Their voices grew in a harmony until it was a full on choir and dance fest. Refa leaned over to me, “They are singing thanks to CARE for bringing them a visitor.”

I have never in my entire life been so overwhelmed and welcomed so graciously. The thing that has struck me so far about this country is that no matter how dire the situation looks to an outsider’s eyes, Kenyans are nothing if not grateful. It’s truly a blessing to experience.

With such a welcome, I knew that my time with these women would be compelling. And I was not let down. One women’s story particularly resonated with me. Her name was Shelfa Aninja. Sitting next to her in the grass was her 3 year old son. When I later took his picture on my digital camera and showed it to him, he looked at me in complete awe. He had never seen his face before. He was her fifth child. But he was the first one to have survived. One lived to six months; another seven. One was stillborn. She said she owed her son’s life in large part because of her involvement in CARE’s VSLA. Through the VSLA, Shelfa learned about the importance of pre- and post-natal health and the warning signs for when she needed to go to an emergency clinic. I was struck by her poise, in the way she held herself, her confidence in telling her story. This woman may have once been considered broken, but now, standing before the group, she seemed strong and proud.

Several other women shared their stories, there was more dancing and song, and a community health worker demonstrated how to use PUR tablets to clean water for drinking. Several girls gathered around me and my camera, gesturing for me to take a picture. When I showed them the results, they laughed like hyenas. I later found out they were all HIV positive.

When it was finally time to go, I was once again surrounded. Everyone wanted to thank me, to hug me, to touch my hand. Seeing the “outcomes” of CARE’s work, meeting the people whose lives are changed, and then going on to change others lives, has been completely and utterly life-changing. And that was just day one.

Looks like my kindred country may love me back after all.