2012 Live It! Project Report

Margo Faulk: Improving Access To Healthcare In Indigenous Communities (Bolivia)

The inspiration for my Live It project began during my January internship with A Tu Lado, a small NGO founded by Macalester graduates. When I arrived in Bolivia, I was introduced to A Tu Lado’s local partner NGO, which builds healthcare infrastructure in the Andean region of the country. They also provide a medical air service for the Beni, a northern rainforest region, where a small and disperse indigenous population makes the construction of permanent clinics financially unfeasible. With a fleet of four small planes, they have transported over 1000 patients to Cochabamba since 2004. In addition to those emergency transports, they regularly fly medical teams to these villages to provide primary and preventative care. While this service has undoubtedly saved many lives, no medical provider attends to patients during transport, placing both pilots and patients in unnecessary risk. To address this issue, our partners had invited A Tu Lado to train a group of EMTs as flight medics.

As a member of the A Tu Lado team, I wanted to bring my own vision of global citizenship to bear on our work. In addition to helping design and teach the EMT course to local responders, I planned a Live It! project that would synergize with the efforts of both partner NGOs, and allow for better communication, record keeping, and evaluation, with a vision towards a better service to the communities who depend on our partners for their health care.

The project began with an expansive vision and a three-prong plan. First, I would create digital maps of the resources available to the flight service. Second, I planned to set up a patient record system, in order to improve individual patient care and to allow the organization to evaluate their delivery of health care. Finally, I wanted to apply the lessons I had learned in public health courses at Macalester and abroad, and interview some of the community members in the villages that were being served, in order to assess the needs of these populations.

As the project developed, it was reshaped numerous times, adjusting to changing circumstances, resources, and the needs of our partners. I quickly learned that flexibility is one of the greatest virtues when working with small NGO’s in unfamiliar cultural contexts. The EMT course became one of the primary focuses during my time in Bolivia, and I learned a great deal about teaching across cultural difference, weighing performance standards against realities, and making-do with improvised materials and rapidly-shifting schedules. The mapping projects shifted continuously and while I still produced ArcGIS maps that the pilots and administration were excited about, I also ended up learning about GoogleEarth, as this was a much more useful platform for the pilots in planning flights. The vision for the flight service also included an electronic medical record system, ideally based on OpenMRS, open source software. While I was able to contribute to a significant portion of the groundwork in starting this system, including helping to establish a collaboration with partners in Chile, we were unable to get the system up and running while I was on the ground. In lieu of the electronic system, I set up a paper record of patient care reports that will preserve patient data and make the transfer of care more efficient. I also helped to set up a flight record for the trips the air service makes, which will log details like flight time, destination, reason-for-flight, and number of patients, which can be combined with the mapping systems to evaluate the efficiency of operations.

This project taught me that even if you have a big, beautiful vision that makes all the puzzle pieces fit and seems guaranteed to improve a situation, as a global citizen, you have to recognize that your individual analysis of the situation is not the only important one. After two months of increasingly spotty communication from our Bolivian partners, we received news that the project was being put on hold, due to a miscommunication over a proposal for the electronic medical record system. This shocked and saddened me but also has made me reflect on how we performed our work, and some of the inherent difficulties of international collaboration. Some of this was cultural difference at play: as Americans, ideas move rapidly from the drawing board to implementation; we also expect a level of responsiveness to electronic communication, personal responsibility and initiative that was not always evident when working with local partners. We also did not anticipate the fact that there seems to be a cultural tendency to avoid expressing difference of opinion. This was a valuable lesson, and the future, I will be exploring ways to ensure I help to create space for discussion that is more open and sensitive. The lessons learned were the hardest I have faced yet, but important ones for a student interested in international work.

After recent conversations, it sounds like our partners will continue to implement the project after an internal review. Looking back on the summer, I am proud of the impact we had, and excited by the fact that I made lasting connections that will grow as I continue to collaborate with these organizations. While the project that unfolded was not the same one that I envisioned when writing the grant, the same goals and values of my definition of global citizenship still remain. The maps that I made and the data systems that I helped to set up will allow them to provide a better, more reflective and efficient service. And although I had only a brief opportunity to spend time with the communities in the Beni, I did speak with some community members and government health personnel, paving the way for future collaborations and more local, dynamic and sustainable solutions to healthcare issues in the region. The educational aspects of the work will also continue, as A Tu Lado has been invited back to coordinate another course at the Universidad de San Simon.

Reflecting on my summer I am so glad I had to opportunity to carry out this project. As I envisioned it, global citizenship is defined not only by striving to make the world a more just and humane place, but the manner in which these goals are pursued. Sustainability, collaboration with local partners, work based on both participatory methods and on evidence-based analysis: these were elements of the vision I strived to bring to my work. And although I encountered many difficulties in translating theory into practice, I learned invaluable lessons in the attempt, and am better prepared for the next opportunity to realize a project of this nature. In teaching the course, I forged relationships with truly inspirational citizens of Bolivia, who are dedicated to developing themselves to better serve their neighbors and communities. The 22 students who graduated from our course are prime examples of this. Besides the fact that it was immensely exciting, humbling and inspiring to be involved in this work, I also had the opportunity to learn about the potential and drawback of technology in development, the benefits and difficulties of working with a small NGO, and the beauty and frustration of networking with organizations and individuals across cultural and geographical distance. The relationships made and the lessons learned will stay with me for many years to come, and have deeply influenced how I see my role as a citizen of the world.