The Minga Bump

In politics, a ‘bump’ is a sudden increase in popularity for a candidate; due, for example, to receiving a key endorsement or attending a key event. The most commonly noted ‘bump’ in American politics is the ‘Convention Bump’: presidential candidates almost always receive a boost in popular support in the week(s) following their party’s national convention. More recently, talk show host Stephen Colbert coined the term ‘Colbert Bump’, a jump in support that candidates supposedly received for being guests on his program.

For over a decade, we at the Minga Foundation have been fine-tuning our approach to development work. At the same time, we’ve sought simple and transparent ways to communicate our basic vision and strategy. In this spirit, I would like to introduce the ‘Minga Bump’.

At our August, 2016 Board of Directors’ Meeting, Board Member and Minga co-founder Jessica Levy coined, extemporaneously, the expression ‘Minga Bump’. For a moment I thought she might be referring to an interpretive dance, which would somehow capture our essence as an organization (those of you who know Jessica will understand my brief hunch). Though to this day I haven’t given up on the dance idea, I quickly realized that Jessica was suggesting something else: that we appropriate the political concept of a ‘bump’, and use it to describe our model of development work.

The loss of a single individual, a single instance of human potential, to problems of under-development is tragic. A common refrain tells us that every individual child who dies before the age of 5 ‘could have been the one that cured cancer,’ and education policies are given titles such as ‘No Child Left Behind.’ We at Minga believe the same type of thinking should apply to community organizations.

Small, community-mobilizing organizations appear and disappear with frequency around the world. Indeed, a core subgroup of Minga Foundation Board members got to know one another as activists for Durham Congregations, Associations, and Neighborhoods (CAN), a local organizing group in Durham, North Carolina.

Unfortunately many such organizations, whether in the United States or sub-Saharan Africa, face problems of sustainability. After coming into existence based on the initial energy of an individual or a campaign, will these organizations have staying power? Will they be able to consolidate their achievements, and set their sights on new projects and goals? Or will they whither for lack of capacity and resources?

As with individuals, the loss of potential community- and world-changing organizations is tragic. As many of you know, ‘Minga’ is the Quechua word for ‘Community Action for a Common Cause’. Community mobilization is at the heart of our vision at the Minga Foundation. We believe that genuinely transformative development occurs through strong communities and advocacy networks; indeed, that the notion of development as an ‘external intervention’ is nearly a contradiction in terms. In turn, for us, the loss of a single community organization with strong mobilizing potential has a direct impact on community members’ well-being.

This problem is all the more pressing for the following reason: most of the most promising and newly forming community organizations around the world are missed by the larger donor agencies and foundations. They do not yet have the capacity to secure the support they need from domestic and international donors; and without that support they cannot develop the very capacity they lack. A catch-22 if I’ve ever seen one….

Enter the Minga Foundation. All of Minga’s projects are conducted in partnership with local organizations in our partner communities, from the Butakoola Village Association for Development; to the Nancholi Youth Organization; to the Lubengoa Women’s Development Association. We chose these organizations, and these projects, as part of a detailed application review process. And we chose them too because we found them to be promising, and at a stage in their development in which the ‘Minga Bump’ could be crucial.

Each of our projects involves the creation of a resource, whether a health clinic, a borehole well, or HIV/AIDS testing and education; but perhaps more importantly, this resource comes with a strategy for capacity-building. We seek to locate small but promising organizations around the world that the big players miss, and to provide their community members not only with an immediate good, but with an advocacy structure that is built to last. We help organizations which might otherwise perish not only survive, but grow, evolve, and consolidate. We give community organizations the ‘Minga Bump’, and our projects thus promote well-being in the immediate and medium-term.

Much more could be said, and problematized. Many ‘bumps’ in politics are ephemeral…the 5-point jump in the polls a candidate receives after his or her convention often quickly recedes, and the race normalizes. Obviously, this temporary and short-lived jolt is not what we’re after at Minga. We seek a truly meaningful boost, which puts in place organizations whose work and community imprint will still be recognizable in 10, 20, even 50 years. This is an immense challenge; and one that we accept and successfully face with enthusiasm and passion.

It’s an honor to be a part of this amazing group and this amazing work. And now, Jessica, how about that dance…?

Choosing Wisely: Selecting Medical Missions With Lasting Impact

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PINCC Trainees in Pearl Lagoon, Nicaragua review flashcards with images of cervical pathology with PINCC volunteers during an afternoon teaching session.

As a family physician with a strong interest in international work and travel, I often contemplate how to best balance my personal goals and needs with those of the communities I serve.  I have a strong desire to serve internationally but with a full time job here in the U.S., I can only get away for 1-2 weeks at a time and must use my vacation time for any volunteer work.  Most medical professionals in the U.S. are in a similar situation to me and thus can only consider short volunteer stints if at all.  As a board member of The Minga Foundation, I am always searching for sustainable projects to work on.  However many medical projects that accept short-term volunteers are anything but sustainable.

There are numerous medical non-profit organizations that specialize in what many consider “medical tourism.”  These organizations send teams of volunteer physicians, nurses and support staff to an “underserved” community for several days or a few weeks, provide donated materials, see hundreds of patients, and then leave.  The volunteers have a great time during their travel, enjoy the experience of “roughing it” and leave feeling as though they have really helped people in need.  But what impact do these projects really have on the long-term health of a community?  It turns out that it depends greatly on the overall design of the project and the behind-the-scenes work between on-site visits.

Short term medical missions not only have the potential of leading to unsustainable health impacts, but can actually undermine the existing health systems of the communities they are meant to serve.  Most medical mission projects provide free care which may discourage patients from seeking care from existing health providers in the intervals between mission visits. Frequently there is a duplication of services provided on mission trips without coordination with the local health system.  The most irresponsible organizations may also bring donations of donated medications that may be expired, unavailable for patients to continue in their home-country or with instructions printed in a language they cannot read.

Projects that focus on improving the knowledge, skills or capacity of medical providers in the community being served are much more likely to lead to lasting health improvements than projects where care is provided by foreign volunteers only.  I recently had the pleasure of volunteering with one of many medical non-profit organizations that truly “got it right.”  Prevention International: No Cervical Cancer (PINCC) is a non-profit organization with a mission to “create sustainable programs that prevent cervical cancer by educating women, training medical personnel, and equipping facilities in developing countries, utilizing proven, low cost, accessible technology methods.”  Though their volunteer model relies on 1-3 week international trips by American or Canadian providers, their work leads to completely sustainable change and has truly saved the lives of hundreds of women.  Knowing this makes the experience of volunteering with them even more gratifying.

PINCC was founded in 2005 by an OB/GYN in the San Francisco Bay Area, Dr Kay Taylor, whose vision was to help eliminate cervical cancer in developing countries where it is a leading cause of death for reproductive aged women.  Thanks to cervical cancer screening programs that emerged in the past century (PAP smears), cervical cancer is now incredibly rare in the United States and other developed countries. PAP smears allow providers to diagnose pre-cancerous changes in the cervix that can be easily treated years before they become cancer.  Cervical cancer is one of the most easily prevented diseases in modern medicine, yet requires a universally available screening program and access to treatment for women whose screening tests are abnormal.  Poorly organized and underfunded health systems, poor health care access for women in rural areas, and cultural stigma are just a few reasons why cervical cancer screening programs have not been as successful in many developing countries.  HIV infection increases a women’s risk of getting cervical cancer and so countries with high HIV infection rates have also seen huge increases in deaths from cervical cancer.

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Nurses in Muhoroni, Kenya reviewing their training manual in preparation for the day’s screening exams.

I recently volunteered with PINCC for one week in Muhoroni, a remote village in Western Kenya, and then another two weeks along the remote Caribbean Coast of Nicaragua.  During my time with PINCC I was constantly impressed with their sustainable approach to providing medical aid. PINCC’s entire model relies on training nurses, clinical officers and physicians in underserved clinics the necessary components for establishing their own cervical cancer screening programs.  To date PINCC has trained over 400 providers at 27 different health centers!  The exponential impact of this work is so much greater than just the 15,000 women who have been screened during PINCC training trips.  Thousands more women have been screened and treated since PINCC ended their involvement with the clinic sites.

Part of the success of PINCC comes from the huge amount of care taken in selecting project sites ahead of time.  Before PINCC ever agrees to visit a community, they require a signed contract from the hosting hospital or clinic confirming their commitment to establishing a cervical cancer screening program for their patients.  PINCC will then provide between 3-4 site visits over a 1-2 year period as well as remote support between visits as needed.  PINCC will also provide donated equipment to help the programs get up and running, but they also make it clear that local health providers will have to determine their own way to fund the screening program in the long run (be it through governmental support, charging small fees for services, acquiring donations, etc). PINCC provides the necessary training and certification for providers and also helps link providers with their in-country medical resources for more challenging cases that may arise.  Very importantly, PINCC makes sure not to duplicate services by only visiting communities where there are not cervical cancer screening programs already in place, and gets permission from the national Ministry of Health to make sure they support PINCC’s work in the proposed communities.

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PINCC Trainees in Muhoroni, Kenya with examination headlamps after completion of first week of training.

As a volunteer, the experience of working with PINCC is incredibly rewarding. One week is spent at each clinic or hospital site with a focus on training providers in the skills needed to perform screening exams for cervical cancer. During our visits to Kenya and Nicaragua, we saw 100-200 women each week and supervised local nurses or physicians as they performed exams.  Any of the women who had abnormal exams needing treatment were treated that day and each site had several providers who were learning to perform the simple and low-cost cryotherapy procedure with the goal of certifying them on future visits.

It was rewarding to see a large number of women receiving cervical cancer screening often for the first time in their lives.  During our week in Kenya we treated over 25 women with pre-cancerous lesions and during our two weeks in Nicaragua we treated 35 women, essentially preventing each of them from developing cancer in the near future.  We also sadly saw 5 women in Kenya who likely already had advanced cervical cancer.  There may not be much to do to save their lives though they were referred on to the national hospital system for possible treatment.  In my entire 9 year medical career in the U.S. I have only cared for 2 women with cervical cancer.  Thus, I also learned from seeing these more advanced cases and the importance of the training we were providing became all the more apparent.

I cringe whenever I hear colleagues talk about volunteer stints in other countries that are clearly not providing sustainable care.  I feel that more of our volunteer aid should be focusing on improving the existing systems of care in other countries rather than swooping in and providing care that will not be sustained when we leave.  Programs that are designed to teach new skills for local providers, increase access for patients to health services (funding clinics, etc. so long as those clinics can be staffed by local providers) or provide educational and outreach services for patients (e.g. community health worker programs) will ultimately be the most impactful in the long run.  As medical volunteers we have an obligation to make sure we are truly providing meaningful help and not actually undermining the health systems of the countries we are intending to help.  I urge anyone considering a medical trip of their own to look closely at the model of care that the organization follows and ask questions if it isn’t clear how they integrate with local health systems and ensure the long term sustainability of their work.  There are plenty of good organizations out there like PINCC who need our help, but it is important to choose wisely if you want to truly make a difference.

For More Information about PINCC, visit www.pincc.org

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PINCC Volunteer Providers during week in Kukra Hill, Nicaragua Nov 2014.

The Effect of Toilets on Education

Did you know that one of the main barriers to girls getting an education starts in the bathroom?

You read that right. Not a lot of people want to talk about it, but in much of the developing world, one of the top barriers to girls’ education is the lack of safe and separate latrines for girls and boys. In fact, in many areas it’s the number one cause of school absenteeism, ahead of malaria and other diseases. In the United States, being able to find a safe, private bathroom is something that most of us take for granted. But only 45% of schools in the least developed and low-income countries have adequate sanitation facilities.

How does a safe, private toilet influence girls’ education, you ask? Well, first it’s important to note that access to adequate sanitation facilities can influence the education of all children in the developing world. These facilities lead to improved sanitation and hygiene, which in turn, can reduce the number of water-born illnesses and diarrheal episodes that cause  – among other devastating outcomes – school absenteeism. But adolescent girls are at greatest risk for being affected!

When a girl reaches puberty, access to a safe, private toilet can make a crucial difference in whether or not she continues her education. Girls need clean water to wash themselves or their menstrual cloths and a place to dispose of their menstrual pads if they are using them. If girls don’t have access to these facilities at school, they will often stay at home during their monthly periods. In fact, lack of safe, private toilets can cause girls to miss up to 20% of the school year. As one might imagine, irregular attendance can lead to lower grades and may, eventually, lead to dropping out of school altogether.

Also, believe it or not- gender segregated toilets that are located in convenient, safe locations at school can protect girls from violence and assault! Women and girls are often vulnerable to harassment or violence when they have to use shared toilets or are forced to go to the bathroom outside. In one survey of schoolgirls in South Africa, for example, more than 30% reported having been raped at school; often these incidences occurred in school toilets that were either shared or in an unsafe, isolated locations. Such violence is a major deterrent to school attendance, not to mention a girl’s self-esteem and desire to learn.

Finally, when girls don’t have access to a toilet at all, they’re forced to go outside. To retain some sense of privacy (and dignity), many girls will choose to ‘hold it’ or limit their consumption of food and drink to delay the need to relieve themselves. Not only can these actions increase the chance of urinary tract infections, but it also means that girls aren’t eating and drinking as they should, which can lead to dehydration and malnourishment.

In sum, there are already many reasons that put girls in much of the developing world at high risk for either dropping out of school or not going in the first place. But when schools have appropriate sanitation facilities, one of those obstacles is eliminated, and one more girl is empowered to make a difference!

Sources:

Welcome to Our Blog!

Since this is our first blogpost, an introduction is in order. The Minga Foundation is a nonprofit organization with current projects in Ecuador, Malawi, and Uganda. Although Minga came into existence in 2010, its organizational predecessor Foundation Human Nature USA was founded in 2003. Many of us have been working together for over 10 years, and this is fitting. Why? Because Minga is about more than any of our individual projects; it’s about a set of ideals, friendships, and experiences that span all of our work and all of our time together.

For all of us Minga is about making idealism a way of life. Beyond implementing concrete projects in our partner communities, we also generate ideas of what a better world might look like, and concrete strategies to make these ideas real. How to achieve long-term sustainability in our projects? How to partner as equals with the communities in which we work? How to promote a culture of progressive activism rather than reactive ‘slacktivism’? How to create the conditions in which international aid is no longer necessary, i.e. how to put ourselves out of business? We wrestle with these questions in our Board meetings, in the classrooms where we teach, in the communities where we live, and now on this blog. Stay tuned.

That said, our idealism and the purpose of this blog goes beyond intellectual debates on international aid and economic development. Minga itself is a Quichua term which means ‘collective action towards a common goal’; a process by which individuals come together and invest their individual time and energy towards a shared goal or resource. Community participation and collective action are at the core of all of our individual projects. They are also at the core of who we are as a team and an organization.

We truly are a unique group with a unique model. We’ve grown over the past 11 years as an all volunteer board without physical office space or any of the overhead costs incurred by most non-profits. This is only possible because each of us as individuals is willing to give freely of our time and energy. This generosity applies also to our families, as well. Our parents, siblings, aunts, uncles, and cousins have all at some point made donations, organized publicity campaigns, and hosted annual retreats. They’ve served as accountants, consultants, fundraisers, and cheerleaders, even when Minga work and responsibilities made our lives more complicated. Our board members and their extended families constitute a living, breathing example of individuals devoting time and energy to a larger, shared cause.

You might ask, what is that cause? What is the shared resource generated by all of these individual efforts? The first and most obvious answer is the satisfaction of improving people’s daily lives. Eliminating malaria in El Paramo region of Ecuador; providing access to clean water in Kayunga County, Uganda; improving education outcomes in Kabadula, Malawi. These are results which all of us are proud of and which in and of themselves merit the above-described investments of time and energy.

However, the truth is that all of us get more from Minga than the satisfaction of doing good work. We’ve been with each other through the thick and thin; through moves and job changes, through personal accomplishments and personal crises. Laughter and smiles can be a scarce commodity in life, but every year we leave our organizational retreat with side pains from late night games of Charades and Balderdash. We are always there for each other, and the friendships and commitments we’ve developed go well beyond our work in international development.

There is nothing more idealistic than creating lasting friendships from a shared commitment to making the world a better place. So, you ask, what do we get from our investments of time and energy? Perhaps most importantly, we get each other; and for that reason this blog will also be about us. It will be about our jobs, our pass-times, our cities, and our pets. It will be about the people who make Minga possible. Check in with us to learn about our projects and our ideas, but also about our team and our experiences.

We are Minga. Minga is family. Come Minga with us!

-Dan Kselman, President, The Minga Foundation