American poverty-fighting assistance saves lives and helps millions of people create a sound future for their nations and their neighborhoods.

And all for less than 1% of the federal budget.

- Martha Kwataine is leveraging a tiny investment of US foreign aid to protect the health of people in rural communities across Malawi. Click here to read more or download briefing note. Also see Martha Kwataine on The Hill's Congress Blog: Foreign Aid: A Beltway Outsider Perspective.

- Alexis Nkurunziza is leveraging a tiny investment of US foreign aid to open up budgets in Rwanda. Click here to read more or download briefing note.

- Majeda Begum Shiru is leveraging a tiny investment of US foreign aid to enable women to speak powerfully to improve health and education in Bangladesh. Click here to read more or download briefing note.

- Tanzanian farmer Emiliana Aligaesha is leveraging a tiny investment of US foreign aid to ensure the success of an early-stage, high-potential start-up. Click here to read more or download briefing note.

- Village Chief Kojo Kondua IV is leveraging a tiny investment of US foreign aid to train fishermen and protect jobs and the environment in Abuesi, Ghana. Click here to read more or download briefing note.

- Mayor Manuel Dominguez is leveraging a tiny investment of US foreign aid to budget for a sound future for his community in the Peruvian Amazon. Click here to read more or download briefing note.

...and many more stories to come!

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Learn more about making foreign aid more effective.

• Foreign Aid 101: A quick and easy guide
• Smart Development: Oxfam on making aid work
• Ownership in Practice: Foreign aid that strengthens the voice of the poor and the responsiveness of the state
• Fighting corruption with aid dollars
• Cutting aid that fights poverty? You must be quackers!

What others are saying about Oxfam's campaign for effective aid

• A compilation from Twitter
• Impatient Optimists: Interview: Oxfam and Gates Foundation Discuss How We Change the Conversation About Aid
• CS Monitor: Changing the face of aid, literally
• Everyday Ambassador: Flipping the foreign aid narrative
• Going International: We're all in this together
• Osocio: Don't Cut Aid: It's Working!
• Spirit in Action: Investing in Individuals
• whydev.org: The changing landscape of advertising on Aid & Africa: Oxfam's new campaigns

Note: Oxfam America does not take US federal funds, but we do support effective development programs.

Around the capital city of Port-au-Prince and in the Region des Palmes, Oxfam has been distributing hygiene and cholera kits to people in need, while continuing to provide information on how to prevent the spread of the disease. In Artibonite, a rural region to the north that was hit hard by cholera when the first outbreak occurred, Oxfam is stepping up its prevention activities. It’s providing equipment to cholera treatment centers, distributing cholera kits to hundreds of families, and collaborating closely with the local authorities.

“Unfortunately, cholera will likely, at a minimum, be endemic in Haiti for years to come,” said Thomas Mahin, a water quality adviser to Oxfam America. “The history of cholera cycles in other countries is that when the outbreak goes from an epidemic to an endemic situation, the number of cases decreases significantly but the percent of cases that are children less than 5 years old goes up. So, while the number of cases will decline eventually, the most vulnerable populations—infants, pregnant women, etc.—will still be at significant risk. So, the total number of cases only tells part of the story.”

The rain Sandy dumped isn’t only affecting the potential for a cholera outbreak. In some areas of the country, rainfall was equivalent to about 50 percent of the yearly precipitation and destroyed houses, bridges, schools, and roads.

In the South-East region, Oxfam is working with local partners to evaluate damage to agricultural areas: Sandy was the third recent weather event to hit the region following, first, a drought and then tropical storm Isaac. The cumulative effects of these crises are devastating to small farmers. Oxfam has launched cash-for-work initiatives for more than 1,000 families. The income from that work can help people meet their basic needs.

Oxfam is gearing up to respond to the flooding and potential for disease outbreaks.

“We are mobilizing all local organizations trained in cholera prevention to prepare a large campaign in the coming days,” said Oxfam’s Amelie Gauthier. “Oxfam is supporting local authorities—the Civil Protection Agency and the National Direction for Water and Sanitation in various localities in the Region des Palmes—providing them with transport, logistics and equipment for now. We are preparing hygiene kits, cholera prevention kits for distribution for some temporary shelters.”

Oxfam is launching an assessment in the department of Nippes—much of it affected by the heavy rain. At least two other departments have also been hit badly by the storm: Grande Anse and South.  As of Friday, the country remained under a state of alert across all of its 10 departments.

“In one area in Croix-des-Bouquets (near the capital of Port-au-Prince), we spoke to several families who now live with 160 families—more than 500 people in a fire station,” said Gauthier.  “There are pregnant women and young children as part of that one shelter.”  She added that many homes have been flooded and families need basic relief items such as plastic sheeting and hygiene kits.

A lack of access to drinkable water and safe sanitation in some urban and rural areas is also cause for worry. Oxfam is monitoring some of those areas closely.

“We’re also concerned at initial reports of destruction of agricultural crops caused by Hurricane Sandy in the south,” Gauthier said. “The south of Haiti is already food insecure because of the drought and impacts of tropical storm Isaac. We’re following the situation closely as this will affect thousands of farmers for the planting season as well as school nutrition programs.”

Donate now to Oxfam's Haiti fund.

Oxfam's Country Director, Andrew Pugh, said: "The worst hit areas are in the east and southeast of the country, but we're recording damage across the board. Isaac didn't deliver the devastating body blow we expected on Friday, but we're still seeing widespread suffering for it's poorest people."

The picture emerging from Oxfam's emergency team assessment is a long list of minor impacts throughout the country that add up to giant setbacks for its most vulnerable citizens.

Oxfam Communications Officer Stephania Musset, said: "For thousands of families, Isaac is still a horrible ordeal. I saw busloads of children without parents still arriving at shelters, and heard from a woman who lost her child as they ran terrified from their flooded home in the middle of the night."

The international agency continues to plan needs assessments in different parts of the country to tailor its response to needs, and ensure it is supporting government-led efforts. Oxfam is also planning a comprehensive cholera prevention push in several areas to reduce the risk of outbreaks such as those that have plagued the country since the earthquake in 2010.

Oxfam Program Director, Yolette Etienne, said, "We're worried that people without clean water are drawing from contaminated rivers. We're also seeing people staying in homes with waist-high water. If steps aren't taken now—including clean water, latrines, and health promotion—the impact of this storm could prove deadly."

Many of those worse affected by the storm are among the 400,000 still living in tent camps, two and a half years after the earthquake that leveled Haiti's capital.

Oxfam Program Director, Maurepa Jeudy, said: "If you're living in a tent, it only takes a puff of wind to blow your house down. Many people who already had little once again lost all. Now they need basics such as soap, toothbrushes, sheets, and blankets, but what they really want is a lasting solution in place of more flimsy tents. This storm is a chilling reminder that Haiti's recovery has a long way to go."

Oxfam is supporting a citizen's watch group that is monitoring Haiti's reconstruction effort and calling for urgent solutions for the 390,000 people still exposed to storms like Isaac that regularly visit Haiti.

Initial assessments of the aftermath of the storm, which cleared the island’s landmass in the early hours of Saturday morning (25^th August), suggest the damage has not been as great as was feared.

There have been media reports of four deaths, but there is no evidence at the moment of major damage to infrastructure or significant casualties.

Camps in the capital Port-au-Prince, such as Jean Marie Vincent, have been flooded, as well as towns in the south of the island, including Les Cayes, Jacmel and Nippes. There are reports of electric pylons collapsing and power outages and some disruption on the roads.

However, with exceptionally heavy rainfall forecast in the wake of the storm and with nearly 400,000 Haitians still living in refugee camps after the massive earthquake that devastated Port-au-Prince in 2010, people remain highly vulnerable to the threat of flooding, landslides and water borne diseases, especially cholera.

Oxfam emergency teams are now heading out to the affected areas of the island as soon as possible, allowing workers to carry out more in-depth assessments and to provide aid to those who need it in the form of clean water, hygiene kits and public information about sanitation.

Jane Cocking, Oxfam’s Humanitarian Director, said: “The storm may have passed but living conditions in Haiti remain so challenging for so much of the population that it’s far too early to say the threat is over. People in Haiti have so little that they are incredibly vulnerable to the risks posed by flooding and disease. They remain in desperate need of our help.”

The aid agency is accepting donations to help support its emergency work in Haiti, which is often cited as the poorest country in the western hemisphere with four in five of the population living on less than $2 a day.

Oxfam is working with a Sudanese partner organization to respond to the humanitarian emergency that began unfolding in the summer of 2011, when armed conflict erupted between government and rebel forces in the states of South Kordofan and Blue Nile; in April of 2012, border clashes between Sudan and South Sudan triggered another wave of displacement in the same states; in all, more than 900,000 people have been displaced or severely affected by the recent conflicts in South Kordofan and Blue Nile.

Oxfam’s partner program in South Kordofan

Aid providers are unable to reach many of those who are caught in this latest conflict, but an Oxfam partner has reached 45,000 people with a range of interventions, including:

• rehabilitating wells and installing hand pumps;
• distributing seeds, tools, and donkey carts;
• promoting health and hygiene; and
• distributing relief materials.

Oxfam’s work in the Jamam camps

Refugees from the conflict between Sudan and the SPLM-N continue to flow across the borders into Ethiopia and South Sudan. In the camps of Jamam in Upper Nile, South Sudan, many are arriving in a traumatized state, having trekked long distances without enough food or water. But the conditions in the camps where they have sought refuge are dire: residents and aid providers have had to contend with severe shortages of food and water, soft soil conditions that interfere with well drilling, and huge price increases for essentials like fuel and food.

Oxfam is helping more than 32,000 refugees in the Upper Nile region gain access to drinking water and sanitation, as well as hygiene materials like soap, and we are providing cash relief to help people cope with rising food prices.

Read more about the Jamam camps.

Estimable lives in a very small earth-walled home near a drainage channel running along a dirt road. The land around her is almost all mud and the road is under a foot of water in places. Floods plague her village, called Lameau, in the community of Grande-Saline in Haiti’s Artibonite River valley.

This is one of Haiti’s most productive agricultural areas, and over the years, the government and international donors have built a network of canals and channels, to divert water to dry areas, and drain out the wet ones. Small villages line these channels. Just after the harvest, many are drying their rice crop on tarps on the side of the road, near their small homes, some of which are quaint wooden houses that resemble gingerbread cottages. Others are more modest earth-walled dwellings. Children play and swim in the channels, laughing and splashing in the sun.

It looks idyllic but the Artibonite River valley can be a tough place to live, Estimable says. “When there’s too much water in our houses, in our fields, we get upset stomachs. It’s very hard to live here with so much water.” The lack of clean water in 2010 after one particularly rainy period coincided with a cholera outbreak which killed 300 people in this area, according to local officials.

Working for cash

Grande-Saline’s mayor, Erole Romeus, drew up a plan to clear out the mud and vegetation choking six kilometers (3.75 miles) of the secondary channels like the one near Estimable’s house. He’s also hired heavy equipment to widen them to handle more water flow. The project is employing two 132-member work teams in a cash-for-work program that provides much needed wages of about five dollars a day for 12 days. The project prioritizes hiring people living near the channels. About 2,000 people in 400 households live in this area and will benefit from better flood control.

Sansion Morisette is one of the workers; she has just spent the morning raking weeds out of the narrow channel running along the road next to Estimable’s house. “It’s about time we started this work,” she says. “I’m out on the street now because water destroyed my house in Rossignol. Take a look around you, we’re lucky if we can get two bags of rice out of our harvest sometimes, the water just eats everything we grow.”

Mayor Romeus says the project in Grande-Saline should take the community a long way towards reducing flooding, especially during the annual hurricane season. “Every time it rains, we can have 200 to 300 small houses destroyed,” he says standing on a flooded road next to the drainage channel, where scores of workers in white t-shirts are clearing away plants and other debris.

“We started talking about rehabilitating these channels as a means to deliver a durable solution to the people here,” Romeus says. “We came to Oxfam America because it is an organization that is interested in helping vulnerable people reduce the risks of disasters.

“Since we cleared all this out, people will probably have an opportunity to harvest. But if we did not, in another week we would have been in danger: the people, crops, and animals.”

Oxfam is devoting $20,000 for this project, which is covering about half the costs and supports the cash-for-work component, wages for heavy equipment operators, and fuel. It’s part of a larger program to reduce vulnerability to disasters in the countryside, and make it easier for people to make a living in farming, an alternative to the overcrowded conditions in Port-au-Prince.

Sancion Morisette is optimistic that the newly rehabilitated channels will help them. “Now I know that when it rains, the water will flow in the channel and go directly to the sea.”

Concerns about human rights and the environment are constantly swirling around the community and mine.

• As the mine was being established in 2005, the community of Sipakapa organized a referendum: The majority voted against allowing mining in their community. Neither the government nor the mine company Goldcorp respected the results. (In 2007 Guatemala's Constitutional Court ruled the referendum was non-binding.)
• By 2008, four different pension funds in Canada and Sweden requested a "human rights impact assessment." This independent report found that the company had not carried out adequate consultation with communities prior to establishing the mine, a violation of the International Labor Organization's Convention 169 Concerning Indigenous and Tribal Peoples, and the right to "free, prior, and informed consent."
• E-Tech International carried out a water study in 2010 that recommended more aggressive management and monitoring of water sources, as well as for a bond to cover cleanup costs after the mine is closed.
• A 2010 environmental health study by experts from the University of Michigan, University of Illinois, and Physicians for Human Rights found heavy metals in rivers downstream from the tailings dam, and called for ongoing monitoring.
• In 2010 the Inter-American Commission for Human Rights issued a set of "precautionary measures" that ask the government suspend mining at Marlin while the government carries out investigations into the pollution and human rights violations.
• The United Nations recently confirmed that the mine did not adequately discuss its plans with local people when it was established: "…the Marlin project was not subject to consultation with indigenous communities," says James Anaya, a special rapporteur appointed by the UN to look at the human rights situation of indigenous people in the country. His report was issued in June of 2011.
• A new cost-benefit analysis by the Tufts University Global Development and Environment Institute finds that the government of Guatemala is getting a relatively small share of profit from the mine: 42 percent of total mine revenues, which is "substantially below best practice in global mining operations." The bulk of revenues and earnings "flow overseas to the company and its shareholders." Local communities, the report says, "bear 100 percent of environmental risk." The conclusion: "...the economic benefits of the mine to Guatemala and especially to local communities... are meager and short-lived."
• Fifteen members of the US Congress sent a letter to the President Colom of Guatemala, urging him to immediately suspend operations and address the concerns of the indigenous communities affected by the mine.

The Marlin Mine now produces more than 300,000 ounces of gold a year.

Conflict and Violence

Critics of the mine in Guatemala and international experts are calling on the government and Goldcorp to accept the precautionary measures issued by the IACHR and suspend operations at the mine. It's a risky stance for local people to take: Amnesty International has noted cases of beatings and death threats against members of the San Miguel Defense Front(known by its Spanish initials, FREDEMI). Community members also report shootings and attempted shootings against mine critics. Aniceto López, a coordinator who works for FREDEMI was beaten in February 2011, along with Miguel Ángel Bámaca, a farmer and public health promoter.

The insecurity is "the worst thing affecting our community now," says Bámaca, who was also shot at late at night in July 2010, just outside his home. Like many other FREDEMI members, he is not comfortable publicly identifying his attackers. He says those who wish him ill "know what we do, where we live, when people meet...they know everything," Bámaca says."Who will help us?" The government, the courts, the police, they are not helping."

Adding to concerns about the environment and security, the ethnic Maya Mam people living in the area consider industrial mining as a form of disrespect for their religion and culture, which worships nature and Mother Earth. "Our spirituality, our vision is that there is harmony between nature, people, and God, we are together and there is balance in our lives," says Maudilia López, an indigenous woman who works for the Catholic church in San Miguel Ixtahuacán. "This mining activity puts our cultural values in danger."

Action in defense of indigenous rights

After the IACHR issued its precautionary measures urging the government to suspend operations at the Marlin Mine, the government initially agreed to do so, then later claimed it did not have enough evidence of environmental damage and human rights violations. Oxfam America has been collecting signatures on an electronic petition urging the government to suspend mining at the Marlin Mine and investigate the human rights violations and environmental problems linked to the mine.

“My friends,” comes the voice from the radio, “take your chairs to sit down and have some discussion about cholera now on your favorite show, ‘Some information about cholera.’”

If it is hard to imagine a show about a deadly disease as your favorite, that may be because you don’t live in rural Haiti. Here, among the beautiful mountains and broad rivers, people live with a frightening reality: it’s easy to catch cholera, and reaching the nearest clinic may take more time than you have.

In remote areas, a special urgency

Without treatment, cholera can be fatal within hours. But in rural Nippes province, what serves as a road may be the bed of a river that after heavy rains becomes a torrent. Or a footpath over steep mountains, where the rocks are sometimes covered in mud so slick that only the most sure-footed can navigate them. Where swift access to medical care is out of the question, cholera prevention takes on special urgency.

“There are some localities where we have to walk three to four hours to reach people. We use horses to go there,” says Jean Bassette, the Oxfam public health officer who hosts the show. “We can’t travel to remote areas every week, but with the radio program we can reach them easily.”

“Ti koze sou kolera,” as the show is called in Creole, invites listeners to call in. The discussions cover whatever cholera issues people want to talk about but usually focus on prevention and emergency treatment.

“If we don’t have oral rehydration salts—or sugar and salt to prepare them—what can we do?” asks one caller.

Stephanie Lormil, an Oxfam public health promoter who sometimes joins the show, explains that coconut water can be a stopgap solution, hydrating the person well enough to make the trip to the hospital.

Sensitive topics like social stigma enter in, as well.

“Treat people who have cholera with respect,” advises Bassette. “Do not humiliate them. People who have the disease need to be able to tell that to the community, and the community needs to support them by preparing oral rehydration salts and helping them get to the hospital. If people with cholera keep the information to themselves, there is risk to the whole community.”

We are not scared of cholera anymore

Feedback on the show has been overwhelmingly positive. Local leaders in communities throughout the broadcast area often call in with thanks and congratulations, and people on the street have kind words for the show.

“When we first heard about cholera, we were scared,” says Jose Mira of Petite Rivière de Nippes, who cited the radio show as one of Oxfam’s successful public health efforts. “We didn’t want to live next to people who had cholera. But Oxfam helped us understand the phenomenon of cholera and gave us training. After that, it became easier. We are not scared of cholera anymore, because we know how to protect ourselves.”

Read more about Oxfam's cholera program in rural Nippes.

Donate now to Oxfam's fund for Haiti relief and recovery.

This, she explains, is the result of education.

The art and science of public health

Every month in the camps near El Fasher town, a team of health workers—elected by their community and trained by Oxfam—fans out to bring messages about health and hygiene to thousands of residents. The workers go house to house, teaching newcomers about disease vectors, hand washing, and the use of latrines, and they organize community-wide campaigns to clean everything from streets to latrines to household water cans.

You might think people would resent unsolicited advice about their personal habits, but the health workers generally get a warm welcome. Women, who have the primary responsibility for the care of children and homes, are happy to receive this information, say the workers. And for the most part they take the advice.

"If they don’t want to accept what we are saying, we don't go harsh on them," says health worker Halima Nasur "We just communicate the information peacefully." But the cost of not heeding hygiene messages could be outbreaks of deadly disease, so the health workers sometimes ask community leaders to intervene. "They nicely teach a woman the importance of our work to her family. Then she listens."

For the health workers, their job is a labor of love. "I believe that all the people in the camp are my sisters and brothers," says Nasur. "We are never going to let our people down."

A powerful impact

When it came to guarding the health of her family and community, Gado needed no coaxing. "From the public health women, I learned to cover food to keep away flies because they transmit diseases. I also learned about keeping things clean—our jerry cans, kitchen utensils, latrines, and my children's hands," she says. "Previously, my children didn’t wash their hands before they ate. They were often weak and not healthy. Now, they wash their hands before eating. They don't suffer from diarrhea, and if they happen to get sick, it isn't something serious."

Once learned, it is hard to forget the life-and-death importance of good hygiene practices, and according to Gado, the work of Oxfam and the community health workers is likely to have a lasting impact. "I learned these values, and I'm going to apply them throughout my life," she says. "I would like to thank all of the people who have supported us," says Gado, "and I wish them good health."