Byakupita Wabinwa, president of the management committee that oversees the Kabimba health clinic, is standing below the sign. He is a small and serious man with a serious problem—one that plagues not only his community but that crops up frequently in this region of Democratic Republic of Congo: cholera.
Here, in the eastern provinces where years of conflict have taken a toll on social services, outbreaks of the waterborne disease are just one of the consequences of underinvestment in everything from roads, to health clinics, to clean water.
Sometimes, if maintenance of the simple delivery system has been lax, the water at this clinic doesn't run at all. That's why an enormous black cylinder is lying on its side in the clinic's front yard. It's a storage tank, waiting for installation as part of Oxfam's program to help ensure the clinic has a reliable reserve of water as well as decent sanitation facilities. In the back of the yard, a pair of pit latrines and two bathing stalls are under construction. And nearby, deep in the ground, lies the newly dug "placenta pit"—the local solution for disposing of hazardous medical wastes including afterbirth from the maternity ward.
Though it has no doctor and just five nurses, this is a busy place—serving an area with nearly 14,000 people. About 75 make their way here each week—some walking two hours down from the mountains—to receive treatment for malaria, to get tested for tuberculosis, to fight the cholera that erupts from time to time, especially during the rainy season.
Tacked to the door of one of the buildings is a sign, warning with explicit detail in Swahili, about the symptoms of cholera. It urges those who've got them to head for the nearest health clinic as soon as possible.
On this day, there are no cholera sufferers at the Kabimba clinic. But sometimes, during outbreaks, as many as 20 people a week come for treatment, though there is hardly the space for them. People lug their own bedding with them and spread it on the floor. A small building—about 30 feet long by 15 feet wide—serves as a quarantine area.
"But how can you put 20 people in that building and keep them healthy?" asks Wabinwa.
Inside, the walls are grimy with stains and the ceiling is collapsing. Of the original 10 cholera beds—mattresses with holes in the center beneath which buckets can be placed—only three remain. The plastic covering on one of the mattresses has pulled away, exposing the foam around the hole and leaving it like a sponge to sop up germs. A rickety wooden rack serves as a post for the intravenous drip.
As primitive and ill-supplied as the Kabimba clinic is by western standards, Trish Morrow, Oxfam's public health team leader for rural villages around Uvira, assures visitors that it's better than many that serve some of Congo's 62 million people, vast numbers of whom live in poverty. Few have the resources to pay for much medical care at all, but many live at risk of contracting serious diseases—like cholera—to which that poverty, with cruel irony, exposes them.
Nowhere is that more clear, perhaps, than along the stretch of land between the Mulongwe and Kavimvira rivers just outside of Uvira, South Kivu province.
It's there, between those two central sources of water, that the greatest number of cholera cases in the area erupt, says Jill Markvorsen, Oxfam's program manager for Uvira. During the first week of January, an outbreak almost reached epidemic proportions. At the cholera clinic in Uvira, workers charted 64 cases of the disease&mdasdh;one shy of the number that would have triggered the implementation of Uvira health zone's cholera contingency plan. Instead, officials, staffers from Oxfam and other aid groups, and volunteers from the Red Cross managed the flare-up by chlorinating water sources, making public health announcements on the radio, and providing information to people about measures they could take to improve hygiene and sanitation.
A few months later, in mid-March, both banks of the Mulongwe River are teeming with activity. Not far from one edge, a bare-bottomed boy dashes behind a bush and squats to relieve himself. Pigs root in a heap of rubbish that inches, black and slippery with mud, almost into the water. It rushes by filled with silt. Men wash their clothes. Others drive trucks and cars into the shallows to rinse off the dust and dirt. Up stream, a market crowded with people hugs the bank.
For those who have no other source, the Mulongwe River also serves as their supply for drinking water. It's no wonder then that cholera, caused by ingesting water or food contaminated by the bacterium vibrio cholerae, is one of the ugly facts of life for people living in this war-torn region.
At the Uvira cholera clinic, Oxfam helped to install a large tank that stores a backup supply of water—collected from the roof during rainstorms and precious for its relative purity. Two large rooms—one for men and the other for women—serve as sick wards. Simple beds—wood frames with sheets of rugged plastic stretched taut across and cut in the center with a hole—are scattered about the rooms. Others are piled outside.
The wards are empty on this mid-March day—a good sign.
Morrow, the public health team leader, says that the medical staff in Uvira has been trained well to provide patients with good care. Though there is not so much it can do to prevent people from contracting a disease that's so closely linked to the lack of public services—like potable water—the staff has been successful, says Morrow, in stemming the tide of cholera deaths.
And in a place where basic precautions take on ominous importance, blue buckets filled with a mixture of water and a heavy dose of chlorine dot the perimeter of the clinic's yard. All visitors are advised to scrub their hands with that solution before they leave. Most do—and duck out smelling like a swimming pool in the western world, but grateful for it.
]]>These community organizations are the leaders in an epic struggle against HIV and AIDS in South Africa. They are doing what the government cannot seem to do: deliver essential services that directly benefit the millions of people in the country infected and affected by HIV/AIDS.
"If the government of South Africa wants to address HIV issues, then it needs to strengthen community-based organizations," says Gerard Payne, who works for the AIDS Consortium, a national organization that supports thousands of community groups. He says that the HIV/AIDS crisis is the most significant challenge facing South Africa since the transition from apartheid.
The scale of the problem requires a local, grassroots response, and community organizations are doing their best to deliver it. Many are overcommitted and underfunded. "Whether it is through financial resources, whether it is through training, we need to strengthen them, so we can reduce the rate of HIV in this country," Payne says.
Payne has just been to visit one such community organization, where he stood in the dusty courtyard outside a two-room cinderblock house in South Africa's North West province as a dozen high-energy toddlers played and ran around him. Four of the organization's home-based care givers prepared to make their rounds, visiting patients in their homes to help cook, clean, and remind them to take their medication.
Payne's job at the AIDS Consortium is affiliate coordinator, so he visits the community-based organizations, assesses their needs and capabilities, and recommends a course of action to train the staff. Many must learn and implement procedures for raising and managing money, and develop a strategic vision for what the organization can be and where it can go. This helps the community organizations get past simply reacting to the HIV/AIDS crisis and working towards measures that will help improve the situation.
One example is in the care of orphans and vulnerable children in the community. The government of South Africa estimated last year that there are 1.5 million children under 17 directly affected by HIV: one or both parents are dead, or they are living with the virus themselves. With so many children now in need of a place to live, or at least hang out after school, get a meal, and stay out of trouble, it is the community organizations that are struggling to meet this need, many of them without specialized training or adequate funds. "They may be running a program, but have no idea how to really do it properly," Payne says. "So we will help them get training so they can provide counseling and other services that will help the children. We help them get to a level where they have good infrastructure and are rendering quality services." This can include a curriculum to teach "life skills" to young people so they can learn how to prevent HIV.
Another essential area where community groups can make a big difference is in helping people living with HIV and AIDS to understand what treatment is available and how to get it—a basic level of knowledge known as "treatment literacy." This is particularly helpful for women, who for reasons related to poverty and discrimination may be unable to get to a clinic or hospital—their families may not give them time, they may not have money to pay for transportation, or they may just simply not know that they are HIV positive and need medication.
Gerard Payne says that even if a patient can get to a hospital, he or she still may not understand what they need to do to stay alive. "Patients go there, the staff does a CD-4 count and gives them some medication, but they do not explain anything," Payne says. "Our objective is to educate organizations how to help patients understand the different treatments needed, and their rights to access treatment."
He adds that educating people about their right to treatment is a big step for many groups that are accustomed to delivering food and other care. "Community-based organizations respond to needs: if someone is sick, they go to them once or twice a week and take care of them," he explains. "We are saying they need to take it a step further. That patient is eventually going to get really ill, so they need to understand what care is available, where to access it, and that they must adhere to the treatment."
Seeing organizations grow and become more effective is one of the things that keeps Payne engaged in his work. "Last year I had one affiliate with no money, so I helped them get financial management systems in place," Payne says. "The first 1,000 rand [US $125] they raised was due to the fact that we showed them how to open up a bank account and write some letters to raise money."
"The joy and satisfaction I get comes when someone tells me that the work we do is making a difference," Payne says.
Payne says that South Africa is at a crucial stage in its history. "We have come a long was as a country, and struggled through many hardships," he says. "We are now in a different kind of struggle, and I want to be able to feel that I am contributing in the struggle against HIV."
]]>"Having secured an arrangement with government units to provide relief in remote areas, Oxfam's five relief teams are putting all of our resources into helping people stranded in rural areas away from the epicenter," said John Sayer, director general of Oxfam Hong Kong.
Oxfam has now committed more than $3.2 million to an initial effort that has commanded response from around the world as headlines continue to bear bad news: A week after the 7.9 magnitude quake struck, Reuters is reporting that 34,000 have died and 30,000 others remain missing; 4.8 million people have lost their homes; and Sichuan Province alone is facing $9.6 billion in economic losses. Hundreds of aftershocks and heavy rain have brought further devastation, including landslides that have reportedly killed 158 relief workers struggling to repair roads in recent days.
"Oxfam is teaming up with medical and hygiene professionals and working in and around the city of Mianyang to prevent an epidemic from starting," said Sayer. Oxfam is also carrying out disease monitoring, control, and prevention in Guangyuan and Zhenzhong.
The organization is concentrating on securing an adequate supply of drinking water for survivors as well as helping to provide safe sanitation services, and carrying out public health education.
Oxfam's first shipment of goods reached Dujiangyin and Guangyuan on Monday. A second shipment is due to reach Qingchuan on Tuesday.
Among the health-related goods Oxfam is sending into the region are portable toilets, intestinal drugs, first aid materials, face masks, and sanitary supplies for women. It has also provided clothing and high-energy biscuits.
Five villages in Gansu Province will also be getting a delivery of aid that will include tents, flour, oil, blankets, and milk powder. The goods will help meet the needs of 3,000 people in Wudu County.
Oxfam, which has more than 20 years experience working in mainland China, is now working alongside the Civil Affairs Department, the Poverty Alleviation and Development Office, several mainland-based aid groups, medical schools, and a variety of volunteer groups.
Additionally, the organization is preparing to reach remote areas of Aba Tibetan and Qiang Autonomous Prefecture.
]]>Oxfam has committed $1.55 million to this initial response. It is also preparing for longer-term projects such as helping to rebuild damaged infrastructure.
Oxfam colleagues based in the neighboring province of Yunnan are now traveling to Wenchuan County in Sichuan, the epicenter of the 7.8-magnitude quake, for assessment and coordination of the relief work. The organization is also planning to provide assistance in Gansu Province where it had been working on development projects prior to the disaster.
Based on our communication with local organizations in the affected areas, our initial assessment is that earthquake survivors need clean water, food, medicine, clothing, and blankets. We also anticipate that there will be a huge need for rehabilitation and reconstruction assistance. Damage to infrastructure and other facilities is significant and Oxfam expects it will take months for the region to recover.
"This is the worst earthquake in 30 years, with a huge impact on people's livelihoods," said John Sayer, director general of Oxfam Hong Kong. "With over 20 years of experience working in China on long-term development work and emergency relief, Oxfam Hong Kong is determined to help as quickly as possible, to guarantee people's safety in the short term, and in the end, as a long-term goal, to improve their livelihoods."
]]>Mogale, 37, is open about her status: she has been HIV positive for two years, and she is living with it. After all, she is doing better now and hopes the worst is behind her. "Now I am really fit compared to when I was sick—I can go a long distance walking now," she says. She regularly walks about one and a half miles to the headquarters of Pholo Modi Wa Sechaba, a community organization where she is part of a support group for people living with HIV/AIDS in her village of Welgavel.
Pholo Modi Wa Sechaba helped get Mogale out of bed and back on her feet. The organization sent a home-based care worker to nurse her, help her get to the hospital for treatment, teach her how to take her antiretroviral medication and manage her diet, and file for a government support grant—a source of money for disabled people.
Pholo Modi Wa Sechaba—meaning "health is the root of the nation" in Setswana, the local language—has about 21 caregivers serving 240 patients in four villages. They ensure that patients are taking their medication; they cook and clean, and disinfect and dress wounds from the many infections that bedevil those with an immune system compromised by HIV. In some cases they deliver food parcels to help families survive.
Pholo Modi Wa Sechaba is just one of thousands of local community based organizations helping the roughly 5.5 million people living with HIV/AIDS in South Africa. They are on the front line of the struggle, and play an essential role in providing services. "Community-based organizations are key in the fight against HIV/AIDS," says Gerard Payne the affiliate coordinator at the AIDS Consortium, an umbrella organization for the thousands of such community groups around South Africa. "Without them the fight against HIV and AIDS is a mere media campaign. They provide essential services in the community, they speak the language, and they understand the cultural issues in the communities."
Oxfam America is working with the AIDS Consortium to provide training and other support to community based organizations like Pholo Modi Wa Sechaba in South Africa's North West Province, one of the poorest areas of the country, with a high incidence of HIV/AIDS. The AIDS Consortium is working with 47 local community based organizations in the North West, and with funding from Oxfam it can expand its efforts to some of the 150 others struggling against HIV/AIDS in the province.
Pholo Mode Wa Sechaba helps patients get tested for HIV and, when patients test positive, counsels them on their treatment options and on how to "live positively." In addition to its home-based care program, it has a daycare for young children and an after-school program for orphans and others who need a place to do their homework and learn valuable life skills including how to prevent HIV.
Learning that you are HIV positive forces you to think about everything differently. Just having to share your status with your family is enough of a crisis for many newly diagnosed people. They then must struggle with how to live with what may at first seem a death sentence, how to make ends meet if they are too ill to work, how to endure the side effects of the medication, and how to manage the stigma of being HIV positive.
South Africa's health care system, while free, is overburdened and does not provide adequate social support for people living with HIV/AIDS. They can be tested, learn the result, and get a CD4 count (a measure of the blood cells that support their immune system). Many get free antiretroviral medication. But then they are really on their own—and if they lack a support system of family and friends, as many do in communities already ravaged by the disease, these patients are in crisis.
Pholo Modi Wa Sechaba helped Maria Mogale with these struggles, and helped her understand her treatment options. These are the most important lessons the organization teaches people in the community, particularly valuable to women who are sometimes excluded from health care options owing to poverty and discrimination—a violation of their right to health care. Family members may insist on traditional medicine, which frequently delays treatment, and can often hasten death.
Mogale learned this from Pholo Modi Wa Sechaba: "If people are sick, they need to go to the hospital, and not just stay at home and say they are bewitched," she says at her home, a three-room house made of metal sheets outside Welgavel. "I tell people, 'AIDS is there, but you can get better.'" She smiles as she speaks.
Mogale is a strong, positive example for members of her community—and this strength, tragically, is also a good example within her own family. Her daughter Portia, 18, learned she was HIV positive two months ago, and her 60-year-old mother Priscilla, who lives nearby, is also in treatment. Both are now thinking about their lives differently as well, and look to Mogale for advice on how to live and think about their future. Portia is in her second to last year of high school and is considering higher education, even as she is still learning what it means to be HIV positive.
For Maria Mogale, her future may involve helping others on a more formal basis: she wants to work with Pholo Modi Wa Sechaba. "I want to become a caregiver, and teach others what I have learned."
]]>Oxfam America was selected as one of only three organizations in the campaign based on input from the eBay Community. Funding from the campaign will support Oxfam?s work to: increase the number of people in rural areas of Ethiopia and Zambia who have access to clean water and sanitation; provide access to new, safer water supplies through upgrades to existing water sources; provide latrines for communities and schools; and train communities on how to manage the equipment and sustain the water supplies.
?The Community Gives campaign is an exceptional opportunity to raise awareness of Oxfam?s work in bringing clean water to poor communities,? said Raymond C. Offenheiser, president of Oxfam America.
?This initiative will make a significant difference in the communities Oxfam serves. Most of us take for granted the easy access we have to clean, safe drinking water and basic sanitation. In the communities we are working with, clean water and basic sanitation can prevent disease?it could mean a child makes it to her fifth birthday and gets to go to school.?
The goal of Community Gives is to encourage the eBay Community to make a donation to the nonprofit that inspires them, and then spread the word about the campaign. eBay Foundation kicked off the campaign by giving Oxfam a grant of just over $325,000. To help encourage giving, eBay Foundation will also give an additional dollar for every person who gives and waive all donation-related fees, so 100 percent of donations will go directly to the nonprofits.
?We are proud to launch the Community Gives campaign and work with an excellent organization like Oxfam,? said Julie Vennewitz-Pierce, program manager for eBay Foundation. ?The campaign will help Oxfam supply clean, safe water to tens of thousands of people in Zambia and Ethiopia.?
Through Community Gives, Oxfam is tapping into the power of online philanthropy thanks to a critical resource eBay Foundation is providing?an engaged Community eager to support concrete, on-the-ground projects that help solve critical social issues.
Anyone who wants to get involved in Community Gives can by donating through PayPal or buying or selling through eBay Giving Works. They can also join Oxfam America?s eCommunity and help spread the word about the campaign by using some of the tools on the website.
]]>A crowded camp sheltering 25,000 people from the horrific violence of Darfur's five-year-old conflict may seem an unlikely venue, but this is no ordinary pop concert. The tunes are traditional, but the lyrics talk of hygiene and explain how people can avoid fatal diseases. Kaltoum is one of a dozen women who have teamed up with Oxfam to hold weekly music festivals in Shangil Tobai in North Darfur. The concerts bring an afternoon of fun to people who have had fled attacks on nearby villages—but they educate as well as entertain.
"Singing is a part of our lives and we like to sing whenever and wherever we can," says Omer, sipping a small glass of extra sweet tea after the concert ends. "We enjoy it, and the people listening enjoy it, but most importantly our singing now helps change people's lives for the better."
"We take Oxfam's advice about good health and sanitation and put it to our own music," she continues. "You can see the songs changing listeners' behavior. The camp is much cleaner now and there are far fewer cases of malaria and diarrhea. Children wash their hands now without being told. When you tell young children to wash they don't always do as they're asked—but when we sing it to them they join in and have fun, and they really pay attention."
The songs change over time to reflect the needs in the camp, adds Zaharisa, another member of the group. "We used to sing about the need to clean the latrines regularly, but now people are doing this well so we no longer have to sing about it. At the moment my favourite song tells people how to safely and hygienically dispose of waste and get rid of rubbish."
Zainab Basher, an Oxfam health promoter in Shangil Tobai, helps the women organize the concerts. She says the impact has been enormous.
"We hear women and children singing the songs at home and work, and the communities keep asking us when the next performance will be," says Basher. "Now the women perform at weddings and religious festivals, as well as the weekly concerts. Each community has its favorite singers, and keeping latrines and water points clean has become a source of pride. Everyone wants to keep their area of the camp the cleanest. Participation in regular clean-up campaigns has increased greatly."
As the conflict has dragged on five long years, Basher says she and the Oxfam team have had to adapt their work. "We held committee meetings, we visited people's homes, and we trained individuals to become community health mobilizers, but the longer people are here in the camp, the more these methods become routine and ineffective. We needed something new and exciting, so we approached the women singers and they were very keen to help."
The concerts are held in different areas of the camp each week, attracting an audience of hundreds each time.
"We want as many people to hear the songs as possible," says Omer. "Oxfam gives us megaphones for the concerts, to make them louder. The next step is to get cassette recorders to tape the concerts, which we can hand out as gifts to neighbours and relatives so people can listen to the messages at home. Not everyone can sing but we still want to involve them somehow. Some of the women who can't sing are good at playing drums, while others help us write the lyrics."
All over the world, children like to imitate their favourite pop stars. Darfur is no different, and Kaltoum and the women have inspired a new generation of singers who meet every week at the Oxfam health centers in the camp. One popular chorus goes:
"Let us go to school to read,
Let us learn to be healthy,
Let us clean ourselves,
All children, let us do this."
Manahir, a 15-year-old girl from the camp, leads a group of children aged 5 to 16. Some sing, some bang on small drums, and others just clap and cheer. A chant of "clean the jerry can, clean the latrine" gradually gets faster and the drums louder, until the children lose their breath and burst into applause.
"We have great fun, and we learn at the same time," says Manahir. "My friends and I come to the center every day from all over the camp."
Nearby, as the women's concert reaches its finale, another singer named Mahasa takes the megaphone and leads a chorus in praise of Basher and the Oxfam team's recent distribution of blankets and jerry cans for carrying water.
"We thank the aid agencies and the people around the world who send us these things when we have nothing," she says. "If they didn't help us we wouldn't be able to stay here in the camp. We'd have to go home and be attacked all over again."
]]>This is where Asewe stays when she's in Goz Beida, a small town in eastern Chad whose outskirts are now flooded with about 52,000 people forced from their villages by factional fighting. But when it's safe, her home is a tent at Kerfi, one of several sites in the area that the displaced Chadians have temporarily settled.
"That's what my beneficiaries are using," says Asewe about her tent. "It's good to use what my beneficiaries are using."
It's there, at Kerfi, that Asewe likes to be best—in the midst of the people she has come to help. A registered nurse and trained midwife, she is a public health promoter for Oxfam, leading a team of three staffers and a committee of 15. Her job is to work closely with families, showing them how to prevent the spread of waterborne diseases. A musical voice, a warm smile, and an untempered passion are her tools.
Asewe came to this region of Chad in mid-July 2007—at the height of the rainy season—her second posting to the country in a long humanitarian career that has carried her around the world from the tsunami-ravaged coast of Indonesia to Afghanistan, Pakistan, Sierra Leone, Ethiopia and back to Chad. It was raining that first time here, too, back in 2004 when refugees from the Darfur region of Sudan were streaming across the border, many of them having walked for days to reach safety.
She was assigned to Bredjing, a camp that now has a population of close to 30,000 people. But back then, it was just beginning to grow, a chaotic sprawl of families, ragged and tired, desperate for food, water, and shelter.
"It was a very difficult situation. Every morning we would come and we would find at least 100 people, towards the wadi, just squatting around," recalls Asewe. "Some would come with small plastic sheets. Some would have traditional mats, but some would have literally nothing. It would be raining the whole night. The children would have literally nothing on top of their heads."
Many of them didn't survive.
"They put in their own graveyard. Every morning organizations like Doctors Without Borders had outreach people just to count how many graves. Yes. So it was very very painful when they first came."
For nine months, Asewe worked with Oxfam, and alongside other organizations, to bring some order to the camp.
"I left happy, though," she says, "because I had seen the beginning and I saw all the changes—everybody putting in a lot of effort." Besides getting water and sanitation services in place, aid groups had even managed to set up activities for children. And the overcrowding was relieved a bit when some of the refugees moved to a new camp—one that was planned for them in advance, so water systems and latrines were already in place.
For the first few weeks of her posting to Kerfi, about 45 kilometers south of Goz Beida, Asewe couldn't even get there. The heavy seasonal rain had swollen the seasonal river, or wadi, swamping parts of the village, and making it impossible for trucks to cross. The short drive from Goz Beida to Kerfi took six or seven hours through the rain, as drivers struggled to negotiate the mud and gushing streams.
Doctors Without Borders was the only aid organization working in Kerfi at the time, said Asewe and it had managed to get there before the rains began to fall. It had parked two of its trucks on the far side of the wadi rushing by the village.
Eventually, workers built a small raft from old drums. An Oxfam driver would deliver Asew to the wadi's edge, and she would float across, her feet dangling in the water, to catch a ride on the other side in a Doctors Without Borders truck.
"We did that until September," Asewe said. "We were not able to get a driver across until October so that delayed all the possibilities."
But once she was able to set foot in Kerfi, Asewe wasted no time in laying the groundwork for her program.
In crowded situations, where there is little room for people and their animals to live as they are accustomed, the spread of waterborne diseases poses a major threat. In December Kerfi was home home to more than 3,000 displaced people—on top of the 4,200 who were already living there.
"The major issue was there was a lot of wadi water, but no clean water," said Asewe, noting that Doctors Without Borders was treating numerous cases of diarrhea. "It was pathetic. The host community, having been completely surrounded, also lost the area they would use for extra space. Their main complaint was they hardly had any place to get their animals to graze." Nor did they have any place left to use as a bathroom.
"Hence the demand for latrines and water," says Asewe.
In convincing people to adopt new ways of doing things, it's important to make them part of the process—so they own it, too. But first, Asewe has to find out what they know, and in this case, it quickly became clear that people were not making the link between the dirty wadi water they were relying on the diarrhea they were suffering from.
"That gives you a key basis where to start," says Asewe.
She organized a development committee of nine women and eight men from Kerfi who would eventually help her with the big task of public education. After some training, together they settled on three main messages they needed to convey to the community.
The messages may sound simple to western ears, but for the residents and displaced people of Kerfi, they could mean the difference between life and death.
Here is what the health promotion committee and Asewe want the people of Kerfi to do:
Part of Asewe's public education program also includes granting families ownership of community latrines—along with cleaning and maintenance duties. About 20 people share each latrine. When a cluster of three or four have been built for people who are under the care of one chief, Asewe arranges for a handover ceremony, with plans made for who's going to keep the latrines clean and how they'll close them down when they're full. And with each latrine, Oxfam provides a latrine kit—a brush and bucket for cleaning.
Some people get the messages very quickly; others are slower to change.
"The best people to target are the children," says Asewe. They learn quickly and adapt readily. "For adults, they may be able to understand, but changing habits may not be so easy."
But whatever the frustrations may be—wadis overflowing with water, insecurity that keeps her tied to Goz Beida, the slow pace of people's adaptation—Asewe says none of that is enough to snuff out the enthusiasm she has for this work.
"I'm still so happy to be the public health promoter who goes to that little house and finds the child and plays around with them and see how you could improve their little lives," says Asewe. "That makes me more happy. It's quite an opportunity and a blessing."
]]>But when they returned, the full impact of the strongest storm in 16 years was all too clear. Sidr killed at least 2,837 people, destroyed or damaged more than 1.1 million homes, and hurt nearly one and a half million acres of cropland.
"There are so many people without homes or basic sanitation, and who are now likely to be unable to get food, that Bangladesh is facing its most serious humanitarian disaster in many decades," said Heather Blackwell, head of Oxfam International in Bangladesh.
Oxfam is responding with an initial $8.5 million emergency relief effort that will provide up to 153,000 people with clean water and nutritional support. Additionally, the program will offer 15,000 households the means to construct temporary shelters. And as many as 400 latrines will also be built—with a design that will ensure privacy for women.
"People urgently need drinking water, food, and medical support," said Enamul Hoque, a public health advisor working with Oxfam on the response. "Many areas are completely cut off from receiving supplies and markets have been destroyed. There is a need for markets to start functioning properly."
Assessment teams visiting the devastated region have reported that dead animals and debris have contaminated many of the ponds on which most people depend for their drinking, washing, and cooking water. The potential for the spread of waterborne diseases, including cholera, remains high.
Oxfam and its partners are working with communities to clean up the ponds and dispose of the animal carcasses. And though access remains difficult, Oxfam has also started to transport water to some of the more remote areas. We plan to install up to 100 solar desalination stills—as a pilot project—in some of those remote areas to provide drinking water.
Our response plans also call for the distribution of water treatment materials to 15,000 households that will allow them to improve water quality to a satisfactory level. In addition, we will provide up to 200 temporary shallow-tube wells in areas where seawater has contaminated the surface.
Sidr caused massive damage to crops in the coastal region which will have both an immediate and long-term effect on Bangladesh. Severe floods in the north a few months earlier also hit the agriculture sector hard, and with the price of food now spiking, aid workers are concerned that people will not have enough to eat.
Oxfam plans to provide supplemental rations for up to 30,000 households for three months. The distribution, intended to complement food programs undertaken by other groups, will meet about 35 percent of each household's food needs.
In addition, Oxfam will distribute basic goods to 30,000 households. Many families lost everything—clothes, tools, animals—and have no means for replacing them. Our distribution of household goods includes buckets, jugs, mugs, blankets, saris, kitchen utensils, and soap.
]]>"This is not a typical campaign,” said Janet McKinley, chair of Oxfam America’s board of directors and of the Campaign for Oxfam America. “We're not raising money for new buildings or for a perpetual endowment. The highest return a donor can get is to put money to work now.”
“Oxfam is seeking investors who want to expand our programs over a five-year period, building the capacity of poor communities, particularly women, to earn more, save more, invest in their families, and better manage their risks,” McKinley continued. “And given the increasing frequency and severity of natural disasters, those risks are rising.” McKinley and her husband, George Miller, have already committed $5 million to the Campaign for Oxfam America.
“The show of support we have seen for the Campaign is especially significant since Oxfam, in order to preserve its independence and voice, does not accept funding from the US government. The organization depends entirely on gifts and grants from individual donors, foundations, and corporations to carry out its mission of poverty alleviation and social justice,” McKinley concluded.
To date, individuals have contributed 57 percent of the donations for the Campaign for Oxfam America. Foundations and corporations have donated 43 percent. The Campaign has received commitments for 10 seven-figure and 50 six-figure gifts.
Among the leading institutional donors, the New York City-based Ford Foundation has already committed $9 million to the Campaign.
“The foundation shares Oxfam America’s commitment to reducing poverty, creating economic opportunities, investing in women and families,” said Susan V. Berresford, president of the Ford Foundation. “We welcome these efforts to create lasting, equitable solutions to the most pressing global issues.”
Another major donor to Oxfam, The William and Flora Hewlett Foundation in Menlo Park, CA, has contributed $4.5 million in current grants.
“Oxfam makes canny use of its financial support,” said Paul Brest, president of the Hewlett Foundation. “We share its goals of reforming aid and making global trade practices fairer as an effective way to lift the world’s population out of poverty.”
Funds raised through the Campaign for Oxfam America will support longer-term investment in four distinct areas of work:
I like to sleep. But by six o'clock the first rays of the sun are coming through the holes in the wall of my family's shelter, the cocks and donkeys start their shouting, and the camp starts to come to life. The first thing I do when I get up is pray. I ask God to look after my family, and bring peace to Darfur. Then I get on with the household chores... so many chores! I boil the water on the fire to make tea, I wash my brothers' and sisters' clothes, and then I clean the cooking pans. I don't enjoy cleaning and sometimes I'm tempted to do it very quickly, but Oxfam is always telling us to clean the pans thoroughly and I'm scared of getting sick if I don't!
By 8 a.m. I'm on my way to the community center. It's a short walk from my house and it's run by Oxfam. At the center I take lessons in hygiene and English. I like the hygiene class because I can see how to make changes in our house that keep my brothers and sisters healthy. Now whenever I see a woman not taking proper care of her latrine, or not cleaning her jerry can (for carrying water) I get very upset with her. I like the English class, too, but it's very difficult. Maybe next time we can speak in English, but I don't think so!
I am not married yet. Insha'allah—God willing—I will be soon. But there are few men my age in the camp. Most people here are women, old men, and children. Many younger men are away fighting. Or dead. There was a boy in my village who my friends used to tease me that I would marry, but now I don't know where he is. So for now I live with my mother, two little brothers aged 8 and 9, and two sisters aged 11 and 13. My father is no longer with us. I'm the oldest, which means I get to be in charge, but also that I have to do most of the work while my brothers get to play soccer.
At 10 a.m. it's time to go home and make breakfast. We have two meals a day—breakfast at about 11 a.m., and then dinner in the evening. I like to eat goat meat but here in the camp it is too expensive. My mother taught me long ago to make stew from vegetables, but it would be so much nicer with some chicken in it. I also like assida, which is one of our famous Darfur dishes. It's like a thick porridge made from sorghum. Back in my village, every time there was a celebration—a wedding, a birth, a new visitor—we would have roasted meat to eat and a big party in the village.
After breakfast I head to the Oxfam water point. I do this at least once every day. At the moment there are big queues. Today I had to wait for more than one hour and it was very hot. But the other women have to wait, too, so I get to catch up on all the news while I'm waiting. I usually take one of my little sisters with me to help carry the water home as it can be too heavy for one person.
We use water for everything. I can't even imagine what it would be like to be without it. Every time I eat I need water—to boil the food, to wash the vegetables, to get rid of the dirt and germs. Everything I drink is either normal water or boiled water for tea. I use the water to wash the clothes of the whole family. We don't have any animals but some of my friends' families have donkeys and the water also keeps them alive and healthy.
The afternoon is more of the same. Living in the camp I really notice how life feels very repetitive. I go to school, I cook and do chores, and then I do it all over again. In the afternoon I go back to study at the community center for an hour or so, and then I go home to prepare the evening meal. Even the food is usually the same.
I very rarely leave the camp. Why would I? Here there's a water point, a market, a community center. Outside there's danger—soldiers and guns. My mother goes out of the camp maybe twice a week to collect firewood, which we can use at home and sell what's left over. This is the only money we get. I feel guilty: It's so dangerous for my mother to do this. The women often get attacked or shouted at or shot at. They won't let me go with her. They say only older women should go as young girls are more likely to be attacked. Secretly I'm glad: I don't want her to go alone, but I don't want to go with her because I'm scared of the men.
When I first came here we saw the camp and the aid agencies and felt safe. Unhappy, but safe. Now even the camp is dangerous. At night nobody really goes outside their shelters. When I'm done cooking I stay home and study. I would like to do my English work but I have nobody to practice with. I study until it gets dark after eight o'clock, and then we go to bed and start the day again.
It's difficult for us here. Look at our shelter—it's very basic. This is not home. Soon the rains will come and then some of the shelters will be destroyed. What will happen to those people? I know the aid agencies are doing their best, but there are so many people here and everybody always needs something. I think the only way our lives will really improve is if we go home. But we can't go home because people are still being attacked. I will stay in Kalma until peace comes. I just hope it won't take too long.
]]>The achievements of Oxfam and other aid agencies in Darfur have been truly incredible. Jan Egeland, the former UN Humanitarian Coordinator, described the humanitarian response in Darfur as among the most successful in the world, and he was right. The high levels of mortality and malnutrition that we saw at the start of the crisis have been greatly reduced. Many people now have better access to water, sanitation, and education than they did before the conflict. However, other things have not improved. People in Darfur still live in daily fear of violence. Those living in camps cannot go outside without risking attack. The number of people in need of help keeps rising. There are now four million people in Darfur who rely on aid.
What are the biggest challenges Oxfam faces now in Darfur?
Safety and security is by far the biggest concern for both civilians and our staff. Our ability to reach people in need is decreasing due to hijackings and attacks on aid workers. Early in my time here I drove for hours through North Darfur, from El Fasher to our programs in Kebkabiya, through quite stunning scenery. Now this road is far too dangerous for us to use and we rely almost entirely on UN flights. In terms of security, we are operating at the very limit of what we can tolerate as an organization, and if the situation continues to deteriorate then we may be left with no option but to withdraw from Darfur. The humanitarian impact of this could be catastrophic. It's vital that the world leaders do more to ensure an end to the violence so that aid agencies can continue our life-saving work.
The crisis is now in its fifth year. Is there any sign that Darfur will move on from being a humanitarian emergency and into a development and recovery stage?
Oxfam has been working in Darfur for more than 20 years, carrying out development work with local communities. We all hope that we can resume this as soon as possible. But at the moment Darfur is still an enormous humanitarian crisis and we cannot resume large-scale development work until there is a sustainable political solution to the conflict. People continue to be attacked and displaced by the thousands. We are still seeing people arrive in the camps where we work. The situation in Darfur is incredibly complex and we have to be very careful. For example, many of the villages that people have fled from are now inhabited by other communities, and if we were to provide development assistance to them we would risk legitimizing this.
What has been your proudest achievement in your time here?
The relationship between non-governmental organizations and the Sudanese government has been complicated and at times difficult. Back in early 2004 we just could not get our staff members the necessary visas and permits to get to Darfur and respond to the urgent needs there. It was very frustrating. Our staffers have since done a wonderful job in building a working relationship with the authorities—both in Khartoum and at the field level—and as a result these problems have now been eased considerably. Without this success, we would not have been able to have such an impact on the ground and provide water and assistance to half a million people.
And your biggest frustration?
When I took up the post of country program manager, Darfur was one of the world's largest humanitarian crises. Today the security situation for people there is perhaps even worse, and the prospect of peace seems as far away as ever. It has been incredibly frustrating to see the hard work of our staff thwarted by insecurity in so many places. In Gereida in South Darfur, for example, the team did a magnificent job to set up water supply to 130,000 displaced people. But since then we have had to withdraw from the area because of insecurity. Across Sudan there are still many challenges. Marginalization and poverty are still endemic, and there are increasing threats to the nationwide Comprehensive Peace Agreement.
Finally, what personal memories will you take from working in Africa's largest country?
Outside Sudan, very little is known about the country, its people, and culture. What does get attention is mostly war and human suffering. Despite the enormous problems in the country, the Sudanese people are incredibly friendly and welcoming. I can honestly say that in my years of working around the world, my job in Sudan has probably been the most satisfying and enjoyable. The Sudanese are also extremely resilient people. It is incredible to go to the camps in Darfur or to the harsh deserts of the east and see how people cope in the face of adversity. It makes me feel confident for the future that Oxfam can work closely with local communities to help build a better Sudan.
]]>"We get water from this ditch, which is a very dirty and murky channel, where garbage is dumped and even dead animals have been found," says Huarcaya, who lives in the town of Huaya Chica. But now, with the help of Oxfam, many families in Huarcaya's town have clean water to drink—thanks to the distribution of water filters and the training in how to use them. So far, the organization has provided 870 water filters in the districts of Humay and Independencia. The goal is to improve significantly the quality of the local drinking water, which often comes from unsafe sources.
Not only did the quake obstruct canals and collapse water treatment and distribution facilities, it also revealed how poor the water quality was in some areas of the countryside. Before the quake, many families had to buy water from tanker trucks or draw it from wells and irrigation ditches. In all these cases the water was unhealthy. The earthquake worsened this situation by increasing the risk of disease.
With the filters Oxfam has been distributing, people are able to remove impurities and sediments. Water that was initially murky, contaminated, and unfit for human consumption becomes clean and free from harmful micro-organisms.
"We get home tired after doing agricultural work (cotton cultivation) and now we have clean water without having to boil it first," observes Delia Mendoza Suárez, a 50-year-old mother of seven children in the village of Palto. Paltoand six other villages now have clean water for drinking and cooking.
Oxfam has been distributing water from tanker trucks in districts where the population does not have sources from which to draw water. The agency is working in coordination with other institutions, such as United Firemen Without Borders (Spain), Pompiers Sans Frontières (France), and Action Against Hunger (Spain). Oxfam has successfully put into service three water treatment plants and has installed 45 water distribution points, including tanks (of 600 and 1,100 liters) and water storage bladders (of 1,500, 3,500, and 6,000 liters), making available an average of 20 liters of water per person per day in each village within the districts of Humay and Independencia.
"Children and adults get stomach illnesses because the water is not clean. After the earthquake, the situation had worsened since there was no water. Now we have it again but it continues to be dirty," said Amalia Valdiviezo Meza, whose family now drinks filtered water.
To help address the ongoing problems, Oxfam is also coordinating a public health campaign through the local press. It's helping to spread information on the proper use of water, latrines, and hygiene to avoid the spread of disease.
"A month after the earthquake, the health risks keep increasing and we must not lower our guard. On the contrary, we will double our efforts to promote hygiene and good health," says Mónica Ramos, Oxfam's public health promoter in Pisco.
As part of that effort, Oxfam has distributed 1,650 hygiene kits, which include soap, shampoo, brushes, and towels, among other items. To achieve a more complete response, latrines and accompanying sinks for washing are also being installed.
Helping Oxfam to achieve its goals have been members of "Jovos," or Young Volunteers for Disaster Prevention, who came from Moquegua, in southern Peru. Assistance has also come from members of the "Grufides" group who have been helping with the installation of tents and temporary shelters as well as with the promotion of public health through talks on hygiene and the proper use and maintenance of water filters.
Maribel Sanchez is the communications officer for Oxfam International in Pisco, Peru.
]]>When Colombo University's Community Extension Center in Sri Lanka uncovered mistreatment of tsunami survivors, the researchers went straight to the country's Human Rights Commission to right the wrongs.
Anawim Trust researchers studying good practices among Indian non-governmental organizations (NGOs) in empowering women didn't settle for documenting what they saw: soon the NGOs were implementing new, more women-friendly policies in their organizations that reflected what they'd learned from the Trust.
And long before the Institute for Policy Studies had published its study on Sri Lanka's disaster management systems, researchers had already helped reshape the key national disaster agency.
This is research at its liveliest, where the findings get results before the ink is dry.
"The studies we're supporting aren't destined for a dusty shelf somewhere, and they're not carried out by academics from faraway places," says Russell Miles, an Oxfam humanitarian specialist. "We're partnering with local researchers who are dedicated to solving problems in their own countries."
The Oxfam program involves a process known as participatory action research. The "action" part of the name has to do with its purpose: getting immediate results, rather than studying issues simply for the sake of learning. And it's participatory in that focus groups and other interactive activities in the communities take precedence over Internet searches and leafing through books at the library.
"Reducing disaster risks is a complex process that requires continuous learning," says Miles. "We've found a way to ensure that community members are at the center of that learning process."
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