A shorter commitment won't get the job done. It takes time to help people build skills and infrastructure, to get policies changed, and to ensure that governments spend their money more effectively.
Smart development demands monitoring and evaluation. Organizations should be accountable to report not only what they do, but also how they measure it. Don't believe stories that guarantee long-term impact after one or two years' investment; that's barely time to lay some groundwork.
We all crave the easy answer, the quick solution, but if eradicating poverty were simple, people living in poverty would have sorted it out long ago. They may lack resources like land, but they certainly don't lack intelligence or insight. Poverty is a global challenge—one that we can overcome together, but listening and learning from people living in poverty, and developing solutions with them, takes time and sustained effort.
This issue of OXFAMExchange includes inspiring stories, but they are just snapshots from a family album: moments in a long journey together. Each story is ultimately about perseverance and the need for long-term commitment.
This report demonstrates what Oxfam has achieved during this past, challenging year. Although this is still in many respects a humanitarian situation we are also working on innovative longer-term programs – involving existing and new partnerships with local organizations – to help in the wider reconstruction effort.
]]>Thomazeau—home to about 52,000 inhabitants—is a rural community in western Haiti, surrounded by mountains and little-touched by the earthquake two years ago. In fact, it was an area that saw a large influx of arrivals from the capital immediately after the quake. But it is also economically deprived.
Most people here are “planteurs”—small-scale farmers living off their land and selling what crops they can. But poor roads are a major problem in getting goods to markets. And, as Dumel pointed out, there are few economic opportunities available in the community.
That’s also true across Haiti, where an estimated 75 percent of the population is not in salaried employment, and jobs are scarce.
Finding work is especially challenging in rural areas, where even the most casual of jobs are hard to come by. This was a major issue in Haiti, as much before the earthquake as now, and it is hampering people’s ability to rebuild their lives.
According to an Oxfam survey last year, finding work is the top priority for most Haitians. And that’s why a project which Oxfam supports in Thomazeau is raising the hopes of many women.
The women have their own section within ODECT known as RAFARE. That stands for Rassemblement des Femmes pour l’Accès aux Ressources Économiques, or Rallying Women to Access Economic Resources. Its goal is to try to improve the economic status of women. The group owned one milling machine and earned money processing grain brought to the center by farmers and merchants. Oxfam hired RAFARE after the earthquake to help provide milled cereals which formed part of food kits that were distributed in the outdoor camps where people had sought shelter.
Oxfam is now helping the women again—with funds and training, including enlisting the help of expatriate Haitian experts with specific skills. The group is modernizing its service center and expanding its operation.
The small building where they’re currently located will double in size, allowing the women to have storage facilities where they can stock processed and unprocessed grains and market milled cereals. Oxfam has helped them to purchase two new grinding machines and is providing training and other equipment. The goal is to enable the women to run their operation as a full-fledged business. They will buy and sell locally produced grain throughout the year, rather than just seasonally; and during lean times, in between the harvests, they can sell surplus stocks in the local market.
“It will bring more economic opportunities here. There will be more jobs and more money coming in,” said Marie-Claude Estenfile, general secretary of RAFARE. “There was always a shortage of grains being sold in the local markets from April to June, but we will be able to provide processed grains during that period.
It means people won’t have to travel an hour or more to some of the markets, like in Croix des Bouquets, 24 kilometers away, to buy what they need. It will be easier to purchase food locally and we will help to strengthen the supply chain. The markets will be busier; the money will benefit the local economy.”
Having proper storage facilities and being able market their own cereals will enable the women to work all year round, and not just stay open for business during the busy harvest period.
“It will guarantee people’s food security here,” said Dumel, adding that it will also create new jobs. “During the lean periods, people would have to buy imported rice and grain from other places. But we will have stocks to sell and supply to the local markets.”
RAFARE’s members are excited about the project.
“It gives me hope for the future,” said Hermircie Alfred, 40. “I hope we can buy and sell the grains locally all year round; and we can make more profits.”
“There are very few job opportunities here,” Alexina Augustin, 45, a mother of eight. “The only jobs we can really find are selling cereals and this project will help us. I lost my home and land a few months ago during flooding and now I can’t send my children to school. This will be a lifeline for me,” she said.
]]>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.
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.”
]]>“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.
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.”
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.
]]>Working in coordination with local authorities and international aid organizations operating in Carrefour, Oxfam will reach an extra 70,000 people with distribution of aquatablets to purify water, disinfection of houses where cholera cases have been detected, and massive public health promotion activities in Riviere Froide, an area of Carrefour. This is in addition to the 77,000 people living in camps in the Carrefour area to whom Oxfam already provides vital sanitation services. This area is highly susceptible to cholera because it lacks even the most basic sanitation facilities and there is very little access to clean drinking water.
“We are talking about very congested areas where open defecation is commonly practiced because there are very few latrines and little space available to construct them. Oxfam can provide an emergency response to the cholera outbreak, but we need the national government, with the support of international community, to provide long-term sanitation facilities and access to drinking water both in rural and urban areas, otherwise outbreaks will continue,” said Roland Van Hauwermeiren, Oxfam´s Country Director in Haiti.
The current cholera outbreak in Carrefour is far worse than the one registered in November. At that time, there were a maximum of 900 reported cases of cholera per week. Now, health organizations are registering more than 300 new cases every single day. However, the number of deaths is far lower than in November as people are able to get help faster
“Haitians are now more aware of how they can catch cholera, how to protect themselves against it, and what to do when cholera symptoms arise. Cholera prevention is very straight forward: drinking clean water and using good hygiene practices. Yet, although people are aware of this, it is very difficult to follow those recommendations without the basic sanitation services in place. The arrival of heavy rains last week has also helped spread the bacteria into local water sources,” said Van Hauwermeiren.
Before the January 2010 earthquake, 50 percent of the urban population in Haiti and over 80 percent of the rural population did not have access to basic sanitation facilities.
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The Haitian authorities need to show greater strategic leadership and take decisions that reflect the priority needs of the Haitian population. They need to initiate public infrastructure projects that put people to work and build skills; support people to return home or allocate land for new houses; and invest in agriculture. The international community should do much more to support these efforts by increasing the capacity and accountability of Haitian institutions.
]]>Their mission? To build some of the 700 latrines Oxfam is helping to fund in the Petite Riviere area of the Artibonite province, where the deadly waterborne disease first broke out in October. It has now reached every province in the country, aided in its rapid spread by Haiti’s poor infrastructure: 50 percent of Haitians don’t have access to clean water, and more than 80 percent don’t have latrines.
For some of the families in this rice-growing region, that’s about to change. The latrines are part of a multi-pronged effort, including a public health education campaign, Oxfam has launched to help 125,000 people in this area stop a disease that hadn’t surfaced in Haiti since 1960. By the end of November, cholera had already sent more than 34,000 people to the hospital and killed more than 1,750 across the country.
Oxfam is also tackling the outbreak in Cap Haitien, Haiti’s second largest city, and in Port-au-Prince, the capital. There, intensive efforts to provide clean water, sanitation services, and public health education to people displaced by the January 12 earthquake has prevented any known cases of the disease from cropping up in the camps where Oxfam works.
Along with the household latrines in Petite Riviere and the construction of 50 school latrines, Oxfam is planning to drill 50 boreholes to be fitted with hand pumps and repair three water networks to provide people with greater access to clean water. But as important as those initiatives are, stopping cholera requires education—how to prevent it and how to treat it and to know to seek medical help when diarrhea and vomiting starts.
In coordination with the ministry of health, Oxfam has taken to the airwaves in Petite Riviere, broadcasting information on how to prevent cholera. It has trained government community health workers as well as peer educators on key messages and they are fanning out to spread the word. Equipped with battery-powered bullhorns, Oxfam health promoters are trekking through fields and across canals, sharing vital information with farmers as they work.
“Members of the community are very keen about what is being said,” said Mario Guerrero, the cholera program manager in Petite Riviere. “They have the feeling when they go into the trainings that there’s no way out if you get it.”
But after people have learned something about the disease and its transmission?
“They have the idea you can do something,” said Guerrero.
Doing something is what Erntz Jean and the team of volunteers were all about: With materials provided by Oxfam—wood for walls and a roof, and a slab to cover the pit—they were helping their neighbors build the first latrines many of them have ever had.
“That’s how we do things here,” said Jean, standing near the just-built wooden structure covering the latrine of Lozina Cena. “We help each other.”
The team picked up their tools and wove between the hedges and small houses to their next location: a narrow pit, six feet deep, just beyond the canopy of a giant mango. They got to work sawing two-by-fours, hammering, and preparing the frame for the housing of the latrine.
“Everybody here is very happy about this. Not only me—everyone in the area,” said Jean, who was among those who received materials to build a latrine. A carpenter by trade, he said he never had the money to build one before this.
“As a carpenter, if there was work, I’d be working and I’d have the money to do this. But there’s no activity here—no jobs,” said Jean.
Down the road, Eugene Joseph, a father of five children, had almost completed his new latrine. He spent a part of five days digging the hole—after starting in a different spot in his yard and hitting rock.
“Before, we didn’t use any latrines. We went in the bush or the street,” he said, noting the street—a rough dirt road—was about 40 meters from a canal leading to the Artibonite River from which his family pulls its drinking water.
“We were never sick,” said Joseph.
But the cholera outbreak scared him.
“We thought it would spread around our house,” said Joseph. And so with Oxfam’s help he decided to build the latrine.
“We’re proud of this,” he added.
A few houses away, Charite Estimable, echoed Joseph’s fear. But she wasn’t really worried about herself: She had been treating her water in a sand filter for most of the past year and had received some chlorine tablets from Oxfam to purify it further. It was her children—she has 11—whose health she was fretting over.
“I was afraid for my children in Port-au-Prince,” she said, noting that six of them were now living in the crowded capital.
Estimable’s neighbor, Altagrace Nicolas, also voiced confidence in her ability to keep cholera at bay.
“I’ve always been careful with myself and my children,” she said. “I’ve never been negligent. The reason it spread in some places is because people were not careful.”
To help everyone become more vigilant, Oxfam has been sending out teams for random monitoring of the water families collect and treat with the chlorine tablets the organization has been distributing.
Toting a bucket loaded with a couple of pitchers and a chlorine testing kit, George Van Vulpen and Elie Saint-Cyr, public heath engineers for Oxfam, hit the dirt roads of Akacite and Trankilite, two communities near the Artibonite River. Stopping at one house here, another there, they took a scoop of drinking water, tested it for residual levels of chlorine, and discussed the results with the householders—all with an eye toward encouraging proper use of the tablets. Had they been adding the tablets to the water? When? Were they dropping in the right number of them?
“For sure they’re using them,” said Van Vulpen, packing up the gear after the last sample of the day. “Most of them (the samples) have residual chlorine.”
That was a good sign—and so was the news he picked up along the way.
“In Akacite, they didn’t know of anyone who was sick anymore,” said Van Vulpen.
“We have a feeling that we are doing better than other parts of the country,” said Guerrero, the program manager for Petite Riviere. “Reported cases are going downward—slightly. But downward.”
]]>Dénéus works for Oxfam in the commune of Petit Rivière in the department of Artibonite in Haiti -- an area recently plagued by cholera. She sets out in the morning in a four-by-four truck, seeking out farmers in the fields who may not have heard the radio programs Oxfam has recently broadcast about proper hygiene and sanitation measures to stop the cholera, avoid infection, or the basic steps to help stricken people survive.
Spotting a crew of five men preparing a field to plant potatoes, she asks the driver to stop the truck, and she bounds out the back, moving across the road, down a well-worn path, jumping across an irrigation ditch, to the edge of the field.
It’s best for those accompanying Dénéus to stand behind her when she gets into action: she routinely uses a battery-powered megaphone to greet the farmers, and her words are loud and carry a long way. She asks them if they have already been trained on how to avoid and treat cholera and proper hygiene and sanitation practices. If they seem unsure or say no, she launches into the routine: she explains that cholera is a bacterial disease, can be passed by drinking contaminated water, and can be controlled by washing your hands before putting anything in your mouth. She encourages them to chlorinate water before drinking it, and to take early action to treat people showing symptoms of diarrhea and vomiting with an oral rehydration solution.
Some of the farmers stop, lean on their hoes, and listen, while others keep piling the moist earth into long mounds, in preparation for planting. But even the ones who keep working shout questions as they go: Where can we get soap? What about helping people who are sick? Where do we get the chemicals to treat our drinking water? Dénéus responds to all the questions: She refers people to centers where oral rehydration solution is available in their village, so they can ensure sick relatives can survive. And where to get one of the 35,000 cholera kits Oxfam is distributing, which have all the things they need to keep clean and treat their drinking water.
One topic dominates discussion in each of the 10 or so fields she sees this morning: she urges the farmers, “avoid going to the toilet right on the ground!” This is a major, longstanding problem in rural Haiti since well before the January 12th earthquake hit Port-au-Prince nearly a year ago: with no sewage system, running water, or proper latrines, many rural households must answer nature’s call in the open. Not all households have a latrine, so the farmers ask for advice: it’s simple, Dénéus says, dig a hole and bury the excrement. But Oxfam is also deploying a team of engineers to help farmers with simple materials to build their own latrines as an important step to reducing vulnerabilities to water-borne diseases like cholera. They plan to help install 700 latrines in Petite Rivière.
Dénéus is relentless, she repeats her messages with the same enthusiasm for each group she encounters toiling in the hot December sun, sweat running down the side of her face. “If you don’t think cholera can kill you, go to the hospital, go to the morgue, and see for yourself,” she tells any skeptical farmers.
Passing by a group she spoke with earlier in the morning now taking a lunch break, she stops and poses a question: “Did you wash your hands before eating?” Of course the answer is yes, but when she asks if they used soap, a few look down, but most of them make no excuses: soap is expensive and they are not accustomed to bringing it to the fields with them. Another form of behavior for Dénéus to change: With Oxfam distributing free soap, expense is not an issue in the short term, and eventually she hopes that farmers will improve their hygiene practices in the fields as well as at home.
After a productive morning tour of the fields, Dénéus stops by a few oral rehydration centers in the community of Marqès. These are simple tables stocked with clean water, mixing bowls and cups, and small packets of oral rehydration salts. These tables are staffed by trained volunteers who can teach people how to mix the life-saving solution, and ensure that anyone with a sick family member has access to this essential therapy. Cholera can kill in just a few hours by completely dehydrating a victim, so oral rehydration is essential. Dénéus checks the supplies, and coaches the volunteers on preparing solutions, how to answer frequently asked questions, and asks if there has been any activity at the centers as part of the monitoring Oxfam is doing in the community.
Dénéus has a law degree and is working for Oxfam because she says the right to life is one of the most basic. “I came here to save lives; that’s what Oxfam is doing here,” she says as she leaves the fields after a busy morning.”I’ve only been working here a month, but I’ve seen Oxfam doing good work, and it is saving lives. The rate of mortality is reduced, and the rate of people getting sick is also lower thanks to Oxfam.”
The work of Dénéus and other public health promoters is reaching out to 125,000 people in the region, using the radio and in-person visits to push key messages about good hygiene and sanitation habits. Mario Guerrerro, Oxfam’s program manager in Petite Rivière, says this effort is proving essential. “The training for people to change their habits is making the difference,” he says in his office, looking over the declining mortality figures in a report from the health ministry. “Once people understand, they do their best to treat their water.”
Toward the end of Dénéus’s rounds this one morning, she encounters nearly 40 farmers in a relatively small area she can hit in one stop. She moves through her presentation, answers a few questions, and concludes her visit with a phrase, a promise, and a wish: “Zero cholera!” she shouts, her final words to the farmers.
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