On Wednesdays and Fridays, with three other Chiri Health Center staff members, I visit one of the ten villages to which we provide immunizations. It’s a real perk for me as the drive and hikes are all amazingly beautiful and it allows me to spend time in the local communities. Vaccinations have been a large part of our public health program since Lalmba began working in Chiri twelve years ago. A few years ago the Ethiopian government started a community health worker program that assigns one or two health workers (called Health Extension Workers, or HEWs for short) to every village. They are trained to give vaccines, assist in deliveries, provide family planning, and other general health promotion activities. Community health worker programs are not uncommon and have worked really well in some countries, improving maternal and infant mortality and sanitation-sensitive illnesses.
Unfortunately we have found the HEW program in our area to be less than ideal. The workers are often young, placed in very rural communities far from family and friends, and are seemingly somewhat unmotivated to do their assigned tasks. It seems that in many cases the HEWs spend a substantial amount of time in Chiri (a relatively large village) rather than in their assigned, more remote villages. Frequently, when we show up to outreach to do vaccinations they are no where to be found and had not told people in the community that we would be coming.
I held a big meeting with all the HEWs who serve in our target areas and the village chairpersons to talk about the vaccination program. I made it clear that from now on the HEWs had to be there when we were scheduled to be in their village, both to help give the vaccines but more importantly to keep track of the records (if both the HEWs and Lalmba are giving vaccines without coordinating, there is a good chance we are over vaccinating people, which is not good). It was a very productive meeting where both their concerns and ours came out and solutions were found. I made it clear that if we showed up and the HEW was absent we would turn around and go home, no vaccines would be given. Unfortunately, the very next day and again last week we showed up to outreach and no one was there.
So here is where the predicament comes up, do we continue to provide vaccines in these areas where the government has its own program to be doing it? Are we enabling these workers to not do their job by our continued presence? While it would be easy to understand why we would drop the program altogether (even though the HEWs are adamant that they want us to come) there is a good chance that the people who would be most affected are the community members who would no longer get vaccinated. It seems like this is the big dilemma for all types of development/nonprofit work- even though the work may positively affect people, in the long run is what we are doing causing more harm than good?
Friends were recently here visiting and this question came up. Is it ever okay for outsiders (i.e., white, American, educated folks like us) to work in a country like Ethiopia? Is our presence here imperialistic? To me it is a very grey area, with no obvious right or wrong answer. There are days when I really question our presence here. Yet on others where I feel very confident that our being here is beneficial. After-all, by being here, we’re able to bring some of the training and skills that we’ve been fortunate enough to receive and that are not yet available to the local community. I think the vaccine situation is a good example of this dilemma. On the one hand, we are able to vaccinate thousands of people each year against diseases that might otherwise kill them. On the other hand, we are doing a job that someone else, i.e., the government, should be doing (which is the case with many other issues that NGOs work on all over the globe -- building schools, hospitals, orphanages, doing advocacy work, etc). Is there ever a situation for which it is permissible for outsiders to work? What about university professors who teach abroad? Engineers or doctors who come to the US to work? Is there a difference when it is people from one developed country going to another developed country versus developed to underdeveloped?
I am curious to know what your thoughts are on this...where do you weigh in on this complicated issue? Any comments are greatly appreciated!
