“Showing up’ is the first step to a successful water and food security project. In Hinche Haiti, over the last 11 years, the Goederts’ report that showing up starts with “hearing our names called out by friends upon our arrival”. Americans may not be accustomed to having loved ones waiting at arrival gates; but in Haiti this is the first reminder that relationships are the foundation of all projects.
This story serves to honor Haitian and American partners challenged to create solutions to food insecurity. Nebraskan partners show up, create impacts, and experience “reverse mission” (receiving more from Haitian partners than we might ever return to them). Central Plateau, Hinche projects evolved from a midwifery education initiative that expanded to projects encompassing potable water, sanitation, aquaculture, and capacity-building within schools. Although the work started through a grassroots initiative “Midwives for Haiti”, founded by Nadene Brunk, to educate rural skilled birth attendants, the focus has morphed to “child survival”. Priorities expanded as the Goederts’ came face to face with realities of hunger, food insecurity and child stunting. Each site where Haitian partners reached out to Martha and James for cooperative initiatives, the problems essentially focused on access to potable water and to adequate nutrition, especially for maternal child health. World Vision uses a recent survey of 300,000 in the Central Plateau to verify that the statistics ranges are accurate, and while improved from a decade ago, mortality and morbidity are still unacceptably high. Approximately 40 percent of the children are stunted, 12 percent of children die under the age of 5, vaccination rates range from 30%-40%, half of the population has potable water access, and 15% of the Central Plateau population uses latrines (John Hasse, World Vision, Haiti, National Director, personal communication, December 15, 2016).
There have been two or three yearly trips to Haiti for the Goedert, over the last decade, apart from their Peace Corps year July 2015-July 2016. Stark realities motivate their current approach that casts a larger net, focusing not only on education, but shifting to survival, starting with water, moving to toilets, adding aquaculture, and combining teaching steps that ultimately will belong to school children and to midwives. Haitian and American experts across disciplines of engineering, aquaculture, public health, nutrition, medicine, nursing, and science systems have been invited to triage priorities, problem-solve with Haitian partners, and to create realistic goals for improving health. Haitians are ultimately the project managers most intimately affected by successes and failures, after Americans depart, ‘wheels up’ to their own Nebraskan communities.
The progress witnessed the second week of December, 2016 has been encouraging, much like being immunized against hopelessness. A case in point is that the progress with aquaculture, introduced and enriched by Greg Fripp (Omaha’s Whispering Roots non-profit) showed that every initiative introduced in March 2015 had been ‘grabbed’ and adapted in their 900 school children complex, SOLT Mission. There was a celebratory character to the compound visit when raised beds, drip irrigation, composting, and preparations for fish pond were witnessed. And, as is the case across our globe, when there is one success, it leads to another. As an example, a pig project has been added to the mission, which will eventually become food-generating, income producing, and community asset-building with dividing and sharing litters with neighbors.
Each trip adds more expertise, with Nebraskans who understand cultural humility, who work across disciplinary silos and who can tailor initiatives to the needs of Haitian partners and circumstances. Although we may not have all the solutions, there are experts from each discipline who have been willing to serve and who have wisdom of ‘forty years’ as described by Buffet (2014). The December 2016 trip involved systems science (hydroponics, Nate Bickford, UNK), nonprofit aquaculture (Greg Fripp from Whispering Roots), engineering (James Goedert, UNL and retired OPPD engineer, Mike Potter), business and finance (Rita Potter, retired UNMC), and global health/midwifery (Martha Goedert, CoPH UNMC, Center for Global Health and Development). The group’s pivot foot focused on co-created Haitian-American initiatives that address the challenges of providing potable water, growing food, creating sanitation models, supporting income generation and engendering community hope for future health.
Chirande (2015) reports that the those most at risk for stunting have community-based factors to consider. When reviewing the risks, it is evident of the intersection of water and food with maternal child health:
- Children from poorest households, in both rural and urban areas.
- Those delivered at home by TBAs or family members.
- Babies from mothers did not attend any antenatal clinics.
- Children who were 5-born or higher
- Children who were perceived by their mothers to be small at birth and those from poorest households
- With no potable drinking water
All community-based work must not proceed (remembering that some helping hurts communities), without listening firsthand to the challenges our partners continually face in rural Hinche. Listening includes quieting expectations and understanding Haitian voices to decrease the blind- sightedness of conclusions and methods that are not locally adaptable. In return, we discover that solutions we thought were nearly impossible, have been now completed by Haitian expert hands upon our return. For example, an expensive imported composting latrine seat prototype, that diverts urine to allow chamber decomposition of feces was fashioned from cement by Manno and Theard. As young boys, our partners Manno Bastia and Theard Elficasse learned pottery skills in a ‘Pots for Peace’, water filtration system initiative under Xaverian Brother Harry’s tutelage. Witnessing the cement composting toilet seat, reminded us to not underestimate what our partners bring to the table with their own ingenuity and expertise. We mine gold when more than one mind actively solves a problem, even ones that seem unsurmountable at the time. (Any ideas from the audience on how to solve the problem of parasites who can scale cement composting latrine chamber walls?)
The story of food insecurity in the Central Plateau of Haiti, has been a sharp learning curve for Martha, in a story Lessons Learned from ‘Matwons.
“Matwons” are village midwives who have experience with supporting and birthing families, with little formal education. One didactic day, almost 8 years ago, I was sitting with the matwons who had requested teaching on pre-eclampsia. They had identified the second leading cause of maternal death globally, that of hypertensive disorders (the first is postpartum hemorrhage). I honored their request, seeing their generous and kind attention to details, in the simulation, in the preparation of moringa to increase protein and calcium, in learning to take blood pressures and to triage those needing to be transported to a higher level of care. They demonstrated estimations of gestational age and size, assessed edema and livers, and saw and measured and mastered the course objectives. Then in conclusion, I reminded them of the dose of moringa for normal pregnancy, “put this much in the sauce”. Then there was silence until Ulysses rose to speak.
“We have no sauce”, Ulysses, the spokesperson, told me. Now, the learning really began. I listened to the repercussions of two years of drought. Famine was the premiere problem, not seizures or maternal death from eclampsia. Meringa, though a miracle food supplement and remedy for protein and calcium needs, was not a panacea for those without nourishment. Ulysses said to me, “Marte, moringa needs to go on sauce for rice or beans; we have none. I have lost six mothers since you were here 5 months ago. The mother’s arms grow smaller and smaller as their abdomens grow larger with the baby”.
So, the story line continues, Haitian rainfall begins a cycle of crops, harvests follow, or not. When sitting in a circle with thirty matwons, the bamboo shelter shaded us all from the sun. There is no shelter for crops in these years of drought. My heart and head felt an overwhelming sense of wonder, not that there were so many dead, but that there were miraculous survivors in my midst. Two health care workers are gone since my last visit. ‘Hypertension’ seems to be the ‘valve’ that explodes between the pressures of life and the pressures of providing for others. ‘We place a grain of salt under our tongues to assuage hunger’. I am reminded of my teaching, just paragraphs before: “where salt goes, water follows”, I have explained. Why can’t simple solutions of protein, hydration, calcium, peace, and rest overcome the sodium imbalance? Even matwons die from low serum albumin and dehydration and no access to medications that prevent stroke. The care providers also have no food. “We know many solutions for preventing pre-eclampsia, when mothers have food. We need help with irrigation and agriculture; we are farmers and preachers, teachers and ‘matwons’. I have heard this before with my head; I understand it now in my heart.
I am missing the faces of two who were here last visit, who have died in the interval; it is real; the pit in my stomach feels incurable. Sitting quietly, I hear my Haitians partners tell me what is what, and how and why they want agriculture help. They are asking not for lifelines but for partners to farm with them, start drip irrigation, enrich soil, remediate solutions for wells that have run dry, create possibilities with growing fish and vegetables, accompanying them on the way. (Martha Goedert’s diary, March 2009)
In the end, there has been a Nebraska response. Martha once again writes in her trip diary from December 2016.
I come from a four-generation farm family, wise and able to grow, to teach and to be in relationship with community and with the land. Each trip, James and I host experts who will sit with our partners and listen to the endpoints needed to help families and schools provide the basics for adequate growth and development of their children. During site visits for problem-solving and data collection, the stage is set for the next project, March 2017. This new initiative will launch a program that combines a long-requested building for a community-owned birthing center where aquaculture programs, WaSH and nutrition can be launched alongside full scope midwifery services. Using a hub and spoke method, the plan includes extension service-like food production education, including drip irrigation and WaSH. The successful front-runners who grabbed the aquaculture techniques from Fripp will now, in turn, give back ‘accompaniment’ to their Haitian neighbors. The excitement captured on film when Nate Bickford started the solar pumps in the hydroponic tank, was electric. I will today email Colleen Stice to see if she will respond to the Haitian request for the Mama Salama stoves. I will loop in Global Partners in Hope to see if they have advice. Nothing is expected, all is hoped for, and we are never disappointed at how grace follows, projects co-create, prayer works and partners show up. It is a simple journey into the most impoverished places in the Western Hemisphere. It requires us to quiet our minds, be ready to respond to requests and to show up. (Martha Goedert’s diary, December, 2016)
- Chirande, L, Charwe, D., Mbwana, H., Victor, R., Kimboka, S., Issaka, A.I., Baines, S.K., Dibley, M.J., & Agho, K.E. (2015). Determinants of stunting and severe stunting among under-fives in Tanzania: Evidence from the 2010 cross-sectional household survey. Pediatrics, 15(165): 1-13. DOI 10.1186/s12887-015-0482-9. Retrieved from https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0482-9
- Frenk J, Gómez-Dantés O, & Moon S. (2014). From sovereignty to solidarity: A renewed concept of global health for an era of complex interdependence. Lancet;383:94-7.
- Global Partners in Hope website, http://globalpartnersinhope.com/about-us/
- Jamison DT, Summers LH, Alleyne G, et al. (2013). Global health 2035: A world converging within a generation. Lancet;382:1898-955.
- Martin, K., & Landigran,P.J. (2016). Global Health’s Grand Challenge: A Healthy Planet and Healthy People. Journal of Global Health, 82(3). Retrieved from http://www.annalsofglobalhealth.org/article/S2214-9996(16)30721-4/fulltext
- Midwives for Haiti webpage, www.midwivesforhaiti.org
- Stice, C. (2016). Mama Salama Stoves: Changing and saving lives. Interview, Metro Community College Interview, October 31, 2016, Omaha, Nebraska. Retrieved from https://www.bing.com/videos/search?q=mm+salama+stove+changing+and+saving+lives+yt&qpvt=mm+salama+stove+changing+and+saving+lives+yt&FORM=VQFRML
- World Vision, Country Headquarters, Port au Prince, Haiti, www.wvi.org/haiti