There’s been an interesting debate going on regarding the Kony 2012 viral video released a few weeks ago. The video is part of an advocacy campaign by the group Invisible Children to bring Joseph Kony, the leader of the Lord’s Resistance Army (LRA) and an internationally recognized bad guy, to justice. Without getting too much into it, the debate is basically about whether good intentions and oversimplification of a complex issue helps or hurts the chances of achieving a positive outcome in Northern Uganda (where, as the video fleetingly mentions, Kony does NOT hang out anymore and where other problems seem more pressing).
Regardless of the merits of the Kony 2012 video campaign, the debate it’s fostered is a good one. Not often does the news media talk about the complexity of international development or how hard it is for those in developed countries to do good in developing ones; or whether that’s something that should be done at all. Indeed, there have been plenty of stupid development ideas over the years that have all been very well intentioned but very ill-informed.
As you can imagine, this is a tricky discussion with all kinds of issues to consider. But the overall lesson is simple enough: the road to hell is paved with good intentions.
This maxim has constantly been on my mind while working on our maternal and child health project here in Rajasthan. Yes, our intentions are good, but, as my cousin Sherri put it to me lately, are we actually helping? Well, until and unless the indicators on maternal and child health improve in the district of Ganganagar AND these changes can be attributed to us AND we can be sure that our very presence isn’t having unintended negative consequences – something that will takes years to do, if it’s even possible – then we can start feeling good about ourselves.
Having said that, in this post I’d like to briefly highlight a few of reasons I am confident that we are helping and that we’ll be able to continue helping in the future.
First, there’s the issue of access to quality care. The gold standard in India is to have pregnant mothers get at least three antenatal checkups before delivery. Getting less than three checkups is associated with poor maternal and child health outcomes. Rural areas in India, and especially in Rajasthan, are not conducive to getting pregnant women to health care facilities where they can get the antenatal care they need. Here in the Ganganagar district, only 13 percent of pregnant mothers got the gold standard of antenatal care (which includes three checkups, a tetanus vaccination and iron supplementation to prevent anemia). Our Kartar Kaur prenatal clinic provides all of these services and more, such as ultrasounds, and is located in a rural area along a main road that’s fairly accessible to women in the region. So far women have been voting with their feet – we get usually between 40-70 patients at our weekly clinic and we’ve helped deliver over 200 babies. It seems like we’re providing something people want.
Second, as mentioned in the last post – this project relies on the involvement of locals and this is a philosophy we’ll stick to moving forward. In the future we hope to further involve village midwives, hire a local staff, and provide much needed training. We also hope to work in concert with the Government of Rajasthan to achieve its health objectives. Working with the local health system, and not parallel to it, is an important lesson from Paul Farmer’s seminal work withPartners In Health in Haiti. So far, local government officials are unperturbed by us and the district’s Chief Medical and Health Officer (CMHO) seems pleased. As he put it, he likes us because we’re not asking for anything and we’re making a contribution.
Third, we are doing our best to combine our good intentions with good information. We want all our initiatives to be evidence based. This will start with a survey I’ll be commencing next week to follow-up on the patients we’ve cared for. We want to see how the mothers who have come to us are doing and gather information to help us scale up the project appropriately.
The bottom line is we want to back up our good intentions with solid planning, good ideas and sound implementation. We’re moving into an exciting phase and I look forward to letting you know how things proceed.
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Some picture here