Helping vs. Hurting

“No das pescado… enseñales a pescar” – “Don’t give the people fish… teach them how to fish” – Peruvian expression

I recently read the book “When Helping Hurts” by Steve Corbett and Brian Fikkert. Many parts of the book have paused me to reflect on volunteer work I’ve done in the past, and on my actions here in Peru in the last year.

Did you know that in 2006, Americans spent 1,600,000,000 dollars on short-term missions?! Often without the volunteers’ awareness, short and long-term mission trips can cause more harm than good in developing nations. Often we have these big expectations and want to GIVE so much - but on our own terms. From my experience, #1- you always get more than you give on a short-term trip, and #2- to be effective, you really need to get a solid understanding of the culture and the community, your role and what is considered “success.”

One important distinction is relief vs. rehabilitation vs. development. Back in college, I signed up for a trip to New Orleans for a few months post hurricane-Katrina. We spent a week gutting homes in what was then a “ghost town” of a city, for persons who were older or had health conditions that prevented them from helping with the manual labor. It was an incredible experience and when the opportunity came up the following year to go back, I jumped right on board. However, the 2nd year’s situation in New Orleans was much different- there was better infrastructure and many people had returned to the city. The work had changed from gutting homes to repair and we spent a week helping rebuild a church. While we left feeling pretty good about ourselves that second trip, I often wonder if we did more harm than good. Where were the church’s community members and why weren’t they rebuilding? Why did we provide relief when we really should have been working on rehab. and/or development?

Another difficulty facing short and long-term missions lies in our individualist (vs. collectivist) culture and the need for rapid, measurable results. Corbett and Fikkert agree that “the North American need for speed undermines the slow process needed for lasting and effective long-run development.” During grad school, I went on a weeklong “alternative spring break” trip to a small desert community in Mexico. For the last decade, students from Regis University had been going to the same community once-twice per year to help build a community center. The progress was painstakingly slow. Most of the men in the community worked 2+ jobs to make ends meet and thus were unable to continue the building once we left without the manpower of the Regis group. The year I went, day 1- we played soccer with the kids and began to plan a health fair, because we were waiting on the actual building supplies to arrive. The manual cement mixing was slow and thus in one week, all that we accomplished was laying cement and getting the roof up. As volunteers, we started out feeling a bit frustrated. I was blown away by the fact that the community was that patient- every year they saw the center grow a baby step closer to completion, but not by much. But what I learned above the patience of the people was the importance of community in the process. To the locals, the groups’ coming meant so much more than construction, health fairs, and a few physical therapy home visits – to them it was all about the feast of a goat, Catholic mass, swimming in the river, playing with the kids, various meals and celebrations together, movie night, a fantastic dance party, and soccer games – community building. It’s not about the product- it’s about the process. And say Corbett and Fikkert, “development is a lifelong process, not a 2-week product.”

The book elaborated on these concepts – development/rehab. vs. relief, processes vs. projects and products, and the importance of empowering people and ensuring local collaboration/participation. Avoid paternalism and don’t do things for people that they can do for themselves. Many lessons I’ve learned here in Peru mirror some of these notions. Another - “I was still amazed to see people in this Kenyan slum who were simultaneously so spiritually strong yet so devastatingly poor.” Though across continents, I see this day in and day out in the people of Peru, too.

So now I look back on my year here in Peru and wonder, did I do more helping or hurting? One of the underlying issues is the idea that providing continuing education is a good idea, but it’s really only putting a band-aid on the “problem.” Why didn’t I focus my energy this year on changing the curriculum of the local PT schools? Is continuing education really worth it? This is something I’ve struggled with as I’ve begun thinking in the lines of public health projects, too. How do we act at the root of the problem, vs. helping the symptoms?

When I first arrived here, I began to learn about the different types of health problems faced. Based on statistics from the WHO in 2008, the number 1,2 and 4 causes of death in Peru are non-communicable diseases. In my community, I noted the poor diet, the low physical activity/opportunities for recreation, and began to see a lot of patients affected by conditions like stroke. In my first month here, I began to envision this project targeting non-communicable disease – exercise classes, educational sessions, an incentive program teaming with the local health clinic, etc.

Right around the same time, I became connected with a number of PT’s here and became very impacted by the lack of continuing ed opportunities and the huge thirst for knowledge. This ultimately shifted my focus for the year. I often wonder how successful a different type of program would have been. I think that ultimately the most important aspect as a volunteer abroad is to listen to – what do the people need? What do they want? What are they most likely to participate in? And how can we build on the skills and strengths that already exist? Reality is, I would be up against a large number of cultural challenges in creating the first project targeting non-communicable diseases– had I jumped right in quickly without really knowing the community, I could have hit a dead end really fast.

That being said, I know that many of my actions could have been better thought through this year. I think that 2 projects – the regular continuing education classes and the planning and execution of the international event - went well and included important cultural factors and community participation. Ultimately I saw the event build relationships and networks, community togetherness, critical thinking, hands-on skills and introspection of physical therapy practice here in Peru. While it doesn’t directly target the cause, as I mentioned in a prior post, I think continuing ed is an important piece of the puzzle.

I’ve been lucky to have 3 short-term volunteer groups of healthcare providers visiting this year. I think that in general, their experiences were well-planned and really tried to get at the sustainability potential in short-term missions. The volunteers were working with community members and people on-site who already knew the ropes, which assisted in their effectiveness. Each group participated in teaching and also had activities planned to visit sites and learn more about the healthcare system here. The opportunities to develop relationships and continued collaboration with the Peru Ministry of Health, a local university that has a PT program, CMMB, etc. were all valuable outcomes of the trips and the beginning of exciting new relationships.

However – when I reflect on my other projects this year, I don’t feel they encompassed as many of the qualities suggested by the authors. Take, for example, the survey of people with disabilities. Here in Peru there are constantly people begging for money – in the streets, at the clinic, even my neighbors and people I know well. There’s a big problem here with free handouts and I don’t think Peruvians and tourists alike realize how much they are perpetuating the process by giving the beggars money. I fear that the survey hurt more than it helped by setting people up to expect free hand-outs from the project. Also, the questions were functional, yes, but some were worded negatively toward “what can’t you do? What do you lack?” vs. the approach of “What are your assets? What do you bring to the table and how can we help develop them?” Ah yes, hindsight is 20/20.

Luckily, I’m still finishing components of the plan for “Rehabilitation con Esperanza,” so I have the opportunity to right some of these mistakes and hopefully leave a well thought out model behind. In this manner I hope to ensure participation by mobilizing the skills/resources of the community and only bringing in outside resources when local resources are insufficient. Thus, the project will ultimately act off some of the authors’ helping principles – as in my favorite Peruvian expression, instead of fishing quickly to produce mass quantities, to slowly teach people how to fish.