David Aday could just oversee a couple of one-week medical clinics in the Dominion Republic and Nicaragua each year, pass out medicine and free advice the way it’s been done forever and claim satisfaction.
And Aday’s platoon of students could just tag along, buying into the rationale that at least they were doing something for what the William & Mary professor calls “the poorest of the poor, the most marginalized of the marginalized.”
But Aday isn’t into easy or shallow. Neither are the students who initially recruited him for two complex international service projects, nor their successors.
If they wanted easy and feel-good, they wouldn’t hike up and over three mountaintops in Nicaragua to knock on doors and get to know the people of one of the country’s most remote regions a whole lot better.
They wouldn’t build communication by continually sifting their questions like flour and analyzing the answers, time and again, to make certain they know what’s vitally important to the people of the Dominican Republic village of Paraiso.
In a world that moves by leaps and bounds, Aday and his students are baby-stepping their way to forming a new roadmap for long-lasting, 21st-century relationship-building.
Aday, professor of sociology and American studies, and Ann Marie Stock, associate professor of modern languages and literatures, were awarded the first Reves Center Faculty Fellowships last spring. The fellowships, Aday’s for International Service Learning, Stock’s for International Student-Faculty Research, run for two years. They include a $5,000 research fund or salary stipend each year and funding of $6,000 for student support last summer and in the summer of 2010.
“What the Reves Fellowship has allowed me to do is to take a relatively small amount of money and get enormous mileage out of it,” Aday said recently. “I use it to support my students in each country, and here back home.”
(Editor’s note: A profile and video of Professor Stock and her work with Cuban filmmakers will appear here in the near future.)
“The basic principle is that if you’re not generating resources with what you’re doing, it’s probably not sustainable,” he continued. “If you bring in resources, they get consumed and then they’re gone. If you bring in solutions, once you leave, it’s likely they fail. So we try to figure out what small steps or strategies we and the community can do to partner with the clinics we put on to keep improving health care, one step at a time.”
It’s an endeavor that requires extraordinary patience, expertise in the most delicate intricacies of diplomacy and selflessness toward people so close to the edge of survival that they’re far more likely to compete than cooperate for what meager resources exist.
“Part of our challenge is to find ways to demonstrate to them that collective or cooperative efforts would actually benefit everyone more than the hard-scrabble, individual, do-the-best-you-can strategy,” Aday said.
Five years ago, Aday was asked to serve as faculty advisor for a medical mission project to the Dominican Republic – SOMOS (Student Organization for Medical Outreach and Sustainability). The students wanted to do more than just distribute medicine, so Aday began teaching a seminar emphasizing ethnographic research and community building. A year later, a second project emerged and students asked Aday to advise and teach seminars to support that project. Based in Nicaragua, the project initially was called Students for Healthy Communities. But the name was recently changed to MANOS: Medical Aid Nicaragua – Outreach Scholarship.
“It’s the students, and their recognition that they needed to connect this to their education in order to make it something with lasting value, that’s at the core of everything,” Aday explained. “If I were trying to recruit students, it’d never work. It only works because these students get it and came looking for a solution and I got lucky enough to be standing in the way.”
For the last four years. SOMOS, the Dominican Republic project, has brought annual medical clinics to the community of Paraiso outside Santo Domingo. The annual January clinic has been expanded through a partnership with a community health project at the medical school at Virginia Commonwealth University. This year, SOMOS will host clinics in January, June and November. In June and November, William & Mary students will assist and act as liaisons between the village and the doctors provided in conjunction with VCU. SOMOS students staff the January clinic and pursue ethnographic research and project building in Paraiso. As many as half-a-dozen will return to spend from three to 10 weeks doing more intensive and extensive research in the summer. The Reves Fellowship supports these students and their research.
The MANOS project is only a half step behind, having now completed three years of clinics and research and preparing for the fourth year of work in March 2010.
Students raise the money to support the medicine and supplies used in the clinics, as well as their travel, food and lodging expenses. Working with their medical partner, Dr. Mark Ryan, ’96, students recruit medical professionals, including physicians, nurses and pharmacists. They also take semester-long seminars from Aday to learn ethnographic research techniques, core concepts, a model of community capacity building, and some of the background literature on international development.
In all, the annual clinics and travel cost about $14,000 and provide free medical consultation and free medicine for, on average, about 700 in Paraiso and about 300 in Cuje.
During summer, students pursue research, both in the communities and on campus to continue the effort to understand the communities, their resources, and the prospects for small-scale health improvement strategies. Those who remain in Williamsburg develop research protocols, analyze data from interviews and observations, and summarize project efforts in preparation for the coming year’s work.
“Just putting on a clinic is like putting a band-aid on cancer,” Aday said. “It’s not going to make much of a difference long term.”
Achieving consensus on what will make a difference long-term in Paraiso is an agonizingly slow process. There is little foundation on which to build: nearly no infrastructure, electricity, running water or plumbing. There are few roads.
In the Nicaraguan district of Cuje, the problems are nearly identical, but are compounded by the sparse population spread across 50 square miles of mountaintops.
Take, for example, two fundamental necessities: potable water and protection from flooding. The communities in the Dominican Republic and Nicaragua have neither. Some villagers must buy their water off trucks, money they can ill afford to spend for water they’re not sure is safe to drink. During the dry season in Cuje, it’s not uncommon for people to walk nearly an hour down a mountain path, fill a jar with water, and walk back up the mountain, twice a day.
And the water very likely is contaminated.
In winter, flooding is a major factor in the spread of disease.
All recognize these as massive problems. Some people think it’s the government’s responsibility to solve them. Others, not trusting the government, believe that God will provide for their needs.
“They feel overmatched by the problems and uncertain of what could be done without significant help and outside resources,” Aday admitted.
He doesn’t want to instruct villagers, doesn’t want them agreeing to suggestions just to humor the Americans, or because they pass out free medicine in the hosted clinics.
“We worry a lot about ownership of the problem and the solution, so we’re not ever going to try to insist on a solution or force a solution,” Aday said. “We want the ideas to come from them though we know we have to be a resource to promoting those ideas or solutions.
“The students and I are deeply involved in a complicated conversation about how we do that next step . . . I have some students on the project who say, ‘Hey, maybe we should let them figure out what they need and help them.’ And we have others who say, ’Look, if they were capable of doing this they would have already done it.’ We’re trying to figure out what the next step looks like . . . I’ve never had a project that’s gotten this far as far having all the necessary information to take the next step. So I’m not entirely certain what the next step looks like . . . This is uncharted territory.”
That makes traditional goal-setting almost pointless. Aday says that over the next three years, he is confident that his students will collect enough health data that they’ll be able to track the improvement in health among villagers. But what specific health issues will be addressed?
“That’s real hard to figure out,” he said. “It’s so dependent on the interaction with the community.”
There is one project that Aday favors that would be of enormous benefit. A foundation in Texas provides free medication for chronic diseases such as diabetes as long as trained lay health-care workers are in place. With the blessing of the village, Aday hopes to move forward recruiting and training lay health-care workers, put them in place between the three clinics and bring his case to the Texas foundation.
When that will happen depends on how quickly Aday, his students and the people they serve agree to move forward.
“That’s in our minds,” he said. “It’s not yet in the minds of the community.”