Expanding my Town's Health Center

The following is the grant proposal that I'm turning in to the Peace Corps on behalf of my town. We are going to be doing a PC Partnership grant of $40,000. You can donate to our project very soon:
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Executive Summary

San Luis Planes on a cloudy day.

The more than 4,000 villagers of San Luis Planes and neighboring towns have identified the expansion of their health center as the area’s top priority.

Health-related problems abound and, because of the highly limited physical space in the current health center, they simply are not adequately being attended to in San Luis Planes. The nearest hospital is an expensive emergency trip away (the equivalent of five-ten days’ wages for a local laborer), preventing many impoverished families from visiting a doctor.

The goal of this project is to more than triple the size of the current health center’s physical space. By doing so, the center will add ten new rooms, including an area dedicated to vaccinations, a maternity ward, an overnight room  and a doctor’s office, thus providing crucial new health services. Ultimately, with an improved building, the town will be able to receive the placement of a full-time doctor from the Ministry of Health and will thus begin work on preventative health and education, the truly sustainable solutions to the area’s health problems.
Community leaders representing the town’s various key organizations have come together to form a committee to oversee this project. They understand the importance of improving their community’s health and are dedicated to fighting for it. Additionally, the mayor of the city of Santa Barbara, the municipality of which San Luis Planes forms part, has promised to support to the project. The two parties together will contribute a total of nearly 65% of the entire cost.

Health is a fundamental public good and a person can’t hope to live a productive life without it, just as a town can’t hope to develop without prioritizing the health of its citizens. Thus we hope that this project will directly contribute to the area’s economic advancement and well-being.

Background Information

A local girl helps her mother on the coffee farm.

San Luis Planes is a village located within the municipal limits of Santa Barbara, the capital city of the department with the same name. The town rests on a plateau at around 1300 meters above sea level, within the buffer zone of the Santa Barbara National Park. There are approximately 1325 habitants and 290 households, putting the average number of people per house at around 4.6. What’s more, the nearly 4000 people of the seven surrounding villages also use the health center. People make a living primarily harvesting coffee and other agricultural endeavors. The average household annual income is approximately 25,000 lempiras (around $1315). San Luis Planes contains a K-9 school with twelve teachers, a coffee cooperative, three churches, a community center, a police sub-station, a soccer field, and said small health center. The town was connected to the national electric grid in 2008.

The town's soccer team and my left index finger.

The greater area has felt the need for this project for years, but hasn’t been able to obtain financial support until now. With that goal in mind, 25 community leaders from various key organizations in San Luis Planes (churches, the town council, the school, the coffee cooperative etc) came together to form a committee to work on this project.  They also have the support of the town councils of the surrounding villages as well as the mayor’s office of Santa Barbara.

Community Need

The Catholic Church during mass.

In San Luis Planes, like in many places in rural Honduras, the population’s overall health is sorely lacking. Some of the most frequent sicknesses include respiratory problems; skin diseases; diarrhea, amoebas, intestinal parasites and other stomach problems caused by contaminated water and food; high blood pressure, high cholesterol and general heart problems; diabetes; and injuries/emergencies related to non-mechanized manual labor. What’s more is that maternal care and sexual education is a growing necessity, considering the high birth and teen-pregnancy rate in the area and the effect they have on family economics.

This second-hand American school bus represents the primary
mode of transportation for most people in my town.

The nearest hospital is 36 kilometers away and an emergency trip there can cost between 500-1000 lempiras, the equivalent of five to ten day’s wages. Because of this steep cost, many poor families simply do not have the resources to visit a doctor when they get sick, much less for frequent checkups. To put it basically, the limited space and resources of the health center are simply not meeting the needs of San Luis Planes and even less so for the greater area. These problems will only become greater with time because of the rapidly expanding population.

The members of the health center committee believe that these problems can begin to be resolved by obtaining a doctor. And in order for the Ministry of Health to send a doctor to San Luis Planes, the health center must be expanded according to a list of specific requirements, more than tripling the square footage of the building. The idea is that along with being able to render more services, the health center’s doctor and new space/equipment will be able to focus more on preventative health and education. More physical space also means a bigger medical storage room and thus the ability to provide more medicine to the patients who need it.

This woman, posing with three great grandchildren, represents the
elderly population of San Luis Planes.

 Community Initiative and Direction

The committee that was formed elected its officers in its first meeting.  An in-depth community analysis followed, using survey results, input from representatives from various community-wide organizations and members’ own experiences and opinions. After the health center came out as the top priority, the committee wrote a work plan and the project proposal. The committee meets minimally once a week for two to three hours in the afternoon, but the officers often work much longer during the week and donate time and transportation without a second thought. Only after all this work was finished did committee members approach the Peace Corps volunteer to ask about ways to go about raising the funds required.

The Health Center's nurse likes to give shots.

Several members of the committee have worked with Peace Corps volunteers in the past on other large projects including eco-stoves, latrines and a new school. Additionally, almost every previous project that brought the current community buildings to San Luis Planes was implemented by at least one person on this committee.

The committee keeps the minutes during meetings, records agreements that are reached, stays in contact with the mayor and other town councils, and works closely with the Peace Corps volunteer who is helping them. When it comes time to buy materials and begin construction, the committee will take charge of managing the inventory, overseeing the foreman’s work, keeping accurate and transparent records of finances, and communicating progress to the rest of the community and to the other donors.

Community Contribution

Tripling the size of this health center will be relatively expensive at more than $40,000. However, between the people of San Luis Planes and their elected officials in Santa Barbara, the community will be contributing nearly 65% of total costs, approximately $26,000.

This is the crowded waiting room.

The people of San Luis Planes will donate the equivalent of nearly 900 work days in difficult manual labor supporting the foreman in the construction of the building. This includes not only helping to move and prepare materials, but also digging a large hole for a septic tank, leveling out the terrain for the new building and helping to install the plumbing, roofing and electricity. When put into dollar form, these 900 work days total out to nearly $7,000, which, for a town whose habitants’ average annual income is only $1,315, is substantial.

The municipality has promised to provide a few of the basic materials needed for construction, like rebar and steel roofing beams, a value of approximately $10,500. They will also pay the foreman and engineer in charge of the building’s architectural designs and construction, totaling more than $8,500.

The remaining 35%, $15,000, will come from this Peace Corps Partnership Program, paying for the rest of the construction materials and the value of the contract to install the building’s ceiling.

Project Implementation

The project’s first phase, which is the phase that corresponds to this Peace Corps Partnership profile, will take seven months. After writing the profile comes fundraising. The community will be in charge of promoting the project locally and organizing the work that people will contribute. The Peace Corps volunteer will be in charge of promoting the project abroad. The committee plans to spend four months on this fundamental step.

The Health Center from the outside.

While fundraising, the committee will also hold a community-wide meeting, passing on the details of their planning to the general public. They will also choose a foreman and write up a contract. Once the funds are raised the committee will purchase the materials and begin construction in February. The construction is planned to last four months until May, when the finished building will be inaugurated.

During the construction, committee members will take turns managing the inventory and will continue meeting once a week to give progress reports. Once the construction is finished, the committee will evaluate the project as a whole, and then enter into a second phase. The second phase will take the committee into November 2012 in which time they will work on obtaining the appropriate equipment and furniture and the placement of a full-time doctor. After the year is up, the committee will switch members. The goal, however, is to maintain the committee indefinitely, giving support to the employees of the health center.

Project Sustainability

Although a better building doesn’t automatically mean development, this project has everything it needs to be sustainable.

The committee, holding up the blueprints of the
Health Center's expansion.

In the first place, this committee is made up of people who have lived here their entire lives, whose families have lived here for generations, and who are dedicated to seeing their town develop. Their dedication to seeing this project through now and into the future is unquestionable because they have a real interest in seeing their area’s general health improve. Another reason they will be the first to defend the well-being of their health center because of the 900 work days they are going to put into its renovation.

The members of this committee are also learning valuable skills when it comes to project design and management and community analysis. The knowledge of how to organize a project this big will be useful years into the future as they start to tackle other issues confronting their community. This, in reality, is at the heart of sustainable development.

Finally, once the health center meets the Ministry of Health’s requirements, San Luis Planes will receive a doctor who will be able to better attend the health needs of people here. But also the doctor will handle education and work on preventing health problems. Education is the key.

Any contribution to a town's health and education is a contribution to its economic development.

Building Trails in the Cloud Forest

For those of you out there who are keeping score at home, my last blog post was about how schools were closed for more than a month because of a teachers’ strike. So, I basically spent the entire post explaining (okay, call it complaining) why I haven’t been able to do part of the work I wanted to in my town because of things that were way out of my hands. (And hopefully those roaring political storms have calmed for a bit and I can soon restart work at the school). But I found it unfair that I didn’t talk at all about the work that I have been doing in the past couple months: so here it is, four brief overviews of solid projects that have been happening around here:
1. Database system at the coffee co-operative

2. Total trail system make-over in the cloud forest

3. Construction finished on community center

4. New project: improve health center

1. Database system at coffee co-operative

In February I teamed up with a fellow business volunteer, Carrie Purdue, UVA grad and good friend, to design a new database system for my coffee co-operative (see picture of us on a hike in a national park outside of Teguz). The administration was looking for a way to digitalize their receipts, to get up-to-date inventory reports, and to be able to track the production and credit trends of coffee farmers who sell to the co-operative over time. So Carrie shared some of her extensive Excel know-how and we sat down and put together a new program that, I’d like to think, is very simple and intuitive to use but that will hopefully be a helpful tool for decision-making.

Up to this point, we’ve been finishing up this coffee harvest using both the old, inflexible and stale database, and the new one, as they’ve been getting used to the new processes. The dream is that this new system will make it easier to manage the co-op in general, using information and technology to be more successful.

2. Total trail system make-over in the cloud forest

Alicia, the PCV who’s working with me on developing ecotourism, got one of her former co-workers in the Seattle park service to come down to Honduras for a month to help us work on our trails. His name is Jack and he’s got years of expertise designing and maintaining trails in the Seattle area.

We held a trail building workshop for fellow PCVs and for their counterparts, as well as members of our communities, a couple weekends ago. About 25 people showed up, which for us, felt like a great turnout. In the training, Jack talked about the three main components of trail building: the grade (or slope/inclination) of paths, water drainage, and the “tread” (or path). Many of the current trails in my town are used by workers and by pack animals getting to and from coffee farms and are basically straight up the sides of hills. That’s not ideal for tourists, however, because it’s a lot more tiring to walk, and when it rains, the paths basically become muddy creeks.

So during the weekend-long training and since then, we’ve been building “switchbacks,” which are zig-zag paths that wind up the side of hills to avoid the steep straight-up paths, and “water bars,” which are rudimentary drain canals perpendicular to the trails. We also have been working on taking out roots and widening the path wherever possible. In the picture here, one team is working on installing a rock-step bridge across the river (which only has water in it during the rainy season). It has been frustrating work sometimes, logistically speaking, but it’s a lot of fun being out in the woods. We saw a coral snake and have heard quetzals and howler monkeys. I think the trails will end up great and hopefully will be a boon for our marketing efforts.

3. Community Center

One of the first things that I did in my site last summer was meet with the Patronato, the local town council, every week. It was a good way to meet the leaders in my town and to see what sort of initiatives were big. Well, instead of big development initiatives like business training or children’s nutrition programs etc, they had prioritized the construction of a community center. The idea was to have a place to hold town meetings, weddings, wakes, political events and, of course, dances. This is the perfect example of balancing the community’s desires with our own ideas and plans as volunteers: although I didn’t think it was priority number one, they asked me to help out, so I said yes. We made a work plan, vetted a foreman and wrote the budget to be presented to the municipality.

Anyway, the good news is that construction was finished in February and they held the inauguration dance for Valentine’s Day. I admit that there was a certain sense of accomplishment upon seeing it finished, though a new building doesn't necessarily mean "development." I will post pictures one of these days. Also, I think helping community members on this project gave me a leg up in terms of their trusting me in the future. Now with my foot in the door, hopefully, it will be easier to work on new project (see number 4 below).

4. Health Center

To finish up, I’ve been meeting with a group of people in my town who wanted to "do a project." Alicia is building a library in her town, using one of the PC grants available to volunteers, so people in my town wanted "something" too. So we met for a couple hours a week for a month and a half in order to analyze the needs/problems of the community and then brainstorm possible solutions. What ranked as the highest need for the community according to my committee was working on the Health Center. Although it wasn't my first choice of projects, the cool thing about service in the PC is that we can respond directly to the desires of our communities. Thus, we are going to be looking at physical expansions, new equipment and getting a doctor. Although this doesn’t specifically have to do with my business project, it may be a good side project.

I must admit that I am highly concerned with sustainability. I.e. we could spend a lot of time and money on fixing the building and getting new equipment, but if the management of the Health Center doesn't improve, it may all be wasted, having little positive impact on the community. For me, the ideal would be to work on fixing the root causes of poor health: lack of education and lack of income generating activities for families. Will continue updating on this…