HIV/AIDS Orphans & Vulnerable Children - Project #1

A bit late, but better than never. Here is an update on the volunteer work that we've been doing here. I've got a lot of catching up to do, but I've got a lot of handwritten notes, and I'll try to bring you all up to speed. The fun stuff is great and all, but Carla and I are doing some really good work down here too, that should have a really lasting impact.

Some of you may find this a bit boring (especially the details about people and meetings), but these notes are for Carla and I too, and I want to make sure I get all the gritty details. Besides, I'm working to see if I can get some credit at Duke for this stuff. The first couple of posts will no doubt be a bit top-heavy since I'm introducing a lot of people who are involved throughout and I want to give you an idea of who they are up front.

Anyway, here goes...

TUESDAY - May 16th, 2005
We arrived in Belize on Monday, settled into our house, and showed up at the Cornerstone Office on Tuesday, eager to get started with a project. I really wanted to do a HIV/AIDS project and Carla wanted to do something with either HIV/AIDS or the Environment. We both wanted to help with the kids program too. It was difficult to get started though, since we couldn't get much help from the Cornerstone Staff. They were all very busy preparing for a conference which was coming up in Belize City on Thursday. The conference was part of a joint initiative led by UNICEF and Cornerstone to support the "Protection and Care of HIV/AIDS Orphans and Vulnerable Children and Their Families" What a great opportunity!

The trouble was, it was so late in the process that nobody wanted our help. This was understandable, since it would take precious time to get us up to speed, but both Carla and I offered our assistance anyway (even if it was just to get coffee for people or register attendees as they arrived). We still didn't get much of a response.

We were persistent though, and on Wednesday, we simply informed the Cornerstone Staff that we were taking the bus to Belize City on Thursday and asked for the address so we could attend. At this point, they got the message, gave us the address, and said it would be great if we could come help out.


THURSDAY - May 18th, 2005
We got up wicked early to catch the 5:45 AM Express Bus to Belize City. This was our first experience on the bus, and it was wonderful. Nice, Air Conditioned and Fast. We arrived in Belize City at 8:30 and walked across town to the Radisson Fort George Hotel where the conference was being held. When we walked into the lobby we noticed a big sign promoting the Belize Audubon Society Bird-Watchers Conference. Nowhere was there a sign promoting the UNICEF-Cornerstone Event. We took this as a bad sign, but after a few moments talking with the Front Desk, we were directed to another building next door where the meeting room was.

The conference room looked like a standard American hotel conference room, nothing special. Carla and I set to work hanging up posters and signs on the walls for breakout sessions later in the day. The volunteer who was the lead organizer of the conference was a girl named Victoria. She was a fellow American Gringo (from Miami) but was previously employed by UNICEF in another Central American country and seemed to have control of things. The volunteers here at Cornerstone fall into two categories: People interested in accomplishing something that will help the people of Belize in some way, and people interested in taking a 3 month vacation, supported by money from either their parents or their universities. Victoria was one of the former.

Anna Silva, Cornerstone's Director, acted as MC for the conference. Anna is a rather soft-spoken Hispanic woman in her early 40s who started out as Cornerstone's Secretary 5 years ago. She is very nice, but not as Type-A as we would expect the head of the organization to be. The conference kicked off with a rousing version of the Belize National Anthem and State Prayer followed by a welcome delivered by Roy Bowen and Juan Fernando Aguirre from UNICEF.

Melva Johnson, a UNICEF consultant, followed the welcome up with a presentation outlining the current impact of HIV/AIDS on Children in Belize. Melva is a tall Kriol (black) woman who is the primary UNICEF contact with Cornerstone. The presentation mostly consisted of statistics that served as a good background for understanding the current problem.

Dr. Paul Edwards, Director of the National Aids Program and Head of Epidemiology for the Belize Ministry of Health (MOH) came next. He was the most compelling public speaker, but his presentation seemed to veer a bit from the subject at hand, and focused mostly on drug therapy programs designed to prevent Mother-to-Child Transmission of HIV/AIDS. I found out later that he was supposed to speak on a totally different topic, but either didn't get the memo, or ignored the request.

The morning session closed with a pair of personal experiences, the first from Dr. Victor Rosado who shared two stories about what children in HIV/AIDS infected families can expect (discrimination, neglect, abandonment, malnourishment, and worse). The most moving speaker of the morning however came from a Mother Infected with HIV. She courageously came forward to tell her story how she is struggling to support her children (she lost her job due to HIV discrimination) and how she worries about what will happen to her children after she dies (her husband has already died from an AIDS related illness). It was a tearful event.

Judith Apuche from the NCFC (an organization associated with Social Services, which is a division of the Ministry of Human Development) had the difficult task of not only following up the HIV Infected Mother, but also Lunch. On top of that, Social Services has a terrible reputation here in Belize. The general understanding is that they only get involved when things are terrible, and when they do, they only make things worse. This is a tough distinction to shake as they seem terribly underfunded (I'll get into that later) and have some of the toughest tasks to deal with (relocating abused children to foster homes or homelessness. Anyway, Judith's presentation focused on how rampant child abuse is in Belize (really terrible) and some of the challenges in dealing with it. She was ripped apart by several community nurses in the audience who shared stories of abused children being taken from their parents only to find their way back to the abusive situation weeks later. It was a tough crowd for her.

Following Judith was a woman named Miyuki Yamashita, from the Dangriga Aids Society. Dangriga is a town on the coast which has the highest incidence per person of HIV/AIDS infection in Belize. Miyuki's presentation focused on how a change in attitude was needed. Over the past few years, there had been such a focus on stopping the spread of AIDS that they demonized the disease, and people afflicted by it. The result was that while the HIV infection rate had slowed somewhat, discrimination was now rampant. The Dangriga Aids Society was trying to set up the first "Aids Friendly Town." This amounted to a mass marketing message educating the community that people can live and work with HIV and still contribute considerably to society. It was an interesting idea, but much too early to determine if it would make a difference.

Minerva Aponte Jolly and Lavern ____ from Cornerstone delivered the final presentation which began with an explanation of the UNICEF-Cornerstone partnership and project goals. Before I get to that though, let me tell you about Minerva and Lavern. Minerva is a extremely outspoken tall, grey-haired 50-year-old Puerto Rican (originally from NY) who moved down to Belize many years ago to raise her children away from the hustle and bustle of city life. She is a nurse by training, a health educator at present and a true hippy at heart. She is incredibly passionate about helping people in need which is inspiring to be around, but she can also be frustrating to work with, because she does consider much else.

Lavern is the head of the HIV/AIDS program here at Cornerstone. She is Kriol (black Carribean), in her mid-30s and even more soft-spoken than Anna is. She has been with Cornerstone for about 2 years now and is in charge of organizing activities for the short-term (3 week) volunteers. Now, on to the Project.

The goal of the UNICEF-Cornerstone partnership is to set-up a National Network to assist "HIV/AIDS Orphans, Vulnerable Children and Their Families" by providing physical and emotional support. The program actually started in late 2003 when UNICEF Regional (Central & South America and the Caribbean) put out a communication that they were accepting bids from country level UNICEF offices (UNICEF is incredibly bureaucratic) to specifically help HIV/AIDS Orphans and Vulnerable Children (OVC as UNICEF likes to call em). UNICEF Belize put a proposal in and was accepted and in 2004 started the program through a partnership with a Belizean Church Group to provide these services. After 1 year however, UNICEF decided that the church did not have the national reach or personnel to do the job. At that point, they switched to Cornerstone primarily because Melva Johnson had successfully worked with Cornerstone before, but ignoring the fact that Cornerstone was a regional NGO (really only did work around San Ignacio, and had not organized any national efforts before).

The Network was to be kick-started by a $50,000 grant from UNICEF which started in January and ran until December 2005 but was to be self-sustaining thereafter. Originally the plan had been for Cornerstone to identify the families at need and then give the money to Human Development to distribute the funds. They didn't think this was a good idea, for the reasons I mentioned above and were working on an alternative plan. The plan they came up with is as follows.

CNAs (Community Nurse Aides) receive training to help teach others how to care for HIV/AIDS infected family members. These CNAs are individuals with medical backgrounds, but no formal training. Some have cut their teeth in formerly war-torn Central American countries but some are originally from Belize. They generally have an interest in helping the community, and receive a $100 stipend from the MOH for their services (it's important to know that this is not a salary (or much money), and that these CNAs are volunteers, not employees).

As the CNAs teach, they also gather information on the needs of the family by filling out a questionairre which Cornerstone developed. Once a month, they bring this questionaire to the District HECOPAB (Health Education and Community Participation Bureau) Offices (when they pick up their stipend money). HECOPAB, as the name suggests, is part of the MOH and is responsible for educating the community about health related issues. The HECOPAB workers (who are sometimes, but not always trained nurses) would then make photocopies of the forms, pass them on to district charity co-ordinating commities called (CICs) who make more photocopies which they pass on to local charities (Rotary, Churches, etc.) who actually meet the needs of the families. The goods collected are then passed back through the chain with an equal number of photocopied forms on the way back. If I have not lost you with acronyms and details so far, you get a gold star!

Ok, so where was I? Ah yes, that was the final presentation of the day. We then broke up into three small workgroups to work on the project directly. This is when Carla and I really started to get involved. We sat at the "National" group which consisted of Dr. Edwards of MOH, Ava Pennill, Director of the Ministry of Human Development (MHD), Judith Apuche, the head of security for Peace Corps. Belize and Minerva.

The discussion started with a criticism of the project as it was currently designed. Everyone jumped on the fact that it was way to heavy in photocopies and there were many concerns about privacy and ensuring that nobody would take advantage of the system. They also wanted to know who this "CIC" would be and who would ultimately take ownership. This group was all too familiar with good-intentioned charity programs which fell apart because either nobody took ownership or because people took advantage of the system. They were not cynical, but they were realists. Just as the discussion started to devolve into a "Why this idea won't work" party Carla and I jumped in.

We basically said that we could take the lead on the work and use our background with computers, databases and analysis to create an online system to collect this information, to eliminate the photocopies, ensure confidentiality and prevent free-riding. The group stopped short of applause, but there were a few dropped-jaws and they were obviously very excited that we decided to visit Belize.

The tone of the discussion immediately changed. Dr. Edwards volunteered the time of his technical team to help us develop the database and Ava Pennill offered to host the database on the computers at the MHD. We then started to discuss logistical details such as what questions should be asked on the CNA forms and where we could find donations. We felt really good about where this was going. We ran out of time before we could really finish the discussion, but we exchanged phone numbers and emails and agreed to meet a month later on June 14th to follow-up. On the bus ride home, I started to jot down notes on what they system would look like and what information we needed to collect. We were both really excited to have a project which we could apply our skills to and which would really make a difference. But that was just the beginning...