- Who We Are
- Why CHI
Prior to the earthquake of 2010, it was estimated that over 10,000 nonprofit organizations operate in Haiti—roughly one organization for every 1,000 Haitians. So the question stands:
Why choose any one organization over the numerous others?
Why should you donate or volunteer with the CHI if you have 9,999 other options?
Why not your local church?
Why not a big, multi-national organization?
Roughly a decade ago, Dr. Chris Buresh and I started work in Haiti. Very quickly we realized how many groups pour a lot of money, time, and effort into this little Caribbean country. At the same time, we weren't seeing a lot of results. An examination of statistics regarding Haiti reveals that most measures of quality of life are not improving. Health statistics, educational statistics, economic indicators—all are essentially stagnant, or only creeping upward... Why?
Isn't the monumental humanitarian effort making a difference? What have the billions of dollars and billions of hours of volunteer efforts paid for? In 2012, after so many years of work by all these nonprofit organizations, how did the World Bank come to dub Haiti as the poorest country on the globe? I believe the answer to this question resides in our standards. In a place like Haiti, aid organizations don't apply the same standards that might be required here in the U.S. Our desire to help drives us to do things that would be unacceptable here at home. The tragic poverty in Haiti compels many good and kind people to take steps to help the Haitians. However, this desire is often distilled into a hazardous mindset:
The painful reality is that this thinking is—in the best circumstances—inefficient and wasteful. In numerous case, "just doing something" further complicates and worsens the situation faced by communities in Haiti. Take for example the plane-loads of cast-off clothing arriving in Port-au-Prince daily. Is it not a good idea to clothe those who are naked? Particularly with those old t-shirts you otherwise would never use? If our thinking stops here, this is a kind, benevolent, and good-hearted gesture. Roughly 75% of Haitians live on less than $2 per day. But in order for this situation to improve in any lasting manner, Haiti needs an economy. It's not difficult to understand that Haitians cannot subsist indefinitely on generosity, Haitians need jobs. One of few employement options for Haitian women is to sew. But how will these women sell what they produce if planes arriving from Miami offload bags of free cast-off clothing daily? Our old t-shirts are grossly hindering the ability of many Haitian women to support themselves and their families.
Similarly, consider many of the medical clinics operating in Haiti. It's common for aid organizations to manage clinics with providers from the US, most of whom have no experience with the health care problems faced by Haitians. These clinics travel to locations ranging from remote mountain villages to the slums of Port-au-Prince. They hand out donated medications without ever returning to followup on these patients. I've seen these clinics. I've worked in these clinics. These aid organizations tout their "success" by simply advertising how many patients were seen during a week of clinic.
At face value, this kind of statistic seems to indicate success—say for example that 1000 residents of a slum were provided the opportunity to see a doctor. What is the value of this statistic? Let's start by recognizing that this is not a fast-food restaurant, and 1000 patients served is not an indicator of how many of these patients are actually better off. When you visit your doctor, do you measure the value and success of your visit by the fact that you got in the front door? Would you be satisfied if your family doctor put up a billboard advertising how he or she saw 1000 patients last week, but never recorded your blood pressure or the medications you take, and never opened his or her doors in your neighborhood again? Obviously not. So why do we consider this a measure of a successful visit for a Haitian? We cannot be happy with the false return-on-investment of 1000 patients seen. When a clinic advertises 1000 patients but kept no records, it's operating on the "something is better than nothing" standard, and it should be no surprise that health demographics aren't markedly changing on Western Hispaniola. Getting in the front door is not good enough in the U.S., and it's not good enough in Haiti. We need to ask how many of our patients experienced the improvement of their pain, resolution of an infection, or proper management of a chronic illness—but we often don't.
By now if you aren't concerned with what aid organizations are doing, you're not paying attention. At the same time, you should be asking:
1) The CHI is culturally invested. We do not simply assume that what works here in the US will work in Haiti. Our staff lives within the villages that we work. We interview, learn, and gain investment from the locals before we proceed with any form of aid. We're well aware that when we enter a community in Haiti, the locals have a much better idea of their needs than we do.
2) The CHI is flexible. We engage in whatever aid is necessary, wherever it is necessary, even if it isn't the aid that we had originally intended to provide. Sometimes the reason for illness in a community is lack of clean water, and rather than doctors treating diarrhea, they need a clean water program. So we scrap the plan and start a new one. In doing so, we will work with whomever, whenever. Christian, Muslim, Buddhist, Atheist, Governmental, Non-Governmental—we don't discriminate. We're all trying to improve the lives of Haitians, so let's leave dogma at home.
3) Evidence. This is the third fundament of the CHI and our one prevailing element of dogma. We demand from ourselves and others proof that our aid works. We demand evidence that your donations are well spent. We demand evidence that our patients are, in fact, better off. We demand evidence that our sanitation projects are successful, our micro-finance projects are successful, and our public health projects are successful. You will find that a significant portion of the CHI budget and activity is dedicated to research and documentation. We have an electronic medical records system to track our patients, document improvements in blood pressure, growth in children, and the resolution of illness. We have graduate students living in Haiti, investigating the conditions on the ground, measuring the results of our interventions. We want to know as much as you need to know that your hard-earned dollars are improving the lives of others.
I invite and encourage you to make these demands of not just us but all aid organizations. Contact us. Ask to see and hear more about our records system. Ask about our past, present, and future research. Ask me why you should donate to the CHI. I look forward to hearing from you.
Joshua T. White, CHI Co-Founder, MD, MBA, FAAEM
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