This ain’t no Michael Jackson video

Thursday 08.11.11

You won’t see these street kids dawning leather jackets, slicked back hair, and waving around shinny pocket blades while perfectly dancing in sync to MJ’s “Bad” song. Street kids in Delhi, India are nothing the way Hollywood would like to betray it.

These children are smart, crafty, strong, and persistent – findingways to survive in a world that has been sounfairly cruel to them. On Thursday, our last full day in Delhi and with our Social Entrepreneurship class, we had an incredible culminating experience. The class piled out of our huge spectacle-mobile (as I lovingly call it) onto some side road near the New Delhi train station. We then took what felt like 50 different rickshaws to a small alleyway where we were split into two groups and told to follow some Indian high schooler around. I had no freaking clue what was going on.

And then I met Iqbal. This 19 year old boy (young man) with an illuminating smile and a very calm disposition is a shining example of the perseverance of the human spirit and what difference one organization can truly make. We didn’t hear his story till later on, but Iqbal didn’t grow up like me. Iqbal was abandoned at age 5 in a marketplace near his home after going to buy fruit with his father. His dad just left him there. This five year old kid scavenged for food, living on the streets till a wealthy couple picked him up and took him in their house as a servant boy. They beat him continuously until he ran away from the house, forced to live once more on the streets. Iqbal eventually ended up in Delhi, led by the desire for easy money (through pickpocketing) and the hopes of becoming a Bollywood star. Eventually Iqbal was found by a Salaam Baalak Trust volunteer who led him to one of their many city-wide centers where he was given a second chance at having a healthy childhood.

Pretty incredible stuff: this 19 year old seems to have it more together than many twenty-something’s and older people I know. Salaam Baalak Trust is one organization that is making a real, tangible difference in India. It doesn’t matter if the data is collected and analyzed extensively to prove the effects of SBT’s work – you can see their success in the faces of the thousands of children they have helped over the last 20 years. SBT is an organization that provides everything from basic services such as medical attention and a meal to shelter housing and education for runaway and homeless children, many of whom come to Delhi via the train system. SBT services are crucial when considering that many of the male street children have the potential to end up drug addicts and the female street children are quickly pushed into prostitution (currently there are over 3500 girls forced into sex trafficking in Delhi – nauseating stuff). SBT has volunteers at the train station in Delhi as well as a collaborative with the local police to lead street children towards one of 15 of SBT’s centers in India versus leaving the children to fight for survival on the streets.

Some children want the help, others do not. That was what was so sobering about this site visit. No matter the persistence of SBT and the police, in the end, the decision belonged to the child on whether or not they accessed SBT’s services and shelters or stayed on the streets. Iqbal, a former street kid himself, lead us through the tiny, dirty alleyways near the Delhi train station to show aspects of the daily life of a street kid. Our group visited one of the centers for SBT, a preliminary facility for street children just arriving off of the trains or the streets, looking for medical aid and some food before going back on the street. It took me a while to realize that some of the children sitting in front me, who couldn’t have been more than 15 years old, were on drugs. This center was a facility to provide basic services to the kids who didn’t want to get off the streets; who preferred a life of quick money, haggling, drugs, and alcohol over the strict sobriety requirements of the SBT shelters.

What I appreciate about this organization is that it remains very realistic – they recognize that changing one kid’s life is still a measurable impact and that this change can be as miniscule as a free meal. This program has the means of a sustainable difference through their City Walk program, which charges a small fee to have some of the graduated street children lead small tours around the Delhi train station to show the different centers and facilities that SBT has – as we saw on Thursday. This organization also sells postcards made from photos taken by some of the children going through the various arts programs hosted by SBT – in particular the photography course (which you can donate old digital cameras to). I purchased some of the postcards, moved by the captured worldview of these children; one of the photos was actually by Iqbal! I also made sure to make a small donation to this organization, knowing the importance of unrestricted funds for nonprofits (keep that in mind next time you want to help out an organization J).

I was really moved by this organization and really impressed by the palpable impact in their target population. Salaam Baalak Trust has a well-established network and services that brought together all the elements of the social entrepreneurship course from the last two weeks. Even though the organization was not functioning solely on independent profits, they definitely had a social entrepreneurial element to them: focused on giving back to the community they serve in every possible way. By hosting City Walks lead by former street children, having annual reunion events that bring in successful former street children who were once part of the SBT program (there are Bollywood actors, fashion designers, photographers, and choreographers galore), and developing unique products to sell that share the message of renewed opportunity, Salaam Baalak Trust is a great example of how an organization can invest extensively in a community; perpetuating a cycle of investment by that very community to ensure its continued success for many many many years to come.

Salaam Baalak Trust

“Give a person a fish and you have fed him for a day. Teach a person to fish and you have fed him for a lifetime.”

Our last site visit was with the Salaam Balaak Trust (SBT). When we got off the bus two tour guides greeted us. We split into two groups to visit one of their shelters. As we made our way through the narrow alleyways, our guide explained to us the mission and purpose of SBT. Street children rescued by SBT often run away from home to avoid unfortunate family situations. They have no where to go but can’t bear staying at home so they run in hopes of finding a better life. SBT seeks to ensure that all children can partake in education regardless of their position or station in life. It gives students that would otherwise not have the opportunity a chance to meet their basic needs. They also seek to teach them the values of independence, decision-making, education, and social values so that they will ultimately become self-dependent, contributing members in society. Street children are taken into one of the 5 shelters run by SBT and given the opportunity to lead a normal life. After arriving at the shelter, we had a chance to visit with a group of young boys in the classroom. Several of them got up and sang and dance with us, and were really excited to have their picture taken. A lot of the class interacted with the students and we all cheered them on. I thought they had incredible talent and it was incredible to see them all still have such huge smiles on their faces. At the same time, I was somewhat heartbroken thinking about all of their stories and how they were all there alone with no family. I can only imagine how isolated and scared some of them must feel being so young. It was evident that a lot of them just wanted attention and to feel like someone was interested in them.

Later, our tour guide took us into a small room to explain his runaway story and how he got to where he is today. His father was abusive and he watched him abuse his mother to the point where it took her life. Unable to bear his home situation, he fled and ended up on the streets. He couldn’t find food or shelter and he got to the point where he thought his life wasn’t worth living anymore. That’s when SBT took him in. Now he is a tour guide, he is educated, and is living independently while making a living with SBT. In this sense, I think SBT is a remarkable organization. Of all the organizations we visited, this was my favorite model. Their system is truly sustainable as they help street children to have a better life and then some of them go on to become tour guides with the organization. This self generating cycle of producing tour guides is a great way to ensure the program is empower the children that are benefiting from the services. The famous adage quoted above seems like the perfect description of what SBT does for street children. I really learned a lot from learning about their model and am definitely more optimistic about the ability for social enterprises to have a lasting social impact that is sustainable over time.

My world changed because of 2 weeks.

"To love. To be loved. To never forget your own insignificance. To never get use to the unspeakable violence and the vulgar disparity of life around you. To seek joy in the saddest places. To never simplify what is complicated or complicate what is simple. To respect strength, never power. Above all, to watch. To try and understand. To never look away. And never, never, to forget" - Arundhati Roy

It's been a little over a week since I've been back home. I can't get India out of my head. I can't stop thinking about how little my life compares to everything I've seen, all the kids I played with, all the poverty I saw, the vulgar disparities and all the injustice that continues to take over our world. I go back to this quote because I haven't forgotten. I can't ever forget what I saw and how I felt. I can't even explain it. I've spent the last 10 days telling friends and family about my 2 week experience and it doesn't seem like it provides justice at all. How can the world be this jarring?

I spent the first day on my own crying. I wasn't sure how to express my emotions on that first day sitting at home and so crying just made sense. Since then every night before I go to bed I think about the kids the most. I miss their ability to be so innocent. It's not fair for kids to resort to drugs because it numbs their pain from abuse, violence, rape, forced labor. They were too small to make the decision so their path was chosen for them and now they suffer from addiction, loneliness, prostitution, and the liberty of basic essentials - a home, parents, food.

Our last full day in Delhi we went to Salaam Balaak Trust (SBT), an NGO dedicated to pulling kids off the street. Their mission - "to celebrate the spirit of survival". I can't help but think that so many organizations have the mission space to further livelihood - this NGO just wants you to survive.

Our role for that day was to go on a citywalk, otherwise known as a walk down memory lane. Our tour guides, past street kids, walk us along their journey of being a street kid to now having the opportunity to improve their lives. Our tour guide, Satender is a 19 year old boy who ran away from home because his father abused him, his siblings and his mother. He wanted to die but SBT saved him and brought him into a shelter. From there he learned English and is learning computer skills. To also help the visibility of SBT and to help show the world about the unspeakable violence he is a tour guide for the NGO. He walks us along the inner city of Paharjung, the railway stations where kids are belligerently high and how they get saved by SBT community workers, and the shelters where the children temporarily live. It was the hardest day for me.

I go to bed every night thinking about them. I continue to think what else can I do in this world. I have my own bed and I have support. I am damn lucky. How can I share that? How can these boys and girls sleep in their own bed and read their own books and be educated and change their life?

Our class ends by writing a business plan. Our goal is to build sustainability and self-sufficiency. I continue to contemplate how I will do this because what I write needs to be implemented. It just takes more than me. I didn't see a world through a different lens to just continue and watch. I did it so the world changes. I just hope it does...

Empowering the women of Delhi with an IUD

Day 10. PSI.

Our first full day in Delhi was spent with Populations Services International, otherwise known to most of the world as PSI. PSI is 3rd largest NGO in the world. That is huge! Leading programs include targeting malaria, child survival, HIV, reproductive health and non-communicable disease. In India particularly, PSI has been working there for almost 30 years - working effortlessly on HIV/AIDS, reproductive health, malaria prevention and child survival. Our day was focused on learning about the reproductive health programs. We began our day in the PSI office of Delhi learning about the Freedom 5 project, or the promotion of IUDs in women of reproductive age (WRA) amongst vulnerable and poor women. Our two hours at PSI was very similar to sitting in class at GW - learning about the objectives, goals, and impact of this project. The goal of this initiative is to increase the use of IUDs by 1.1% by 2012. Now, that at first seems small but let's talk about the number of women that live in Delhi - 1.1% will make an impact!

After gaining an understanding of the mission of this initiative, we were guided to a specific neighborhood the Freedom 5 program is implemented. We first went to a clinic that is often visited by poorer families. Here we spoke with the physician on call to learn more about the women that come in asking for an IUD. According to the physician, most women come in after their fourth or fifth child at which time they are ready to stop having children (at least for awhile)!

We then went to a specific locality where health promoters were conducting their work - going door-to-door obtaining information on who lived there, the number of children, what languages they speak, etc --essentially a census, a very detailed census. This allowed the health promoters to be more strategic in talking to women and families about PSI, family planning and IUDs. It was incredible to watch. These health promoters had so much information one each household in the entire neighborhood. They knew their health issues (more than just the reproductive health concerns). As these women gained credibility in the neighborhoods, they gained relationships with the families living there and were able to have honest conversations around family planning and also help women understand the process and implementation of an IUD. There were a number of things I found to be quite interesting today.

1. In many instances women asked to wait for their husbands to come home from work so they could have the conversation of family planning together AND the mother-in-law was the one in most households who remained the barrier to obtaining proper family planning tools. It made sense but wasn't my first thought. I initially just assumed husbands would be the largest barrier in implementing this program.

2. How is this being sustainable. Yes, wonderful health promoters are going into the field and teaching women the notion of family planning and empowering them through education and birth control essentially, but what happens after that? Once women have IUDs inserted - are they teaching others the power of education and smaller families particularly in lower income neighborhoods?

3. How is this being evaluated? There seems to be a lack of data when it comes comparing women who discuss and implement family planning vs. not.

Our day spent in these neighborhoods was extremely educational. Learning from PSI, an internationally known integral NGO it was calming to see how a program is conceived in a conference room and then fully implemented in the field. Our other days in India, we focused on smaller firms that had more narrowed mission spaces. Seeing that even larger NGOs can continue on a focal point was refreshing. I think at times, I get caught up thinking that larger firms fall into the corporate traditional enterprise and the smaller firms though they are doing amazing work get caught in the struggle of limited funds and low resources. Today affirmed that it really does not matter where you work -- the programs get initiated the same way and the work gets implemented with determined, honest, and passionate individuals.

Changing the world, one child at a time

In the public health world and in the nonprofit sector, so often it is necessary to wait until the numbers have been crunched to determine whether or not the services provided are making an impact. However, this is not the case with Salaam Balaak Trust.
On our last full day of the course, we spent the afternoon with Salaam Balaak Trust, an organization providing basic services to runaway and homeless children, many of whom come to Delhi and other major cities via the train system. Iqbal, our tour guide, lead us through the alleys and pothole-ridden streets of one of the neighborhood bordering Delhi's main train station, explaining the nature of the runaway community, opportunities they seek to earn money, and trials and tribulations of their journeys, literally and metaphorically, into and through homelessness. Iqbal explained that many children have been abused or neglected – he himself was simply left in a busy market by his father at 5 years old – and SBT works to reach out to children on a level they understand, building relationships based in respect and trust, and thus maximizing opportunities to reach these children.
We were lead to SBT's intake center on the second floor of a simple building next to the train station. SBT staff, each providing individual attention to one child, worked diligently to fill out forms, complete a basic medical exam or just talk to the child with whom the were working. Other children, who ranged in age from 10 to 18, sat on the floor together, talking amongst themselves while drawing or coloring.
We were then brought to one of the many shelter homes run by SBT, this one in particular for boys. Our group missed the talent show they put on just minutes before, but had the opportunity to spend some time with the boys. I sat down in the front of the room and was swarmed by 4 boys, all of whom quickly introduced themselves to me, and immediately challenged me to thumb wars, and taught me some of their handshakes. They were so excited just to have us there, to have their pictures taken and, I could tell, just to be noticed.
I can not begin to imagine the things some of these children have gone through, especially with no safety net to catch vulnerable populations such as young children should they fall. Social services to the degree of those available in the US are not available in India. If it was not for SBT and organizations like it, these boys, along with the 1000 other children SBT serves, would be out on the street. While this is a grant-funded organization, they do have an income generating aspect – they charge a small fee for tours, such as the one in which we participated, and sell t-shirts, postcards of artwork by or pictures of children served by SBT, and chai carriers made from wire. All proceeds go directly back into the organization.
The work SBT does is incredible, and the impact they make is palpable when standing in a room with those they serve. It was a great way to close out the course: in terms of social services, there is so much needed in India, and it was so refreshing to see a functioning organization making a real difference. They reach those who are outside of the system – children with no families or homes. It was exhilarating to just be in the presence of these children – to see how they clung to Iqbal the moment he walked in to the room – they love him and it is a direct reflection on the organization and the good work they do. SBT is an excellent example of innovation of services, as well as orchestrating efforts with others working in a similar space, such as ChildLine. This organization provides much-needed services to the under-served and I felt privileged for a glimpse into their work.

Reproductive health is everyone's health

Wednesday, 08.10.11

Today we met an organization that focused on the population and issues that get me fired up. I mean REALLY get me fired up.

I spent two years in undergrad marching down Peachtree Street in Atlanta, Georgia towards the State Capitol with one hand holding a Planned Parenthood poster and the other hand raised high and clinched tightly like the Che Guavara spirit I was channeling. I was a revolutionary for family planning – or really for reproductive choice. I was loud, I demanded to be heard, and I wasn’t going to listen to any prolife stance. Damnit, I was right!

circa 2008

Over the next 3 years I have been earnestly trying to find a way to channel that energy and passion into a tangible impact. Activism is great and definitely serves its purpose of letting an issue ring in everyone’s ears. For me, however, I knew the real change I wanted to make would be individualized; helping men and women at the grassroots level one person at a time. I focused my senior thesis around reproductive health in Latin America, organically leading the topic of my thesis to be centered on family planning initiatives by President Alberto Fujimori in Peru in the 1990s – showing that investing in family planning and women’s health can lead to significant economic, social, and political impacts. There were some issues with Fujimori’s approach to nationalized family planning programs, so invite me over for some tea and I can tell you all about it. For now, though, we’ll stay on topic.

My senior thesis is what helped mature my desire to be in public health, particularly women’s health and family planning. I was finally able to see a very powerful link between investing in women and developing a nation; my background in political science was finally paying off! After graduation, I worked at the American Cancer Society to get my foot in the door of the public health arena and be sure this was the path I wanted to pursue. It was and still is. After having worked in a very conservative, professional environment, having many conservative friends, and having had my foot shoved into my mouth a few times, I am learning how to explore family planning from all perspectives. My goal has been and continues to be focused on having a respectful and calm dialogue regarding family planning that promotes dignity, respect, empowerment, and development for all parties involved. Graduate school has aided in this much needed perspective, directing me towards facts and figures to back up my side of the argument. No longer am I just some fiery twenty-something belting prochoice mantras into a megaphone, attempting to lead my reproductive revolution. It’s befitting to say that I can now carry a calm conversation (well, sometimes) that is centered on helping women help themselves through reproductive health. You’ve definitely come a long way, baby!

All of this brings me to my reflection on my time with PSI (Population Service International) and what information I want to share with you. I appreciate the work that PSI is doing and the vast communities that they serve. They are really making a difference even if it is still too soon to measure statistical significance (all you biostat people). Their service in Delhi is focused on family planning through IUDs (intra-uterine device) and medical abortion (MA) kits. Given the very conservative community that PSI is serving, there are definitely many barriers that this organization faces by introducing these forms of family planning methods. One of the female doctors from the local hospital shared with us how many women have to seek out the IUD secretly because they cannot get their husbands approval. Most of the women asking about the IUD are married women who have already had three or more children. The community that we visited in Delhi was predominantly Muslim and contraceptives are not allowed by the conservative sect of this religion. So what’s a woman to do? She lives in a developing nation where there are high maternal and infant mortality rates, mediocre health care, and lack of access (and rights) to pregnancy-preventing contraceptives. Well, in this case study, women go to their local physician and have an IUD inserted.

Here’s a commercial produced by PSI India that plays on local TV stations addressing the importance of family planning and IUDs for married couples: Lock and Key

Here is my stance, one that has taken some time to mature and understand completely -

Overall understanding of the importance of family planning:

*When a woman has control over her fertility (through contraceptives, family planning, sterilization, or abstinence), she has the ability to finish her education (versus adolescent marriage and/or adolescent motherhood) and pursue a career all her own and become a contributing member of society. The developing world is not investing in half of their population and the well-being of those nations is definitely suffering from this investment slack.

[Quickly let me add that stay-at-home moms are great, especially if they choose to stay at home. However, a mother/woman being tied to the house because she keeps getting pregnant and has no choice in the pregnancy and/or is forced to quit school because of pregnancy/marriage without her choosing is not okay by me]

• Women have the RIGHT to have full authority over their body and decisions regarding their body
• Women have the right to choose what family planning measure works for them
• Women should be allowed to access all contraceptive measures available
• Women have a right to an equal education
• Women have a right to equal job opportunities
• Women should be allowed to have control over their fertility and the amount of children they have
• Women have a right to quality and affordable health care
• Women are amazing J

Given my stance, let me say that access to IUDs and medial abortion kits are crucial in my book. I uphold that your political/social/religious opinions are moot when it comes to contraceptives access. You do not have to use the contraceptives, you do not have to condone the contraceptives, but they should ALWAYS be readily available and the right of women (and men) to access them should ALWAYS be there.

There should always be quality and affordable healthcare available to all people and contraceptives should be in ample supply and nearly free of cost to all communities. When a nation invests in their family planning programs and services they are investing in the well-being and future success of their nation. Take Peru for example, via my senior thesis escapade. When Peru invested in nationwide family planning programs and services, they experienced monumental economic and social growth – finally they were investing in the other half of the population! (Read “Half the Sky” to get the full picture of my point).

Family planning = growth, prosperity, and an end to the cycle of poverty (poor people making more poor people making more poor people). Brilliant!

Now, I know the whole idea of the medical abortion kits might turn many readers’ stomachs. Unfortunately, family planning’s red-headed step child is definitely abortion. However, abortion is not a preferred family planning measure, so rest assured that MA kits will rarely be chosen over continuous, effective birth control methods. Abortion is used mostly in dire situations, where other measures have failed. (I have oodles of statistics on abortions in the US that I can share sometime…)

When a community invest in family planning and respects the female and her decisions with her body, abortion rates significantly decrease. Abortion would rarely, if ever, be needed if reproductive health was given the same focus and investment as cosmological surgery and consumer product purchasing in the US. However, in some settings, in some situations, another child is too much. Especially in developing countries, in impoverished communities, another mouth to feed is damn near unfathomable when a family is subsisting off of less than $2 USD per day. That’s when the PSI medical abortion kits come into play. Whether a pregnancy is intended or unintended, safe medical services are vitally needed. Too many maternal deaths and morbidity occur from illegal, unsafe abortions. What PSI is doing is providing a safer means for a very discrete and difficult decision to end the possibility of a pregnancy. Whether we agree with abortions or not is beyond the point right now – what is so incredibly important is that there are services out there for women and families and that the option of a safe, affordable (nearly free) emergency measure is readily available. According to the pharmacist we interviewed in the Muslim community in Delhi, 4 to 5 medical abortion kits are sold daily. Let me repeat that: daily. Obviously, there is a need for serious family planning services in this community. Until that investment can be made by the government, the community, and the individuals themselves, emergency contraception is going to have to remain part of the equation.

What I am hoping is that a community like the one I visited in Delhi will begin to embrace the use of contraceptives and family planning services, such as IUDs, so that medical abortion kits will not be needed as much. But things happen, life happens, accidents happen, mistakes happen, terrible things can happen so medial abortion kits should always remain readily available.

I was so impressed by the services and information provided by PSI. Bravo for them for tackling a VERY testy subject that manages to impassion just about everyone (in one direction or the other). There is definitely room for growth, development, and data evaluation in their services to know what sorts of differences are being made within the specific communities. However, their services are just the start – just the beginning of the conversation surrounding family planning in this community. As I mentioned, your opinion on contraceptives and abortion is moot in the grander cry for access to all forms of family planning methods. When a woman/family/couple has a choice over fertility and family size, so begins the conversation on gender equality, respect, and overall well-being of the community as a whole.

Family planning is the answer. Access, quality, and affordability are nonnegotiable terms to a healthy future for any community.

Unlimited Capacity for Change

Our last day in Mumbai we went to the “Hub” - a place where social entrepreneurs, visionaries, and volunteers have a place to share ideas, and create and implement change. I loved being at the Hub. The place was built to welcome innovation and collaboration.

At the “Hub” we met with UnLtd India and Acumen Fund – both organizations that help build capacity for social entrepreneurs and projects.

UnLtd India is an organization that provides seed funding to start-up NGO’s and stands as an incubator for social entrepreneurs. Their goal is to help initiate NGO’s and accelerate their progress from inception. Whereas, Acumen Fund seemed more similar to an investment fund, supporting social enterprises.

I was particularly intrigued by UnLtd India and the sustainability they provide in initiating ideas and organizations. With such a large number of organizations failing within the first six months of inception due to various reasons (lack of money, sustainability, resources, etc) UnLtd India provides a mechanism for these organizations and ideas to continue to exist. Its just so much more than an organization folding within six months. It’s the community that could have been saved or the people that could potentially have better access to health care, better education or improved lives. UnLtd India really attempts to alleviate this.

It seemed quite fitting to be at the hub as today provided more of a space for us to think about logistically how this all works. How do non-profits exist? How do they remain sustainable? How do they get to the bottom line: Social Impact? Today helped hone in even more questions I continue to ponder over and marinate as I continue to think what else can I do and how else can improve existing organizations and/or ideas to maintain sustainability while improving lives.