Day 9: Salaam Baalak Trust and Saluting the Child

On Thursday morning, we were greeted by Iqbal and Satender as we began Salaam Baalak Trust's City Walk. Needing to split us into two groups, Satender sported a mischievous smile and urged us to pick the guide we found most handsome. We set out on the tour with our guide, Iqbal (sorry Satender), a former street child himself. Iqbal led us through Paharganj - the neighborhood abutting the New Delhi train station where Delhi's railway children reside. As we walked, Iqbal narrated what we were seeing - a recycling wallah's small shop where kids sell plastic scraps - across the narrow alley, a small room housing a video game system where kids spend the few rupees they earn, an alley where residents combated public urination by installing tiles depicting Hindu gods and Jesus (genius, by the way). Iqbal was an excellent guide - serious but goodnatured, always happy to answer our questions. It was mind blowing to think that at 19, it was just a short time ago that Iqbal had run away from an abusive father and fought to survive on streets like the ones he was guiding us through. That combination of indomitable spirit with a dash of luck is usually the stuff of Hollywood and Dickensian novels. But here Iqbal was - determined to educate himself and make his way in the world.

The City Walk is a truly ingenious way to generate unrestricted funds - the most precious kind of funds for non-profits. For just about $4, walkers are treated to background information about Delhi's street children, Salaam Baalak Trust's work, a tour of Paharganj and a brief visit to one of SBTs temporary short-term shelters. It's the most worthwhile $4 I've ever spent, that's for sure.

At the short-term shelter, we were able to spend some time with boys - some of whom were new arrivals - who were congregated in the modest concrete foyer and doing some drawing. Seeing these children, who we know live such a difficult life, engaging in the basic and universal childhood pastime of drawing produced some major cognitive dissonance. Looking closer, I noticed that two of the boys were drawing homes. I felt that one in my gut.

Meeting with one of the Trust's management team members, I was reminded about the fickleness of funding and the constant need for local organizations to fundraise to carry out their missions. The Trust was a sub-grantee to FHI under a USAID-funded project for four years - but that funding had just ended. For many small NGOs, we ask their employees to be excellent at implementation as well as marketing/selling their ideas to secure more funding. How much time is taken away from running excellent programs in the scramble to secure additional funding? Reflecting on this, the need for income generating arms that support social programs seems even more apparent!

Day 8: PSI

On Wednesday, we were hosted by staff at PSI India in their New Delhi office for a presentation on the second phase of their Women's Health Project. After meeting with community-based and national organizations, it was quite a different experience to meet with the country office of a large, world renowned NGO. Below are some of the highlights and takeaways from our time with PSI:

• Just because you're big, doesn't mean you're clunky! It's easy to assume that large organizations, with their inevitable bureaucracy and heft, can't be effective at the community level. PSI's Women's Health Project dispels this myth effectively. In the first photo below, a PSI staffer is describing the map of the New Seema Puri neighborhood, divided into blocks and with important landmarks identified. In the second photo, you see an extremely detailed and comprehensive household survey that PSI's community health workers use to plan and record their marketing and outreach (photo credit to Meagan Smith on photo 2). PSI proved that with the right models and a motivated staff, large international NGOs can be nimble and operate effectively at the community level.

• Effective social marketing promotes a cohesive, unified message at every level of communications. In the office, PSI staff showed us a tv commercial for the Freedom 5 IUD that centers around a"lock and key" metaphor. Later, we saw how this metaphor was also used in one-to-one interactions between community health workers and IUD candidates in New Seema Puri (photo credit to EOPhile). Note that in the BCC materials below, the IUD acts as the "lock" on the door.

• A woman's choice about family planning involves a whole lot of people. PSI is keenly aware that women are influenced by a whole set of actors that affect her access to contraception. At home, husbands, mother-in-laws and sister-in-laws can apply pressure for women to have more children. In the community, health workers, doctors and pharmacists provide a continuum of information and service provision. For such a personal decision, I was surprised to learn about the myriad of people who affect women's decision-making and access!
• To satisfy your mission, it's important to diversify funding. The Women's Health Project, which promotes IUDs as well as safe abortion kits, was funded by anonymous (and I'm assuming very generous) donor. While the project appears effective and well-run, and meets PSI's organizational objectives, it would never have been funded by USAID do to that agency's restrictions on support for abortions. With diversified funding, PSI is able to implement activities in a mission critical area that may not have been possible if it were entirely dependent upon USAID.

Our day with PSI was exciting and intellectually satisfying. It was clear that the program was based on a solid logical framework, which itself was based upon data from dependable sources like India's National Family Health Survey. With donor's increased emphasis on evidence-based programming, it seems that PSI is well positioned!

Day 6: Managing the hell out of ideas

During one of our first classes in DC (which now feels like a lifetime ago), Dr. Vyas asked us to introduce ourselves and share why we'd registered for the class. I recalled an "a-ha" moment I had during a Net Impact conference back in 2005 when a speaker said something along the lines of "I don't think I'll have the next big idea. But I can manage the hell out of the process." YES. That was a key moment early in my career as I began to think about the role I wanted to play in development. Over the years, it's boiled down to something like this: I want to link social entrepreneurs to the resources, networks and tools they need to develop their ideas and bring them to scale. Monday was going to be a big day for me, since we'd be meeting with two organizations - UnLtd India and Acumen Fund - that do just that. I eagerly anticipated what each organization would have to say because of what I view as a shared philosophy - the problem isn't a lack of good ideas - the problem is that most good ideas don't get off the ground because an idea plus passion without some serious management acumen will get you a whole lot of nothing.

First up was UnLtd India and a presentation by Pooja Warier and her colleagues. Here are some things that really struck me about UnLtd's presentation:

• UnLtd has an exceedingly clear vision statement. Hearing Pooja talk about the gap UnLtd is filling (support between the concept stage and semi-maturity), UnLtd's organizational goals (identifying stars at the nat'l level, leaders at the state level and fostering a general culture of changemakers), and the characteristics they seek in social entrepreneurs was an excellent reminder that engaging in/supporting social entrepreneurship takes a lot of up-front thought and clarity of purpose.
• UnLtd embraces their "failures", or people who's ideas don't make it to the "star" or "leader" level. While the romantic view of social change is that it's spontaneous, it actually takes a ton of planning, stops and starts, and big old mistakes. I can't recommend the following book, that I picked up in the Mumbai airport en route to Delhi, enough- Adapt: Why Success Always Starts with Failure. Mohammed Yunus' first development project was a huge flop - who knew?! As a proposal writer, I have an often singular focus on what worked - what impact did we have? what did we do that was right? I think UnLtd is really onto something by creating a space where it's OK to say "man that was a disaster and here's what we learned"
• UnLtd doesn't focus on a particular sector or group of sectors. If someone has an idea that is not religiously or politically affiliated, they're eligible for support from UnLtd. This approach has pros and cons. On the plus side, some ideas are stifled by others' (read funders mostly) need to put them in a neat category with a bow tied around it. Abstaining from forcing ideas into boxes let's them be exactly what they are, and not what a funder, or manager, or communications person writing a fact sheet wants them to be. It also contributes to UnLtd's larger goal of creating a general culture of creative problem solving in India. On the other hand, there's something to be said for doing a few things well and going deep. Even though UnLtd's staff provide chiefly management expertise, some technical expertise is surely needed. By not focusing and being a "jack of all trades", is UnLtd then a "master of none"?

Next up was Acumen Fund with a discussion on their model and health portfolio. Acumen is different from UnLtd in two key respects: exclusive focus on for-profit enterprises, development of a portfolio in key technical areas (such as health, agriculture, and energy). Like UnLtd, Acumen is filling a gap by providing capital and technical assistance to social entrepreneurs with promising ideas that can be brought to scale. They emphasize their application of "patient capital" that fills a gap left by traditional investment models that require faster and larger returns than fledgling social enterprises can likely produce. Here are some of the highlights from our conversation with Acumen:

• Need does not equal demand. Brilliant and devastatingly simple. A social entrepreneur may have a brilliant model for delivering clean water to rural households with a well thought out business plan. The water is at a price point that people can afford. A delivery system removes the barrier of walking several miles to the water source. Clean water will reduce health problems in communities. But what if no one is buying?! What may be needed is a model that combines the business know-how of Acumen with the social marketing skills of PSI (see Day 7's post!). Food for thought...
• Measuring social impact is hard! This is a no-brainer, but we had a really interesting conversation about who's responsibility it is to measure the impact of Acumen programs. Even though enterprises are screened with a set of criteria that includes"social impact" it seemed that rigorous impact evaluation of investments could be strengthened.

As my classmates predicted, I was blissed out during our meetings on Monday and had a bit of an afterglow throughout the evening. These organizations are utilizing a model that I think holds a lot of promise. It was an affirming day for me - but also a reminder that I have a lot to learn and more questions than I know what to do with!

Our Last Day

Day 8

It is our last day in Delhi as we board the bus to the Salaam Baalak Trust. As we disembarked I will never forget Iqbal, our tour guide for the day. His smile was the first thing I saw stepping into the muddy street. It was bright and almost childlike, you would never know what hardships and heartbreaks he had weathered.

Iqbal is part of the Salaam Baalak Trust, an organization which provides support for children who have either chosen to live on the streets or were simply left to fend for themselves. Many of the children who leave home do so because of physical, sexual, or mental violence, or simply because there is not enough to eat at home. To these children, the street is the safer option.

The majority of these children are boys; the girls are quickly picked up and often sold as sex workers within 24 hours on the street. Once again, I am impressed with a message that resonates- not only are children altogether vulnerable, but it is almost dangerous in some areas of India to be born a little girl. This is perhaps one of the most uncomfortable thoughts I have had through our entire journey because this was not simply a one-time feeling, but a motif.

The boys found on the street by members of Salaam Baalak are quickly taken to the headquarters where they are registered and looked over by a member of the medical staff. There children are scared and many are on drugs. Often they are not there because they wish to be--all these reasons provide barrier after barrier for their care. At the headquarters, there is a small room with painted murals of a peacock, a tiger and many colors. The little boys we saw that day were crowded onto a carpet where they played board games and colored. As we looked at what the boys were drawing I could feel the wave of heartbreak spread throughout our group. The little boys were drawing houses.

One of the oldest boys told us he loved to make 3D models and proceeded to make two models for one of our group members, Cara. She in turn made him a paper crane and a 3D ball of paper. The exchange was almost silent, but had meaning beyond words. I know for a fact Cara has the 3D model in her luggage home.

We then walked through the alleys and streets Iqbal knows so well to the home for the boys. Inside there is a small office and a “sick room.” The walls are brightly painted and decorated with pictures of current as well as past members of Salaam Baalak. The boys were welcoming and full of life as we visited with them. They sang and danced without hesitation, they had intoxicating smiles and spirit. There are three homes for the boys throughout the city and two for the girls.

Once found by a member of Salaam Balaak, a child is never forced to go home. They are provided with meals and vocational training. However, all children are given support if they express desire to go home. Iqbal stated about 70% of those found on the street eventually go home without prodding. For these children, the Trust will deliver a follow up phone call once per month. The children also have access to a child help line operating within five districts of Delhi.

I was struck most by the joyfulness of each of the children I saw. Walking through the muddy streets and alleys of Delhi I can say my attitude was anything but joyful. Even after all these children have been through, they maintain an innocence and lightness that is beyond all expectation. Salaam Baalak contributes greatly to this in each of the boys I saw. This was most apparent in Iqbal who kept his smile even through his story of abandonment at the age of five by his own father in an open market. As a child he could not generate income for his father, so he was left on his own. Iqbal was exploited on the streets, but eventually found Salaam Baalak. He told us he pursued education and eventually hopes to work in computer software. I have no doubt he will find a way to do so.

Salaam Baalak was our last site visit in India. As I stepped on the bus that day, I knew things were different. Over the past 12 days we had all been exposed to scenes of misery as well as joy, scenes of hope and a few that quite honestly, seemed hopeless. It will take time to process all that we have seen. Even as we part from each other and board our planes and trains to various destinations all over the world, we will always have that time in India where together we traveled and learned. However, mostly we grew as indiciduals who were exposed to the world as it is and are learning to use the full scope of humanity’s potential to raise the baseline of expectation and improve standards for every community no matter the geography.

Each woman I traveled along side, and also Dr. Parrish and Chance, have my utmost respect. I am humbled and thankful for everything I witnessed. This exposure and experience has left a mark on each of us, I now believe the interesting next phase will be to observe what avenue each of us take from this point forward. For each member of our group I would like to express my full confidence and support!

Population Services International

Day 7

Fresh off our plane into Delhi we walk into the building of PSI, or Population Services International. This NGO is the third largest worldwide and not surprisingly so…

As a student focusing in maternal and child heath, the Women’s Health Project presented by the PSI representative, Sanjeev Dham and colleague, was of special interest. The goal of the Women’s Health Pahel (Project) is to reduce maternal mortality and morbidity through increase in use of Intrauterine Devices (IUDs), from 3-4.1% in targeted areas, and an increase in medical abortion (MA) kits. This project exists only in urban areas in three states; 1 in Delhi, 9 in Rajasthan, and 10 in Utter Pradesh.

The overarching goal is to support the empowerment of women. The target population used to achieve this goal includes women of reproductive age, medical providers, pharmacists, and communicators. Interpersonal communicators (IPC) have a background in social work and are trained by PSI staff to go into the community and speak with the women at their homes about IUDs and MA kits. Their objective is to dispel myths associated with IUDs and MA and also provide support and education. The IPCs provide counsel and if the women are interested in IUD insertion will then give a referral coupon. The woman may then present this at the nearest designated clinic to receive the IUD at a discounted price, usually what translates to $6 U.S. dollars. The IPC will make a note at headquarters of who was given a referral coupon and the medical provider will submit the name of who actually came in for the procedure. From this data, the impact of the IPCs may be evaluated. Also, the women are tracked and given follow up phone calls. Approximately, 800-1,000 outbound calls are made every two weeks to offer support and answer questions post IUD insertion.

Several media sources have been used to support this “lock and key” idea of the IUD. For example, a television commercial run in prime time shows a women behind locked bars holding the key while her husband cannot get to her. The commercial ends with the couple sitting with a physician discussing how they can control the “lock” or IUD, with a “key” by choosing when it is inserted and removed.

Women are offered a variety of support; in addition to follow up calls they are given the number to a “helpline” in which they may call at any time with any question. The Helpline is confidential and non-judging. The Helpline receives about 600 calls per week. It is important to note that the majority of women do not have mobile phones and will receive follow up calls within their home where their husbands have full ear shot of their conversations. If a woman has not told her husband, or is afraid to do so, this method of contact fails. In fact, 20% of IUDs are removed within the first month. Some removal is due to unwanted side effects of heavy bleeding and abdominal cramps, but the bulk of this percentage is because husbands force their wives to have the device removed.

Husbands must be considered in all campaigns for contraception. The fact that few women have complete say over their choice of contraception, or even to use it in the first place has proven to be a cultural barrier that has no easy answer.

Medical abortion kits are also addressed by the IPCs as they walk the neighborhoods of Delhi. These kits require a prescription at 9 weeks of gestation. Local chemists sell 80% of the MA kits, many of these pharmacists set up shop on the corner of the street. The chemist we spoke to as we went on site relayed that he sells, 4-5 MAs per day.

PSI currently has two and a half years of data, which is undergoing analysis to measure the effectiveness of the advocacy campagin.

Visiting the site of a clinic that offers the insertion service to the women was an interesting insight into a culture that permeates into the clinical care of the women of Delhi. The clinic was full of women, the only men to be seen were those who were awaiting the birth of a child. Reproductive heath outside of childbirth is often an unsupported decision. We had the opportunity to speak with the doctor in between patients, and she informed us the majority of women for whom she inserted the IUD had already given birth to four or five children. In addition to this information, the majority of women had not discussed this decision with their husbands. Many gave the impression their husbands would not be supportive.

The doctor also told us many of the teenage girls who come into the clinic with their mothers appear to be pregnant, yet due to cultural barriers these young women cannot be administered pregnancy tests. Outside the context of marriage, sex is not discussed.

Women need to be empowered not only to choose their own means of contraception, but to feel they can discuss their choices with their husbands. IPCs must be given more training to speak with the husbands as well as the wives. Many times the wives will invite the IPC inside her home to also speak with her husband; this idea and practice should be brought up to scale. Along these lines, IPCs should also receive training to address teenage reproductive health education. It would be inappropriate to tell a woman how to raise and educate her daughter, but speaking of the importance of this education and how it could benefit the health of her daughter is matter of fact.

Health education takes time and results can be slow, but with the aid of the PSI Interpersonal Communicators, the team of health providers, and the staff manning the helpline, the women of Delhi are being reached one block, one street, and household at a time. In this there is much promise.

"The Hub"

Day 6

As we gathered in the loft of “the hub,” the ideas and excitement within the room were almost palpable. We first learned of Unlimited India from the co-founder herself, Ms. Pooja Warier. Her presentation crisp and well defined.

In the non-profit world, 9 of 10 ventures will fail. Most often there is initial support at the conceptual phase, then later, investment after three years of success. Support during those three in-between years is crucial. Ms. Warier and her colleagues understood this need and addressed it by creating Unlimited India, an organization that focuses financial and non-financial support for those who present a promising and original entrepreneurial idea.

There are three ways in which an entrepreneur in the non profit sector can make it to the three year success mark; procuring investment and backing from family and friends, producing quick results, having an attitude that will not easily give up on an idea. The first of these three listed avenues of success does not culturally fit the mold of India. In most families and circle of friends there exists little approval of social entrepreneurship. Beyond that, it is difficult to provide quick successful results especially for those who lack a background in organizing business models and budgets. This is where Unlimited India provides support and an avenue for success-they provide support for even the least experienced social entrepreneur.

Unlimited India specifically lends support during the first four years of the life phase of a social idea. This non-profit also provides funding anywhere from $15,000 to 45,000 and lastly, the physical space in which to come together as a team. The end goal of Unlimited India is to develop the culture of the social sector and action within the social sector-ultimately, the goal is to demonstrate that, according to Warier, “there is worth in investing in individuals who want to make change.” Unlimited India must first approve the individual and his or her plan before providing services. The team at UnLtd India will analyze the vision and resourcefulness of the individual to attract funds. The team will also gage the potential for the idea to create change and meet demand, and also determine whether the idea matches the person. Lastly, if the UnLtd India analyzes what they may bring to the idea, if they cannot add to what is donated then they do not agree to back the start of a potential client. A fundamental part of this filtering process is also determining whether the idea is already in works elsewhere. To elaborate, UnLtd India will conduct research to see if the idea of a potential client is already in existence-perhaps the most efficient move is to simply link the social entrepreneur with the bigger organization attempting to bring the idea to fruition.

In terms of operation, there are three phases;

PHASE 1: the identification of the social impact (this is when UnLtd funding is used only to invest in the project itself).

PHASE 2: Affirmation of effectiveness of the idea. At this point the entrepreneur is expected to work full time and a portion of the funding is used for salary.

PHASE 3: The development of the business plan. This is when the group of entrepreneurs is divided into those who can write a business plan and those who cannot.

In order to advance through these three phases UnLtd India provided personal coaching and monitoring, the representatives working with the entrepreneurial clients ask key questions to keep the project moving forward. Networking is also provided since most of these entrepreneurs work in isolation. UnLtd brokers relationships so financial issues can better be understood and managed. Workshops and clinics are set up to expand legal understanding and facilitate the meeting of like-minded entrepreneurs. UtLtd India uses peer learning and provides and expert panel to push the individual further with a set of individually issued stipulations.

The entrepreneur will have a meeting with a representative of UnLtd Inida one time per month and while the impact of the potential non-profit may be for all of India, it must be based out of Mubai in order to gain support form UnLtd. India. The entrepreneurial motivation cannot be religious or political in nature and the loan repayment must be made within 3-5 years.

UnLtd India is funded domestically and globally through individual and corporate donations. This organization is truly impressive because it has successfully and critically teased out major reasons behind social entrepreneurial failure within the period of 0-4 years of start up. Providing financial as well as non-financial support is smart and necessary. “The Hub” truly did provide a great space to generate ideas for social change, I have a feeling all that is needed is time.

Our next meeting was with representatives of the Acumen Fund. This non-profit invests in direct and indirect spheres of influence. However, there must be potential for social impact, financial sustainability, scalability, and a committed management team. The Acumen Fund has $60 million invested worldwide with $25 million invested in India alone. The three investments for India are in the education sector, clean water, and electricity. The key problem is not simply how to fill the need for education, water, and electricity, but also how to do so on a consistent basis.

One example includes Lifespring Hospitals. These are a chain of low cost maternity hospitals. At these hospitals, women may receive care for a normal delivery, cesarean section if necessary, and even gynecological surgeries such as a hysterectomy. Government care is free in India, but the quality of this care is seriously lacking. Many Southern Asian women undergo cesarean sections because complications develop in their first deliveries due to poor care. By providing quality labor and delivery care at low cost, the health outcome of labor and delivery has the potential to greatly improve. Developing a plan to maintain the cost effectiveness of this venture is essential, whether by sharing the management or heightening marketing the cost of care must be kept low to achieve success.

The end of these meetings also marked the end of our time in Mumbai. It was a full circle ending to our site visits-these meetings in “the hub” were the first we had truly been fed of social entrepreneurs in action.

Tomorrow, we fly to Delhi…

Closing Thoughts

It has been a whirlwind two weeks and I have more travel ahead, but I wanted to take a moment to reflect on what I learned on this trip. There were so many shocking realizations about the many problems the people of India face, but equally as many touching moments when the people we met demonstrated the hope they have for the future. Also, time and again I was inspired by each organization working to bring change in this country.

I went into this trip thinking it would help me solidify what I want to do when I finish my degree, but instead it raised a dozen more questions. Currently I can’t even decide what class I want to take for my final elective this fall! But I think this is all good, all part of the learning process that one should go through in graduate school.

I decided to pursue my MPH because I wanted a career that was more fulfilling on a personal level, in which I could feel like I was making a difference in the world. When I first started reading and learning about social entrepreneurship I thought, this is it, this is the model that will make a difference on a broad scale. I know I am not alone on this, having just finished reading Bornstein’s book. But after this trip, I find myself still questioning what exactly is and is not social entrepreneurship and how I can get involved in something that must start from within a community.

However, like Pooja Warier said, I do not think we should focus on definitions and nomenclature. And, like many of the organizations demonstrated, there are plenty of opportunities to help people working for change in their communities. In addition, I know that I can take what I learned and apply it to social problems in my community, whether that be my hometown in Ohio, my “new” home in Washington, D.C., or the US as a whole.

There will be plenty of time to reflect on this trip further, and I know I will continue to look back on all these experiences as I take my last semester of classes and move on to my practicum. So for now, I just want to say how thankful I am to Dr. Vyas, Dr. Parrish, my fellow students, GW, and all the wonderful organizations we met with for this invaluable experience.

Day 8 – We Shall Overcome

In our final day of activities in Delhi we spent time with street children at a center run by Salaam Baalak Trust. The haunting yet hopeful story we heard from our guide is unfortunately not unusual for the thousands of “children of the street” in India.

At the age of 10, our guide watched as his abusive father beat his mother so badly that she died from the injuries. Then, after worsening abuse from his father, he decided to run away at the age of 13. He hopped a train and ended up in Delhi, where he was quickly initiated into the dishonest culture of people who often take advantage of street children, for example by making them work all day with the promise of food that is never delivered. With no food, no work, no option to return home (“my father would kill me,” he said) and the constant fear of beatings from the police, our guide told us nonchalantly that he decided his only option was suicide. For me this simple statement, spoken in a seemingly monotone voice, devoid of emotion, was heartbreaking. Thankfully, before going through with the suicide, he happened upon a woman who offered to help him and decided that if he was going to die anyways, he might as while give one more try.

Luckily this woman turned out to be trustworthy and connected him with Salaam Baalak Trust, through which he found a place to live and was able to finish school. Now the organization pays him to give tours that generate revenue to support its centers for street children (one model of social enterprise), and he has hopes of attending college. I was moved beyond words by this story and the work Salaam Baalak Trust is doing on behalf of so many children. However, it only reaches a few thousand children every year, and so many more remain on the streets.

Children as young as five end up the streets either because they are lost, abandoned by their families who cannot feed them, or run away due to abuse. The situation for young girls is even worse as they are often captured by pimps who force them into prostitution. Organizations like Salaam Baalak Trust, Childline (which we read about for class), and others are doing what they can to intervene and give these children a more hopeful future.

We had a chance to meet a group of boys staying at the center and they were overjoyed to sing and dance for us. A couple showed off their Bollywood skills, while one imitated Justin Bieber. In the most touching moment for me, one young boy was proud to show off an English song he knew and came up front to sing “We Shall Overcome,” as all the boys clapped along. In thanks, we sang back “You Are My Sunshine.” Knowing the harsh reality these boys have faced at such a young age, it was absolutely breathtaking to see them find so much joy in singing, dancing, and talking with these strange people who had come from far away to meet them. I will never forget this day.

Day # 10 Goodbye India.

Today was our last day of the course. We had a quick wrap up session to reflect upon the past two weeks and talk about our business plans for the final project. The past two weeks have been a rollercoaster of experiences and emotions, and I am truly grateful to be given this opportunity to join this class and embark on the first course of its kind at the SPH. I will always remember the people that we met, the places we visited, and have high hopes of returning to India to help in my own way.
As for my business plan, it is in the works. Some of us had time to share our ideas and receive feedback in class. One thing I have always appreciated in my public health courses is the extent of diversity in experiences and skills each student brings to the course. As Dr. Vyas pointed out in class as well, it is amazing to see how discussions are influenced by people and how their background/skills/interests push questions even further.
I am looking forward to the rest of my trip in India. I will be staying in India till Sept 2, 2011 to volunteer at an adolescent girl’s school in the rural regions of Gujarat. I plan on learning from the staff/students, and hopefully share my knowledge and skills as well.
Thank you all for reading.
Rashi

Day # 9 Saalam Baalak Trust

Our last full day of the course was spent with an amazing organization called Saalam Baalak Trust (SBT). SBT houses children from all walks of life. These Children come to SBT from all over India. Some flee their homes due to alcoholic parents, abusive parents, step-family, and forced young marriages. Other children may also be kicked out, left in the market to live on their own, or lose their family in heard full of people. They not only house them, but educate them, train them, and follow them up until they are 18 and until they get a job. SBT also connects lost children with their families. Some children however, refuse to go home, and SBT respects their decision, and allows the child to stay with them.

The tour of SBT started off with a young boy, who told us his story of how he had run away from home when he was 11 years old. His family life was abusive, disruptive of his sibling welfare (one is now blind), and his father was an alcoholic. Eventually he found the SBT and over the past 7 years he has been raised by the gracious people who work for the trust and now is a salary paid employee of SBT. He provides tours, and is a mentor to the younger children. He is and independent, educated young man, and has aspirations of attending college in the US.
After the tour we were able to play with the children we had met at the trust. These children were thrilled to see us. Their tiny classroom where they sat without chairs or tables was FULL of joy and laughter. They spent an hour singing and dancing for us, and eager to use our cameras.

The stories I have heard and the children that I have met today will forever be engraved in my memory. This visit has inspired me to return to India one day and be able to do my part and give back to my community. I have met many South Asian Americans who return to India to build Asharams and am eager to go back home to see how I can be of service to them in the future. I am also excited for the next chapter of this trip where I will be going to Valsad, Gujarat and working at a tribal adolescent girls school.

PSI Day # 8

PSI is the 3rd largest NGO in the nation, and we had the pleasure of meeting with meeting PSI India today. PSI India focuses on three regions; Delhi, Rajastan, and Utter Pradesh. Their main goal is to empower women, which in India and similarly in every nation, is essential in creating social change.

Over the course of this class we have met with many NGOs working in India. It was interesting to see the different levels of organization within the various NGOs that we have met with, and then to see PSI’s. I was impressed and happy to see was to see an international NGO working in India. Their presentation and program layouts were very similar to what I am learning in the MPH program, and I finally felt like I could relate to the planning of PSI programs.
PSI funds the Pehel movement in India. The Pehel initiative in India is to reduce Maternal Mortality and Morbidity as well as to empowering women. Their social marketing strategies were thoughtfully planned, and descriptive in urging women to use the IUD contraceptive. I thought it was a great idea to remind people of IUD by promoting its use on Bhindis rather than handing out flyers that would otherwise be less effective. Another part of their program that I thought was great, was the helpline PSI provided for women may be interested or have already had/have an IUD inserted to call and ask questions, or for their husbands to have someone to call and explain what an IUD does, and diminish any myths.

Day # 7 Welcome to New Delhi

Hello from NEW DELHI!

We spent most of the day in transit to New Delhi. In the evening we had the pleasure of meeting Ms.Nandita Chopra from NIH for dinner. She has been working in D.C. for the NIH for many years now, and was recently invited to work in India for their $30.1 billion project through the NIH. Dinner was great, and I am excited for PSI tomorrow!

THE HUB Day # 6

Our last day in Mumbai consisted of meeting at the HUB with Unltd India, and the ACUMEN Fund. The HUB is a location in Mumbai where social entrepreneurs can come together for meetings, rent office space, volunteer with the community, and a meeting place for NGO’s and young social entrepreneurs potential collaboration.
Unltd India’s vision is to create a culture/support system where individuals can act upon their visions without the help of the government. This organization works with start up NGOs that are 3-4 years old to provide incubation support through the HUB, and the Unltd Lab. The Unltd lab consists of 3 levels of loans and acts as a testing period for the organization. They have an extensive process of assessing individuals and their ideas. Individuals who come to Unltd must have a personal connection with the service, be resourceful, and attract money (not necessarily to make money). Their idea must have potential such as being in demand, or need, and prior research should be done to ensure that they are invested and are aware. An important piece that start up programs must have is to be willing to give back to the start-up community once they have succeeded. All these criteria are essential for Unltd investment.
After meeting with Unltd India, we had the opportunity to meet with ACUMEN Fund. ACUMEN Fund is a 10 year old organization that invests in programs concerning water safety, renewable energy, agriculture, housing, and health. The health portfolio is 10 million, and several projects are functioning throughout Mumbai. They strive to influence social entrepreneurs to create a positive social impact impact, but we were surprised that they are were to provide evidence of their programs’ impact, and Although they are unable show how far their investments have gone, It was fascinating to hear about their programs and the extent of innovation one idea has brought to surface.
It is amazing to see the concept of social entrepreneurship utilized within these two organizations. I was excited to hear about previous ideas people had come up with to start their enterprises. One project was called the Bee Box, and a lady they now call the “Honey Lady” started distributing bee hives to allow people to make and then sell honey for more hives. There was no follow up of the Honey Lady, and I am curious to find out the extent of sustainability of the project.

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.

“Personocracy” and the idea of sustainability

08.08.11

Monday’s meeting with Unlimited India and the Acumen Fund provided some much needed perspective on our India trip thus far. It all actually began over lunch when Dean Parrish and Dr. Vyas began dissecting the ridiculous amount of information we have been consuming on this trip. Due to a quite frustrating mishap with FedEx India (to be discussed later), I was only able to hear the last bit of our lunch discussion. But what I took away was powerful: what really entails a sustainable business model and what services are you providing to a community that is really “unique?”

In India there are over 3million non-profits and over half of them will fail/ dissolve within the first 6 months. This high rate of “failure” makes my rational, business-self put a huge, blaringly red STOP sign in front of my emotional, bleeding heart-self. Why are these organizations failing? Part of the reasoning that Dean Parrish provided was through his coined term “personoracy;” that individuals are more consumed with getting their name in an organization and being the founder of a non-profit that they do not research what services are already out there for their community of interest and how they could provide their “new idea” to an already established organization.

Think about this: what happens when a non-profit fails? The services end, of course. However, what I feel I am guilty of ignoring is that the disruption of those terminated services has a real impact on the community the non-profit was serving. At the end of the day, the members of the non-profit are able to walk away from their work, shrugging their shoulders and say, “geez, what a shame that that endeavor didn’t work out. Oh well.” But what about the community that was being served? They became reliant on the services in place by the non-profit and suddenly those services are no more. What if the community members are relying on the non-profit’s medical services for important check-ups and medicine distribution? What if the non-profit’s educational services are the only ones in that community? Now what? A failed non-profit is not just some lost money and volunteer hours – it’s a devastating blow to the well-being of the community being served; not to mention it destroys any trust that the community will have towards non-profits and their efforts in the future.

Now, obviously, no one wants their non-profit to fail. A bleeding-heart, philanthropist does not work their face off for years developing a new idea and business plan with the hopes of failing. However, this is a serious reality check for all the idealists out there looking to “change the world.”

Wake up. Take a step back outside of yourself and your amazing idea. Now, what do you have left?

You have a desire to help a community. You have a new idea, new service that you feel like was not being provided beforehand. Take that idea and run with it – develop it to its fullest. However, do your research. Start exploring what organizations work with the community of interest or similar communities. Is it possible to take your brilliant new plan to an already established organization, with an already established relationship within the community and an already well-established fund-stream, and get this established organization to take on your new idea as one of their services? You, of course, come with the service; I’m not asking you to sell your dreams and passions without your intricate, vital involvement.

Now how do you feel? Yeah, it really sucks to not be able to slap “Founder” on your newly printed business cards and to have a fascinating tale of “passionate pursuits” to share at those star-studded fundraising dinners you have envisioned for your beloved organization. But when it comes down to it, the real nitty gritty of why you are doing what you’re doing, those business cards and self-glorifying cocktail chats don’t mean squat.

You are there for the community you want to serve, to make a real difference in real people’s lives. With a big-picture perspective, the “world change” you are pursuing has a different significance – it’s no longer about you. Now rinse and repeat: it’s not about you.

Now allow me to step down from my soap box and talk about the two organizations we met with today: Unlimited India and the Acumen Fund. Both of these organizations are great supporters of social entrepreneurship but contribute at different stages in the game.

Unlimited India – pretty much if you’re an Indian in Mumbai with a brilliant new idea that will change the world and have a social impact in some way, you go to Unlimited India. They love the innovators and dreamers. Through business savvy support and financial funding for the beginning stages of an idea, Unlimited India encourages individuals to take action and develop a culture that supports the “innovators,” “activists,” “social entrepreneurs,” whatever you choose to call them.

This organization is great and kind of the “oh that’s so sweet” organization for this trip. They definitely have in place a detailed business plan and structure that has been working great for the last few years. However, I just fear for the sustainability of an organization such as this one. They are investing in the dreamers and the revolutionaries, not the strong businessmen. Like I said, I think this organization is super duper – we need more people investing in the great new ideas – however, how long will outside funds support these world-changers?

The Acumen Fund – After you get your great innovative idea on the ground and have a few years of hard work under your belt (to prove your new organization or idea will actually survive), you go to the Acumen Fund. This organization was talked up a bit by some of my colleagues, and I had heard of it loosely before the meeting. I understood them as sort of the big wigs of the NGOs world that promote sustainable NGO business models. Well, that perception was altered with our meeting. It took some time to digest what information they were sharing, but once we talked about it as a class afterwards, I understood where even the “golden child” in non-profit business is faulting.

The Acumen Fund representatives were very passionate, well-spoken young professionals with a glimmer of idealism in their eyes but a firm, unwavering business demeanor. They were great but were missing something very important in their business model for their public health projects: measurable outcomes. They told us this absolutely INCREDIBLE story about low cost maternity clinics in one area of Mumbai that were serving a very poor population. The clinic was open to any family, but 95% of their population would be considered “impoverished.” The clinics provide high quality service and care at a mere 1/3^rd of the cost. Obviously this is an amazing service that is making a dramatic difference. However, the Acumen Fund and their donors are not measuring the difference they are making. For a public health professional, we hear quality maternal care and immediately think, “Great! Lower maternal and infant mortality rates; lower rates of disease. This is a wonderful thing!” And yes, these “Life Spring Hospitals” are indeed a great addition to the health services for these 12 communities in Mumbai. However, the Acumen Fund, as I mentioned, are not measuring the difference they are making.

Dr. Parrish asked the Acumen Fund representatives what data they have collected and what impact they have analyzed- to find out that the representatives didn’t know how to measure health impacts. Mind you, they spouted out some very well-phrased answer, something about that it was too soon to measure the impact or that they couldn’t do it yet. But still, Dr. Parrish brought up something that I do not think I would have noticed right at that moment: that even the “golden child” of business-oriented NGOs needs some help. Once we discussed our thoughts on the Acumen Fund’s presentation, I realized the importance of us public health professionals out in the field. We’re not only there to deliver food and medicine to the hungry and sick; we’re there to also make sure that public health programs are ACTUALLY making a difference; a difference worth investing in.

Meeting with the Acumen Fund was quite the reality check. Beforehand, I just naively assumed that organizations as well-established as the Acumen Fund had all their T’s crossed and I’s dotted. I mean, they pretty much made the business model for social entrepreneurship in the developing world. Just goes to show (1) never assume anything and (2) public health professionals are needed everywhere!

This was a great experience, conversation, and opportunity to reflect upon how I can contribute to organizations already serving communities in need. Once again going back to the idea of “personocracy,” establishing my own non-profit is not nearly as important as me offering my services and skills. Also, along this idea of “personocracy,” it is VITAL that organizations have the manpower to go with the great face the organization dawns. For example, the woman who is the CEO for the Acumen Fund is spectacular and can fundraise like no one’s business. But without a full range of skilled team member to support her and the organization, any NGO would perish quickly. This was really eye-opening and provided a great, new perspective for me and the governance/ accountability end of a non-profit. Quite different the everyday muddy feet and smelly clothes perspective we’ve been exploring thus far…