Recently, Laura Libman, President of Tia Foundation gave an interview to the Thunderbird Alumni Magazine. We thought there were many important questions asked that may give you some good insight into the work we do…and love. (en espanol debajo)
What prompted you to start the Tia Foundation?
I spent part of my childhood with my extended family in Mexico, going to school in Guadalajara and summers on a ranch in rural Mexico. I fell in love with the people there. Toward the end of my education at Thunderbird, I had difficulty finding NGOs who were using the successful ID models that I learned about in class; the models that create independence and sustainability.
I also discovered that in most cases, the downward spiral of poverty in rural areas of Mexico was often precipitated by something health related. A farmer would get injured or his wife would die in childbirth, which meant that productivity suffered, so they produced less food for the family and nothing left over to sell. Then everyone in the family would become malnourished and consequently more prone to illness and less productive. Trying to prevent that first precipitating event would do a lot to improve quality of life.
What was your prior experience in providing healthcare in Mexico?
I do not have any prior experience in providing healthcare in Mexico, but work closely with those who have extensive experience. One partner in particular, La Universidad Autónoma de Guadalajara (UAG) has been working in rural communities for over 30 years through their Community Medicine Program (PMC).
Though my experience in healthcare is very limited, I did a great deal of research on other programs worldwide. From those, I gleaned the best practices and adapted them for rural Mexico. I also spent many years as a project manager.
Why the approach of teaching those in remote villages healthcare practices rather than bringing in American healthcare workers, like other NGOs do?
A lot of why we are doing things differently, you can blame on my Thunderbird International Development Classes ☺ Here are a few reasons why we do not bring American healthcare workers in:
1. Our whole philosophy is based on a “teaching them to fish, rather than giving them fish” model. We want them to learn to be independent and self-developing.
2. Our model of using local resources ensures sustainability, rather than being dependent on outside resources that may not always be there. We also connect them to resources within their local and state governments which also enhances sustainability.
3. There is more buy-in and therefore more sustainability when the villagers themselves determine their own health development priorities, rather than having someone come in from the outside, who would be less familiar with their culture, language, and typical health conditions.
4. Working with local medical schools and local government health entities for the training and continuing education, we are able to better customize a program suited to each particular community, instead of replicating an identical program using doctors from the outside. For example, some communities have a problem with deaths from scorpions, others from dengue fever, and others chronic dysentery.
Is this your first graduating class of promotoras, or have you had others?
Yes, this is the first graduating class. We are in various phases in other states.
How do you get them trained? Who does the training? How long to train them?
First we find a medical school in Mexico who is willing to work with us. We identify a microregion to work in that has up to 30 villages. I developed a thirty point weighted matrix of success criteria, similar to a political risk analysis matrix, to use to narrow down which villages to start in.
Then we conduct a baseline data study. I accompany a small brigade of medical students and a professor or two and we take medical histories and other statistics on about 25% of the village. The data study serves a number of purposes. It identifies the particular needs of the community so we can tailor the education and medical kits for that community. It also allows us to track our results.
During this same trip, we try to get as many villagers together to elect their promotoras (Community Health Workers). So far, the villagers have unanimously chosen women as their promotoras. We explain what we would like to do and ask for them to explain their greatest health needs and concerns. Then we tell them when the training will take place and ask them to bring any sick or injured people to a specified location the week we return.
Tia then works with the medical school to develop the curriculum for that village or cluster of villages. We try to train no more than ten promotoras at a time, so they can receive individualized instruction. How long the training takes depends on which medical school with whom we are working and the structure of their particular community medicine curriculum. The fastest method so far has been with UAG because they have a block schedule which devotes an entire week periodically to community medicine. For illustration purposes, I will describe how our launches are completed with UAG.
With UAG, the training takes a week and a brigade of about 12 people. In the morning, the promotoras receive about 4-5 hours of instruction. In the early afternoon, the brigade divides in half, with half going to the local schools to give classes on health, sanititation, nutrition, hygiene, and accident prevention. The other half holds village classes for mothers, grandmothers and fathers on pre and post natal care, geriatrics and subjects similar to those being taught to the children.
Then in the late afternoon, classes resume for the promotoras for another 4-6 hours. During their instruction, the promotoras receive hands-on instruction as they treat their own community members as well as education in a variety of other health conditions, such as stabilizing a patient for transport, cleaning, dressing, and stitching wounds, midwifery, injections, rehydration, diagnoses and a wide host of other conditions.
At the end of the week, we hold a graduation ceremony where each promotora receives her medical kit and diploma for having completed the first part of her training. Often, the villagers come out for the graduation event and the promotoras demonstrate some of the skills they have mastered. Whenever possible, we try to have a high municipal government official in attendance at the ceremony.
Continuing education is provided mostly by the municipal government (similar to a county in the US). A municipal health department doctor visits the villages once a month with several purposes. The doctor treats patients and monitors progress with the promotoras, so they continue their learning process. The doctor surveys the medical kits to arrange to supplement items that are needed. Additionally, the doctor instructs them on new subjects and when necessary, alerts the promotoras to anticipated problems, such as an expected influenza epidemic. The promotoras learn how to treat the new threat and to be able to identify when a condition has escalated to point where the patient needs to be stabilized and transported.
At least once a year, usually more often, Tia and the medical brigade return to gather data on the results of the progress and to identify areas that need to be strengthened.
Of course, health development is usually not a matter of simply training promotoras. We also hold continuing education for the villagers and implement other programs as needed. Where there is malnutrition, we bring in agricultural students and nutrition students to teach the villagers how to design a garden based on their needs. Some villages have voluntary self-insurance funds that can be used for an ambulance service or specialized training for the promotoras.
How do you fund this effort?
Funding is a constant struggle for us as it for most nonprofits. Currently, the majority of our funding comes from individual donors and philanthropists. We are in the process of grant writing and finding corporate sponsorships.
Can you tell me a story about how the Foundation has impacted a village or person in that village?
A great increase in self-esteem has become an amazing and unexpected outcome of our work All of our promotoras are women, who are often virtually voiceless, powerless and invisible in their culture. When we held the graduation ceremony in El Reparo, some of the women were actually teary when they received their diplomas. We had the Assistant Municipal (like a county in the US) Secretary there to present the diplomas. Many of the villagers were there to see the promotoras graduating and receiving their medical kits. Some of the women told me that it was the first diploma they had ever received and that other members of their community were treating them with more respect, like a man.
Una entrevista con Laura Libman fundadora y Presidente de la Fundación Tía.
Recientemente Laura Libman, Presidente de la Fundación Tía dio una entrevista a la revista de egresados de Thunderbird. Pensamos que hay muchas preguntas importantes que le hicieron que pueden darles una buena introspección del trabajo que hacemos y amamos.
Que te empujó a iniciar la Fundación Tía?
Pasé parte de mi infancia con mi familia extendida en México, asistiendo a la escuela en Guadalajara y los veranos en un rancho enel campo en México. Me enamoré de la gente allá. Hacia el final de mi educación en Thunderbird, se me complicó encontrar ONGes que estuvieran aplicando exitosamente los modelos ID, sobre los que aprendí en las clases; los que crean independencia y sustentabilidad.
También descubrí que en la mayoría de los casos, la espiral descendente de pobreza en las áreas rurales de México se precipitaba con frecuencia por algo relacionado con la salud. Un ranchero que se accidentara o su esposa que muriera en el parto, significaba que la productividad se afectara, se produciría menos alimento para la familia y no quedaría nada para vender. Luego todos en la familia estarían malnutridos y consecuentemente más propensos a enfermedades y menos productivos. Tratar de prevenir este primer evento acelerador mejoraría considerablemente la calidad de vida.