Patience and partnership: MCC and health programming
These reflections by Paul Shetler Fast, MCC’s health coordinator, are from the Spring 2020 issue of Intersections, a quarterly periodical examining the wide range of issues that MCC and its partners encounter. Explore this special centennial issue of Intersections, which provides glimpses into MCC's development work over the decades. (Top photo: Dr. Chris Isichei, director and founder of Faith Alive Foundation and a physician at Faith Alive’s clinic and hospital in Jos, Nigeria, talks with patient Josephine Eze in 2017. Eze is HIV positive, but her 2-year-old son Destiny Eze does not have HIV. Precautions taken during pre- and post-natal care and labour and delivery services offered through Faith Alive, an MCC partner, help Eze and other mothers avoid passing HIV to their children.)
MCC’s health programming has taken many shapes over the last 100 years. That includes distribution of medical supplies in 1940s Europe during war and post-war reconstruction, staffing mental health hospitals in the United States during World War II, construction and management of clinics and hospitals around the world from the 1940s to the 1980s, HIV responses in the first two decades of this century, support for water and sanitation projects and responses over the past decade to trauma and sexual violence.
Throughout this complex history, two central and unresolved tensions have persisted in MCC health programming: the tension between shorter-term relief and long-term change and between direct management and partnership.
In Vietnam in 1959, MCC workers Dr. Willard Krabill and Dr. Donald Goering do a tendon transplant on a leprosy patient at Banmethuot Leprosarium run by the Christian and Missionary Alliance. The facility not only works with leprosy patients but also has clinics and a general hospital. No name was available for third attendant at the procedure.MCC photo
Short-term relief or long-term change?
MCC was founded in 1920 by Mennonites to provide short-term humanitarian aid to coreligionists in Europe. During World War II and its aftermath, much of MCC’s international programming was built on a short-term relief model, including in health, where the focus was on sending supplies and personnel to address immediate medical needs.
However, by the early 1940s, as MCC put down roots in more diverse contexts, its approach to health began to shift. As MCC worker Robert W. Geigley explained in a 1943 evaluation of struggling health programs in Paraguay, “here you cannot assume that [short term] material aid will bring any lasting result. You save a man from syphilis and he dies of tuberculosis. You cure him of TB, and he goes back to the same home with the same poor food and diet, and in six months he has TB again. . . . The approach to problems here must be very different than in the case of European areas . . . we, therefore [propose] a long, slow-developing program, with the idea of starting at the bottom with broad projects . . . looking for results only over a period of ten to twenty years.”
“ . . . here you cannot assume that [short term] material aid will bring any lasting result. You save a man from syphilis and he dies of tuberculosis. You cure him of TB, and he goes back to the same home with the same poor food and diet, and in six months he has TB again. . . . ”
- Robert W. Geigley, MCC worker, Paraguay, 1943
This push toward longer-term impact in health work can be seen across MCC programs from the 1940s to the 1960s.
Short-term solutions, like providing temporary staff to struggling mental hospitals in the U.S. as part of the Civilian Public Service (CPS) program, gave way to research and advocacy for systemic changes and the creation of new institutions like Mennonite Mental Health Service in the U.S. and the Mental Health Program in Canada.
Similarly, clinical staff placed at non-MCC hospitals around the world quickly realized that if the fundamental systems of healthcare and the drivers of ill health were not addressed, their efforts would result in only superficial impact. This realization in turn led to a flurry of hospital and clinic construction and management around the world: in the 1950s alone, this included the construction and management of clinics in China, Haiti, India, Indonesia, South Korea, Mexico, Paraguay, Philippines, Taiwan, Uruguay and the United States.
Crowds wait to see the doctor at the hospital in Grande-Rivière-du-Nord, Haiti, in June 1960. MCC began providing medical care in Grande-Rivière-du-Nord in 1959, treating 71 patients in two partially finished rooms the first day. Two months later, hospital staff were treating over 200 patients a day. Many walked hours to receive care.MCC photo/Dr. John Bender
Similarly, clinical health programs serving urgent needs, such as the MCC-run hospital in Grande-Rivière-du-Nord, Haiti, frequently spun off projects serving longer-term needs like water and sanitation, education, agriculture and reforestation.
However, MCC has remained committed to addressing immediate needs in health programming, which has created a productive tension with the desire to support long-term change. For example, in Haiti, MCC work began with short-term medical interventions in the 1950s. It started to pivot away from short-term medicine in the 1970s in favour of working for longer-term systemic change. This shift peaked in the early 2000s, when MCC focused entirely on health-related advocacy and basic water and sanitation infrastructure.
Nurse Adeline Sainvilus weighs Dalondin Benoit in a malnutrition clinic run by MCC partner organization Konbit Peyizan in the Artibonite region in Haiti in 2019.MCC photo/Christy Kauffman
However, by the late 2010s, MCC had returned to a more balanced approach between these poles, with both long-term public health and advocacy work as well as direct support for interventions addressing mental health, sexual violence and acute child malnutrition.
Partnership: direct management or partnership?
Another persistent tension in MCC’s health programming has been between letting diverse local partners drive programming and retaining more centralized control. This tension is closely intertwined with the tension between long-term impact and short-term results. However, this history is not a simple path from direct control to local partnership.
MCC worker and nurse Jean Osmann measures the height of a student in San Franilla, Bolivia in 1971, and Emma Mendoza records the measurement on a chart. MCC nurses held school checkups once a month in three villages. Mendoza was in training to be a community health promoter.MCC photo/Cecil Graber
Even by 1944, MCC’s health work in Paraguay included pairing a local apprentice with each foreign doctor MCC sent to Paraguay, with the vision that the apprentice would eventually take over the work.
Similarly, when MCC started medical work in different countries for the first time, it nearly always did so by working through existing institutions, such as Hôpital Albert Schweitzer in Haiti, Cuauhtemoc Regional Hospital in Mexico or the Hebron General Hospital run by the Anglican Church in the Jordanian-controlled West Bank. However, over time these seeds of partnership grew to include more and more national staff, more local organizations as partners and less reliance on imported staff and solutions.
In the 1970s, MCC accelerated this move away from directly implemented programming and toward a partnership model of programming.
However, despite its clear advantages, reliance on partnerships has brought recurrent challenges and a counterbalancing desire for more direct control, common priorities and uniform standards.
Early support for partner hospitals in the 1940s and 1950s quickly moved toward directly running hospitals when MCC staff grew frustrated with lack of control, different quality standards and failures of partners to fully align with MCC values.
By the 1970s and 1980s, however, many of these directly-run hospitals were turned over to local partners and staff as MCC emphasized local ownership once again.
In Los Laureles, El Salvador in 2006, Enrique Borja and others attend a workshop about HIV and AIDS led by Nery Misael Rivas of MCC partner New Dawn Association of El Salvador.MCC photo/Melissa Engle
At the same time, while relying increasingly on partners and local staff to implement health programming, MCC showed a growing willingness to set central program priorities and standards. For example, while MCC’s Generations at Risk HIV initiative in the first decade of this century was implemented by partners, it set more centralized direction, prioritization of approaches and minimum standards of care than had been present before.
In the Morang district of Nepal in 2017, Kabita Devi Rajbhar prepares roasted corn, beans and rice to make super flour, which is improving the health of her 2-year-old son. Rajbhar is a participant in nutrition and kitchen garden trainings of MCC partner Brethren In Community Welfare Society.MCC photo/Colin Vandenberg
Finding Balance
Over the past century of health programming, the relative emphasis within these two sets of tensions has been constantly shifting over time and between places. This history is not a clear evolution from bad to good, or even from one model of work to another. Rather, it represents a slow and largely decentralized evolution of MCC’s approach to health programming that attempts to be responsive to the many diverse contexts where MCC works, the push and pull of various stakeholders and the gradual accumulation of experience and wisdom.
Paul Shetler Fast is MCC health coordinator, based in Goshen, Indiana.