Karleen, what an excellent post about assumptions made by those in the United States.  

I have an additional assumption that also gets overlooked in US dominated discussions.  There is often the assumption that what has worked well in other cultures is NOT adaptable to the United States.  While some things may not be adaptable, many others are. There is a whole body of work that has been done well in developing areas that I have adapted to my work in the United States, ironically among the very privileged just as well as the very under privileged populations where such strategies were developed and on the lower East Side with WIC moms. Believe it or not there are existing infrastructures and health care practitioners in all the developing areas that I have visited even tiny villages in famine prone Africa.  The first thing I always do is listen to the health workers on the ground. They often know very well whether or not they need assistance and if so what type of assistance.  

I have to say that the type of lactation consultant conferences I have attended are not structured at all like the type of focused pragmatic working group style conferences and workshops I attended when I worked internationally.  Relationships were built up over time through working jointly on problem solving and implementation of pilot projects followed by scaling up over a period of decades if not years.  Assessment and evaluation were embedded in these efforts.  Before rushing into implementing a tactic such as licensing, for instance, a full discussion of the pros and cons and potential unintended consequences would ensue with ALL the stakeholders, not just those in favor of the tactic. Then the broader picture of what else needed to be included in the discussion to see if there were ways of complementing other tactics and creating synergies while avoiding circumstances that might result in creating other bigger problems.

Where relationships failed was when outside organizations did not listen first before assisting with implementing new projects, when they didn't build on existing projects and programs, when the assistance was short term, and when the approach was superficial and general. 

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