In thinking about the whole issue of why the International Health Community
looks at health care issues in such a different way than some of us who work
within health care systems think about health care issues, I realized that
Paula Meier is a perfect model of the successful International Health
approach.  It is exactly the type of approach that USAID would love.  I
could readily take that idea and sell it to them of the type of model that
should be "scaled-up" in their jargon. I'm sure they have some new Buzz word
now since I haven't written a grant proposal to them in over 6 years.


The elements in her program that are successful are the following:
1) Empowering the women with whom she worked.  They were given authority to
take charge of the situation by learning how to do the crematocrits
themselves and monitoring the fat content of their milk.  They were not
treated as if they could not learn and they were not patronized.
2) Creating a social network for these women.  They had groups that they
attended - if I remember correctly - it was once a week or more.
3) Providing access.  She had a van pick them up at their home.

If you listen carefully to her talks, you realize that her project has an
impact that goes far beyond the intended health benefits.  Some of these
women became leaders.  Maybe they would have otherwise, but participation in
the project might have been the tipping point.  Her project really address
many of the perceived obstacles to improving breastfeeding rates in low
income developed country situation and she did it with one of the most
vulnerable populations.

AND I was very impressed by the low cost of her project at $30,000 a year.
Taken to scale, that approach would have a huge impact on infant mortality
in the US.


So, if you are feeling defeated, that you can't change things because "my
clients are too low SES" or "my clients have poor nutrition" or whatever
obstacle seems to be the most limiting, take another look. Think outside the
box.  Change happens slowly, but it can happen.  Institutions can change
slowly and they are not as powerless over low SES as one would think.

Best regards,

Susan E. Burger, MHS, PhD, IBCLC

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