“The International Rescue Committee’s New Roots Program”: 2014 Finding Big Ideas Winning Essay

The first New Roots program started in 2009 at the San Diego office of the International Rescue Committee (IRC) when a group of Somali Bantu refugees were resettled in a nearby suburb.

By Jennifer Fei

This essay is one of two winning entries to the 2014 Finding Big Ideas Essay Contest. The other winner is Shrey Goel’s essay, “Rendering the Private Public: A Collective Approach to Slum Improvement.” Last year’s winners were Courtney Mullen’s essay “Belenpampa Clinic,” and Narissa Iqbal Allibhai’s “Young Artistic Leaders Rising from the Slum.”

Fei-Group 1The first New Roots program started in 2009 at the San Diego office of the International Rescue Committee (IRC) when a group of Somali Bantu refugees were resettled in a nearby suburb. When caseworkers and program managers realized that this particular group of refugees was having a difficult time adjusting and thriving to their new life in the United States, they asked what they could possibly do to make the transition easier. The Somali refugees replied that they were farmers, and would prefer to be close to the land in any way that could help bring them back to a life they once knew. A small community garden was established shortly thereafter to add an experiential component to the IRC’s resettlement services. Currently, the farm offers large market production beds, designated areas for users to compost, and even a place to participate in bee and chicken coop keeping.
Like most IRC refugee resettlement programs, the New Roots program is offered nationwide. Currently, 16 of the 22 IRC offices across the United States provide gardening and agricultural opportunities to those they assist. Shared goals of the program unite offices in one unified mission statement – to provide refugees with a safe gardening and food production space in which they can integrate their homeland expertise. Implementation depends on both the reality of and needs in the geographic location of the specific office. For instance, the needs and availability of resources such as land to start gardens and farms in Phoenix, Arizona differ greatly from the availability of land around the New York Regional Office. Despite this, a broad network of program managers and directors pull and share resources from one another to constantly work towards improving the various New Roots programs across the nation.
According to Kathleen McTigue, New Roots Program Manager at the IRC’s New York Regional Office, 50% of resettled refugees have some sort of agricultural background – be it through farming, food production, vending, or marketing – and thus have grown up with a sense of close relationship to their food. This makes sense – the majority of IRC refugee clients (excluding Iraqi and Afghani Special Immigrant Visas) come from conflict-torn regions of West Africa and Southeast Asia. When the Family Education coordinator started the New York Regional Office’s New Roots program in 2011, the IRC maintained one small garden bed at Drew Gardens in the Bronx, NY. Since then, the land rights licensing agreements have expanded the IRC’s gardening sites to two large plots at separate locations. Both locations are in the Bronx to maximize land area and proximity to low-income refugees whose first apartments, upon resettlement, are typically located in this borough.

The New Roots program works well for many reasons. First, refugees are able to apply agricultural knowledge and experiences from their home countries to their new lives in the United States. This empowerment is especially crucial in an environment where refugees may feel that their previous skills and work experiences are inadequate for the highly sanitized and industrialized job market in major cities. Exposure to green gardening spaces can also be a therapeutic and healing space for refugees who are experiencing post-traumatic stress and/or a general weakened state as a result of their move to the US, especially when moving to an overwhelming, hyper-urban metropolis such as New York City. The New Roots program also facilitates community integration – by establishing a physical space for refugees to work together on a plot of land. They are able to work alongside each other, take part in group decision-making processes, and have an equal voice in this space. Kathleen McTigue mentions that this type of work environment often differs from the more socially and politically oppressive communities that refugees, especially young women, may come from. There is a strong sense of dignity established for refugees who are empowered to take a physical space of land and challenge themselves to be productive with it. An economic development component also strengthens the validity of the New Roots program: if refugees are able to successfully grow fruits and vegetables, then they are able to reduce food spending at supermarkets and grocery stores. Furthermore, in some cities, New Roots participants are looking to expand beyond small-scale production to start their own farm businesses.

Fei-Aerial View CropWithin the IRC community, the New Roots program serves to foster cross-cultural understanding. Deciding what type of seeds to sow and for what purposes initiates multicultural dialogues about culture and cuisine from around the world, bridging the cultural differences that may exist between refugees. There is also much to be said about providing fresh food to refugees in need in low-income and economically disadvantaged situations, and about improving community health. Excess produce from the week’s harvest is washed and brought to the IRC office, where refugees can come by and take however much they need for their own nutritional benefit. This also helps refugees who are not yet adjusted enough to their new homes to be able to go to the grocery store in their neighborhood to access the food they need to survive in their initial weeks in the US.

From an economic empowerment perspective, the New Roots garden provides refugees with an option to take on an experiential learning opportunity. Working at the garden helps build resumes while re-familiarizing themselves with farming practices that may seem familiar in concept but differ in practice based on new terrain, norms, and climate conditions. Even though farming practices may share common fundamental features, the New Roots program  must also account for gaps in knowledge, experiences, and expectations between the refugees and the local American farmers and practices in their new cities. IRC Employment specialists, who are focused on career development assistance for refugees, are currently working in conjunction with Kathleen McTigue, the New Roots team, and employer partners in food-related industries to create an employment pipeline program through the New Roots program. Through this pipeline program, refugees’ experiences as farmers in the New Roots space can translate to meaningful professional development experiences for those who wish to work in the food services and/or production industries in the future. As a sort of guaranteed first job, the IRC hopes to build upon the New Roots program so that it may become a source of stable employment and skill-building necessary to navigate the experience-based needs of the US labor markets and employers.

McTigue’s main role as the sole Program Manager at the New York office, beyond simply maintaining the land, gardening upkeep, and community relations with the Department, is to conceptualize the impact of the New Roots program within the broader IRC resettlement services philosophy. She hires new interns and staff and researches initiatives that align with the goal of expanding the Program’s impact across national offices, and more specifically within the NY regional office specifically. With a Bachelors’ degree in International Development and Agricultural Economics, McTigue pulls from both her academic training and her experience in agriculture and NYC community gardening initiatives since she joined the IRC in May 2013. Beyond the garden’s direct impact, she has also worked on initiating the “Food Secure Resettlement” program within the IRC’s New York Regional Office’s core initial resettlement services that currently include housing, immigration, healthcare and employment access assistance.

McTigue’s vision incorporates the New Roots program into a broader nutrition education program within “Food Secure Resettlement” initiatives. As part of the IRC’s  overnight food amenities package provided to newly arrived refugees, McTigue asserts that a more culturally sensitive array of foods should be provided to better suit the tastes of the refugees during their initial days spent in their new homes. For instance, instead of offering American grocery staples including eggs, milk and bread to all refugees regardless of culture, McTigue has begun incorporating tea and rice as comforting and healthy food options for Southeast Asian refugees who arrive and are resettled through the IRC. “Unfamiliarity with a new place breeds vulnerability,” she explained. “Within the parameters of the Overnight Food budget, small changes can go a long way for refugees who are seeking familiarity in their new lives and homes.” McTigue’s work implies that nutrition education for refugees should be regarded as just as important as other core services in the resettlement process, prioritized on the same level as finding appropriate housing, employment and healthcare. For instance, McTigue has designed grocery store orientations and planned open-air farmers’ market outings to show refugees where they can access fresh food in their area. Federally funded Food Stamp and WIC check programs are also accepted at these vendors, which help weaken the barriers to access to affordable nutrition in the United States.

Community gardening is not a new concept and can be found consistently in major cities and metropolitan zones; New York City is no exception. Municipal and state governments in Boston, Atlanta, and Idaho, have established community gardens and farm networks for refugees and new immigrants. What makes the New Roots program in particular a Big Idea is its contextualization within a broader framework of the US refugee resettlement process as conceptualized by a large international non-profit. Despite the global scale on which IRC operates, the tangible community aspect of a community garden is certainly achieved through the geographically tailored New Roots program. During a visit to the Bronx New Roots Community Garden this past July for a World Refugee Day celebration, I was able to witness the children frolicking throughout the garden space, and families gathering to enjoy the production of their dedicated collective labor. At the office, refugees regularly express their joy in receiving fresh green onions, basil, kale, and root vegetables with which to cook dinner for their family. Based on McTigue’s observations of consistent attendance, engagement with the land, and the quality of their food production output every week as seen at the office, refugees from primarily farming backgrounds exhibit enthusiasm and diligence on the job at the garden.

The IRC’s institutional reach across its 22 U.S. offices certainly facilitates its ability to expand the New Roots program to other cities and areas within the nation. The community gardening work model would need to be further evaluated for cross- cultural applicability should international expansion become a goal for the New Roots program. However, by nature of it being a program to help refugees adjust to the new terrain of the United States, it makes more sense for the New Roots program to stay and develop its reach and program features domestically. Program managers like Kathleen McTigue could then focus on strengthening the core and peripheral elements of the New Roots program, including the gardens themselves, nutrition-based education, and initial resettlement resources and employment networks that are provided to supplement the New Roots Program farmers. This comprehensive approach to newly resettled refugees’ social and economic empowerment has truly been the key to the New Roots Program’s success thus far, and will certainly serve the initiative’s positive impact well into the future.

“Rendering the Private Public”: 2014 Finding Big Ideas Winning Essay

I had so mentally prepared myself to come away jaded, to witness the messy side of development work, that when the big idea I encountered this summer hit me, it felt like a revelation.

By Shrey Goel

This essay is one of two winning entries to the 2014 Finding Big Ideas Essay Competition. The other winning essay is Jennifer Fei’s essay, “The International Rescue Committee’s New Roots Program: Uncovered Terrain in US Refugee Resettlement.” Last year’s winners were Courtney Mullen’s essay “Belenpampa Clinic,” and Narissa Iqbal Allibhai’s “Young Artistic Leaders Rising from the Slum.”

Rendering the Private Public: A Collective Approach to Slum ImprovementMy foray through the Global Poverty and Practice Minor unfolded almost exactly as I imagined it would: theory, followed by praxis, followed by reflection. And yet, in following this trajectory so precisely, my experience through the Minor was also unexpected. I had so mentally prepared myself to come away jaded, to witness the messy side of development work, that when the big idea I encountered this summer hit me, it felt like a revelation.

This summer I worked with an organization called the Urban Health Resource Centre (UHRC) headquartered in Delhi, India with program sites in the cities of Indore and Agra. The organization addresses urban poverty by entering into slum communities and holding discussions with community members, proposing the idea of forming community women’s groups. These conversations aim to stimulate the women in slums to think about whether or not collective community action can help them confront the challenges they face. I was fortunate enough to have the Executive Director of the organization, Dr. Siddharth Agarwal, serve as my mentor throughout my time in India. In my conversations with Dr. Agarwal, he explained that an important aspect to this process is not pushing group formation on communities.  If community members do not express interest, the UHRC steps back until interest grows. They firmly believe that, in the absence of an organic investment by the people, the initiative will simply be unsustainable.

Once a group has formed, the first step is basic training surrounding health outreach and advocacy. Trainings cover tracking and surveying vulnerable groups (such as pregnant women) in slums as well as reaching out to government, private, and volunteer health providers to run camps in communities. At the first women’s group meeting I attended in a slum called Nagla Devjit in Agra, one of the group leaders proudly told me about how before one of their youngest members, affectionately called Baby, joined the group, she was pregnant with her first child. When she went into labor, she didn’t have enough money for the delivery.  The women pooled together whatever money they could from their personal funds. Asking neighbors to chip in, they escorted her to the hospital and offered whatever they had to the doctor. This is the kind of support the women are able to provide to their communities through their health outreach and tracking activities.

After groups are well established, they pursue higher-level activities with the support of UHRC field workers as new needs emerge. For example one need that became evident early on was financial resilience to health exigencies and other similar events – in essence, resilience to what Appadurai (2001) refers to as “’the tyranny of the emergency’…that characterizes the everyday lives of the urban poor” (p. 30). When this need emerged, the UHRC began helping women’s groups establish collective insurance funds by providing trainings on how to collect member contributions, keep records, and administer loans. These collective insurance funds are different from microfinance loans because the seed money comes entirely from group members and loans are granted for home improvement initiatives and health emergencies in addition to microenterprise. Rules[i] are established and enforced by women’s group members who decide on conditions together, rather than following the mandates of an external institution.

Another need that emerged early on in the UHRC’s operations was infrastructural improvement in communities and knowledge about applying for government programs and enacting government advocacy. To address this, the UHRC began facilitating trainings on petition writing to local municipal authorities, discussing with groups the best ways to write collective appeals and document all their communications. Groups began learning to write reminders to local officials when their requests for things like street paving and drain installation were ignored. As the capacity of groups has grown over time, they have also created workshops for learning how to conduct sit-ins at government offices when they need to submit applications for multiple community members and are facing resistance by government offices. From time to time, this collective action takes the form of advocacy rallies and protests on issues the women deem relevant, such as alcoholism and gambling. Most of these initiatives come from brainstorming sessions at women’s group meetings.

What I’ve outlined thus far is how the UHRC works in the field. But why has the UHRC elected to approach urban poverty in this fashion? India’s trajectory of urbanization has led many families from poor rural and peri-urban areas into city-centers, but they arrive faster than the planning process can incorporate them. They are relegated to informal and often illegal occupations of whatever free space they can find, where they erect impermanent housing units or occupy existing run down units. Katherine Boo (2012), in her novel Behind the Beautiful Forevers centering on a slum community in Mumbai, explores how the allure and pursuit of better economic prospects pits poor urban families in slums in competition, thus leading to fragmentation where families are unable to work in solidarity towards mutual empowerment. The city promises families a better economic future for their children through upward mobility in exchange for hard work. The reality, however, is that regardless of hard they work, many families remain relegated to resource-deficient, unsanitary living environments. All these oppressive factors result in decreased household and community-level social cohesion in slums. Therefore helping communities build stronger bonds through collective action is the goal that underlies the UHRC’s initiatives.

The modern Indian slum is riddled with health risks due to environmental conditions. Many urban households, particularly slum households, either have no access to drainage networks, or are connected to open drains clogged with stagnant and pollution ridden water (Kala & Kumar, 2013; Agarwal, 2011). The slum often acts as the processing plant for the waste of the city. Much of the informal sector is involved in recycling the solid waste produced by the city, which is frequently dumped near slum areas (Talyan, et al., 2008; Boo, 2012; Agarwal, 2011). The health risk exposure of slum residents has consistently proved to be higher than that of the average urban population. Infant mortality is much higher for the urban poor than the urban non-poor (Agarwal & Srivastava, 2009). Issues with sanitation infrastructure contribute to these disparities. Data collected in 2005-2006 revealed that under half of the urban poor could access adequate sanitation compared to about 95% of the urban non-poor (Chaplin, 2011).

One of the largest barriers to improving slum conditions is that many slums go undocumented. Because most slums are informal settlements with no tenure rights, their illegal status excludes them from official listings (Agarwal, et al., 2007). The oversight of informal or illegal urban regions leads to the exclusion of these residents from urban governments’ mandate to provide basic services like drainage, sanitation, health care, and water (Agarwal, 2011). By focusing on coalition building at the community level, the UHRC seeks to galvanize slum communities to gain legitimacy in the eyes of the government.

According to Bandura’s theory of self-efficacy, an individual’s belief in their ability to accomplish a task influences their actual capacity to accomplish it (1994). Applying this concept to groups, Gibson has theorized that just as individuals have self-efficacy, so do groups have group efficacy (2003). In a conversation with Dr. Agarwal, he explained to me that both forms of efficacy depend upon small instances of success early on in order to build confidence for more ambitious endeavors later because each victory enhances people’s belief in their ability. This is why the UHRC begins with basic health outreach activity, which lends itself to higher success rates than petitions for infrastructural improvement that require greater persistence and higher degrees of organizing. However as groups slowly progress, they develop the confidence to interface with municipal authorities and local officials, and this confidence has led to huge improvements in many UHRC program slums, such as paved roads, covered drains, and regular street and garbage cleaning.

Going into my Minor’s “practice experience,” I knew I needed to be critical. I might have been joining an organization with paternalistic practices, like a for-profit MFI in which group loan leaders enforce institutional rules for women’s group members to follow, and participation is elicited coercively. The decision to focus on women is not unique – the rationale adopted by the UHRC is similar to many orgs, which support this choice on the basis that women and children bear the burden of poverty disproportionately. A consequence of this reasoning, however, is that these institutions end up adding to the “time burden” of already over-burdened poor women (Molyneux, 2008, p. 48). Yet, what I believe differentiates the UHRC is it’s underlying ethos. The UHRC has elected to pursue what Dr. Agarwal calls a “deprojectized” model of development. The organization has no intention of leaving the communities it operates in, and in many cases, other NGOs have come to Agra and Indore to run short-term programs, offering employment to UHRC women’s group members who are able to serve as a high-capacity work force. The women’s groups have become a platform for future development, but the UHRC doesn’t just strap women with responsibility and then leave – it stays and provides continual support through field workers and field offices.

In Ananya Roy’s 2010 book, Poverty Capital, Roy quotes Fazle Abed, founder of the Bangladesh-based BRAC: “At the heart of BRAC’s approach to development is organizing the poor” (p. 119). Roy takes this point and argues that while the Bangladesh model of development spearheaded by MFIs like BRAC and Grameen has adopted a “public transcript” of “microfinance evangelism”, what sets the Bangladesh model apart from mainstream microfinance is a “hidden transcript” of “putting pressure on the state” by “organizing the poor” (p. 119-120). I would argue that what the UHRC is doing is rendering public the “hidden”, private transcript of the Bangladesh model. The UHRC is publicly arguing on behalf of social protection and government accountability through grassroots organizing rather than making its public cause the inclusion of the poor into financial markets.

The UHRC’s approach aims to tackle poverty at a fundamental level. This comes with a unique set of challenges. While it is highly resource efficient, and effective, relative to costly multi-national aid initiatives, it requires true dedication on the part of NGOs, field workers, and communities. The need for genuine community member investment coupled with low levels of funding from donors mean that community groups must consist of volunteers, not employees. The work is not glamorous and requires time and patience – nothing can be rushed because if a fast pace is adopted, people will be left behind and the communities doing the work will lose investment. Furthermore, in bringing community knowledge and expertise to the forefront, this approach challenges the current centers of poverty knowledge generation (such as research institutions and global development banks). It asks poverty experts to recognize community knowledge as legitimate.

This is why the UHRC’s methods have so much potential. I remember one day speaking with some women’s group members in one of the poorest UHRC Agra slums called Indra Nagar. For most of its history, Indra Nagar has been a tent colony, home to nomadic merchants and craftsmen. One of the women explained that before the UHRC, nobody would even come into their slum. Nobody would loan them money and women could barely even leave their homes due to highly conservative gender dynamics. Recently, however, she was able to take out a 10,000 Rupee loan from her Federation.[ii] She was able to open up a storefront and is currently paying back her loan at a rate of 1,000 Rupees per month. It is because of this high degree of community member investment that, this summer, I heard many women talk about going to unorganized slums to establish women’s groups in Agra.
I believe UHRC’s work is rooted in something basic – what Dr. Agarwal frequently calls trust. What he means by this is that by putting trust and faith in slum community members, an iterative process of mutual learning is able to take place. It’s a process that allows slum residents to cultivate their faith in their ability to navigate urban institutions and to build a stronger social fabric. It’s also a process that demonstrates the poor can be active participants in their own empowerment. And that to me is a very big idea.

Works Cited
Agarwal, S. (2011). The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities. Environment and Urbanization, 23(1), 13-28.

Agarwal, S., & Srivastava, A. (2009). Social Determinants of Children’s Health in Urban Areas in India. Journal of health care for the poor and underserved, 20(4A), 68-89.

Agarwal, S., Satyavada, A., Kaushik, S., & Kumar, R. (2007). Urbanization, urban poverty and health of the urban poor: status, challenges and the way forward. Demography India, 36(1), 121.
Appadurai, A. (2001). Deep democracy: urban governmentality and the horizon of politics. Environment and Urbanization, 13(2), 23-43.
Bandura, A. (1994). Self‐efficacy. John Wiley & Sons, Inc..
Boo, K. (2012). Behind the beautiful forevers. Random House LLC.
Chaplin, S. E. (2011). Indian cities, sanitation and the state: the politics of the failure to provide. Environment and Urbanization, 23(1), 57-70.
Gibson, C. B. (2003). The Efficacy Advantage: Factors Related to the Formation of Group Efficacy. Journal of Applied Social Psychology, 33(10), 2153-2186.
Molyneux, M. (2009). Conditional cash transfers: a pathway to women’s empowerment? Pathyways of Women’s Empowerment, Institute of Development Studies, University of Sussex.
Roy, A. (2010). Poverty capital: Microfinance and the making of development.
Sridhar, K. S., & Kumar, S. (2012). India’s urban environment: Air and water pollution andpollution abatement.
Talyan, V., Dahiya, R. P., & Sreekrishnan, T. R. (2008). State of municipal solid wastemanagement in Delhi, the capital of India. Waste Management, 28(7), 1276-1287.

[i] Such as monthly per-member contributions, late fees, and repayment interest rates, which rarely exceed 3%

ii] A Federation is a collective of women’s groups in a particular region that runs a higher level collective savings program and pursues larger-scale initiatives

“Belenpampa Clinic”: 2013 Finding Big Ideas Winning Essay

The adoption of the women’s houses in Belenpampa into surrounding rural clinics of Cusco would likely alleviate maternal and infant mortality, and result in an increase in positive women’s health outcomes in Peru.

By Courtney Mullen

This essay was one of two winners of the 2013 Finding Big Ideas Essay Contest. The other winning essay was Narissa Iqbal Allibhai’s “Young Artistic Leaders Rising from the Slum.” The winners of the 2014 competition are Shrey Goel’s essay, “Rendering the Private Public: A Collective Approach to Slum Improvement,” and Jennifer Fei’s “The International Rescue Committee’s New Roots Program: Uncovered Terrain in US Refugee Resettlement.” 

A small two-lane highway stretches hours into the Andes mountain range from Cusco – a city of over 500,000 near the Urubamba Valley in the south-eastern part of Peru.  Concrete buildings, paved roads, and constant blaring of horns on the busy Cusqueñan thoroughfare of Avenida de la Cultura gives way to an marked increase of small adobe buildings, and dirt roads.  Each small village is centered on one public plaza for Sunday market.  The larger villages may have one Ministerio de Salud (or public health clinic).  Further from the main highway, the isolation of the rural Andes is much more apparent.  Trash collection, sewage treatment, and running water, becomes more rare.  Residence of these remote villages may walk hours to see a doctor, leaving their farms and families a great distance away. 

Most of the rural towns surrounding Cusco are based off of subsidence farming.  Almost all families make less than 1,000 soles a year (362 USD), which translates to about one dollar a day.  In addition, women’s education is not culturally encouraged or favored in these communities.  The vast majority of women within the campo regions had a primary education, a partial primary education, or no education at all.  Some sign their names by a stamp of their thumb.  Illiteracy is not uncommon in Quechuan villages, especially for women.

This past summer, I spent eight weeks volunteering in Cusco for the NGO, CerviCusco, which is dedicated to lowering rates of cervical cancer–especially among indigenous Quechan women living in nearby rural Andean villages.  This volunteer experience was a required part of my Minor in Global Poverty & Practice, a popular undergraduate program housed within the Blum Center for Developing Economies at UC Berkeley.

While I was researching CerviCusco before the summer, I came across the name of the Belenpampa Clinic. I learned that it was one of the first clinics in Cusco to adopt the vertical birth method. In Quechan culture, it is customary to give birth vertically at home, with the support of a woman’s husband and family.   The decision to adopt the birth method into the clinic’s obstetrics wing shows the clinic recognized a need to serve the cultural and personal preferences of Quechan women looking to give birth comfortably in a culturally sensitive environment.  In this way, the clinic recognized a need to adopt indigenous birthing practices into the hospital in order to cater to the health needs of its patient population, who would have otherwise shunned western, sterilized rooms.

However, what surprised me the most was its construction of two small adobe buildings that houses both patients and their families for free leading up to the child’s delivery.  The construction of the adobe buildings demonstrates the outward concern the hospital has toward making its patients comfortable in seeking maternal healthcare.  Many contemporary clinic births contribute to widespread unattended births—about 52% in the campo regions of Cusco (Fraser, Barbara).  Whether the lack of attention to these pregnancies in a rural environment is a byproduct of monetary factors, unreliable transportation, or lack of affordable temporary housing, or perhaps a combination of all three, I am unsure.  Regardless, the presence of family for a child’s birth is quite important in Quechua culture.

The Belenpampa clinic of Cusco differs from its many publically funded counterparts in the city by addressing healthcare disparities; particularly those between the rural, often indigenous poor, and the urban center of Cusco.  Although Peru has universal healthcare, Belenpampa recognized positive healthcare outcomes are much more dependent on the social factors surrounding access, and cultural values surrounding health care.
Belenpampa’s family houses did not specifically take place within the context of my practice experience, however, I believe it significantly reinforced why the idea is so powerful for increasing positive health outcomes for women living in rural areas of the Andes.  If the clinics I visited with CerviCusco were able to house patients in free housing, as with the clinic in Belenpampa, I believe the amount of women seeking care and having an attended birth, as well as for other aspects of primary care, would see a large percentage increase.  I believe access to such clinics, not the free cost of Peru’s socialized health care, is the primary limiting factor for women living in isolated rural areas.  The need for extra support is crucial in the campo regions–much more so than the urban environment of Cusco due to the lack of infrastructure in regards to ad-hoc transportation of cars converted into taxis, collectivos (small minibuses), and trucks, (which are much easier to obtain in Cusco), and almost unlimited supply of major hospitals and public clinics.  Regardless of universal healthcare, lowering the burden on women’s social obligations to their work and families is much more needed.

I believe the adoption of Belenpampa’s free housing to families of expecting mothers should be adopted in the surrounding rural Ministerio de Salud clinics outside of Cusco, due to the variety of answers I garnered while conducting CerviCusco’s surveys this summer.  Mainly, there is still a severe disconnect between the health of the rural poor, and the inhabitants of the metropolitan Cusco city center.  Regardless of a rural village supplying medication, and access to nurses, doctors, and widwives, for comprehensive health care to be effective and utilized routinely there needs to be some cushion that incentivizes the cost of leaving their precarious farming household and livelihood for a short period of time to increase maternal and other aspects of primary health care in the surrounding rural areas of Cusco.

While working with CerviCusco this summer, the clinic conducted a variety of “campaigns” to rural villages on average about 2 hours away from Cusco.  While the majority of the visiting medical students were conducting pap smears, and the Peruvian clinic staff helping with the intake of patients, I conducted surveys surrounding patient knowledge of cervical cancer, and how accessible doctors are to these women.  The survey included a variety of personal questions including but not limited to education level, annual income, and number of children.

I must have asked this question, “Cuanto dinero gana tu familia en un año?” or, “How much money does your family make in a year?” countless times this summer.  Almost every reply was “un poco,” a little, nothing, or less than 1,000 soles.  I remember being told by a Ministerio de Salud worker, or, equivalent to a public health worker that everyone makes less than 1,000 soles annually in the campo regions of Cusco.  There was no point of even asking that question on the survey.

It was through these many campaigns, and speaking to so many women, that the idea I witnessed made me much more cognizant of the fact that the Peruvian government should take steps to implement this idea throughout all of their public Ministerio de Salud clinics.

The “family houses” based in Belendpampa, if constructed next to other Ministerios de Salud in the campo regions of Cusco, would significantly alleviate the cost burden of finding housing for family members wanting to support their loved one, and the baby’s delivery.   This would encourage Quechan women to have their kids under the oversight of medical personnel, rather than forced, out of financial constraints, to have their child at home.

While giving the survey, I also needed to ask the patients, “Que distancia viajaste por el Panaicolaou hoy?” How long did you travel for your pap smear today?  The responses ranged from 10 minutes of walking, to 2 hours. For one woman to walk to up to 2 hours to get to the nearest clinic where we were conducting the pap smears demonstrates the fact that there is a severe lack of accessible and reliable transportation to and from surrounding areas of the rural villages.  Though many of the clinics we visited kept an ambulance, there did not seem to be any off-road jeeps or cars that could get quickly and reliably to farms accessible only by dirt roads.  I inferred that the ambulances were only kept for emergency transportation to and from Cusco, which is much more equipped to handle more advanced surgical procedures, and diagnostic tests.  Therefore, if transportation is precarious and at times inaccessible during the rainy season, then, housing should be the next piece of concern to meeting the needs of Cusco’s surrounding rural areas.

Though Peru’s Comprehensive Health Insurance covers women of all childbearing age, “in order to be effective, public health insurance should also cover transportation to and from the health center and the cost of pre-delivery stay at the waiting house” (Fraser, Barbara).  In addition, according to Ramirez in Fraser’s article, maternal mortality is “not just a matter for the health ministry, it is a social problem.  Maternal deaths have to do with poverty, education, access to employment, access to roads, transport, and housing.”

My time in Cusco thoroughly supported these assertions.  Positive healthcare outcomes are much more dependent on surrounding social factors, rather than universal healthcare itself.  The adoption of other family houses to one of the many surrounding rural communities of Cusco, and developing an impact report before and after its construction would be quite useful to see if the “family house” idea could be extended outside of the urban setting of Cusco.  The adoption of the women’s houses in Belenpampa into surrounding rural clinics of Cusco would likely alleviate maternal and infant mortality, and result in an increase in positive women’s health outcomes in Peru.

“Young Artistic Leaders Rising from the Slum”: 2013 Finding Big Ideas Winning Essay

This young and vibrant force, united in cause, is the start of a cycle of social empowerment of slum communities. 

By Narissa Iqbal Allibhai

This essay was one of two winners of the 2013 Finding Big Ideas Essay Contest. The other winning essay was Courtney Mullen’s essay “Belenpampa Clinic.” The winners of the 2014 competition are Shrey Goel’s essay, “Rendering the Private Public: A Collective Approach to Slum Improvement,” and Jennifer Fei’s “The International Rescue Committee’s New Roots Program: Uncovered Terrain in US Refugee Resettlement.” 

“Don’t let where you come from determine your destiny,” declares bright-eyed 14-year-old Moses Mwithi, in the prelude to the catchy music video “Destiny Up,” filmed in Mathare slum, his home in the heart of Kenya’s capital. Next up in the young group’s song is Penina Njeri, 12, a talented rapper and dancer. As these young musicians sing and dance, their joyful faces and ambitious hopes will bring you inspiration and a sure smile.
Like many other inhabitants of Nairobi’s Mathare slum, Mwithi and his family sometimes spend days without food. Living in an illegal settlement, he could be forcibly evicted any day. His good friend Masteba is an orphan who is lucky when well-wishers offer him a place to sleep for the night. Many of their peers are already drug addicts or part of criminal gangs, wanted by the police.

The Billian Music Family is a CBO that works with musically talented youths from Mathare slum, empowering them not only musically, but ensuring their education and fostering responsible leadership. Artistic talent in the slums usually comes to nothing, as survival comes first, not to mention the fact that slum dwellers are marginalized voices in the Kenyan population. Each week, 30 musical children, between the ages of 4 and 17 meet, gather to express themselves though song, dance, and rap. They collectively decide on the song themes and all have the chance to compose verses. They are given opportunities to be professionally trained, create studio recordings, collaborate with other local artists, and perform to large public audiences (such as at a UNEP gathering). Such a musical group is a one of its kind in the Kenyan slums.

Billian Music Family (BMF) has grown to become an incubator of responsible educated leadership. The group prioritizes above all ensuring that every member completes high school and maximizes that opportunity. Donations and funds from performances go toward paying for the neediest children’s school fees. BMF recently opened a centre that the children use to do homework in a quiet environment, which is not always possible at home. These promising youth are given many chances to hone their leadership skills, such as through heading the group during music practice and other activities. A mentality of community giveback is cultivated, and the kids lead several community-building activities including community cleanups, tree planting, and peace marches.

Billian Music Family was founded by Kenyan musician Billian Okoth, who was orphaned back in high school and had to move to Mathare slum. He knows the struggles of slum life and has seen much artistic talent go to waste. 3 years ago, Billian was walking through the slums and rapping to himself. A couple of kids started following him and some began to rap along with him. Billian paused and listened with amazement to their freestyle rapping. The idea suddenly hit him. He organized auditions, identified 6 musical children, and the Billian Music Family was born. Billian works side by side with Jeff Andare, another emerging local artist from the slum, to empower these talented children from the slum. I came into contact with the energetic duo behind Billian through my old music teacher, while on a trip back to my home in Nairobi.

Billian explains his choice of “Billian Music Family” as the group name: “We are all equal and are a growing family of musicians—more are constantly being born.” Indeed, BMF is a family and a haven of comfort, fun, free expression, and open minds. During tense political times like elections, for example, BMF’s weekly gatherings give the children relief from the chaos, violence, protests, and ethnic tension that are accentuated in the slums. Children of different ethnicities, genders, and financial situations come together for a common cause, with equality as a core group tenet.

The initiation and growth of Billian Music Family has not been an easy one. It took time to gain parents’ trust to leave their children with Billian and Jeff every Sunday afternoon. Often family members do not see the value of sharpening musical skills and would rather see the children engaged in more directly useful activities. Availability of resources has been the biggest constraint so far, starting with physical resources. BMF’s small music speaker is donated, their drum is shared, and their guitar is broken. However, they do have access through Jeff to a good piano and a fully equipped music studio. Billian and Jeff plan to invest future funds into acquiring more musical equipment. Finding a practice space has been another hindrance to BMF. In their initial stages, the entire group would have to walk several kilometers to Jeff’s studio or try to use school classrooms that were usually unavailable. Then, they managed to share a room on the edge of Mathare slum with another community organization. They have been working on putting together their own studio, which finally opened as a multi-purpose centre earlier this week. As the group expands and more funds come in, such issues arise and are gradually overcome.

The young members of Billian Music Family are part of the 60% of Nairobi’s population who live in slums, which extend over a mere 6% of the city’s land.[i] Most of these informal settlements are on unutilized government-land or privately-owned land, and many tenants pay rent to landlords who do not actually own the land. With no security of tenure, residents constantly face the threat of forced eviction. Kenyan land and housing law does not adequately address the housing needs of the urban poor. It simultaneously allows forced eviction for government projects or private development.[ii] The number of people in Nairobi’s slums (currently almost 2 million[iii]) is on the rise, aided by increased rural-urban migration.

The settlements of the BMF kids and other slum dwellers are usually on low quality land (such as around open sewage), with little, no, or overpriced access to clean water, adequate sanitation, electricity, garbage collection, toilets, and other basic needs. Amnesty International reports that “people living in poverty not only face deprivation but are also trapped in that poverty because they are excluded from the rest of society, denied a say, and threatened with violence and insecurity.[iv] Indeed, many slum inhabitants harbor a feeling of inferiority due to their lower living standards, financial struggles, seclusion from the rest of society, and lack of education. Being illegal settlers, they are unable to demand their basic rights, and are basically ignored by and seen as a nuisance to other city-dwellers.

Billian Music Family is creating a cohort of young, conscientious leaders from within the slums. Finally given a voice and a public platform for expression, these young artists spread awareness of slum life, issues, and their hopes for the future. They come together from different tribes as one force dedicated to uplifting their community. The kids take ideas of ethnic unity home and forward in life, passing them on to friends, family, and community leaders. Educating the children ensures they will be on a level playing field with more privileged citizens. The musical and leadership training open up a plethora of opportunities that slum kids rarely have. A musical performance group is an alternative activity to crime, drug usage and violence—that is simultaneously fun, healthy, and an investment for their futures.

The possibilities for taking forward this concept are exciting and boundless. Currently, Billian Music Family focuses on rap, dance, and song. Billian and Jeff envision a community youth arts center where children can nurture a range of skills including playing instruments, acting, drawing, painting, and more. Given the eager participation of youth in Mathare slum, there is potential to expand this idea to other slums in Nairobi. Even beyond Nairobi, there are many latent voices of young leaders in other areas of Kenya, in other African countries, and beyond. Starting within Nairobi, if similar groups are created in other slums, there will be endless possibilities for collaboration—jamming, learning from each other, mass performances, creating a larger social network/extended family, a bigger social change movement representing the voices of slum dwellers, . . .

Billian Music Family means that musically talented children from Mathare slum can dare to dream. These 30 young musicians are just the start of an empowered, self-reliant generation of socially conscious leaders with roots in the slums. It has the potential to become a powerful movement of creative youth using their talents for positive social change. This young and vibrant force, united in cause, is the start of a cycle of social empowerment of slum communities. 

[i] Kibera UK – The Gap Year Company (2007). Facts and Information about Kibera. Retrieved from http://www.kibera.org.uk/Facts.html
[ii] Amnesty International (2009). Kenya The Unseen Majority: Nairobi’s Two Million Slum Dwellers. Retrieved from http://www.amnesty.org.uk/uploads/documents/doc_19453.pdf
[iii] UN-Habitat (2013). Country Programme Document 2013-2015 Kenya. Retrieved from http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3479
[iv] Amnesty International (2009). Kenya The Unseen Majority: Nairobi’s Two Million Slum Dwellers. Retrieved from http://www.amnesty.org.uk/uploads/documents/doc_19453.pdf