Concern America

Transforming Need Into Self-Sufficiency

Concern America is a globally focused community development organization that provides long-term solutions to support economically impoverished communities throughout the world. Recognizing that lasting transformation begins by engaging communities in the solutions to their problems, Concern America's training of community members in health, sanitation, and income-generation builds upon their own knowledge and experiences so that the villagers themselves become their own health care providers, water system builders, and cooperative members. Since its establishment in 1972, the organization has worked in fifteen countries on four continents, making a measurable difference in the lives of more than two million people in thousands of communities. Currently, Concern America supports community development programs in Colombia, Guatemala, and Mexico. All field programs are managed by teams of professionals who serve as non-salaried personnel. These Field Team Members give a minimum of two years of service, yet as a result of the quality of the programs and the intent of the organization, the average Field Team Member serves for five years. A significant difference to other groups working in international health is that Concern America's health professionals do not directly see patients, but train and entrust local people to become their own health care providers. The focus is not specifically on providing health care, but instead, the building of local capacity and community members who are able to provide these services themselves.

While there are other organizations that train health promoters, they are usually community educators who promote wellness and health education. health promoter practitioners, however, are trained to be a community's primarily health care provider, attending to 80% of primary health care issues that includes identifying and diagnosing illnesses, providing the correct treatments, and performing basic surgeries. Concern America's practitioner model offers a way forward that is not dependent on the presence of a medical doctor for primary health care. The long-term presence and accompaniment provided in the programs allows community members the depth of training and understanding needed to provide advanced, quality care.

By training community members in health care, clean water, cooperative models, and as leaders, Concern America ensures that the skills and knowledge are built within the community so that they themselves are able to meet their needs, leading to a lasting impact in the region. Because of Concern America’s training of community health care providers, clean water providers, teachers, artisan cooperatives, and other community leaders, about 255,000 people now have access to these life-saving and sustaining services, all in their own communities.

Concern America’s impact is measured by the availability of quality health care services in regions previously without such services as well as the emergence of local leaders within the program. Specifically, the program measures the skills of health promoter practitioners through their courses, their abilities to diagnose and treat patients in their villages, and decreases in diseases and increases in the health and well-being of community members, as evidenced by clinic logs and community visits. Additionally, local leaders assume roles carried out by program staff to build towards a sustainable local health care program. Now, local practitioners are leading program activities, managing the clinic, accounting, budgets, reporting, and even traveling to other programs to lead trainings there.

Build Community Capacity to Provide Primary Health Care - Concern America brings health care to impoverished regions by training community members as their own health care providers, known as health promoter practitioners. Developed over the past 25 years and recognized by Buckminster Fuller Institute, Conrad N. Hilton Foundation, among others, this model is unparalleled in its quality of instruction and accessibility to individuals with little formal education. In addition to coursework, hands-on training includes extensive field practice in the programs’ teaching clinics and during community visits. Practitioners are trained with a depth of knowledge, skills, and ability to provide health care, in their native languages, comparable to that of nurse practitioners and physician assistants in the U.S. Their skills include minor surgeries, palliative care, complicated deliveries, orthopedics, trauma management, diabetes control and treatment, and managing psychiatric conditions. Concern America’s integrated approach to health care also includes midwives, as well as environmental health efforts, including the development of potable water sources and healthy and fuel-efficient stoves.

Build Community Leadership Capacity - Concern America works to develop long-term health care solutions by building and strengthening local capacity. The building of community-based organizations, run by the local community health workers, provides these local leaders with the ability and confidence to lead health activities, coordinate with organizations and government agencies, and have an impact on health services and interventions in their region. By leading health courses, the teaching clinics, environmental health projects, and much more, local leaders have already assumed most of the responsibilities previously carried out by Concern America’s international field personnel. Local Guatemalan team members even travel to Colombia for extended periods and provide essential training to Concern America’s Colombian practitioners. This true south-south collaboration promotes the importance of local leadership and empowers other practitioners to take on these roles to improve health care, clean water, and education, solutions in their communities.

Integrated Development - Concern America utilizes transformational pedagogy to build community capacity in order to teach health care, water and environmental health, and education and cooperative efforts. By using popular education materials and activities that train community members, Concern America strengthens community-based development and empowers local leaders, many with very limited literacy skills, to continue to improve their communities. As Concern America's Appropriate Technology Team in Chiapas, Mexico, describes: "It's not about just creating a water system; it's everything else that happens in the process. It's an opportunity to dialogue about the environment where we live, the implications that our environment has on our health, and how we can care for our environment.” Most notably, Concern America’s newly published health practitioner manuals make possible the expansion of the health promoter practitioner model. A resource for both trainers and practitioners, the manuals expand the understanding and possibilities of the high level of care provided by community members, previously without opportunities for formal education.

Concern America is based in Santa Ana, California, and focuses its work in Latin America, including:

Chiapas, Mexico –Chiapas is one of the poorest states in Mexico, and actual statistics on rural poverty there are bleak: thirty percent illiteracy (more than two and one-half times the national average), more than half the population has no running water, and more than one-third of the population has no electricity (although the state's hydroelectric systems generate over 60% of the nation's electricity). Moreover, Chiapas has a very significant indigenous population, and like other parts of Mexico and the world, indigenous groups are even more marginalized. Recently, the region has seen a sharp increase in violence due to the presence of organized crime organizations and government corruption.

San Miguel de Allende, Mexico- Communities around San Miguel de Allende face serious economic, health, and social challenges, with lower education levels and increased rates of illnesses compared to Mexico’s national averages. Poverty-level incomes, lack of potable water, and diets of processed foods further exacerbate health in the region. Additionally, high levels of migration have left many towns to be largely made up of women and children.

Petén, Guatemala - The northern Petén region is made up of smaller communities, many of whom were formed by refugees who reentered the country after its 36-year civil war ended. 57% of all Guatemalans live below the poverty line and 27% endure extreme poverty. These figures are even more drastic among indigenous populations with 87% living below the poverty line, and 61% suffering extreme poverty. Guatemala ranks as the Central American nation with the highest infant and child mortality rates, the lowest life expectancy, the most malnourished population, and the lowest level of public health expenditures, all of which are more severe in the remote region of Petén.

Chocó, Colombia - The department of Chocó is one of the poorest and isolated regions in Colombia, combined with one of the largest populations of displaced peoples in the country, and most communities are only accessible by boat or jungle path. In Chocó, 64% of the population live below the poverty line and 33% live in extreme poverty (compared to Colombia’s national average of 34% below the poverty line and 10% living in extreme poverty). In the isolated, war-torn region, the majority of the population is indigenous and Afro-Colombian and communities are continually caught between and severely affected by the armed factions operating there.

I can still remember, over two decades past, the image of the young group of new Health Promoter Practitioner candidates in Guatemala from the recently formed, returned refugee community of Nuevo Amanecer (New Dawn). The families had escaped the violence in Guatemala and fled to Mexico, returning to a new home a decade and a half later with the signing of the peace accords. Silvestre, at only 18 years old, was chosen by his community to be one of his village's health care providers. Like his fellow recruits, having grown up with paved roads passing by his refugee camp in Mexico, Silvestre seemed to be in shock at having to walk hours through the jungle mud of Petén to reach the main, unpaved road where he would catch a ride in the back of a pick-up truck to begin his health studies with Concern America.

Almost two decades later, Silvestre is one of the leaders on the Guatemala team as an advanced Health Promoter Practitioner, co-leader of the program's Environmental Health team, and member of the Spoonmakers of Petén spoon carving cooperative. When his fellow villagers chose him to study all those years past, they must have known that he was the kind of person who has a heart for community, for serving others, and for rebuilding his country. They were right. What follows is an excerpt from Silvestre’s latest field report about a water system he and the Environmental Health team just built in the community of Belén. I find myself regularly returning to his report; his words beautifully describe the work of Concern America:
 
"Every day was difficult. People had to carry all the materials a distance of about 200 meters, and because the hill they chose for the tanks was the highest one in the community, the whole route was almost vertical. We always tried to do the difficult work in the morning as it was not as hot and did not have as much sun. No matter what, it was tiring. Each person would spend at least half an hour to climb with the load of materials. We talked about how organizing this way was the best thing for their families and that they would be able to say how they participated in the construction. Each
day, between 8 and 12 people would come to help. At several moments during our work, people would tell us how this was the first time that they had worked in this way. It was not just the building of the tanks, but the beautiful way in which people were organizing as a community."