The most recent brigade team at Colomoncagua was certainly cause for great anxiety. It was our inaugural brigade for our new Honduran Brigade Team. Half of the team, Laura and Paul, were in the States for a brief vacation. The brigade itself was completely new to Shoulder to Shoulder, never having visited Honduras as a group in the past. Shoulder to Shoulder has never hosted a brigade in Colomoncagua, this municipality only added to our health care coverage area two months ago. Beyond all this, the brigade members themselves did not comprise a unified group. They consisted of the Maine-Dartmouth Family Medicine Residency, the pharmacy team from Long Island University, a mother daughter mental health team from California, and a nursing student from Bethel College in Indiana. All competent, well-qualified professionals, ready to serve, but unknown to one another in this unfamiliar environment, each must have felt a certain insecurity of how this experiment would turn out. At dinner at the first night, they sat silent, staring at the exotic food on their plates, perhaps escaping deeper into their own heads, focusing on the familiarity of their disciplines, but wondering how they would relate one to another, how would they come together. They were anxious and we were anxious. It seemed someone had dumped the contents of three different jigsaw puzzles on to the table and given us the task of putting all the pieces together into a cohesive whole.
But the first day of our actual clinic work seemed to change this reality, the heavy cloud of anxiety rose and the brightness of common goals of human service and dignity filled the air. A hundred persons waited to be seen at the clinic on that first day. Everyone rushed into action. The nursing crew set up their stations to take vitals. The physicians began seeing the patients, forming opinions, making consultations, and prescribing treatments. The pharmacists set up their medications, and read and filled the prescriptions of the doctors. The professionals assumed their roles with great ease and skill, they appreciated and respected their relationships one with another and the patients, and quality care and compassionate service flowed effortlessly.
By the last clinic day, with over 500 patient visits completed, the dinner table was no longer silent, but laughter, story, and the familiar banter among friends filled the room. A week ago, these people were strangers in a strange land being lead by other strangers to serve the needs of yet others unknown to them. Now they were all colleagues, sharing in common respect for their professional roles. Some of them had even found friendship among one another and among the Hondurans they came to serve. Compassion and service are universal ideals that quickly overcome our insecurities.
It certainly seemed that these puzzle pieces didn’t fit: too many pieces, too many diverse sizes and shapes; too many colors that didn’t blend. But somehow during the course of the week, the pieces found connection. Such a beautiful scene emerged – a harmony of service, commitment, and respect to produce a profound hope for health, well-being, and empowerment.
What does an ancient Chinese game called Tangram, the First Unitarian Church of Rochester, the University of Rochester, and thirty primary school educators have to do with sustainable development in the rural, isolated communities of San Marcos de la Sierra? Everything.
No one knows how many millennia ago the game Tangram was invented. Its genius is its simplicity coupled with its enduring applicability as a paradigm for life and learning. Seven geometric shapes — five isosceles triangles of three distinct sizes, one square, and a rhomboid or a parallelogram — are cut from a large square. Putting them back together is the first challenge. It sounds easy enough, but it is a brain squeezer without a diagram. Even with the diagram, it takes extraordinary concentration. The rebuilding of the square is the first, and simplest, task. There are thousands of geodesic designs of animals, persons, flowers, etc. that can be created by re-arranging the seven pieces. This game, this simplistically profound art form, is being employed as a motivational learning tool in a wide swath of disciplines and enterprises. Primarily, it is being employed as curriculum in primary, secondary, and university level educational institutions.
It teaches plane geometry. At the surface level, this is obviously true. But, subtlety, it teaches so much more. It teaches relational play between logic and creativity. It demonstrates spatial relationships and the use of symbol and design in making connections and communication. It unites logic, mathematics, and art to self-expression and self-understanding. The builder builds and at the same time the builder is built. This all happens on an individual level. When the dynamic of simple design creation is placed into a collaborative, team model, a great deal more is discovered. Some recognize their talents for thinking and problem solving. Others realize gifts for organizational skills. Yet another finds support as a motivator, a team builder. The articulate spokesperson, the story-teller, emerges from the group. As the simple game requires the rearrangement of the seven tiles into a cohesion, so too the players take note of their unique shape and how they fit into the whole. Besides all that, it’s fun.
Or at least I was having fun. I and Laura, about thirty primary school educators, a number of medical residents, doctors, and medical students from the University of Rochester brigade, and three or four translators packed into a small classroom to play Tangram. The First Unitarian Church of Rochester had developed the curriculum to share with the teachers. The church has been developing curriculum, teaching teachers, providing educational materials and supplies, and sponsoring students’ education for many years. The First Unitarian Church, the University of Rochester, and the people and associations in San Jose are all pieces of the Tangram puzzle. In relating one to another, they begin to discover their unique shapes and roles, and how they fit. The design they are creating might be called sustainable development.
As I sat there playing the game, getting to know the teachers, brigade members, and translators, I thought of how utterly different these persons are. Some speak English, some Spanish, and a few both. Their cultures and environments are divergent, almost to the point of being exclusive. They don’t look alike. I doubt that they think alike. They have little by the way of shared references. How do they come together? Isn’t it our sameness, our commonality, that binds us one to another? But then again, a square doesn’t look like a triangle. A rhomboid is after all only a deformed rectangle. But putting these pieces together leads to discovery and creativity. That which didn’t seem to fit, fits extraordinarily. And the discovery of that fit yields harmonious beauty.
The University of Rochester brigade has been in San José, San Marcos de la Sierra, Intibucá, Honduras for the past two weeks. More importantly, they have been there for the past decade. Apart from the medical brigade work that they offer so generously, their development projects are building a Tangram of sustainable development. Micro-financing, micro-business, clean and reliable sources of water, nutrition, health care, and education are a few of the pieces of the Tangram. They bring people and resources to the community of San José who are perhaps of a different shape. But they find a good fit. The people of San José have found their fit as well. Divergent shapes find a unique means to mesh into a creative beauty.
When we build together, we are built. That which we create sustains us and empowers us. We overcome that which impoverishes us. We are enriched by our commitment one to another.
Read more at:
University of Rochester, San José Partners, initiatives: http://www.sanjosepartners.org/who-we-are/initiatives
The First Unitarian Church of Rochester, Honduras Partnership: http://rochesterunitarian.org/ministries/social-justice/honduras-partnership/
Many years ago, I ran cultural exchange programs in Puerto Rico. Carmen Judith Nine Curt, a Puerto Rican educator who specialized in cultural, non-verbal communication, often offered training in cultural differences. One afternoon, I sat next to a team leader. At a particular point in the presentation, he became very emotional and I noticed tears welling in his eyes. After the presentation, I sensitively asked what had caused his sadness. An overwhelming sense of guilt overcame him as Professor Curt explained cultural differences relative to eye contact. In the US, eye contact is valued as a sign of respect or attentiveness. In Puerto Rico, as in many other cultures, direct eye contact between opposite genders is generally understood as suggestive, and between the same genders as a threat. (Non-Verbal Communication in Puerto Rico, Dr. Carmen Judith Nine Curt, May 1984, http://files.eric.ed.gov/fulltext/ED258468.pdf) He recalled his days as a high school teacher. He had disciplined many Puerto Rican girls and boys for not looking him in the eye. He had made them stay after class and forced them to look directly into his eyes. He had unintentionally disrespected them by assuming that his cultural norm was universal. Lesson learned.
Shoulder to Shoulder deeply respects Hondurans and their culture. In many ways we, North Americans from the US, share a great deal with Hondurans: our aspirations for a just society, our desire to assist persons violated by poverty, a hope that our lives are purposely lived, and much more. Still, we look at the world slightly differently, we consider different approaches to problems, and we sometimes misunderstand one another. But, if we are willing to invest in a long-term relationship of working shoulder to shoulder to empower substantive change, we will find common ground, grow in mutual respect, and learn from one another. Relationships among persons from the same culture are difficult. Relationships between cultures are exponentially more difficult. It would be so much easier to simply assess the problem, design the solution, create a budget, send money, and tell the Hondurans what to do. No involvement, no partnership, no commitment to relationship. It is in fact easier, but it doesn’t work. Plenty of organizations have tried this, and still do. Like water poured on a duck’s back, it runs right off. Shoulder to Shoulder has chosen the less traveled path: investment, engagement, and commitment. Not an easy path, but certainly the meaningful one. Shoulder to Shoulder’s Health Care Service Area
I was reflecting on all of this as Laura and I attended the inauguration ceremony of Shoulder to Shoulder’s new Convenio agreement with the Honduran Ministry of Health on Tuesday, April 28th in Camasca. This was an amazing occurrence. Overnight, Shoulder to Shoulder has literally doubled its responsibility in providing health care. Camasca and Colomoncagua are now included in our system, stretching our coverage south of Yamaranguila to the El Salvador border, from 37,000 persons to 69,000 persons. Two major clinics, one in Camasca and one in Colomoncagua, a birthing center in Camasca, and three satellite clinics in Colomoncagua have been assumed in Shoulder to Shoulder’s health system. Four doctors, six health promoters, three professional nurses, two dentists, two lab technicians, and 16 auxiliary nurses have been added to our health personnel. This is a phenomenal expansion. Shoulder to Shoulder is now essentially the exclusive provider of health care in the Frontera of Intibucá. Julio Alberto Vasquez, Mayor of Camasca, Intibuca
“Wow,” I thought as I arrived in Camasca at around 8:45 AM for the inaugural meeting scheduled for 9:00 AM. Laura and I, the Americans, were the only ones there by 9:00 AM. Over the next forty-five minutes a few people stroll in, but the major players, the doctors, the administrators, the mayors, the Ministry of Health personnel, have yet to arrive. I realize that this is how it is done in Honduras. A major meeting scheduled for 9:00 AM will not start prior to 10:30 AM. Though my cultural sensitivities are offended, though I want to scream “What about efficiency, good management, and accountability,” this is useless. If I actually complained, it would be met with expressions of incredulity. If you didn’t want to stand around and wait, why did you come on time? Still, I’m thinking of all the other things I could be doing. This is annoying to me. But, to a Honduran, this is valuable, the way things are done. So, I grin and bear it. As I wait, something else strikes me. As I boil inside and anxiously look around the room, I realize something else. Laura, I, and one other person, Kate, are from the US. Everyone else here is Honduran. Though this was the dream of people from the US, it is being realized by Hondurans. This is empowerment. This is development. This is a shoulder to shoulder enterprise. Officials from the Honduran Ministry of Health
The meeting finally starts sometime shortly after 10:30 AM. The presentations from Shoulder to Shoulder, the local governments, and the Ministry of Health are all celebratory and congratulatory. It emphasizes our capabilities and possibilities all in a positive tone. The questions and comments from the audience express fears and anxieties. There are many challenges of implementation yet to be faced. I guess they will be faced, hammered out, as we walk together on this journey. But I’m not thinking about our celebratory presentations or even the challenges of implementation we’ve yet to face. I’m thinking about how we arrived here at all. I’m thinking about the early years of our journey when US university brigades were the only health care in this huge swath of territory. There were no systems of health care save for a couple of gringo doctors and nurses who visited isolated towns without roads, electricity, or water. What tremendous cultural challenges they must have faced? I imagine them holding a community meeting with locals. The Hondurans arrive two hours after the scheduled time. Maybe those brigades felt frustration and anger. Maybe they chastised the people. Maybe they managed to hold their breath. Whatever it was, however great the cultural discord, they must have managed to stay the course, move beyond the cultural distance, and form relationships of mutual respect and empowerment. They must have shared their dreams, because these dreams are realized today among competent Honduran professionals. The shoulder to shoulder commitment today sustains a system of service and development anchored among the people of southern Intibucá. Dr. Jessica Aleman, Shoulder to Shoulder’s Health Network Coordinator
Convenio, not easily translated into English, is derived from Latin and means to come together. The word Covenant is a derivation. Covenant is much more than a contract. A covenant implies not only the commitment of a task or property, but the willingness to give oneself over. This means challenge and personal transformation. It involves risk, it is difficult, and most of us will avoid this level of commitment. When divergent cultures are involved, it is wrenching. Why would anyone enter into a covenant relationship? Because it is the only way to effect substantive and meaningful change. New convenios found in honest cultural exchange await as we journey shoulder to shoulder.
The most recent brigade team at Colomoncagua was certainly cause for great anxiety. It was our inaugural brigade for our new Honduran Brigade Team. Half of the team, Laura and Paul, were in the States for a brief vacation. The brigade itself was completely new to Shoulder to Shoulder, never having visited Honduras as a group in the past. Shoulder to Shoulder has never hosted a brigade in Colomoncagua, this municipality only added to our health care coverage area two months ago. Beyond all this, the brigade members themselves did not comprise a unified group. They consisted of the Maine-Dartmouth Family Medicine Residency, the pharmacy team from Long Island University, a mother daughter mental health team from California, and a nursing student from Bethel College in Indiana. All competent, well-qualified professionals, ready to serve, but unknown to one another in this unfamiliar environment, each must have felt a certain insecurity of how this experiment would turn out. At dinner at the first night, they sat silent, staring at the exotic food on their plates, perhaps escaping deeper into their own heads, focusing on the familiarity of their disciplines, but wondering how they would relate one to another, how would they come together. They were anxious and we were anxious. It seemed someone had dumped the contents of three different jigsaw puzzles on to the table and given us the task of putting all the pieces together into a cohesive whole.
