When I talked about building a child empowerment framework previously, I highlighted the effectiveness of our Casa Girasoles model. Health Bridges International’s (HBI) models work best with empowered people taking on the adaptation, sustenance, and improvement of the program. But empowerment work is full of sobering challenges, which is why our work requires flexibility and long-game commitment, as seen in our experience with the Ines Project for medically fragile children.
The Ines Project serves families living in poverty with children experiencing complex medical conditions. With our partners (local pharmacies, volunteer health professionals, nonprofits such as Direct Relief, and faith-based organizations such Caritas) we create a comprehensive care plan for the well-being of the medically-fragile child. The plan assigns a healthcare team – including a community-based health ambassador, a nurse care coordinator, and physician-in-charge of the project – to work with the family to (1) improve the health of the child and (2) empower the family with the knowledge and skills to self-advocate and navigate Perú’s health systems. Upon graduation, families can independently care for their child, determine their needs, and successfully connect with appropriate healthcare services.
The Ines Project has helped over 150 children and their families, but it is one of HBI’s programs pivoting to better align with our new strategy and focus. Complex problems require comprehensive solutions, and we’re ready to do what it takes to serve the most vulnerable children in Perú.
Elizabeth’s Story: Resilience & Hope
Elizabeth* is one of the strongest survivors I know. At 24, she had a complicated pregnancy with her third child and was advised to seek specialized medical support. She left her small town in the mountains, only to find that the nearest hospitals lacked the right specialists and equipment. She gave birth prematurely and her baby was diagnosed with glucose regulation metabolic disorder, a rare, inborn complication that causes weak muscular development and failure to thrive. Her quick-thinking doctors worked with a local politician to transport Elizabeth to a third hospital in Lima, where her baby received life-saving support. However, without access to medical specialists, the child was held for observation for a month then discharged with a general care plan that wasn't sufficient to meet the child's complex healthcare needs.
Elizabeth had no family or friends in Lima, but she was able to rent a small hut atop a motor shop by working informally as a clothes cleaner for her neighbors or by selling food on the streets. She was earning less than S/10 soles (approximately $2.50) a day, same as most families in the Ines Project. Elizabeth’s situation was not only challenging and isolating – it was dehumanizing. Although Elizabeth was working tirelessly to support herself and her children, she couldn’t meet all the demands. Eventually, her efforts to find the best care possible for her child, while simultaneously balancing childcare and work, brought her to the attention of an HBI Ines Project Health Ambassador, and she enrolled in the program soon after.
Our first step through the Ines Project was to assure Elizabeth that she was neither forgotten nor alone – she had a whole team helping her form and implement a clear medical plan of action. Together, they sourced medication, identified nearby medical specialists, and determined that she would relocate to Lima. Secondly, the team encouraged Elizabeth’s innate self-advocacy skills by teaching her how to talk to healthcare providers and request for her child’s needs. We connected her to a CESAL, a Spanish NGO through which she accessed mental health assessments and therapy, continuously engaged her in trauma-informed conversations, and supported her transportation, medical, nutritional, and financial needs. The Ines Project even worked with the Peruvian Ministry of Health to approve the importation of medicine her child needed and partnered with a US-based pediatric endocrinologist for more support.
As she spent more time in the program, Elizabeth revealed a background of deep trauma and abuse, and as a result, would abruptly leave and rejoin the program. It disrupted her progress towards graduation. Her deep lack of trust only worsened when her husband left her: he refused to move to Lima, sent their two older children to her, and stopped all communication. Elizabeth’s story demonstrates that people experiencing poverty are fighting deep personal, mental, and socio-economic challenges that cannot be solved just by pooling resources or connecting them with the right medical specialists. There needs to be systems-level change to offer people like Elizabeth - whose children need her more than ever - a stronger safety net.
Why EIizabeth’s story matters
While the Ines Project met the medical needs of the child, it could not erase the effects of trauma, abuse, and poverty on their mother. There is much more work to be done to ensure families like Elizabeth’s attain true empowerment and sustainability. We have seen that without systems-level safety nets or a wider variety of social service partners working with families to address their socio-emotional and economic challenges, their progress in the Ines Project (or any program, for that matter) will not substantially change their quality of life. Our plan now is to shift the Ines Project’s scope to ultimately prevent highly vulnerable children from entering child welfare programs.
Today, Elizabeth is still working closely with our team to graduate from the Ines Project by December 2021. Graduating means finding financial stability and permanent housing, independently connecting with community and public services, and doing so with confidence. We will keep learning from families like Elizabeth’s and helping them every step of the way. Even if it means that our programs have to evolve, we are determined to build a future where mothers like her can sustainably advocate for their children.
Mothers like Elizabeth need your support. Will you join our team in helping them in their journey to care for their vulnerable children and become stronger advocates for their families? Please consider making a donation. Thank you!
*Name changed to maintain privacy
The HBI Blog is a rotating journal from our staff. Our Blog is a series of messages from the field, insights from our work, and lessons in service.