The True Meaning of Service

I came across a memo from the Heritage Foundation entitled “How Americans Can Provide Real Public Service.” The memo agrees with Obama’s proposals to expand service programs such as AmeriCorps and Peace Corps except the following key differences:

1. They encourage the wrong motivations for volunteering;
2. They confuse government work with public service; and
3. By centralizing control, they reduce the individual and community empowerment that fosters public spiritedness.

I completely disagree with this characterization of service as it perpetuates a romanticized version of Adam Smith’s invisible hand of charity.

1. The author assumes that financial incentive is the only reason why people participate in government service programs. From my personal experience and from others I have met who have participated in these programs, I would have to strongly disagree. The money that AmeriCorps and Peace Corps members receive is technically not considered an income but rather a living stipend. Without this stipend, Corps members would not have the time and resources to fully devote their time to improving the communities that they are serving in. Furthermore, it is faulty logic to assume that altruistic motivation is a necessary quality to volunteer and that financial incentive either eliminates or repels altruistic motivations.

If the author of the memo had read some of the research done regarding the impact of AmeriCorps, he would have seen that the majority of AmeriCorps members increase volunteering the communities they serve in and continue to volunteer after their term of service and often enter into public service and similarly related careers. If that is not an increase in volunteering, they I do not know what you would call it.

2. It is a tragedy that hundreds people are turned away due to lack of funding. This rate of refusal is not an indication that members work for bureaucracies but rather the type of relationship that AmeriCorps members have with the community they serve is not directly exchangable through weekend volunteering. Once again, this is a question of committment, particularly in the case of AmeriCorps VISTA members who are assigned to a specific organization to build capacity within the organization to better serve the community. While short-term volunteering opportunities such as helping in food banks and mentoring children are needed and essential, some of the long-term activities that AmeriCorps members do are not and can not be done in a part-time capacity. Nonprofit organizations may lack the funding, expertise or manpower to complete these activities which are vital to the survival and improvement of the organization. AmeriCorps members help to meet these needs of the organizations that participate.

3. Expansion of service programs will meet the needs of organizations and communities that are currently slipping through the cracks. This expansion is not an intrusion but rather a way of coordinating matches between the needs of organizations and the interests of volunteers. Participation on the organizations’ part has and will remain voluntary. AmeriCorps members will learn to adapt their approach to the needs and ways of the communities that they serve in. It seems to be a rather extreme approach to assume that the ability of a community to better themselves is compromised or even eliminated due to the addition of a so-called “inhabitant.”

AmeriCorps members are not puppets for the federal government to make them do as it pleases. I would think that someone who had faith in “the civic force that is the American citizen” would have enough faith to see that people wanting to serve would put the community’s best interests before their own or anyone else’s.

News about mobile phones and public health and safety

I have come across quite a few great applications of mobile phones and technology in the public health and safety that would be nice to share.

1) Promoting HIV awareness through soap opera vignettes

A campaign developed at Rutgers University’s School of Nursing has produced a series of soap opera vignettes that demonstrate safer sex and proper condom use. Researchers believe that mobile phones provide an ideal delivery system because they allow women privacy and multiple viewings. I think that the ease of propagating this campaign by word of mouth through forwarding will allow it to have a larger impact.

Hat tip: @DigiActive on Twitter and on the Web

2) Protecting public safety at NFL games

The NFL has started a new service that will allow fans to text information about public disputes and disturbances in games so that they can be dispelled before escalating. Allison Fine at the Social Citizens blog speculates about future uses in creating safer communities by allowing citizens to safely report dangerous activities. While safe whistleblowing may open channels of communication somewhat, I think there is still a great deal of work to be done in increasing trust in and respect of authority if this were applied in the community context.

Hat tip: @socialcitizen on Twitter

3) Promoting adherence to DOTS, treatment for tuberculosis

Companies have finally started to realize the need for actively promoting adherence to DOTS, or directly observed treatment, short course, the recommended treatment for tuberculosis. DOTS requires that a health care worker directly supervise a patient that the drugs to treat the tuberculosis. However, due to a number of factors including a health care worker shortage and insufficient funds, this is not possible in many developing countries. Companies are working to increase access to mobile phones so that patients may receive text reminders to take medication.

Read The Lancet for more information.

4) Monitoring child growth and nutritional status in Malawi

Columbia University and UNICEF are the winners of the U.S. Agency for International Development’s Development 2.0 Challenge. Their project will establish a “RapidSMS” system that will allow health care workers to use basic mobile phones to share information about child growth and nutritional status in Malawi. This will be an interesting one to watch to see if they can scale it to other countries and other populations. The dearth of current statistical health information of many developing countries, particularly in Africa, makes measuring success difficult and distributing much needed resources properly impossible.

Social movements 2.0

flickr photo courtesy of racoles

The jury is still out on the potential that social media has to facilitate social change. I would argue its widespread prevalence is a major shift in itself at least in person-to-person interaction. I wondered what the world would look like if all of these individual interactions coordinated as a major social movement, linking online and offline activity.

The old way that social movements used to progress: emerge–>coalesce–>bureaucratize–>outcome–>decline

Social media definitely has the possibility to revolutionize this progression, making participation more democratic. I think the new movements start globally and move locally rather than the opposite in the past. There are countless wonderful posts describing what social media does best, so there is no need for me to reinvent the wheel. Here’s what I see as some of the defining characteristics of social media’s effect on social movements.

1) Linkages between offline and online activity are essential.

Armchair activism will not lead to substantive, sustainable change. The danger in social media is that people can mistake these tools as an end, rather than a means to an end. Rather than eliminating face-to-face interaction, social media enables and facilitates communities united behind that may not have otherwise formed, or may have been weaker for lack of social media.

• Meetup can help coordinate those initial meetings to formulate an action plan or plan events to gain more supporters in a given locality.
• If your cause starts after a physical meeting, keep in touch by creating your own online social network with Ning and create an online hub to recruit supporters and share news and insights.
• If your supporters are not all in the same city, which of course is virtually every online community, dopplr will allow you to let people know when you are in town.
• Don’t forget that call to action while you are online; Social Action’s newest product, the DonorsChoose plugin, allows you to have suggested steps for action alongside your WordPress blog post.

2) Technology facilitates social change by reducing costs of resource mobilization.

Resource mobilization is what allows your newly formed group of supporters to organize your actions into a single coherent message targeted to the individuals and institutions that you are hoping to influence. Usually people think of money, when they see resources but there are a number of other resources related to significant actions including recruitment, advocacy, raising awareness, communication and publicity. One of the best things that social media does is reducing the monetary costs, given that many of the services are free. It also saves resource-poor groups and organizations from things like high printing costs.

• Need to find a expert and/or mentor? LinkedIn connects professionals worldwide and may help find your cause’s version of a celebrity advocate.
• Online fundraising? Awareness raising? Showing off your online networking profiles? Sprout allows you to build mini-sites, widgets, etc. to embed on you Web site, blog and several popular social networking sites.
• Social networks for change such as Care2, change.org, and TakingITGlobal allow people around the world to find out about your cause. Social Actions aggregates several of these platforms together, making it easy for organizations to publicize their causes and calls to action.

3) Supporters have the ability to tell and publicize their cause’s stories, needs, and goals.

Mainstream media in the past presented a tough barrier to getting the word about your cause. Organizations usually had to relay on time-intensive means of publicity like word-of-mouth, which could be slow and impractical. Social media lowers the previously high bar to awareness raising, allowing you to tell and show the emotional side of your cause in words through blogs, audio, photos, and videos. Once your supporters are emotionally engaged, they will be more likely to become more involved in advancing the cause.

• Microblogging through Twitter gives you 140 characters to talk about anything and aids in community building. Tumblr provides the sense of Twitter with the look of a blogging interface. Posterous is like blogging for dummies, allowing you to email your entries.
• Got podcasts? Make sure to submit them to podcast search engines like the iTunes directory so the public can hear about your cause. If you want to capture insights immediately auditorially, use your mobile phone to record and publish with Utterz so people can hear what you hear.
• For those visual learners, photo and video sharing sites can show the impact of your cause in living color. With Flickr, you can share photos; YouTube and Vimeo both facilitate video sharing.

4) Social media enables greater transparency into the political process.

I wouldn’t characterize any government as being open and transparent, but there are some changes afoot that allow you a peek into the inner works of the federal government. Transparency of the political process, or at least substantial knowledge of the process, is key to help secure lasting change related to your cause. I feel that my year living in DC with several friends working on the Hill was a crash course on how the government works on a daily basis. For those who have not had this privilege, you can check out a few of the resources below.

• Social Butterfly aka Alexandra Rampy created a wonderful list of government agencies and legislators active on Twitter. Hopefully this list will grow even longer in the future. You can also check out the list of blogs and podcasts that the federal government produces.
• Learn from other activists who have worked in public policy and politics by reading wikis. Wikipedia is of course very popular, but PBWiki and Squidoo are good resources to look at as well. If it is not there yet, you can help build it!
• Along with wikis, presentations provide a resource about tips related to advocacy. SlideShare is one of the most popular sites to share presentations.

A front row seat to community mobilization

There have been major things happening at work that I have not had the opportunity to write about due to the need to act first and think later. The clinic that I work at has found themselves in the middle of a political battle not of their making that threatened both my supervisor’s job as head of the clinic and the continued existence of the clinic for people living with HIV.

How An Internal Personnel Conflict Became a Municipal Problem

Most workplaces have at least one person that seems to cause more problems than most; the clinic that I work at is no exception. Both the staff and the patients do not like Dr. Ruiz. She has managed to be manipulative, verbally abusive, incompetent and otherwise a horrible person as she lies, cheats and steals her way to getting what she wants.

She precipitated this situation with a denunciation against my supervisor saying that he mistreated the staff and patients and that she was the only doctor who worked. This denunciation arrived on the desk of the municipal Secretary of Health Dr. Jaime Henen who in turn involved the Director of Management of the centros de salud Dr. Martin Silberman. The denunciation supposedly included the signatures of 15 of the clinic’s patients. To date, the only people who have read the denunciation are Ruiz, Silberman, and Henen.

Two weeks ago, the entire staff met with Silberman and Henen to discuss the allegations. Dr. Ruiz took that opportunity to continue lying about her work at the clinic. The rest of the staff shared a number of stories about her propensity verbally castigate the staff and her unethical dealings with patients. Henen and Silberman left the meeting saying that they would think about the next steps to take and would return the following Monday to inform everyone of their decision. The staff was confident that the authorities would remove Dr. Ruiz from her position. Dr. Ruiz took the one week delay to mean that she could yell at patients in the waiting room and continue to spread rumors about the staff.

How That Municipal Problem Became A Political Cover

Henen and Silberman returned to the clinic last week on Monday to deliver their decision. Dr. Ruiz would keep her job at the clinic. They announced plans to create a new position to coordinate the municipal program for HIV/AIDS and they intended my supervisor to take the raise. In reality, there is no municipal program for HIV/AIDS as most programming is run through conventions and medical protocol. To replace my supervisor as the head of the clinic, they wanted to bring in a new head of the clinic from outside rather than hiring one of the doctors on staff. Furthermore, the authorities announced plans to bring in other specialties such as pediatrics and vaccination into the center.

The decision that the authorities made was shocking on several levels. Doctors had presented evidence that her actions were at least unethical, at most illegal. Henen and Silberman feared exposure in the media by Dr. Ruiz. The raise offered to my supervisor was a back-handed way to fire him from a position that he has had for 22 years. The raise also presented an opportunity to sideline my supervisor for the now apparent purpose of the authorities’ involvement. The clinic is located in the middle of the city and they want to take advantage of the central location for “normal” patients. Offering yet another location for vaccination in a neighborhood that has two locations within walking distance permits the appearance of action against the rise in infant mortality observed since this administration took office.

How Patients Fought the Political Decision

After the shock of the blatant political decision wore off, the staff began to formulate a plan to use the media to pressure Henen and Silberman to rethink their decision. The patients, now involved in the conflict and their own health at stake with the recent decision, also started asked for ways that they could fight. By the end of Tuesday, patients had begun collecting phone numbers and sending text messages. A small core group cam together to draft a statement of support addressed to Henen and collected signatures from other patients.

On Thursday, patients gave interviews with the three major newspapers of La Plata and the stories came out last Friday. One of the local television stations came to the clinic to speak with them and the report was broadcast on Thursday night.  One of the patients did a radio interview with Henen. They also organized the meeting with Henen today at the municipal office for the Secretary of Health. They also gave interviews with Radio Provincia and other news media today. Their efforts resulted in over 100 signatures in support for the center continuing in its present state without the intervention of the authorities.

Their impassioned discussion during this morning’s meeting did not seem to emotionally affect Henen and the two other directors who briefly attended the meeting. Although in many ways Argentina’s approach to HIV/AIDS is more advanced than other countries such as Mozambique, the perception still exists that people living with HIV passively accept challenges to their quality of life. However, I do think that the organized effort and strong, emotional defense caught them by surprise. Previously, Henen and Silberman showed no inclination for negotiation, but today Silberman came and promised one concession. My supervisor will continue as chief of the center, but they still want to bring in the other specialties.

Next Steps

Tomorrow, patients and their families, staff and I are going to the Consejo Deliberante, which is the municipal legislative body. Involving the legislature is an important step for several reasons. The most important is that Argentina’s Constitution protects the right to health in general, and there are laws from the national level to municipal ordinances that legally obligate legislators and politicians to provide services for people living with HIV. This attempt to marginalize the services offered by the clinic violates a number of these legal protections. Allowing additional opportunities for patients to advocate for the center provides invaluable skills; Silberman agreed to the creation of an advisory body of patients for future decisions and programs. Presenting the case before the Consejo will also help to solidify the new arrangements.

This intersection of health, politics, and human rights has been interesting to explore through experience rather than through studies.  It has shown me that I am more than unwilling to sit on the sidelines. I have actively taken part in meetings, helped to write declarations and wished that I could do more to protect this clinic which has been a large part of the lives of so many for years. It is hard not to take the words and actions of these politicians personally as they have shown no desire to learn about the work or the patients who frequent the clinics. I find that the anger combined with the desire and ability to act does have concrete and substantive results which might be most valuable lesson to learn from this situation.