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Making Change: A Conversation with Dr. Maria Compte

July 23, 2006

By Linda Lopez

Some of MCA-I NY’s film festival supporters have careers that routinely bring them up close and personal with issues most of us only see on film or read in the news. Maria Emilia Compte, MD, MPH&TM, the vice-president for programs at Intermed International, talked with me about her work on behalf of communities in the developing world.

FOCUS: Dr. Compte, I know you work closely with the populations we have learned so much about through the film festival. Would you tell us about what you do?

DR. COMPTE: Linda, let me first say that it is a privilege to be with you and with FOCUS on New York Media’s readers. Very specially, allow me to congratulate you and the MCAI-NY team for taking the initiative to organize the Stories from the Field Film Festival for a second year now.

It is a cliché but also a reality that today we inhabit a much more globalized, interconnected planet than was the case only 30 or 40 years ago. The tragedies of far away peoples greet our days with each morning newspaper, Dr. C w/graduating midwifeor accompany our dinner table from the TV screens. Disease, suffering and injustices have been with humankind since time immemorial, it’s just that, thanks to the incredibly efficient communication networks we have today, people everywhere are becoming more aware of them. This is a good thing, depressing as some of this news may be. But when a mom in Omaha buys her 9 year-old son a soccer ball, it is good that she learns that there are good chances that that ball was stitched together by another 9 or 11 year old boy in India or Honduras, a child who is likely malnourished, not attending school, and who will never have the time, or the money, to kick around a ball like the one he produced for the equivalent of 75 cents a day.

It is this increasing public awareness, made possible through concerned Nicaraguamedia professionals like those in MCAI-NY, that is invaluable for people like me and my colleagues in the frontlines of fighting disease, poverty, and ignorance. Humans are relational beings, and the more people in economically-advanced societies feel that there is some kind of connection, at a personal level, with what other people do, or how other people live their lives, it arouses their interest and motivates them to take some action to alleviate the situation.

F: It’s true. Even we are learning just how powerful films can be in communicating with and about our world; they’re like campfires for the modern age. What is your role in this particular story?

Dr. C: Well, I wear many hats but the core of my duties as vice president for program management at Intermed International is simply to give people living in some of the poorest regions of the planet a chance for advancing their own health and education, and lifting themselves out of abject poverty.

We are a small, independent non-governmental organization that has been around for 45-plus years now. In my case I’ve been involved in direct medical and public health initiatives in developing countries for the past 22 years, mostly in Latin America. I have worked with marginalized urban and periurban populations in Argentina, and with rural and indigenous people in Honduras and Nicaragua, and most recently in Laos and Thailand.

F: What are some of the projects you have worked on in Latin America.

Dr. C w/KlisnakDr. C: For the last 17 years we have had different projects with Miskito and Mayagna Indian communities living on the banks of the Coco River, on the Nicaragua-Honduras border. This is one of the most remote and disenfranchised regions in Central America, which is to say a lot. People typically live in wooden huts arranged in small clusters along the Coco or a few other rivers; there are only a couple of basic health facilities in the main town, which is hours to days away from most settlements. So people just make do with whatever “healthcare” is locally available, typically “sukias” (witchdoctors) or “curanderos” (herbalists). No wonder infant, child, and maternal mortality are among the highest in Central America.

Our current program there is based on interventions that help mothers take better care of their own health and that of their children and families, since they can’t really rely on the government or any other institution to provide services on a regular basis. We are working with the local people in the villages training their traditional healers, especially midwives and health promoters, as well as the mothers and caregivers themselves.

F: And you say that recently you have been working in Southeast Asia. Please tell us more about those projects.

Dr. C: Historically most of Intermed’s projects have been in Asia, and there we are currently working in Laos, Burma and Thailand. In Laos and to a lesser extent in Burma we have blindness prevention and vision restoration projects. Asia has the highest number of cases of avoidable blindness in the world, mostly due to cataracts, and now there are new simplified surgical techniques that allow doctors to replace the diseased natural lens with an intraocular plastic one in 12 minutes without the need for sutures.

A few months ago I had the chance to join a field cataract campaign invited by our partner in Laos, Dr. Vithoune Vissonavong, the director of the Eye Institute. We traveled up and down the length of Xayabouri Province, and in five Cataract patientdays four eye surgeons were able to restore the sight of nearly 400 people. It was an amazing accomplishment.

In northern Thailand we have a partnership with a very experienced Lao-Thai social worker who runs a microenterprise which trains village women in handicraft production so that they can support themselves and their families, working from their homes, producing beautiful textiles and other products for the tourism industry. Considering how serious the problem of prostitution and “sex-tourism” is in Thailand, and the related scourges of human trafficking, indentured sex labor, and HIV/AIDS, projects like this give poor young Thai and Lao women a safe, dignified option to lift themselves out of poverty.

F: Speaking of the sex tourism in Thailand, does AIDS pose a significant challenge among the rural populations you work with, or is it largely confined to the cities?

Dr. C: It really depends on the individual country. Typically an HIV epidemic begins in cities and later spreads to the countryside, so as a rule, the more “mature” the epidemic is in a country, the more likely is that rural populations are affected. This depends both on the extent of the urban epidemic and also on how much interaction there is between urban and rural populations.

In India for instance you can easily track the spread of the epidemic over rural areas literally by looking at the road map. This is because the virus circulates mostly between truck drivers and prostitutes. The trucker typically gets infected in a major city and in his subsequent trips spreads the infection to prostitutes along his route, as well as to his wife or girlfriend back home.

Specifically, in the case of Thailand, they had a very serious situation in the 1990s centered mostly on the sex industry. They have been able to control it to a reasonable extent, but the epidemic is far from over, and there are signs that prevention efforts are waning, mainly due to a drop in condom use among high risk groups.

The most tragic fact in rural areas everywhere is that, because of the inadequate or absent health services, in most cases we don’t even know what the HIV situation is until people begin to die. Prevention is of utmost importance in controlling the spread of AIDS. In rural Nicaragua, where there have still been only a handful of cases, we just finished a training workshop on HIV/AIDS for village health care providers; we also started to offer counseling and testing to people that might be at risk.

F: Most of your projects seem to be focused in rural areas. How do the rural populations compare generally with urban ones in those countries, in terms of being underserved?

Dr. C: That is where the need is greatest because health care delivery to impoverished, dispersed rural populations is usually very challenging and few organizations are willing to tackle it on a serious, on-going basis. People live far away Wiswis midwifefrom each other, scattered in difficult-to-access areas, so the ratio of expenditures per beneficiary is very high. It’s not what a cost-benefit analyst would consider “an efficient project” by any means. Plus there are no tsunamis or other “charismatic” disasters hitting the news and helping raise significant funds to support projects like these, so a lot of agencies shy away from them.

Still, these are the people that quietly struggle for a life, quietly ail, and quietly die in two-thirds of our world today. Which takes me back to the importance of initiatives like the Stories from the Field Film Festival that show the public the “quiet” side of life – and death – in distant places, and what is being done to effect positive change.

F: One challenge we in the developed world face – including those of us who are working to see the Millennium Development Goals become a reality – is how to keep caring people engaged. In the face of so much need, it’s easy to slip into emotional burnout; how do you keep your own commitment alive after so many years?

Dr. C: Yes, these are certainly two challenges that we face. Regarding maintaining the public’s interest, one way, as I mentioned before, is to show how the increasing interconnection between the developed and the developing worlds can affect us in some of the most unexpected ways.

A few years ago the bride, the groom, and dozens of guests at a wedding reception in Pennsylvania became sick with gastrointestinal disease. The culprit was found to be a rare parasite called cyclospora, which contaminated raspberries used in the wedding cake. The raspberries had been imported from Guatemala, where they had been handpicked by Indian peasants working in very unhygienic conditions, without even basic latrines or hand-washing facilities. This is just one example of how improving conditions for people living in places that are seemingly so remote can have a direct impact on our own health.

As for what I myself do about job burnout, well, I have learned, over the years, if not to avoid it altogether, at least to manage it. It has been a process, but for me the key has been learning to be humble in my expectations. Lasting change in the developing world typically happens slowly and incrementally and must involve the local people from the start. One should always bear in mind that at the most we are only catalysts, facilitators for change, but it is the local people who actually have the right and responsibility of improving their own lives.

Allow me to finish with a personal story. When I first went to work in the Coco River region, Juana Castellon, one of my four nurses’ aids – my full staff at that little wooden hospital – had a 9-year-old daughter named Alma Iris. We supported both mother and daughter with their studies and training for several years. Juana followed up on her nursing career and she is currently the Chief Nurse in our project. Alma Iris went to medical school and last year became the first female Miskito physician. Today she is back serving the people of the Coco River villages where she grew up. I can tell you, Linda, that, if for nothing else, just Dr. Alma Iris has been well worth these 20 years of my commitment.

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