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Saving Help or Toxic Charity: Case Based Study of Successes and Failures over 20 Saving Help or Toxic Charity: Case Based Study of Successes and Failures over 20 Years in Global Health   Jeff Heck, M. D. President, CEO MAHEC, Asheville, NC Professor, and Associate Dean UNC School of Medicine Founder Shoulder to Shoulder Jeff. [email protected] net Special thanks to Robert Lupton, Atlanta GA for clarifying this perplexing dilemma in his book Toxic Charity.

“Buy-one-give-one” or “Wear change. ” Buy-one-give-one Wear change Tom’s Shoes Nisolo brand • Buy “Buy-one-give-one” or “Wear change. ” Buy-one-give-one Wear change Tom’s Shoes Nisolo brand • Buy one pair of alpargata design Argentinean slip-ons and another is given away to a poor child • Celebrity supported • Invited to the White House • But… competes with local entrepreneurs, not sustainable • Shoes made by Peruvian artisans in local market • Founder Patrick Woodyard helped create market and create local entrepreneurs • Mission Statement: Our goal is to empower talented artisans in the developing world, allowing them to shape their future by way of their extraordinary work.

 “Both marketing models are motivated by genuine compassion for the poor. Both move “Both marketing models are motivated by genuine compassion for the poor. Both move the poverty needle – but in opposite directions. ” Robert Lupton

The Dilemma with Donations The Dilemma with Donations

The Dilemma with “Technical Support” Earthquake at San Miguel The Dilemma with “Technical Support” Earthquake at San Miguel

The Dilemma with Efficiency and Speed The clinic that was built too quickly The Dilemma with Efficiency and Speed The clinic that was built too quickly

Watch out for help that is: too much, too soon, too fast Watch out for help that is: too much, too soon, too fast

The Global Health Bandwagon The Global Health Bandwagon

AAMC Senior Student Survey: International Rotation? AAMC, Medical School Graduation Questionnaire AAMC Senior Student Survey: International Rotation? AAMC, Medical School Graduation Questionnaire

What is our ultimate motivation? The case of an inspired dentist What is our ultimate motivation? The case of an inspired dentist

William Easterly: The White Man’s Burden “When you are in a hole, the top William Easterly: The White Man’s Burden “When you are in a hole, the top priority is to stop digging. Discard your patronizing confidence that you know how to solve other people’s problems better than they do. , Don’t try to fix governments or societies. Give up on sweeping and naïve institutional reform schemes. The aim should be to make individuals better off, not to transform governments or societies. ”

The Myth of Cultural Competence Really? The Myth of Cultural Competence Really?

Voices of the Poor Can Anyone Hear Us? Voices of the Poor – Deepa Voices of the Poor Can Anyone Hear Us? Voices of the Poor – Deepa Narayan • 60, 000 interviews of poor people • 60 countries • Basic question: Who helps?

Determinants of Health and Disease Determinants of Health Examples Social Determinants Mother’s literacy Household Determinants of Health and Disease Determinants of Health Examples Social Determinants Mother’s literacy Household income Household care Physical Determinants Ecology Sanitation Water Quality Food Quality & Quantity Environmental Stability Cultural Determinants Faith Health Beliefs Genetic Determinants Risk for diseases Health System Determinants Primary Health Care Health and Disease In a Community

Is it possible to make a difference and not be amazing? Is it possible to make a difference and not be amazing?

Principles of volunteerism to avoid toxic charity • Listen more, do less. Don’t assume Principles of volunteerism to avoid toxic charity • Listen more, do less. Don’t assume you are culturally competent. Take the time to listen and learn. • Don’t do it alone. Enlist local partners and plan. • There is no magic bullet. Health is affected by multiple determinants, each matter.

Benefits for involvement in a sustainable international program • Help • Learn • Reflect Benefits for involvement in a sustainable international program • Help • Learn • Reflect