HealthStore in Print
The Miracles of Barefoot Capitalism
Authors: Jim Klobuchar and Susan Cornell Wilkes
About the Book 180 pages, ISBN 1-886513-46-5
Publisher: Kirk House Publishers
Purchase the book at Kirk House or Amazon or B & N
* Chapter 8 *
No Mirage: A Pharmacy Shop in the African Bush
Almost hidden in the banana trees and scraggly bush of central Kenya are a half dozen huts and a muddy little road that make up a settlement called Rwabiti. You can't call it a village. It's not big enough and almost nothing is sold there except -
Except for pills for sick kids, malaria tablets, gauze and aspirin, cough syrup and other medicine in small bottles sitting on the spare shelves of a tiny dispensary with no pretense of being a drug store. Call it a kiosk in the brush. It looks forlorn but somehow brave. It's crude with its clapboard walls and simple counter, an architecture that resembles what you see in the touring carnivals, the makeshift storefront where hawkers offer stuffed dolls at a dollar for three pitches. But it's clean and straightforward. It seems to announce quietly, "We have medicine. Not much, but we can help."
There is no cashier here. A young man, a church worker, attends it when he can find time from his house calls to give counsel to the sick in his district.
And yet when you come to this obscure place like Rwabiti a few miles from the equator, you come with great respect. There is a difference between this storefront and the scruffy one in the carnival. This one is tidy, and the white paint is fresh.
There's a final difference: It saves lives.
Nothing on the surface connects the kiosk of Rwabiti with a scene several years ago on a lonely rain soaked highway in New Zealand, where an American lawyer-businessman named Scott Hillstrom lay bleeding in the night in the wreckage of his car. But the events of the next two hours that night changed the direction of his life and ultimately brought those medicines to the bush in deepest Kenya.
It's a fight just to stay alive in Rwabiti. But there are no throngs at the counter of the little pharmacy shop. Rwabiti is home to 75 people, maybe 100 at most. The ones you see are children. The women are working at home and the men hire out as farm laborers. They will come to the Good Samaritan pharmacy shop a few times a month for discounted drugs they can buy for a few cents. If they have no money, they're not likely to be turned away. Other customers walk miles to get here.
The Good Samaritan pharmacy shop would not be there if Hillstrom had not examined his life while he lay in his mangled car waiting for help.
The saving of lives, the uplifting of millions of people in the poorest parts of the world, is not the province of miracle workers or political potentates. Today's microcredit movement grew from the hard-headed conviction of social entrepreneurs that poor people had dreams and ambitions like anybody else and could be trusted to borrow or manage money; they could be trusted to run plain frame little drug stores buried in banana trees.
Those entrepreneurs come in all races and from all niches in the world's economic fabric, from millionaires to wandering rainmakers with the guts and creativity to pursue an idea. The names of most of them -like Scott Hillstrom, Jonathan Campaigne, Millie Leet, Sam Daley-Harris and Brian Lehnen-appear on nobody's list of global celebrities. Campaigne once hunted for gold and built houses. Millie Robbins Leet was a peacekeeping activist who honeymooned down the Danube to take part in a UN conference on population. Sam Daley-Harris played drums in a symphony. Brian Lehnen was a biologist. You will meet some of these people in Kenya. And why?
The poor and the overwhelmed sometimes have more friends than they realize. Sometimes the hard drivers and swashbuckling achievers of the world, the Type A's, find a way to join the side of the angels and humanity.
The humanity in Africa needs them more than the angels do. Three of those Type As, Campaigne, Hillstrom, and Lehnen, independently took their restless energies and their unblushing idealism into East Africa. Hillstrom and Campaigne began by refining the principles of microcredit and adding an element popularized by some of the worlds biggest corporations-franchising.
And today as a result, thousands of children in Africa are living healthier lives, and tens of thousands of small business folk are providing decent households and a future for their families.
Hillstrom's entry into the lives of thousands of Africans was something close to an out-of-body experience. He was a man of spiritual depth and corporate success. Yet aside from experiencing the normal compassion toward people in struggle, he had no special interest in actively trying to elevate the lives of anybody beyond his immediately family until that night when he lay alone in his mangled car in New Zealand.
A relaxed life in New Zealand with his family seemed like a reasonable reward for Scott Hillstrom. He was a lawyer and a businessman from Minneapolis, confident and secure after the sale of his company. He was young enough to move in any direction corporately and wealthy enough to be looking for a home for his family in the remote reaches of the Pacific, his Paradise on earth.
That vision was stifled by a rainstorm. Driving a slippery highway in New Zealand after a fishing trip in the mid-90's, he collided with a truck rounding a curve. Both vehicles were destroyed. The truck driver was unhurt. Hillstrom crawled into the rear of his car trying to stem the bleeding from his face. He called to the other driver and asked him to go for help. The nearest city, Queenstown was 25 miles away. The trucker had to walk and run miles to a telephone on the lonely mountain road, and it would be more than an hour before an ambulance arrived. While it was en route, Hillstrom examined his life. He was drifting towards unconsciousness, in danger of developing hypothermia in the cold New Zealand night. He was fearful of internal bleeding and believed death might be a few minutes away. He thought of summarizing what he had achieved in life: success in career, fulfilling his goals and more. "What I learned was that all the accomplishments, fame, and fortune that life is capable of delivering counted for nothing. Family, friends, God, and fellow man were everything. I resolved that if I got through the night …I would spend the days God gave me in a better way."
Sometime later in the United States, Scott Hillstrom attended a retreat, read from scriptures, and probed his values. He asked himself what skills he had, what energy he could deliver in finding a better way. While mulling the options, he discovered a startling statistic: 25,000 children die each day, 9 million each year, because they don't have medicine that costs less than a cup of coffee in the States.
He volunteered for some of the larger charities as a resource to make inexpensive drugs available to the poor. Most of those organizations, he grants, perform an acceptable amount of good. But he found some of them were routinely helping pharmaceutical firms to dump drugs into poor countries in order to reap tax and public relations benefits. In Nairobi he met a microbiologist with a Ph.D., Eva Ombaka, who is a recognized world authority on the distribution of essential drugs. This is what she told him:
Between 70 and 90 percent of the death and illness in developing countries is caused by four or five diseases, including malaria and diarrhea. All are treatable with inexpensive, generic drugs. So, he asked, why was it so hard to get life saving medicines to the most vulnerable, the children? The big players in humanitarian aid ought to be able to do that. But most of those today are involved in AIDS education and prevention and in community health development, which are big-ticket projects. In the midst of these big programs, Hillstrom found, large numbers of children were dying of diseases like malaria and dysentery. And those lives could have been saved with 50 cents worth of medicine. Further, efforts by some medical organizations to reduce children's diseases sometimes ran afoul of loose management on the ground that made it possible for pharmacy shop operators in the programs to cheat by selling adulterated drugs or peddling drugs on the side.
Hillstrom's solution came right out of the corporate gospels. Put it on a business basis and pull the charity out of it. But how? Walking by a McDonald's restaurant one day, he had the answer. Create pharmacy mini-shops in some of the poorest parts of Kenya, the flagship country, by selling franchises to small partnerships that would include at least one qualified community health worker. He and Eva Ombaka, who became his associate, estimated that a partnership could begin operations with approximately $3,500. That was enough to stock the shelves with essential drugs and medicines purchased at discount rates from reputable dealers in Nairobi and to cover overhead costs and training. The partners would take loans from micro-credit donors and sign strict payback agreements covering the three-year life of the loan.
They had to comply with rigid rules of accountability to keep the franchise. And they have. By 2002, two years after the system opened, 27 pharmacy shops were operating in Kenya. Most of them are making it, under the original banner of Cry for the World Foundation. It seemed like a powerful label at the time, pulling at the heartstrings. It has now become a somewhat more dignified Sustainable Healthcare Enterprise Foundation (SHEF), perhaps more attractive to corporate donors. Yet under any name, it's the obscure health workers in the villages who give it value and a quietly powerful message to the poor and their children: they are not alone and will not be abandoned. Because that message is being heard, Hillstrom's foundation was augmented in 2002 by the prestigious Boston-based Management Sciences for Health (MSH). As a result, it now envisions expanding the number of its pharmacy shop clients from the present figure of more than 100,000 a year in Kenya to 3 million people served annually from nearly 400 outlets it envisions by the year 2006. And it fully expects that entire network to be self-sustaining. An adjunct of MSH, funded by the Bill and Melinda Gates Foundation, will provide technical support for the expansion of those shops and permit the foundation to expand its care and to school its clients in disease prevention and health education.
Those figures are attainable. But they don't hit you in the face when you drive to Rwabiti. To do that you take the main road from Nairobi to Mt. Kenya just south of the equator. After an hour the highway sweeps north and the road to Rwabiti starts plowing into gumbo, passing through fields of maize, small grains and bananas. The coffee growers have moved, denting the meager economy of this part of central Kenya. A few scattered clothes on the lines between huts and three or four kids playing barefoot in the mud tell us that here is Rwabiti. There is practically no commerce. But here is the freshly painted little kiosk, Good Samaritan, belonging to James, Josiah, and Jacob.
On two white shelves are a smattering of medicines: antacids, malaria pills, ascorbic acid, chewable tablets for the common cold, folic acid, tablets for anemia, eyedropper fluid, disinfectant, tablets for heartburn, and aspirin. In a little cabinet next to the shelves is a small collection of adhesive tapes, gauze, surgical scissors, a bedpan, surgical gloves, and a small case of condoms. The three responded to the foundation's offer through their church in a neighboring village. All of them have community health work backgrounds, which means they routinely make house calls for their church and now for the pharmacy shop. They tell the women what to do when the children have diarrhea. Not so long ago, thousands of children were dying daily in Africa because their mothers believed the way to stop diarrhea was to withhold fluids.
"They know now that this is not the way," James said. "The information we give is as important as the medicine. We sell what we can to take care of their pain. We can't sell prescription drugs, but many of our customers don't need those. Many of them simply come to us for advice or for things like coughs and stomach disorders that could get worse. About malaria, we tell people to use mosquito nets, and we sell them cheaply; we tell them to cut down bushes and drain standing water where mosquitoes breed. We talk about the need for rehydration when their children area sick, and we talk about the best ways to keep water drinkable."
In the face of the massive health crisis facing most of the world today, what's happening in these little pharmacies in Kenya may seem to be a microscopic response. But one of the most respected health experts in the world doesn't call it that. Dr. Denis Broun is the former chief of health for UNICEF and is now involved with the Gates Foundation that is assisting Hillstrom's SHEF in Africa. He says this about the bush pharmacies in Kenya;
"The SHEF shops are so far the only mechanism that have really worked in developing countries to deliver high quality essential drugs to the world's poorest communities in a sustainable manner. Not once, not from time to time…but every day, all the time, through highly motivated private sector franchisees. (SHEF's costs are) a mere pittance compared too the millions of dollars regularly sunk by cooperation agencies and development banks to reorganized central medical stores that benefit far less people."
James Mugo, Jacob Kamau, and Josiah Muchira aren't familiar with the prestige of Dr. Denis Broun or the ambitious schemes of Scott Hillstrom's planners. They are the young investors, partners, in SHEF's Good Samaritan pharmacy shop in Rwabiti, Kenya. They have been at it for two years and they are not getting rich.
But they are saving the lives of kids.
James receives approximately $40 a month for attending the shop daily. The other, investors, receive a token dividend, but none of them has much income, and their lives are pretty much devoted to the health of their villages. That is a commitment. They don't look on it as a sacrifice. In poor African villages, the healthy take care of the others. A small honest pharmacy is one way. "If they can't pay," James said, "we have something in the budget to take care of them. They trust us. People walk here from several miles away. They know they area getting the medicine that's on the label. We sell or give away condoms and we talk to young people about taking care. We don't preach. But we know we are saving lives, because we know that children have starved here before, or died because there wasn't any medicine, and we don't want to let that happen."
There weren't many customers in the two hours we spent there. But the Good Samaritan performance sheet for 2001 read in part: Cases by diagnosis, malaria 2,809, amoebiasis 232, pneumonia 79, worms 388, pain 201. Just pain. Nothing very special about that. Unless you were the one who had the pain. And in this little place in the middle of Africa, someone now cares about that pain.
The deeper your travels take you in Africa and elsewhere into the world's poorest lands, where the need for food, medicine, and friends is the most desperate, the more clearly you grasp a truth about humanity at the turn of the millennium. At a time when words like greed, corporate crookedness, ethnic hatred and pandemic illness are common currency in the languages of the earth, the traveler is struck by another and pretty wondrous side to human nature: the side of service. It is a commitment tens of thousands have embraced. It reveals once more the selflessness of which human beings are capable when confronted by suffering.
This needs to be remembered at a time when our screens are full of angry faces and homeless multitudes, realities that are part of the daily gruel of the earth's news. But there is another reality too powerful and precious to ignore. It comes clothed in all colors and in all ages and all levels of income, skill, and energy. To see it and to be touched by it does not mean you are hopelessly naïve about the real world. There area people who care, and care passionately and without regard for the time of day, the season of the year, or the stench of poverty and death.
James, Jacob, and Josiah happen to be Africans, caregivers and dispensers of medicines and therefore life to people only slightly poorer than themselves.
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Reprinted with permission of:
Kirk House Publishers
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