Verona’s house is a little different from most of the other homes in Marekaj. Marekaj is a village that sits across a valley from Opyèg, the market just on the Tomonn side of the border with Boukankare. It’s an area pleasantly divided between farmland and trees. Most of the houses are clustered in little groups of five or six, which Haitians call “lakou.” Generally, a lakou will be home to a single extended — or not so extended — family. Haitian houses, especially in the countryside, tend to be small, but even a family with a relatively large house will spend little time indoors. Life in rural Haiti passes in the lakou, not in the house.

What sets Verona’s house apart in Marekaj is that it’s set apart. It stands by itself, on the top of a hill, a good ten-minute uphill walk from her nearest neighbor. It’s surrounded by a coffee grove. Not, unfortunately, a productive one. She lives with a few of her sons — two of them grown — and a couple of grandchildren.

She’s been doing fairly well in our program. Her youngest two boys appear to be taking good care of her now-pregnant goats. She’s been buying poultry with what she can save from her weekly food stipend, and she took money from her savings club and started a small commerce. She buys coffee beans in the market across Bay Tourib, in Regalis, and sells them in Opyèg or down in lower Boukankare.

Chemen Lavi Miyò is fundamentally an education program. It includes giving our members assets, which they need to establish regular income and protect their health, but it has very little in common with simple giving. Our goal is to help extremely poor families fundamentally improve the way they live, and these improvements depend in part on their learning new habits, so the heart of the program is the education that it offers.

CLM education has several different aspects. It includes basic training in management of income-generating assets: six days at the start of the program and four-day review sessions every three months after that. More importantly, it includes weekly one-on-one coaching with a case manager for the full eighteen months.

During those coaching sessions, members receive advice about caring for their livestock and managing their businesses, they talk with their case managers about their own and their children’s health, and they are pushed to plan, to make decisions that reach deeper than just where to find their next meal. Much about these coaching sessions is almost as unpredictable as any dialogue could be. We know that there are certain topics that must come up for discussion, but it’s hard to foresee just what will be said.

One part of each weekly visit, however, is tightly scripted. We call it the “issue.” Every week, members and case managers go through one out of a rotating list of ten health-related subjects. Going over the week’s issue involves dialogue. We try to draw from the members what they already know about the issue, and since the issues are repeated every ten weeks, members have more and more to say as the time goes on. But the dialogue is not open-ended. We don’t leave it to our members to decide whether vitamin A is good, whether prenatal care is important, or whether they should keep their homes and their children clean.

When presented properly, the issues have a three-part structure. First, we ask a member to consider a danger that hangs over her family and herself. We want her to feel threatened. We then go over the measures the member can take to protect herself and her family from the threat. Finally, we push the member to commit herself to making the changes she needs to make.

Last week’s subject can serve as an example. The issue was, “Too Early Pregnancy is not Good.” We start the issue by going over the dangers inherent to mother and child when the mother is too young. We describe how childbirth can tear apart an undeveloped body, how very young mothers can suffer or even die, and how their children are likewise at risk. We also describe how rarely very young mothers are socially or economically prepared to take care of their kids, and how rarely they can expect the baby’s father to help them out. Then we suggest to them that girls should refrain, if they can, from sexual activity until they’re at least eighteen, and that they should probably not have kids until they’re 25 or settled enough to be capable of taking care of them. Finally, we ask them to say how they can integrate the lesson into their lives, and to commit themselves to doing so.

In the case of too early pregnancy, that last step might be hard to imagine. After all, everyone selected for membership in the CLM program is already a mother. Many of them are already grandmothers. Verona, for example. Talk about too-early pregnancy might seem as though it comes too late to do any good.

But Verona responded to the issue with enthusiasm, and we quickly learned why. When I asked her how old she had been when she had her first child, she said she had been thirteen. She explained that she had become pregnant after an older man raped her. The baby died during labor. Verona explained that her body had just been too small to give birth. She had been badly wounded herself, and took over a year to recover. As she said, only her mother’s care brought her back.

So the commitment Verona made was to talk to the girls she knows about her experience, to help them see the importance of patience. And she wasn’t the only one. The previous day, I had spoken with another grandmother, Elimène. She lives with children and grandchildren in Fonpyèjak, just uphill from our base in Bay Tourib. The lesson brought her oldest daughter, Sensilyèn, to her mind. At 25, Sensilyèn already has eight children. She simply started too young. Elimène can see the price the whole family pays. Like Verona, Elimène told her case manager that she would talk to the girls around her, her younger daughters and her granddaughters especially, about how important it is for them to take care.

And it is not merely a matter of giving our members advice that they can share. I think there is something deeper involved. Our members start with a strong tendency to take their poverty for granted. They think of it as something that has happened to them. It’s a destiny for some; for others, an accident. They look at it as something outside of their control.

One critical part of the transformation that CLM members need to undergo is for them to understand that poverty has some causes that they can act upon. Members need to learn that their decisions matter. Everything we can do to help them learn that the decisions they make can dramatically affect their lives is a step on the road from victim towards actor. And walking that road is a key part of the pathway to a better life.

The isolation that CLM members have lived with prior to joining our program means that they often come to us with serious problems that have never been addressed, health issues among them. Healthcare in Haiti’s Central Plateau is inexpensive for everyone, thanks to our close collaborator, Partners in Health, but access to healthcare depends on more than just its availability.

It’s only literally available to rural Haitians who would have to walk three-four hours or more to get to a clinic. Even under those circumstances, one finds expectant mothers, for example, who hike to their monthly prenatal check-ups, but not all are convinced enough of he importance of these check-ups to make that sacrifice. Healthcare is also practically unavailable to anyone who doesn’t know how to access it or who doesn’t know that they have that right. And it’s not accessible to someone for whom going to see a doctor doesn’t present itself as an alternative to hoping that things will somehow turn out all right. That’s why, for particular diseases like AIDS and tuberculosis, which Partners in Health especially emphasizes, the institution has pioneered the use of professional accompaniers, who make regular home visits to people in treatment, ensuring that they are on their meds and doing well.

Our CLM team thus comes across instances of striking, untreated illness that only our members’ lack of connectedness to their neighbors and their resignation in the face of their poverty can explain. We work hard to get them to pursue diagnosis and treatment in these cases. Our special relationship with Partners in Health means that all our members receive healthcare that is free, rather than merely cheap. But we find we have to invest a lot of time and energy in getting members to use the services nonetheless.

That’s why I spent a day recently at the hospital in Kanj, with a social worker from Partners in Health and three CLM members’ kids: Yvona, Elisson, and Raynold.

Yvona and Elisson are blind. Neither one has been so all their lives; each could see until a few years ago. Yvona is probably about twelve or thirteen. Elisson is almost twenty. Their families have watched each lose their vision without knowing what to do about it. Elisson and Yvona spend their days sitting in their parents’ front yards, with neither the vision they would need for normal participation in their families’ lives nor the adaptation to blindness that someone sightless from birth would naturally have.

I first met Elisson a few weeks ago, when hiking through his village, Elmani, with his family’s case manager, Benson. Benson has only been with us for a few months, so the main purpose of going out with him was to coach. One of the important, if peripheral, parts of his job is to get to know the whole family well, ensuring that he can speak to any of them about issues that are important. When I saw a boy sitting alone in the middle of the yard, detached from Benson’s presence, not obviously even aware of the visit, I went up to him to chat. I wanted Benson to see my effort to engage the boy in what we do. That’s when I discovered that Elisson is blind. His vision has steadily deteriorated over the last three years. When we met, he told me that he can see dark shapes pass across his field of vision, but that he can’t identify them.

We made an appointment for him at Kanj on a day we had confirmed that the ophthalmologist would be available. He and his mother got there early, and were in line before I was able to arrive with one of my other charges, and by the time I saw them, he and his mother were being led out of the hospital by Nahomie, the Partners in Health social worker who is part of our Bay Tourib team. The news was bad, and their faces showed it. Elisson has glaucoma. There is nothing anyone at Kanj can do to restore his sight.

I wasn’t aware of Yvona’s blindness until the case managers told me that they had decided to send her to Kanj the same day I would be there. She lives with her family close to the town of Bay Tourib, not far from our residence there, but I haven’t yet been to her home. She’s a thin little girl. Her news is much more encouraging. She has cataracts, and Kanj can do the necessary surgery. She’s been scheduled for February, and stands a very good chance of recovering her sight.

Raynold’s case is more complicated. I met him at his mother’s house in Anba So, a remote neighborhood of Boukantis, an area outside of Bay Tourib. I’ve written about the area before. (See: MoreCholera.) He was at home the day I went to his neighborhood with one of our case managers to spray the area with bleach. It had been hit suddenly with multiple cases of cholera. Raynold’s parents were away when I arrived. They left him to look after their nine younger kids, so he’s the one who let us into his parents’ house so we could spray, and he’s also the one who showed us to the other houses we needed to see. A couple of weeks later, he met me when I returned to the area to see how folks were getting on, and he spent the day walking with me from house to house.

That walking was not easy for him, not as easy as it should be for a boy his age. But Raynold suffers from scoliosis (http://en.wikipedia.org/wiki/Scoliosis). His spine is badly curved. He lives with constant pain around his right hip. He can walk only slowly. The curvature also puts pressure on his ribcage, which affects the way he breathes. It’s enough for regular breathing when he’s resting, but won’t allow any vigorous effort at all.

Getting him to Kanj involved some planning. His mother couldn’t take him because she would be in a weeklong workshop with other CLM members when we wanted him to go. So we picked him up on a Monday morning, and brought him to spend the night with us at our residence in Mirebalais. Tuesday, I would put him on the back of my motorcycle, and take him to the hospital myself.

I had a Monday evening meeting it Port au Prince, so I had to leave Raynold at the residence with our team. I wasn’t sure how that would work. Here was a seemingly shy rural boy, from a very isolated little settlement, suddenly dropped into the middle of a residence full of strangers and strange experiences.

When I got back at almost nine, I discovered that there had been nothing to worry about. Raynold had been well-fed by our residence hall cook, Nanoune, and was listening to music with one of the case managers, Ismith. Ismith had insisted that Raynold spend the night in the empty bed in his room, had shown him a Haitian movie on his laptop, and was chatting away with him like they had been brothers since birth. Raynold was a happy as could be.

The next day, we went to the hospital, where the news was not what we had hoped. The Kanj orthopedist said that Partners in Health does not have the expertise on staff to treat Raynold. They sometimes have visitors who could do so, but it’s not a regular, predictable thing. All he could do is suggest that we bring Raynold to see him regularly, so that he can keep track of the curve as it develops. As Raynold grows, he said, the spine may well continue to both bend and twist. Things could thus get worse. For now, all we can do is watch.

Raynold got back on the motorcycle, and I drove up towards Boukantis to drop him off. We spent quite a bit of time talking when we got there. He hadn’t really understood much of what the doctor had said to him, and I wanted to make sure he had a clear message he could give his mother when he got home. So we went over things several times. I also told him that the social worker would come to see his mother this week, and that I’d be in Bay Tourib next week if his mother still wanted to talk.

But before he walked away, he told me that, if it was all right with me, he’d just tell his mother that he was leaving home to come live with us in Mirebalais. He said she wouldn’t mind.

It was easy enough to understand. He’s the oldest of ten kids in an extremely poor home. His mother can barely have the means to feed them all. She hasn’t been in the program very long. And as an older child he’s no doubt asked to make sacrifices for younger kids who don’t yet understand. Nanoune fed him wonderfully, and Ismith made him feel liked a well-loved young boy.

I explained that I thought that his mother really needs him. He can see that, with CLM, she’s working really hard to change their lives. But none of it is easy, and many of her children are still small. I want her to succeed, I said, and cannot imagine how she’ll do it without him. He said that he understood and agreed, but I’d be lying if I said that I felt sure that he did, or that I was certain about my own words. The reality is that we cannot turn our CLM residence into an orphanage. We need to keep focusing on helping the kids we encounter have better lives in their own homes.

So we will have to continue to stay close to Raynold. At the very least, we need to help ensure that he sees the Kanj orthopedist regularly. We’ll also look for any others who might be able to help him out. He deserves a chance at good health. But not only that: As a strong and healthy young man, he could be a major part of the path out of poverty that his family takes.

Working with CLM members means more than just giving them assets. We visit them weekly to coach them as they struggle to turn those assets into livelihoods. And that coaching must include much more than business advice. Each visit addresses specific matters, like good nutrition, hygiene, and other key aspects of a healthy life. And the visits must address broader and more fundamental questions as well. Everything about the way a member lives can affect her ability to lift her family out of poverty.

Jean Manie, whom I recently wrote about, is only a particularly striking example. Because she was living in servitude, she had no way to care for her pig. So it died. Her goats managed to survive, but they’ve suffered from neglect as well. Now that she and her boy are living in their own new home, we hope and even expect that she’ll start moving forward towards graduation. It won’t be easy, but we believe she will succeed. (See: Jean Manie.)

But you don’t have to be living in servitude to find yourself in a social situation that will block your progress. Jean Manie’s fundamental social barrier to progress seems to have turned out to be removable. We have, however, come across much less dramatic barriers that we could not get past.

We regularly find women, for example, who qualify for CLM but who do not agree to join the program because the people who live around them — their neighbors, the members of their family — convince them that it would be a bad or dangerous thing. The women are understandably suspicious of a program that claims it will do as much for them as we will do. No one has ever done anything for them before. And the people around them, for any number of reasons, turn these suspicions into fears that we cannot always overcome. We work hard to face these issues, but we can’t always resolve them.

In addition, we come across some women who cannot join CLM because the men in their lives are unwilling to let them try. For convenience, I’ll call these men “husbands,” though the word may apply only loosely. These husbands might resist the program for a variety of of reasons. Some are moved by the same suspicions-turned-fears that motivate reluctant women. We had a young father in Nan Joumou, named Soiye, who initially discouraged his also-young wife, Perrona, because he was pressured by his older brothers to do so. Are far as I can tell, the brothers were simply jealous that they had not qualified for the program. Soiye and Perrona are teenagers, and they lacked the moral resources they would have needed to resist their elders’ views.

Soiye’s pressure and Perrona’s own nervousness combined to keep her out of the program for six months. Happily, hers was one of the rare cases where she could reject the program when we passed through her area and still join it later as we signed up new members in a neighboring zone. And because Perrona’s mother and Soiye’s older sister joined the program and are prospering, the couple received encouragement that countered the pressure they had first received. They are now making good progress, thanks to a case manager who cheerfully hikes a difficult hour each way, every week, to get to their home from the nearest other homes on his route.

Other husbands may worry that a program that helps their family by building up their wives could threaten their position in the home. The social reality here is that it’s hard for a woman to join if her husband won’t agree. We have one member in Mannwa, Sorène, who left her husband, in part because he was blocking her, and is now moving forward without him, but that’s not the usual way of things. And it isn’t always clear whether Sorène’s solution is worth even hoping for. She has three girls under six and is pregnant, she and her husband have nothing to do with each other, and in Haiti there is no way to insist that he help support his kids.

Even after women have joined the program, relations between them and their husbands sometimes get in their way. Husbands who collaborate closely with their wives can do a lot to help the family move forward, but husbands who do not can make things very hard. That’s why Martinière, a CLM case manager, and I spent Saturday morning with Oranie and her husband, Sentobè, trying to help them work through their differences.

They live in Gapi, a neighborhood along one side of a steep hill overlooking Viyèt, in northeast Boukankare. In some ways they’ve prospered since Oranie joined CLM. The three goats we gave her are now eight, and she and Sentobè now live in a nice new house. They got fourteen sheets of roofing material from us, and that would normally be the factor that determines their new home’s size. But through their own hard work, they bought ten additional sheets, so they were able to make their house much bigger than our members normally would.

But not everything is going well. Oranie has really struggled to establish her small commerce, and Sentobè is a big part of the problem.

Commerce was the enterprise she chose to go together with her goats. All CLM members choose two. This helps them manage the risk involved in any financial activity. Commerce is especially useful because it can provide a source of daily income. Though goats are the most popular and reliable enterprise among our members, they just can’t bring in money every day.

Oranie’s commerce started off well. She invested in beans. She would buy a sack in Opyèg, a rural market in the mountains north of Gapi, and carry it on her head to sell it at a significant profit in Difayi or Domon, more accessible markets down the hill. It meant hard work, but the business was starting to prosper.

Oranie’s problems started when she and Sentobè got into a fight. He beat her up, enough so that she couldn’t lift her beans to carry them to market for sale. By the time her case manager, Martinière, got to her, Sentobè had fled, abandoning her and their children. Oranie told Martinière that she did not think he would be back, and the two of them began to plan a new business.

They chose charcoal. She could buy trees and pay someone to turn them into charcoal for her. For better or worse, it’s Haiti’s principal cooking fuel, and so it sells very reliably. It also has a very long shelf life, so it would not be a problem if Oranie had to wait to fully recover before she could start moving it to market.

So she started filling sacks with charcoal and storing them for sale. She started slowly, but Sentobè returned and her production then grew. With him there, Oranie no longer had to hire someone to make the charcoal. Sentobè could do that part of the work. Before long, they had produced 21 sacks of the stuff.

He also started selling the sacks. This might have been helpful, as she was just getting strong enough to start moving them around. But he wasn’t accountable to her about the income they were making. He would invest some in his farming, but she wouldn’t know how much. He’d give her some household money for expenses, but she had no idea where the rest of the money was going. Asking questions only led to further arguments, and since he had shown his willingness to speak with his fists, she was reluctant to make much noise. Martinière continued to visit them regularly and hear her complaints, but somehow, whenever he showed up, Sentobè would be elsewhere. Though he had spoken with Sentobè when Sentobè first returned to the house, enough so that he had been able to communicate quite forcefully that Sentobè’s abusiveness could not go on, they hadn’t seen each other since.

But Oranie kept telling Martinière how unhappy she was with Sentobè, so he sent Sentobè a message asking him to stay home on a Saturday morning to meet with me. Martinière and I wanted to go up together to see whether we could help them figure a way to work things out. Sentobè was willing to ignore a meeting with Martinière, but he wasn’t as comfortable avoiding me.

You would have a hard time finding two less likely, less qualified marriage counselors than Martinière and me, but others were not available, so we spent much of the morning talking with them. In our presence, Oranie was willing to tell her husband forcefully that he needed to stop treating her so badly. She said that he had been hitting her and threatening her for all of their eleven years together, but she spoke without any leverage except what Martinière and I could manufacture. Her family is dreadfully poor. If she were to leave him, it is hard to see where she would go. Her mother lived with them briefly, but Sentobè apparently accused her of sponging, and she left.

For his part, Sentobè professed a willingness to change. But the issues between them were hard to address clearly and in depth, especially since we felt obligated to begin and end the discussion with what amounted to a threat: If he hit Oranie again, there would be hell to pay. We told him that violence is not a CLM matter but a police matter, that our team has very good relations with local law enforcement, and that if we had to come again, we would not come alone. It’s hard to have a frank and serious conversation when threats are in the air.

But on a more constructive note, Martinière went minutely through Oranie’s finances with both of them. We wanted Sentobè to see the financial interest he has in peaceful collaboration with his wife. Not to be unsentimental, but a big part of their relationship is a simple economic partnership. We also wanted to establish where that partnership stood. Oranie said that Sentobè owed her — or at least owed the partnership — 3000 gourds (about $75) in income from the sale of the last seven sacks of charcoal.

Sentobè at first admitted having borrowed only 500 gourds from her. We asked him not to look at things quite that way. We wanted to avoid suggesting that he owed her money, because we wanted them to look at household finances as a common problem. We wanted him to see that the work that CLM is doing with her is good for them both.

What really seemed to get Sentobè to be serious was when Oranie complained that she had saved up enough to buy school uniforms for their three kids but that, because Sentobè had squandered their money, none of the kids was yet in school. He had to agree that, for a couple that had sold 21 sacks of charcoal in the last couple of months, the fact that their kids had uniforms but were not in school was both sad and strange. After much discussion, he agreed to put 2000 gourds back into the common pot. We told him that he, Oranie, and Martinière would sit together once he produced the money to figure out how they could use it to get their kids into school and her business back off the ground.

Martinière and I returned to Gapi on Wednesday near the end of a very long day and were surprised to hear from Oranie that Sentobè had left again. He had told us on Saturday that he would be going to Port au Prince for a couple of weeks to earn the 2000 gourds, but Oranie wasn’t sure he was coming back. She had offered him the hundred or so gourds he’d need to get there, but he refused — angrily, she said — to take “her” money, and instead sold a chicken.

What’s worse: One of his neighbors claims that Sentobè stole produce from his garden on his way down the hill. We don’t yet know what the evidence is. It could be merely that he left his home unusually early in the morning, around the time at which the malanga roots are thought to have been stolen, but it’s rumored that he was seen carrying them down the hill. The neighbor told others that he will have Sentobè arrested immediately if he returns to Gapi. He added that the only thing keeping him from burning down the new house is that he knows that Oranie is responsible for most of the work. For now, at least Oranie seems safe.

In some ways, this accusation, by threatening to keep Sentobè from returning home, might be a good solution for Oranie. But it’s hard to know for sure. She’s living in a home she built on her husband’s land. I worry that, without him there, her hold on the house might be fragile. Her own family is too poor to have anything that they can offer her.

In any case, Oranie is determined to move forward. As the end of December draws near, the price of goats should increase. She has arranged with Martinière that she will sell three of hers at the end of the month. She’ll use the proceeds from that sale, together with some of her savings, to buy a horse.

Having a pack animal could make all the difference for Oranie. It means that she won’t have to depend on her own strength to carry merchandise from the remote markets she buys in to the places where she sells. It instantly means she can make her business at least three times as large as it can be as long as she carries all her merchandise on her head. She’d like to be able to send the kids to school right away, but she knows that they’ll be better off if she can get her business on sound footing. Sentobè’s 2000 gourds would have helped her, but she’s ready to succeed on her own.