[Congressional Record Volume 140, Number 100 (Wednesday, July 27, 1994)] [Senate] [Page S] From the Congressional Record Online through the Government Printing Office [www.gpo.gov] [Congressional Record: July 27, 1994] From the Congressional Record Online via GPO Access [wais.access.gpo.gov] LESSONS WITHOUT BORDERS Mr. SARBANES. Madam President, last month I had the honor of participating in the launching of the U.S. Agency for International Development's Lessons without Borders Program series at Morgan State University in Baltimore. At that event, city officials, community leaders, and USAID professionals came together to initiate a dialogue on some of the problems that affect developing countries and U.S. inner cities alike, with the goal of sharing methods and solutions. The program demonstrated not only that we can learn from the experience and creativity born of hardship in other countries, but that together we can develop common approaches that result in greater benefits to everyone. In areas such as providing preventive health care services, making credit available to small mom-and-pop businesses, eradicating preventable diseases, and lowering childhood mortality, there is much to be gained by taking advantage of some of the cost- effective and broad-based solutions that have been applied in the developing world. By sharing directly the ideas, information, and techniques that have been used in their respective areas, community service professionals and development experts are multiplying the impact of investments in domestic revitalization as well as in international development. I would like to commend USAID Administrator Brian Atwood, Vice President Al Gore, Jr., Baltimore Mayor Kurt Schmoke, and all of those USAID and the city of Baltimore who made the June 6 event possible, and I would ask unanimous consent that the attached articles about the program, along with the Vice President's speech, be printed in the Record. There being no objection, the material was ordered to be printed in the Record, as follows: Lessons Without Borders (By Vice President Al Gore) I've just come from a ceremony commemorating D-Day. We remember the actions fifty years ago today--not only of the allied soldiers--but also those who sacrificed at home. But anniversaries of famous battles aren't just the cause of celebration. For while they remind us of the heroes of freedom and democracy they also remind us of the grim horrors of war--destruction and loss. They make us renew our effort to prevent future wars. After WWII, it was the Marshall plan which aimed at revitalizing the economy and communities in Western Europe. And it was a success. We helped Western Europe build a self-sustaining system which embodied participatory democracy, protected the free market and unleashed their productive energies. And the Marshall Plan's success led to other foreign aid efforts. Like President Kennedy's Foreign Aid Act of 1961 which extended aid to Africa, Asia and Latin America. He said soon after entering the White House that the developing world is ``The great battle ground for the defense and expansion of freedom.'' Since that time, we have learned many lessons in our efforts to aid developing nations. Lessons about housing, nutrition, vaccinations, prenatal health care and disease. Now it's time to bring the lessons we have learned abroad home, for these are ``lessons without borders.'' That's why we're here today. To continue a dialogue between development experts and those here at home who are working to solve economic and social problems in the United States. I am particularly pleased that USAID has taken the lead on this. Under Brian Atwood, the Agency has taken on the task of redefining its mission to meet the needs of the post-Cold War world. USAID has been a leader in the program I chaired, the National Performance Review, and it has made itself an official reinvention laboratory. Those who may think reinvention is just another word for shuffling around bureaucratic boxes should look at what USAID is doing here. Since the Foreign Assistance Act became law thirty-three years ago, thousands of Americans have become involved in the rebirth of nations. They're agricultural experts, advising on soil conservation, cattle breeding and crop management. They're teachers--helping communities establish schools where children are now learning to read, and technical facilities, where adults learn the skills they need to compete in a changing world. They're water and waste experts, helping to set up clean water supplies and develop efficient, affordable ways to recycle waste. They're public health officials--setting up clinics where expectant mothers and their children can receive health care, and whose effect is felt long after they have left. They are precisely the kind of people who can help us solve problems within our borders. Whether it's developing vaccine programs in Mali and Manhattan, or treating dehydration in Bangladesh and urban areas in the U.S. such as right here in Baltimore, some lessons are universal. Let me give you some examples: immunizations A few weeks ago we recognized Immunization Week at the White House. We pledged to keep working on developing new immunization strategies until children cease to die needlessly from diseases which are easily prevented. In 1990, only 39 percent of inner city children in the United States were immunized against measles. In Mali, infant mortality rates are among the highest in the world: over two-thirds of childhood deaths could be prevented by vaccination. The University of Rochester is currently working in partnership with the Columbia University in Mali to improve child immunization levels among the poor, urban populations. dehydration Dehydration kills 3 million children every year. In the United States it kills up to 600 children and hospitalizes thousands every year. USAID has found that feeding children a mixture of water, sugar, and salt prevents diarrhea from causing dehydration. This treatment costs pennies a day. It now saves more than 1,000,000 lives a year. social marketing USAID is using marketing techniques all over Africa, much like Colgate toothpaste, to ``sell'' socially important products like condoms, or messages stressing the importance of breastfeeding. They pretest, package and promote the materials and launch the products just like a business would. This cause-related marketing is another example of something we can use within our borders. community based services USAID identifies credible people within the community and forms a network between these groups--in places like Kenya, Nigeria, Guatemala and El Salvador. The groups then serve as actual service providers--going door to door to identify children with diarrhea or pregnant women. They then pass along their knowledge so the people can ``help themselves.'' This is an excellent example of community empowerment and we can use this same idea right here at home. pest management Alley farming is a technique used in Nigeria to control crops without pesticides. Rapidly growing trees are planted in bean fields, becoming an artificial host for parasites. The beans are allowed to grow quickly. The Nigerians then plant corn, and the pests feed on the beans. We can use this cheap, environment- friendly technique in Georgia and the Carolinas. microenterprise development Credit and loans are now within reach of the poor. A commercial bank in La Paz, Bolivia now gives loans solely to low-income people. The average loan is about $400. This bank makes more loans than the entire banking sector in Bolivia combined. In the United States, there are 200 microenterprise programs just getting started--and here's a technique that can help. The underlying solution we see from these examples is cooperation. Development comes from communities and individuals working together. It is a natural outcome of empowerment. The community activists in this room know all too well that the problems on the table are severe and require considerable personal responsibility. But they also know that they are made worse by hopelessness. The mother who doesn't get prenatal care, who doesn't know about nutrition or when to have her children immunized--her situation is made worse by a feeling of powerlessness. The young man who wants honest work but lacks the means to start a business--his situation is made worse by a reasonable lack of hope. We can't ``develop'' people, or make them assume responsibility for their own lives if they don't want to. This is as true here as it is overseas. But we also know that we can use cooperative approaches to give people a sense of control over their futures--that they matter as positive contributors to society--not just as victims. The federal government has a role to play and that's the basis of our community empowerment program. But the government can't do everything. This is why I'm especially eager to see programs of microenterprise and community banking flourish in our poor neighborhoods. In developing countries, these programs have given tens of thousands of poor people the means to begin small, informal businesses that give them the strength to live lives of purpose and hope. In neighborhoods where no one is literate--in homes where most infants are expected to die--in nations torn by violence and hunger and despair. Yet even in such environments, they have learned how to bring hope. Now they're bringing those lessons home. As the programs of Accion International and FINCA have demonstrated in Latin America, the real strength of microenterprise and neighborhood banking is empowerment at the grassroots level. It helps people take control of their own lives. It creates bonds among strangers. It helps to make a neighborhood from a bunch of buildings. USAID, along with other development agencies and private voluntary organizations have learned how to achieve things in environments that have few resources, if any, It reminds me of an old story about the business man who went to the oracle and said his abacus counters couldn't keep up with the workload--but couldn't afford to hire any new workers. What should he do? ``Each abacus counter must grow another finger on each hand,'' said the oracle. ``That's very wise,'' said the businessman. ``But how do I get them to do that?'' ``Ah,'' said the oracle. ``I only make policy. Implementing it is your job.'' We must remember that when it comes to implementing--we all have a role to play whether in the public or private sector, or through volunteer groups. Eric Sevareid once told President Kennedy that: ``It doesn't make much sense when two people are sitting in a boat for one of them to point a finger accusingly at the other and say `your end of the boat is sinking.''' We know that we are all in the boat together. Only together can we formulate solutions which will put an end to poverty and ensure economic and social freedom for all--both overseas, and in our neighborhoods. The time and opportunity are upon us. It's always been easy for Americans to lend a helping hand, but far more difficult to accept one. On this day when we remember how Americans lent a helping had to Europe, let's dedicate ourselves to a continuing effort abroad, but also renewing our commitment within our own borders. Yet here we are--truly helping ourselves--bringing the lessons we've paid for to our own doorstep. It is a hard path, but a necessary one. can traverse it best by traveling it together. ____ [From the Washington Post, June 11, 1994] Foreign Aid Comes Home The ``Lessons Without Borders'' program launched by Vice President Gore in Baltimore this week is supposed to be a winning proposition for all. The idea, generated by the U.S. Agency for International Development, is to bring to America's poor communities some of the lessons AID has learned while operating programs in the developing world. Baltimore Mayor Kurt Schmoke volunteered his city to be AID's opening act. His reasons for doing so were candid and telling about America today. ``It is an unfortunate fact of life,'' said Mayor Schmoke, ``that we have in certain parts of our city health problems, housing problems, that resemble those in Third World countries.'' Those words, could have been spoken by any big- city major in America. The similarities of conditions in the developing world and American inner cities and rural communities are mortifying. There are poor neighborhoods around the country with infant mortality rates that rank right up there with countries where Peace Corps volunteers and American aid workers are being dispatched to work. We think of children who die from diarrhea as being only found in countries like Bangladesh or Burkina Faso. In America's inner cities and in rural communities, however, hundreds of our own children are dying or being hospitalized each year from disease. Vice President Gore noted that only 39 percent of inner city children were immunized against measles in 1990. Stack that up against poverty-ridden Egypt, where AID reports a 90 percent immunization rate, or India's 80 percent or the 88 percent immunization rate achieved in the Philippines. The sad fact is the some of what ails the most devastated countries on earth also afflicts communities within our own borders: illiteracy, poor nutrition, little or no prenatal care, disease, joblessness and, ultimately, hopelessness. The Agency for International Development can't be expected to solve problems on American soil; the law prevents AID from doing that. But perhaps the agency--take a page from the developing world--can lend a helping hand by advising hard- pressed U.S. communities how they can use techniques from the Third World to address their own problems. After decades of work abroad, AID has learned many lessons. This experiment can usefully teach Americans another lesson: Images of Third World deprivation are universal; they can be even found on U.S. soil. ____ [From the Baltimore Sun] Lessons from the Third World For more than three decades, the United States has been sending small armies of people to poor countries to aid economic development efforts. Now, when Americans have plenty of reason to be concerned about their own economic well- being, many voters are beginning to look askance at the money spent on foreign aid. The partnership inaugurated this past week between Baltimore and the U.S. Agency for International Development is aimed at finding ways to apply the lessons learned in development efforts overseas to some of America's urban ills. The lessons abound: Haiti may be poor, miserable and desperate. But in many areas it does better in immunizing its children against common childhood diseases than some parts of Baltimore. Could we learn something from their approach? Bangladesh also has enormous misery and deprivation. But through its innovative Grameen Bank it has found a way to provide capital to millions of poor people, particularly women. In this country, poor people are caught in a credit bind, vastly limiting their ability to capitalize on their own initiative. Without money or other assets, it is hard to qualify for a loan. The Grameen Bank has found that loans of even $10 and $20 enable women to invest in spinning wheels or other equipment necessary to begin very small businesses, or ``micro enterprises.'' By helping these people tap into their own energy and initiative, the bank enables them to magnify their household income and improve their family's standard of living. Programs modeled on the Grameen Bank have given similar chances to poor people here; how can we expand these efforts? Anyone familiar with the lives of very poor people, whether in inner cities or rural areas, knows their problems transcend national borders. Their problems reach far beyond the daily challenge to maintain adequate food and shelter. From unanticipated pregnancies, infant mortality and unhealthy children to lack of jobs or no access to credit, the problems of poor people in Maryland look a lot like those faced by the poor elsewhere in the world. It is refreshing to see that a federal agency charged with funding development programs in other countries can also recognize the importance of finding ways to share what it learns with people in this country. That not only enriches efforts to help poor Americans; it also helps to inform taxpayers about the vital role foreign aid can play in a dangerously unstable world. ____ [From the Baltimore Sun, June 6, 1994] Baltimore to Try Third World Remedies (By Scott Shane) For decades, the U.S. Agency for International Development has sent Americans into the Third World to attack the problems of developing countries: infant mortality and childhood illness, unplanned birth and sexually transmitted diseases, poverty and chronic unemployment. Now AID wants to teach at home what it has learned abroad. In Baltimore and elsewhere, the agency wants to share remedies for the ills of urban America--infant mortality and childhood illness, unplanned births and sexually transmitted diseases, poverty and chronic unemployment. Because Mayor Kurt L. Schmoke put aside boasterism and responded to AID's offer with a candid acknowledgment that the city needs help. Baltimore is the first U.S. city to be targeted by AID's ``Lessons Without Borders'' program. It is an unfortunate fact of life that we have in certain parts of our city health problems, housing problems, that resemble those in Third World countries.'' Mr. Schmoke says. ``And, if there are some techniques that AID has used overseas that can be used here. I'd like to apply those problem-solving techniques.'' ``Lessons Without Borders'' will debut today with a conference at Morgan State University that will bring together Baltimore officials and staff members from AID, the major distributor of foreign aid. Vice President Al Gore will be the keynote speaker. By law, AID is not permitted to fund programs in the United States. But, by offering advice and cheerleading, the agency is seeking to be midwife at the birth of a new generation of U.S. social programs. AID officials acknowledge that they hope ``Lessons Without Borders'' will help them sell skeptical American taxpayers on the value of foreign aid. But, budgetary motives aside. American specialists in Third World development say the initiative is a long-overdue recognition that creative programs being used to attack stubborn social problems in Africa, Asia and Latin America could be useful on U.S. soil. Whether it is immunizations in Haiti--where in some desperately poor neighborhoods the rate of childhood inoculation is far higher than in Baltimore--condom distribution in Central Africa or small enterprise development in Bangladesh. Third World social programs have much to teach U.S. policy makers, say Americans who have worked abroad. ``A lot of us who've worked overseas have been waiting a long time for this to happen,'' says Julie Convisser, who runs an AIDS preservation project in Portland, Ore., based on a similar effort in Zaire. ``As Americans we sometimes believe no other country has anything to teach us. We're wrong.'' Portland's Project Action, the first U.S. effort of Population Services International, which operates in 24 other countries, is among a handful of successful transfers of Third World programs to this country. In Zaire, the battle against AIDS incorporated television soap operas promoting safe sex and condoms on sale for 2 cents apiece in every roadside bar or shop. In Portland, Project Action has produced MTV style television shows for adolescents and placed 185 vending dispensing condoms at 25 cents each, Ms. Convisser says. ``Lessons Without Borders'' was born of a conversation late last year between AID Administrator J. Brian Atwood, 51, who was a few months into his job, and Marian Wright Edelman, the longtime head of the Children's Defense Fund. As Mr. Atwood described AID's work abroad and Ms. Edelman recounted disheartening statistics on child health and poverty in the United States, they saw an opportunity, Mr. Atwood said last week by telephone from Geneva. He was returning from a tour of African famine areas undertaken at the request of President Clinton. In a November appearance on C-Span, Mr. Atwood said, he ``blurted out'' the idea that AID hoped to consult with U.S. cities. Among the viewers was Schmoke aide Lee Tawney. He passed the word on to the mayor, who decided Baltimore should be part of the collaboration. Mr. Atwood said AID has not previously sought to apply its expertise in the United States partly because the agency long felt beleaguered, a pawn in superpower politics that came under fire for dubious spending. ``During the Cold War, we did waste a lot of money to buy influence overseas,'' Mr. Atwood said. The agency's budget peaked in the early 1980s at about $12 billion, much of it directed to fighting communism in Central America and elsewhere. Today, the budget may be less vulnerable to political pressure to steer the aid to allies, but it is down to $7 billion. ``Lessons Without Borders'' could protect that spending by providing visible evidence to Americans of the effectiveness of programs developed by AID. Other developments make AID's initiative timely, public health experts say. The debate over health care reform has given new urgency to cutting medical spending and one way to do it is to get away from the high-cost approach traditional in this country. ``We Americans like the idea of being rushed to a high-tech hospital,'' says Dr. William B. Greenough III. professor of medicine and international health at Johns Hopkins. ``A great many things can be done at lower cost and with equal efficacy in the community and not in the hospital. In countries with very limited resources, you have to save the patient and save money at the same time.'' A striking example is treatment for dehydration caused by diarrhea, says Dr. Greenough, who worked for eight years in Bangladesh before returning to the United States in 1985. For many years, doctors in Third World countries have treated the condition with ``oral rehydration therapy'' a packet of a few cents worth of salts and sugars that can be mixed with water and drunk by the patient. If such a packet is not available, chicken and rich soup is a fine substitute, as Hopkins physicians have long pointed out Yet the United States severely dehydrated patients generally are hospitalized and hooked up to an intravenous drip at a cost hundreds of times greater than the low-tech alternative. Indeed, because diarrhea is dismissed as a triviality, Dr. Greenough says, it often goes untreated, leading to many unnecessary deaths, particularly among nursing home patients. Remedies that can be administered at home ``lack TV appeal'' and are not considered real medicine by Americans, who have an almost superstitious belief in costly machinery. ``Basically, our witch doctor's mask is a lot more expensive,'' says Dr. Greenough, who welcomes AID's push to bring in low-tech methods. Elizabeth Holt, an assistant professor of international health at Hopkins, is another public health professional who has worked on both sides of the great divide between domestic and international programs: in a poor urban community outside Port au Prince, Haiti, and in Baltimore and elsewhere in Maryland. In the Haitian community, Dr. Holt says, the rate of complete immunizations by 1 year of age reached 85 percent in the late 1980's. In Baltimore, while nearly every child is immunized by school age, the rate at 2 years of age is only 55 percent, says Dr. Peter Beilenson, Baltimore's health commissioner. The problem, Dr. Beilenson says, is not a shortage of facilities for immunization and other preventive care. It's the failure of people to take advantage of what's available. That's why Baltimore's Healthy Start program, which seeks to reduce infant mortality and the incidence of low birth-weight babies, hires community residents to do outreach work, identifying pregnant women and bringing them in for early prenatal care. Healthy Start may have something to teach AID, says Margaret Neuse, deputy director of the agency's office of population. ``Lessons Without Borders'' should be a two-way street, she says. In Latin America, Africa and Asia. Ms. Neuse says, she has faced difficulty in getting people to use health services. ``I just came back from a place in Ethiopia with a population of 30,000, where a program serves just 10 clients a day. We had a case in Nepal where you couldn't pay women enough to get them to go to a clinic.'' Joe Bock, a former Missouri legislator who has worked for two years for Catholic Relief Services, says he sees great potential for transfer of programs outside the area of health care to U.S. soil. Many programs in the U.S. war on poverty have ``failed miserably.'' says Dr. Bock, who will soon take over Catholic Relief's operations in Pakistan. ``We're looking around for new ideas.'' One such idea, he says, is what development professionals call microenterprise: tiny, family-based businesses started with minimal capital. The Grameen Bank (``rural bank'') of Bangladesh, which has served more than 1 million poor women, has inspired a number of fledgling U.S. programs. As the United States grapples with welfare reform, microenterprise offers an alternative approach to fighting poverty, one based on poor people becoming small-time entrepreneurs rather than cashing monthly checks. ``Unfortunately, we've had the idea of the U.S. riding in as a knight in shining armor to teach these countries.'' Dr. Bock says. ``In fact, we can learn a lot from what they're doing.'' ____ [From the Baltimore Sun, June 7, 1994] Gore Launches U.S. AID's Help for City (By Richard O'Mara) Vice President Al Gore launched a partnership yesterday between Baltimore and the U.S. Agency for International Development designed to apply here the agency's expertise in helping people mired in poverty. Speaking at a conference titled ``Lessons Without Borders,'' at Morgan State University, the vice president referred to the efforts of the tens of thousands of health workers, literacy teachers and small business advisers sent abroad since 1961 to focus America's attention on the plight of the Third World. ``It is time to bring this knowledge back home,'' he said. ``The idea might sound strange but it's not,'' he added. ``Whether developing a vaccination program in Malawi or Manhattan, some lessons are universal.'' The partnership is the first of its kind, but other cities--Chicago, Atlanta, Boston--have expressed interest in drawing on AID know-how. J. Brian Atwood, AID adminsitrator, said, ``It is people like those in Baltimore who invested in the foreign aid programs. Why shouldn't they benefit from it?'' The suggestion by Mr. Atwood, made on C-Span television late last year, was seized upon by Mayor Kurt L. Schmoke. The vice president spoke to about 250 health and socialworkers and community activists at the Morgan conference, plus as many guests. After that he visited the Family Place on Ashland Avenue-- which provides services to needy families, such as literacy training, prenatal care, nutritional information and vaccinations--and was shown around an immunization bus that roams Baltimore's neighborhoods inoculating children. At Morgan State, Mr. Gore pointed out that in 1990, only 39 percent of American children were immunized against measles. (In Baltimore, fewer than half the city's two-year-olds are up to date with their immunizations, said Charlotte Crenson, a city health program adminsitrator, who was on hand for the vice presidential visit to East Baltimore.) Because of AID's skills abroad at propagating the importance of inoculations, a lot of developing countries are doing much better in immunization, he said. AID marketing techniques also are effective at spreading the word in foreign countries about the protection against infant illness that breast feeding provides. The agency encourages and underwrites banks in Third World countries to lend small amounts of money to poor people who have no collateral, but do have an idea for a business, or ``microenterprise,'' Mr. Gore said. AID also trains and deploys local community volunteers to assist professional health workers and community activists abroad. The vice president called the use of volunteers ``an excellent example of community empowerment, a technique we can use here. Something developed to help nations elsewhere can help here.'' And the reverse can be true. Baltimore can teach AID a thing or two, agency officials said. For example, workers at Healthy Start, a prenatal care program, have devised strategies for dealing with substance abuse among the people it helps. Healthy Start was founded in 1990 to help lower infant mortality rates in certain Baltimore neighborhoods that had reached Third World levels--19 deaths per 1,000 live births in Harlem Park and the area around Johns Hopkins Hospital, according to Daisy Morris, who runs Healthy Start. ``When we began we found that substance abuse was a tremendous problem, between 30 and 35 percent of [expectant] moms'' had it, Ms. Morris said. The experience in dealing with this, Ms. Morris believes, is ``what gave us the edge on a lot of cities, because we understood our moms.'' Margaret Neuse, deputy director of AID's Office of Population, who has visited Healthy Start, said, ``We have a lot to exchange with Baltimore. We have met different problems.'' Everyone who addressed the Morgan State conference stressed that the partnership would be more than a rhetorical one, a friendly gesture from a Democratic president to a political ally in a nearby city. They insisted this was the case even though AID is prohibited by law to operate within the United States. Other speakers included Mr. Atwood; U.S. Sen. Paul Sarbanes, a Maryland Democrat; and U.S. Rep. Kweisi Mfume, D- 7th District. Mr. Atwood announced that a working group would be set up with representatives from AID and the city to decide on reasonable expectations for the partnership. Mr. Slater listed several likely AID initiatives. It would send field directors just returned from abroad to Baltimore to lecture and hold seminars; provide access to AID's enormous library to Baltimore health and nutrition workers; create internships for social workers from the city; and send people in the local helping professions to visit foreign development programs. Later in the day, Mr. Gore went to the Social Security Administration headquarters in Woodlawn and continued a theme that he raised at Morgan State: the benign intervention of government. ``Twenty-five or 30 years ago, more than 70 percent of the American people felt that government would do the right thing in solving national problems. Now only 20 percent believe that,'' he said. ``We have to put the customers (citizens) first,'' he emphasized. ____________________