Giving Back and Gaining Perspective Olivia Akin, Senior Associate, Oxeon Partners and Margaret Rollins, Associate, Oxeon Partners

Giving

Spirit of Generosity is an Oxeon core value. At least once a month, team members work with organizations like New York Common Pantry, University Settlement, Friends of the Hudson River Park and other local non-profit human service organizations. But most days, we practice this value by living vicariously through our clients – Health IT and Services organizations committed to improving community and population health. (Really! It’s not just jargon.) Nonetheless, we all crave the opportunity to give back and get involved in a more tangible way. To meet the people we are helping. To hear their stories. To gain perspective.

This past October, eleven Oxoenites – across business lines, offices, and levels of seniority – embarked on Oxeon's inaugural international corporate volunteer trip. We traveled to Antigua, Guatemala, where we spent a week partnering with a local social enterprise, Maximo Nivel, to support their ongoing medical campaigns.

Not unlike the US healthcare system, the healthcare system in Guatemala is shaped by a mix of political, economic, and social factors. The Peace Accords of 1996, which ended Guatemala’s 36-year Civil War, outlined a vision for universal health care. The Accords focused on increasing access and quality of care – particularly preventive health care – to the rural and indigenous populations. At the time, 46% of the population, primarily indigenous communities, had no access to health services. The following year, the government created a new framework to expand access to care, the Programa de Extension, which essentially outsourced healthcare services to non-profits, NGOs, and faith-based organizations. By 1999, these organizations were providing basic primary care to 3.5M people or about 32% of the population, largely in indigenous communities. (Source: USAID)

"Access" was an imperfect solution. Following rising dissatisfaction in the quality of care provided by non-profits and questions over how contracts were awarded, new legislation was passed in 2013, prohibiting outsourcing of health services to these organizations. At the time, the government announced no plan of how these services would be replaced, and unsurprisingly, a few years later the USAID Health System Assessment in Guatemala concluded widespread "inequity in health outcomes, disease burdens, service access, and health spending," with the starkest differences falling along urban and rural, and ladino (non-indigenous) and indigenous lines. (Source: USAID)

When the idea for an international service trip first emerged, we understood the risks – real and perceived. The term "voluntourism" came to mind often in discussing what not to do. We were acutely aware of the negative impact people with "best intentions" – those who come hoping to help and instead leave things in worse shape – can have. We were determined to do better.

Before our first day of volunteering, we sat down with Norma, an indigenous Guatemalan woman, who helped contextualize our time in Guatemala. Norma works with Project Starfish, a social enterprise that empowers girls and young women to prioritize their education. She gave us a crash course on the decades long Guatemalan Civil War and aftermath, the political and economic disparities between the rural and urban and the indigenous and ladino populations, and the impact of gender in a society built upon machismo culture.

She put up with our questions (and admiration!) about how she took her education into her own hands, how she is raising her teenage son, but most importantly, how to make sure we weren't doing harm to the community or falling into the pitfall of voluntourism. Norma did not sugar coat what she saw nor the role voluntourists have played in Antigua’s community. Her guiding piece of advice she left us with was to "Look at what they do have, not what they don't have." This asset-based mentality and approach resonated.

Our days were split in two parts. We spent mornings driving to different communities surrounding Antigua setting up a health "clinic" in the home of a generous community member. We provided community members with basics like anti-parasite medications and toothbrushes (which doubled as an exciting new toy at the afterschool program we supported). We also worked alongside a local physician, Dr. Raphael, and a doctor from the US, Dr. George, to provide primary care visits to thirty or so community members each day. In the afternoon, we'd return to Antigua proper to Casa Maria, a nursing home for "orphaned" elderly, those who no longer had family that was able or willing to care for them. We helped in constructing a new kitchen and dining room for Casa Maria’s eighty residents.

During our first morning on the medical campaign, we went to a neighborhood just blocks from the local hospital. And yet, most of the patients we saw hadn’t been to a doctor in years. One individual came in with excruciating pain in his abdomen. Dr. George quickly identified the source of the pain. He had kidney stones; the treatment was a simple, straightforward surgery at the hospital. Instead, Dr. George wrote a prescription for ibuprofen, to be taken three times a day for five days. When we asked why, he explained that the cost of any sort of medical procedure in the hospital was so high, that the man would never be able to afford it.

It would be easy to look at the statistics, to hear this story, and see the things that the Guatemalan healthcare system lacked, the systemic issues and how they played out on the individual level. And it's true, there are countless areas of improvement in terms of access, quality, and cost. But, now's the time where we remind you of Norma’s sage advice: "Look at what they do have, not what they don't have."

On our last day in Guatemala, we visited a community about an hour away from Antigua, both the most rural and poorest town we'd been to. We were greeted by a line of more than thirty people – all waiting to see the doctors. We set up in a small two-room home, with dirt floors and tarp roofs.

An elderly woman, we'll call her Rosa, came in that day because she had a skin rash. It was her first time seeing a doctor in a few years. Before inquiring what brought Rosa there that day, Dr. Raphael did a full work up. He took her blood pressure and listened to her lungs (both good); he asked about her diet (primarily white bread and coffee); he asked about how she was sleeping (not well) and more broadly how she was feeling (she was anxious). In addition to treating Rosa’s rash, Dr. Raphael prescribed omeprazole to treat her acid reflux, recommended that she adjust the angle of her bed to prevent the vertigo that kept her up at night, and suggested an herbal tea that was readily available in her town to help calm her anxiety.

In total, Dr. Raphael’s thorough interaction with Rosa lasted about twenty minutes. During this time, he joked with her and got to know her, he diagnosed multiple issues that were affecting her wellbeing, and he took the time to ensure she understood her diagnosis and treatment plan. Of course, this was not the ideal situation; one would have hoped that Rosa had access to a better diet or more frequent health services. But no one could deny that Dr. Raphael delivered high quality care to Rosa that day. He provided thoughtful solutions, used the resources available to him, and genuinely and compassionately engaged with Rosa to improve her health. Watching this interaction, it was clear that Dr. Raphael was delivering patient-centric, holistic care to Rosa and that Rosa would be leaving the visit with a realistic and personalized action plan for how she could live a healthier life.

The Guatemalan and US healthcare systems are apples and oranges; to compare the two of them would be a disservice to both. However, there is universal value to Norma’s philosophy, to focus on what we do have instead of just what we lack, whether considering the healthcare system in Antigua locally, systemically in Guatemala, or in the US at large.

The challenge of being an entrepreneur, or someone looking to fix the healthcare system, is that you’re constantly looking for what’s broken and what needs to be fixed. As a Healthcare Growth Services firm we experience this a lot. In addition to practicing one of our core values, our time in Guatemala taught us that it’s important to pick your head up once in a while, remember what works, and celebrate what we do have. Just as we saw Dr. Raphael and all of the individuals we worked with at Maximo Nivel embody this mantra, we also witness this every day in the companies we partner with, the individuals driving those companies, and the work they're doing to improve our healthcare system.

Olivia is a Senior Associate at Oxeon Partners and has worked to build out the leadership teams for a number of Oxeon's portfolio clients, including Health Leads, Aspire Health, Privia Health, Ieso Digital Health, and Evolent Health, among others. Internally, Olivia has contributed to Oxeon's marketing efforts, including redesigning and launching their website and co-producing FWIW for over 2 years. Margaret serves as an Associate at Oxeon Partners and has worked closely with Oxeon's high-growth healthcare technology, services, and investor clients, including Air Methods, athenahealth, Clover Health, Crossover Health, and the Heritage Group. In addition to her search work, Margaret is a member of Oxeon's Building our Business team and supports improving operational efficiencies across business lines as well as Oxeon's Client Success Team. Olivia and Margaret traveled with the Oxeon team to Guatemala in October 2016 and both are based in New York, NY.