Nagaland

In addition to working here on the Thai border, my organization also works on the China and India borders with Burma. Each has its own challenges, some of which I've written about before. The India border, though, has always been particularly difficult.

We work with eight partner organizations there, each a health program affiliated with a local ethnic organization, of which there are many. We work with Naga, Kuki, Chin, Arakan (Rakhine), and Zomi. All of these groups live in a relatively small area, but have distinct cultural identifications, and languages (sometimes several)

Nagaland, for example, is an area traditionally inhabited by the Naga people, that spans the border. Naga groups have been resisting the federal governments of both countries. On the India side, insurgent groups resist the national and local governments, and often, fight with each other. They often flee into Burma to hide from the Indian government and military. On the Burma side opposition groups also exist, but with many fewer resources, and with much less effect. When they cross the border, it is usually to seek refuge from the SPDC (gov't of Burma), or to obtain supplies or health care in India. They seek a separate Naga homeland. I suspect most Naga people would settle for peace. There have been as many as 21 different armed groups operating in this small mountain land.

Of all the partners we work with on that border, the Naga are the hardest to communicate with (because of lack of communication infrastructure, not language or culture), the hardest to get data from, the most likely to have supplies stolen en route, the most likely to be arrested, and the least able to train new medics, and yet they are probably the people that need support the most, and have the least access to health care.

This irony isn't new to GHAP - indeed this is where we try to work - in this space between need and possibility, trying to provide some kind of support where others can't, or create some kind of access to health care, where others haven't been able to reach. Its this irony that brought us to the India border, and to the Naga. But when it comes to getting the job done, it sure makes it damn hard.

One of the biggest hesitations large international NGOs have about supporting cross-border aid is that once it is across the border you don't know what happens. Indeed, GHAP has invested intensely in setting up meaningful monitoring systems, and conducting evaluations, in places many consider too difficult, or where some existing mechanisms aren't appropriate. We have helped local community organizations prove to international supporters that they can monitor and document the implementation of interventions, and their outcomes. Which is crucial. But then we get back to this funny gray area. If our Naga partners have their data stolen en route to the training; or if they ditch the data forms in order to avoid arrest before passing through an improptu checkpoint; or if a flooded river prevents a site visit to another clinic; does this lack of ability to monitor mean that aid shouldn't be given? Or is it symptomatic of an even greater need for aid?

Our org has staked its reputation on proving that it is possible to monitor and document, even in very difficult settings. But if it is really not possible, in the worst of those settings, have we tacitly endorsed a corollary that endorses the inverse?

Even well meaning aid can lead to unintended outcomes. I fully believe its important to understand to the best of your ability the outcome, intended and otherwise, of your intervention. When it comes to the Naga, there is a lot I can't know. But it feels wrong to therefore do nothing.

The interim solution has been to provide the kinds of support that have the least potential to do harm. Such as providing clean birthing kits to traditional birth attendants, and financial support to local organizations providing famine relief. But when the need is great, you cannot help but ask if you can do more.

There is a Naga medic, who has journeyed from Nagaland to our trainings farther south for the last three years in order to increase her skills in providing maternal and child health care. The supplies she receives at training are the only source of supplies for her organization. There is a shortage of midwives in her area, so the training she gives to TBAs effectively represents the highest level of care most women in her area can get for pregnancy or delivery. She is desperate to increase access to maternal and child health services for women in Nagaland. In making biannual trips to attend training, this medic has been arrested, beaten, threatened, and robbed. But she still comes. She will not fail in her commitment to the women that count on her. And so I cannot fail in my commitment to her, though it requires treading in a very gray space, whose borders are perhaps as ill defined as those of Nagaland.