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The Street-Level Solution

By David Bornstein

When I was growing up, one of my father’s favorite sayings (borrowed from the humorist Will Rogers) was: “It isn’t what we don’t know that causes the trouble; it’s what we think we know that just ain’t so.” One of the main insights to be taken from the 100,000 Homes campaign and its strategy to end chronic homelessness, which I wrote about in Tuesdays’ column, is that, until recently, our society thought it understood the nature of homelessness, but it didn’t.
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A Plan to Make Homelessness History

By David Bornstein

Mattie Lord

Donna, who was homeless, with her original survey team, showed off the key to her new apartment in Phoenix.


This is a story about a plan to end chronic homelessness in the United States. It’s not an indeterminate “war on homelessness,” but a methodical approach to do away with a major social problem. Each day, roughly 700,000 people in the country are homeless. About 120,000 are chronically homeless. They often live on the streets for years and have mental disabilities, addiction problems and life-threatening diseases like heart disease, cancer and diabetes. They are also five times more likely than ordinary Americans to have suffered a traumatic brain injury, which may have precipitated their homelessness. Without direct assistance, many will remain homeless for the rest of their lives — at enormous cost to society and themselves.
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Spreading the Care

By Tina Rosenberg

The comments on this week’s column on kangaroo care were extraordinary.  Reader after reader told personal, emotional stories of how they did kangaroo care — wearing a baby for many hours a day on a parent’s chest — with their premature babies.  I particularly liked the story sent in by Anita Bruce of Modesto, Calif.: her five- and seven-year-old boys also took turns kangarooing their preemie sister.  Many other readers discussed the wonders of holding their newborns of normal weight, and even older children.  Clearly, kangaroo care was already familiar to many people, and its benefits instinctively appreciated.
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The Human Incubator

By Tina Rosenberg

Bullit Marquez/Associated Press

A mother in the Philippines used the warmth of her body to nurture her prematurely born daughter.

Sometimes, the best way to progress isn’t to advance — to step up with more money, more technology, more modernity. It’s to retreat.

Towards the end of the 1970s, the Mother and Child Institute in Bogota, Colombia, was in deep trouble. The institute was the city’s obstetrical reference hospital, where most of the city’s poor women went to give birth. Nurses and doctors were in short supply. In the newly created neonatal intensive care unit, there were so few incubators that premature babies had to share them — sometimes three to an incubator. The crowded conditions spread infections, which are particularly dangerous for preemies. The death rate was high.
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When Lenders Won’t Listen

By David Bornstein

At the end of this week’s Fixes column on ESOP, an organization in Ohio that helps prevent foreclosures, I promised to share some stories of homeowners’ experiences. I also asked readers to write in with their own mortgage tales. Many did. The stories illustrate why trusted, nonprofit, third-party intermediaries like ESOP, which know how to communicate productively with both homeowners and lenders — and are committed to finding solutions — are needed to ease the housing crisis. Even better, a few readers offered suggestions about how to avoid this problem in the future.
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Foreclosure Is Not an Option

By David Bornstein

Ben Baker-Smith

A home boarded up in Slavic Village section of Cleveland, Ohio, in October of 2008.

Given the grim news in lending and home financing in recent months, it would appear that little can be done to stem the tide of foreclosures sweeping the nation.

Nationally, some 4 million homeowners are facing foreclosure this year and another 11 million are “underwater,” meaning that they owe more on their mortgages than their homes are now worth. During the past quarter, foreclosure filings were reported on more than 930,000 properties, with September 2010 being the first time banks repossessed more than 100,000 homes in a single month. The Obama administration took a positive step last year when it established the Home Affordable Modification Program, an agency devoted to helping homeowners in trouble, but by most accounts, it has been a disappointment. To date it has yielded only 520,000 active permanent modifications.
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How Iran Derailed a Health Crisis

By Tina Rosenberg

So how did Iran do it?   How did a conservative theocracy decide to deal with its drug addicts as if it were Canada?  In Tuesday’s column, I wrote that Iran is treating its massive epidemic of injecting drug use mainly as a health problem.  With this strategy, it has effectively managed to lower H.I.V. rates among drug users and keep the disease from spreading.  It has taken an approach to drugs known as harm reduction, which includes the provision of methadone maintenance therapy and clean needles to drug users.
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An Enlightened Exchange in Iran

By Tina Rosenberg

Associated Press/Enric Marti

A nurse prepares an injection of methadone at a rehabilitation center in Iran.

This is a story about a courageous policy in an unexpected place. In this place homeless shelters have vending machines selling clean syringes for injecting drugs. Drug users are not prosecuted as long as they are in treatment programs. Drug addicts are given clean needles and methadone maintenance therapy ─ available on a widespread basis even in prison. These tactics have worked to reduce crime, lower H.I.V. rates among drug users and keep AIDS from spreading out into the general population. The place is not Amsterdam. It is Tehran.
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Secrets Shared Must Be Handled With Care

By David Bornstein

When I was in Mexico City last month doing research on the Antenas program – the subject of my Fixes column earlier this week — I had the opportunity to sit in Antenas’ room and have a conversation with the animated character used by psychotherapists to communicate with children. I found the effect surprising. Antenas, guided by a therapist named Elsa Molina in the next room, began by asking me simple questions, as he does with all children. Antenas asked: “Why did you come to Mexico City?” I replied, “I’m a writer and I’m doing research.” Antenas asked: ‘What is a writer?’
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A Safe Haven in Cartoon Confidants

By David Bornstein

Antenas por los Ninos

Talking about abuse to Dulas, instead of an adult, has been therapeutic for some traumatized children.

For months, psychologists struggled to reach the eight year old boy in the burn unit of the Pediatric Hospital of Tacubaya, in Mexico City. He had been discovered in the basement of a house, tied to a water tank after being burned along the backs of both legs with a clothes iron by his uncle and aunt, who were later arrested. Every time an adult tried to talk about his abuse, the boy would turn away and repeat, “No, no, no, no.” One day, a therapist said to a colleague, “Nothing is working. Let’s try Dulas.”
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Green Strategies for the Poorest

By Tina Rosenberg

Vestergaard Frandsen

Vestergaard Frandsen

On Tuesday I wrote about the LifeStraw Family, an in-home water purification device. The product itself is interesting, but what I wanted to highlight in the column is how its manufacturer, Vestergaard Frandsen, is planning to make money with it. Not from the poor families who use it — they will give it away in western Kenya. Instead, the company plans to be paid in credits they can sell on the global carbon markets. In this system, credits are awarded to projects that reduce greenhouse gas emissions. They may then be then bought by polluting companies or governments to offset their own emissions. LifeStraw Family users no longer have to boil their water to make it safe to drink. Less boiling means fewer emissions.
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Clean Water at No Cost? Just Add Carbon Credits

By Tina Rosenberg

Pieter Bauermeister

Water must be transported by hand when there is an absence of fresh water in villages. These women in rural Kwa-Zulu Natal, South Africa, trek one and a half hours to gather water from Nongoma, a larger town.

In America, I turn on the faucet and out pours water. In much of the world, no such luck. Nearly a billion people don’t have drinkable water. Lack of water ─ and the associated lack of toilets and proper hygiene ─ kills 3.3 million people a year, most of them children under five.

Lack of access to clean water is one of the world’s biggest health problems. And it is one of the hardest to solve. Lots of different groups dig wells and lay pipes ─ but the biggest challenge comes after the hardware is in.
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The Ways of Empathy

By David Bornstein

It seems that just about everybody has had experience with babies or bullies — or both. Which is why the commentary that followed this week’s Fixes column about Roots of Empathy — an organization that decreases bullying by bringing babies into school classrooms — was so rich, personal and detailed. At the end of the column, I asked readers if they had ideas for ways to reduce bullying. Many offered suggestions about organizations, techniques and books (some of which I list at the bottom of this column), but many more readers reflected on their own experiences having witnessed bullying or the surprising effect babies can have on children and teenagers.
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Fighting Bullying With Babies

By David Bornstein

Stop Bulling Now Campaign

The problem of bullying has attracted federal attention. Above, an excerpt from a cartoon in the government’s bullying prevention guide for children.

Imagine there was a cure for meanness. Well, maybe there is.

Lately, the issue of bullying has been in the news, sparked by the suicide of Tyler Clementi, a gay college student who was a victim of cyber-bullying, and by a widely circulated New York Times article that focused on “mean girl” bullying in kindergarten. The federal government has identified bullying as a national problem. In August, it organized the first-ever “Bullying Prevention Summit,” and it is now rolling out an anti-bullying campaign aimed at 5- to 8-year old children. This past month the Department of Education released a guidance letter to schools, colleges and universities to take bullying seriously, or face potential legal consequences.
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Doing Good by Default

By Tina Rosenberg

At the end of Tuesday’s Fixes column about changing the default choice from “opt in” to “opt out” for decisions like putting money into a 401(k) account, donating organs or taking an AIDS test, I asked readers to send in their own ideas about where else the opt-out default could be applied for the common good.

Readers had some very useful ideas about how to use a new default to do just this in different fields.
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The Opt-Out Solution

By Tina Rosenberg

Americans don’t save enough. In 2005, Americans’ personal savings rate was negative for the first time since the Great Depression ─ instead of piling up savings, we are piling up debt. According to Financial Engines, an investment advisory firm that has surveyed the 401(k) retirement savings plans of 2.8 million people, only 28 percent of savers are on track to retire on 70 percent of our final salaries ─ and 70 percent may not be adequate to pay for health costs or travel. Worse, only one third of American workers participate in 401(k) savings plans at all.
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Filling the Gap Between Farm and Fair Trade

By David Bornstein

Root Capital

Maraba, a coffee cooperative in Rwanda, has been a Root Capital client since 2005.

We’ve all seen the ads for fair trade coffee with the beautiful photos of villagers hand picking coffee cherries in exotic regions around the globe. Fair trade is one of those ideas that’s always in the air, but we don’t often consider what it means. What does it really take to connect rural producers in the developing world with consumers in wealthy countries — so that everybody benefits?
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Beyond Ribbon-Cutting

By David Bornstein and Tina Rosenberg

When we started Fixes, we were hoping that interested readers would write in with their own ideas and experiences. Anyone who read the comments on our debut column, “Health Care and the Art of Motorcycle Maintenance,” knows that this is exactly what happened. Readers responded to our column on Riders for Health ─ an organization that maintains the motorcycles used by health care workers in rural Africa ─ with a variety of ideas for improving transportation on that continent. They also proposed many intriguing fixes of their own ─ some of which we will look into for future columns.
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A peer mentor for H.I.V.-positive pregnant women and new mothers travels through Lesotho on a motorcycle maintained by Riders for Health.

Health Care and the Art of Motorcycle Maintenance

By Tina Rosenberg and David Bornstein

A peer mentor for H.I.V.-positive pregnant women and new mothers travels through Lesotho on a motorcycle maintained by Riders for Health.

Welcome to Fixes.
This is a series about solutions, or potential solutions, to real world problems. It focuses on the line between failure and success, drawing on the stories of people who have crossed it.

Most of us tend to be better informed about problems than solutions. This presents two challenges: if we rarely hear about success when it occurs, it’s hard to believe that problems can, in fact, be solved. Also, knowledge about how to solve problems ends up being concentrated in too few hands. It needs to circulate more broadly so that it can be applied where needed.
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