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Elizabeth Stuart, Deseret News
A Mozambican child smiles during a village celebration to thank Care for Life for helping the community.
A compassionate woman, so pumped full of love it leaks out the corner of her eyes, Cindy Packard doesn't empathize with people; she internalizes their pain.

MOZAMBIQUE, Africa — The father takes a Fanta bottle in his hand and whacks it against a rock. CRACK. With the broken glass, he carves a name onto a roughly constructed wooden cross: "Cesilia." Nearby, the mother, draped limp and unmoving over a child-sized wooden casket, doesn't make a sound. A wiry black woman, body hardened by a life of hauling water and working in the fields of rural Mozambique, her eyes are blank, as lifeless as the five-year-old girl she is burying.

The funeral doesn't take long. Friends gather around as the men of the family take turns digging the grave. They sing as the casket is lowered into the ground along with the child's few belongings — a bundle of frayed clothing, a few handmade toys. The melody is heavy with the tears they don't shed.

When they've patted down the dirt and erected the homemade monument, two friends lift the mother, wailing now, from the ground. She claws at them, kicking as they drag her from the grave site. The father stays by his baby girl a minute more before turning to nearby grave and listlessly tracing his finger over another hand-made cross, remembering. Another daughter. Buried just a few months after birth. His friends offer to walk with him, but he waves them away. He makes his way back to his village alone with his thoughts. The sky is as gray as his mood.

Far from home

There was a time when Cindy Packard lived her picturesque life in Gilbert, Ariz., the wife of a well-to-do physical therapist, blissfully unaware of such pain. Statistics about disease and dying babies in Mozambique had little bearing on her daily dealings as a part-time midwife raising six children in a powder blue, clapboard house straight out of the iconic television series "The Waltons."

But today, Africa's troubles are very real.

Wearing a T-shirt and capris, feet slathered with DEET to discourage flesh-eating bugs from burrowing their way through her TOMS, the 60-year-old is 10,000 miles from home in a mud hut village outside of Beira, Mozambique. She has a naked baby in one arm, tugging a harness up over his legs with the other. Once secure, she hefts the infant up onto her hip and clips him into a hanging scale. He fusses when she lets him down, kicking his legs at the empty air. Packard coos. A nurse in a white coat scribbles down the baby's weight.

Five foot five, blonde and blue eyed, Packard couldn't look more out of place. Yet, as she works, it becomes clear the white woman, a warm, effervescent person who is easy to tears and quick to laugh, fits here somehow. It's been 11 years since Packard's first such visit to Mozambique and 10 since she and her husband founded the nonprofit Care for Life, which has brought her back dozens of times. Packard tries to go about life as usual, but, she admits, even at home in Arizona, she's never been quite the same since trying her hand at humanitarian work. And neither, the statistics suggest, has Mozambique.

In the villages where Care for Life works, the death rate has dropped from an average of 22 deaths every six months to five. The percentage of people with adequate housing is up from less than half to an average of 85. Thirty percent more children attend school. Employment statistics have more than doubled. Adult literacy rates have increased from 50 to 77 percent. More than that, though, Care for Life seems to have discovered a formula for inspiring hope among the destitute and giving them tools to help themselves. Even after the nonprofit pulls out of a village, the statistics continue to improve. The local people report using leadership systems established through the Care for Life program to reach community goals like bringing in electricity or connecting villages to the main road system.

"Cindy is like a gardener," remarked one Mozambican. "She planted a seed. The seed grew into a tree and now it is producing many mangos and feeding many people."

Care for Life kicks against a couple long-held traditions in humanitarian aid. Most international development experts suggest picking a need, like clean water or infant mortality, and becoming an expert. Care for Life focuses on eight areas of emphasis: community participation, education, health, nutrition, sanitation, income generation, home improvement and psycho-social well being. The nonprofit organizes the villagers, teaches leadership skills and, through a system of goals — individual and community — requires them to earn everything they get. No handouts. No exceptions.

"Care for Life is the future of humanitarian aid in developing countries," said Warner Woodworth, a global social entrepreneur who consults for international NGOs. "In three decades of work, I haven't seen anything to equal what they've accomplished in the villages outside Beira."

Leap of faith

With two teenagers still at home, Packard had her hands full in 1999 as the president of the local women's organization for The Church of Jesus Christ of Latter-day Saints when a friend approached her with some disheartening facts about infant mortality in Mozambique and an idea: "Have you ever thought of going to Africa?"

Of course she hadn't. In fact, she'd become quite adept at ignoring Africa. A compassionate woman, so pumped full of love it leaks out the corner of her eyes, Packard doesn't empathize with people; she internalizes their pain. So, as a matter of self-preservation, she breezed right over the headlines about toil and strife on the world's poorest continent. "I couldn't stand to look at those heartbreaking pictures when everything seemed so hopeless," she said. When she prayed about the idea — something she agreed to do only to get her rather persistent friend off her back — she did so halfheartedly.

"God?" she asked, kneeling down next to her bed one day. "You don't want me to go to Africa do you?"

Within four months, Packard was bumping along an ill-kept road in Mozambique, dodging women balancing 50 pounds of water atop their heads and potholes big enough to swallow a small car. Rivers of sewage wound in, out and around shacks made from scrap metal and old tires. Barefoot children in shredded, too-small clothes played near six-foot-high piles of trash. Cripples dragged their bodies through the dirt hand over hand. The smell was acrid. The sight, overwhelming.

"What am I doing here?" Packard thought.

She didn't have a plan. "I just knew I was supposed to help," she said. But within a day of her arrival, she stumbled upon the answer: a truck marked "pro familia" parked on the side of the road. "My cousin is the minister of health," said the woman inside. "He's having dinner at our house tonight. Do you want to meet him?"

Packard is convinced it was providence.

On the southeast coast of Africa, Mozambique, with it's palm trees and white sand beaches, was once considered one of the world's top honeymoon destinations. Now, abandoned by the Portuguese who colonized it and torn apart by a 16-year civil war, it is the 10th poorest country in the world. Disease runs rampant through the population, where close to 60 percent of people drink contaminated water and 38 percent don't use sanitation facilities. With it, comes death. About 1.5 million of Mozambique's children have been orphaned by disease or abandoned because their parents were too poor to care for them, according to UNICEF. HIV rates are climbing: 12 percent of adults and more than 90,000 children are living infected. Malaria, acute respiratory infections, diarrhea and vaccine-preventable diseases claim the lives of close to 124,000 children under the age of five every year. Life expectancy is 37 years.

For lack of a better idea, Packard asked the minister of health if she could use her midwife training to help deliver babies at a refugee camp where people displaced by a recent hurricane had gathered. Instead, he sent her on a tour of the country to find out what people in rural areas needed most.

She nearly gave up when she heard their list of grievances.

"I was silly to come," she thought. "I am just one woman."

But in a school's humble request for pencils, she found hope. "Pencils?" she thought, perking up. "I can do pencils."

From there, for the next six years, she continued to stumble along blind. With no experience in international development, Packard relied on networking to learn the skills she could and recruit help with those she couldn't. She appealed to friends and neighbors for help funding the effort. She relied on God for direction. Moving forward. Praying. Changing course. Moving forward again.

Back at home, Packard used her connections with the LDS church to mobilize women across the western United States to put together rural birthing kits. With the help of the World Health Organization, she put together a curriculum to teach basic sanitation to children in schools. At first she took volunteers from the United States to Mozambique to teach the classes. Eventually, she decided it would be best to train locals to do the work year round. She purchased a cinder block building in the suburbs of Beira, Mozambique's second largest city, and added literacy and income generation to her repertoire of classes. She partnered with World Food Programme to pass out food to hungry students. A local nurse volunteered to start seeing patients in the corner of her classroom.

Hundreds came. Hundreds were helped. By all accounts, it was a huge success.

Yet, something didn't feel right.

"We had this center," said Cindy's husband, Blair Packard. "We were offering a product. It was a good product, but we weren't impacting people in a lasting way."

Rather than telling the people how to change their lives, the Packards decided, Care for Life must become an outreach program, going to the villages and mentoring them through the process of changing. They recruited an international development expert from Brigham Young University, gathered the Mozambican staff, and went back to the drawing board. By 2005, Care for Life had a makeover.

The program now centers around behavior modification, using a reward system to motivate villagers to make changes in their lives. Each family makes goals built on Care for Life's areas of emphasis: education, sanitation, family relations. The community makes goals together. Care for Life monitors their progress, and, as they reach goals, they are awarded with the supplies they need — but can't afford — to improve their quality of life.

Simple. But, in a way, revolutionary.

Packard cried when the nonprofit's board made the decision to stop passing out food — or any handouts for that matter. "The children are starving," she argued, heart throbbing. But in the end, she agreed it was for the best.

"There are a lot of folks out there trying to do good — and I think a lot of them do accomplish that — but a lot of them are just creating dependence on foreign goods and foreign help," Woodworth said. "Care for Life is attacking this from the root up, changing behaviors so people can help themselves."

Doing the work

Packard pulls into Chiverano, a rural village 30 minutes outside Beira of about 1,180 people, in a big, white truck. The engine sounds like a disgruntled dinosaur in this quiet, walking community. It's a siren call to the village children, who come skipping just to run their grubby fingers over the shiny paint. In a few months, the fields that surround the area will fill up like cranberry bogs, but today dust swirls around Packard's feet as she climbs out to greet the children. Felipe Castro Duarte sees her coming and ducks inside his cement house to fetch her a plastic patio chair. They've never met — these days, Packard's role in the nonprofit mostly consists of sitting on a board in Arizona — but Duarte greets the "mother of Care for Life" with sparkling eyes. "My life is very different because Care for Life came to my village," he said.

He takes a break from his work (today he is installing a cement floor in his bathhouse) and sits to chat. His wife tinkers around inside a separate cooking hut, cleaning fish. One son is away tending the family business. Nearby, one of his daughters sits on a wooden stool, pouring over her homework.

Duarte claimed this plot of land in 1986 after his village, caught in the middle of Mozambique's civil war, was looted and set on fire. His family fled during the night, taking with them only what they could carry. Here the community gathered again, started over, building houses of sticks and stones and smearing mud over top to hold it all together. Duarte used an old canvas tarp as a roof, securing it with rocks and old tires.

It wasn't an ideal set up.

When it rained — a daily occurrence during springtime in Mozambique — the mud melted off the walls and the canvas leaked.

"I never knew if my house would be there at the end of the day," Duarte said. "It would just disintegrate. I would have to rebuild it."

When the village was still in the process of establishing itself, Duarte, along with several others, were kidnapped by a rag-tag rebel force while buying sugar and shipped off to fight the country's civil war. At home, the women made do. They drank what water they could find. They didn't have latrines, so they relieved themselves in the bushes. When people got sick, someone would hoist them up onto their back and make the hour and a half trek to the nearest hospital on foot. Things didn't get better when Duarte returned. Life had a rhythm: find food, sleep, find food.

"We just tried to get from one day to the next," Duarte said.

The villagers greeted Care for Life warily. Many non profits had come, bringing with them gifts and promises. The gifts never lasted. The non profits always left. The village remained unchanged. There were many things the villagers wanted for their community — a health clinic, a well, a better school. Care for Life didn't offer to install any of them. In fact, they informed them they wouldn't be giving the villagers anything — at least until they'd earned it.

"I was very suspicious," said Joao Chandirica Manuel, the political leader of Ngupa, a village where Care for Life works. "I thought, 'What can these people do for us?'"

But Care for Life got glowing reviews from the locals. The villagers agreed to give it a try.

"Maybe we wouldn't gain, but we had nothing to lose," Manuel said.

Care for Life asked each family to make goals.

Hoping to expand their road-side business selling snacks, Duarte and his two teenage sons signed up to take Care for Life's income generation class. His wife, who had no formal education, made a goal to learn to read and do basic math. As a cheap way to put food on the table and add variety to the children's corn-heavy diet, the family decided to plant a garden. They made a goal to dig a latrine, start burning their garbage and treat their water. School became a priority. Once a week the three younger children attended a club where they learned about self esteem, leadership, values and how to protect themselves from HIV.

For their part, Care for Life brought education. Villagers had access to classes in nutrition, agriculture, business, literacy, conflict resolution and health — among others. Care for Life employees helped them work out the kinks of applying what they'd learned.

Care for Life rewarded the villagers for their diligence, too. After Duarte built a rudimentary latrine using sticks, the nonprofit donated some cement to the effort. For faithfully attending classes and treating his water and garbage on a regular basis, he got cement to build strong walls for his house, corrugated metal to replace the canvas on his roof and mosquito nets to protect his children from malaria. As a community, the village earned a bicycle ambulance that made trips to the hospital quicker and easier.

From the beginning, the villagers were expected to shoulder much of the responsibility of implementing the Care for Life program. The families were divided into zones, with each selecting a leader. Zone leaders checked in with each family weekly to assess their progress on goals. Other people from the community were asked to become teachers. They attended seminars on various topics ranging from health to home improvement, then returned to their neighbors to share their knowledge.

Duarte was elected zone leader. His son, Castro, 18, volunteered to help teach other villagers how to read and write. His wife became the community health liaison. She attended workshops where she acquired basic medical knowledge. When villagers are sick, she coordinates a community effort to get people to the hospital.

"Before, she was just a woman and he was just a boy," Duarte said. "But now they have something to share with their community."

This morning finds Duarte hard at work smashing rocks with a hammer. He'll mix the rocks with the cement to make a floor for his latrine. He shows off his little home with pride. He's completed his Care for Life goals, but he isn't done with goal making. Since then, he's built a cooking hut and installed electricity in his home.

At first, Duarte said, he worked because he wanted to earn rewards from Care for Life. In the end, he worked because he realized his life was better.

"Other organizations come to give goods," Duarte said. "Care for Life comes to give work. For that, I am grateful."

Duarte has a lot of theories about why he and his neighbors didn't do these things before. "We were poor." "We didn't believe in ourselves." "We were lazy." "We didn't know we should."

"I did not know what it was to make a goal," said Joao Alexandre Salva, a 51-year-old villager. "When you are so poor, I think you stop believing that things can be different. It made me feel powerful as a father to make these decisions for the good of my family."

Care for Life took away their excuses, gave them education and a reason to try, Duarte said. And before long, the community began to change. There's now a lively market at the center of the village — small businesses increased by 26 percent. The path in front of Duarte's house, once unusable because people relieved themselves anywhere and everywhere, is now clean and bright. The percentage of people using latrines increased from less than 40 percent to close to 90. The trash heaps that used to dominate public walkways are gone. Ninety-seven percent of villagers now burn or bury their garbage.

As the community cleaned up, so did the villagers' health.

Duarte remembers a time when there were two funerals a day in his village. In his own home, malaria was a monthly visitor. He lost two sisters to cholera. They didn't know all the simple things they could do to prevent cholera and malaria like using latrines and clean water, he said. "We didn't know how to save our children."

Today, it's been nearly six months since Duarte has taken a child to the hospital. It turned out to be a false alarm. To his relief, the little 9-year-old didn't have malaria after all.

"I will probably never stop worrying," he said.

Hope on the horizon

In Mozambique, death still confronts Cindy Packard at every turn. The man the nonprofit employs to guard their offices in Beira lost his entire family. At church, she asks friends how they've been doing. They reply with stories of disease and loss. But, slowly, one person at a time, things are changing. The death rate in Care for Life villages has improved by an average of 77 percent.

Some might say Care for Life saved Chiverano. Duarte would not.

"Care for life taught us how," he said. "We did the work ourselves."

And that's exactly how Packard wants it.

EMAIL: estuart@desnews.com