Things are not progressing smoothly for Idalia. She’s lost some livestock, and she’s not settled into a constructive relationship with her case manager.

She was feeling chastised as we started to talk. He case manager’s supervisor had called her out in front of other CLM members because she has been out and about, missing more than one of her case manager’s visits. Members know when the case manager is scheduled to see them, and they make a commitment to be at home. “I know I was wrong to be away without telling him, but the way the other women smiled. . .. It was like they thought I did something really bad, like selling my animals.”

We gave her two goats and a pig, but she hasn’t been able to make much of them. One of the goats died early in her experience. She remained optimistic when her other goat had a litter of two kids, even though she never thought the nanny looked particularly robust. It hasn’t grown and looks sickly. She was not surprised when one of the kids died.

Now she’s not sure what to do. Her neighbors say that she should try to nurse the nanny goat back to health enough so that she can sell it and use the money to buy another. She at leave needs to keep it as long as the kid is nursing. She’s struggling to keep the kid healthy, too, but it hasn’t been growing they way it should be either. It has sores around its mouth that may be interfering with its nursing and eating, and she’s been treating them the way her neighbors suggest, but she’s had no results so far.

The situation with her pig is, if anything, even worse. She received it on a Monday in February, months behind schedule because a shortage of pigs in the local markets combined with an increase in pig diseases in the region to make pigs hard to acquire. By the very next day it was showing the symptoms of Teschen Disease, a viral infection that is fatal in about 85% of cases. So she had the pig slaughtered on Thursday. The whole proceeding at least suggests a willingness to act, to take responsibility. Many CLM members struggle to emerge from an initial passivity, but Idalia is ready to act. She should receive money from the butcher eventually, but rural butchers buy sick animals with credit, not cash. It could be weeks or even months before she’s paid.

Work on her home is proceeding slowly as well. At first, she didn’t want to build it at all. She’s living right now in Gwo Labou, but she doesn’t think of Gwo Labou as home. Home is Jinpaye, a community on the other side of the mountain, in Kòniyon commune. She fled Jinpaye because her husband got in trouble with neighbors, but she wants to go back. She and her husband have land they can farm there. “I can go into my own field and harvest things to eat. If I want land to farm here [in Kolonbyè] I’ll have to buy it or rent it.”

Eventually, she accepted advice from case managers who told her that she should construct at least a small home in Gwo Labou to live in, even if it’s just for the time being. They reasoned, she says, that the program would not be able to help her in Jinpaye. So she’s decided to invest effort in getting a room built. She may eventually sell it or break it down so she can move, but it will give her a secure and dry space to live in for at least a time.

So she’s fallen behind many of her fellow members, but that’s not what’s bothering her these days. Her teenage boy has been sick. She took him to a mobile clinic that we organized, but couldn’t get help. There is only so much doctors can do without the diagnostic equipment that mobile clinics lack. Then she took him to the University Hospital in Mibalè, but he wasn’t even seen. Here again she showed willingness without know-how. The hospital is big and complicated, and she didn’t know how to navigate its various lines. The CLM team has a nurse who works effectively as a patient advocate, ensuring that members and their families get care, but Idalia didn’t think of contacting the nurse. Her case manager would have helped her do so, but he wasn’t aware how worried she was.

And that’s the heart of her problem. She feels as though her case manager takes her boy’s sickness too lightly. And his inability to communicate his care for the boy has pushed her to try to rely on her own devices. It’s also made her other communication with her case manager poor. She hasn’t told him about her struggles to keep her goat’s kid alive, and it’s a shame because between his own knowledge and the knowledge he could mobilize from the CLM team he could greatly improve her chances of success.

Idalia has a long way to go in the program, and her case manager has time to win her trust and help her turn things around. But the sooner he invests the time and attention it will take to reach out to her, the better her progress is likely to be.