For example, Haitian Hearts mainly works in the downstream or mercy arena. We provide medical care to poor Haitians and bring children and young people to the United States for surgery. We respond to these emergency problems, most of which have their root in poverty. We don't more broadly address this poverty.
Some of our patients with heart problems have these problems due to rheumatic fever, a preventable disease. For rheumatic heart disease, upstream work might focus on educating doctors and people on strep throat and its treatment (penicillin) so that rheumatic fever doesn't develop. Work further upstream might be getting funds for more clinics and doctors and nurses in Haiti so that health care is more widely available.
A nun I know frequently talks to me about a friend of hers who runs an orphanage in Ecuador. This orphanage takes in mainly disabled children who have been abandoned. This seems to fall under the category of downstream or mercy work. But then it struck me: any work that benefits children must be considered upstream work, too. Children, we have so often heard, are the future. They will grow up and create the world anew. Helping children contributes to a just future, a future that is downstream for us now.
What could be better than that?