I have learned that the community had the answer. They even told me so, though I ignored it at first. But they left it up to me to figure out the 'how.'That is from a nice paper that Jim Hennigan sent me by David Gaus, titled The Rural Hospital in Ecuador. It's about how a highly trained doctor and public health expert came to Ecuador with his own well developed sense of what should be done.
The quote above hints at a successful combination of bottom up and top down: too often experts come in thinking they know what to do as well as how to do it. But communities generally know what they want; they just don't know how best to get it. And that is where expertise brought in from the outside can make a real difference.
