Many believe the idea that “charity begins at home,” and strive to live by this principle. However, the word “charity” can have a negative connotation as well, with some believing charity can lead to dependence and entitlement. That negativity often comes from getting a hand-out versus a hand up.

What’s the difference? There are many third-world countries where a trip to a dentist is not only cost-prohibitive, it’s logistically very difficult — the full day trip just to get to the dentist means an adult doesn’t work that day, and possibly forfeits the ability to feed himself or his family. And not only is there a loss in time, there’s the actual cost of the care being provided. Sacrificing dental health in favor of dinner is probably an easy choice.

A worthy cause

Here’s an example to paint the picture of the difference between ‘a hand up versus a hand-out.’ Roy Hammond, a Utah dentist who opened his dental practice in 1967, decided 25 years ago to take his expertise to places where adults and children had no access to proper dental care. His decision led to Smiles for Hope, an organization that has gone on more than 100 humanitarian missions to places like Guatemala, the Dominican Republic and Nepal, treating up to 120 patients a day in remote areas that often require hours of riding a bus on unpaved roads. The missions generally last for 7 to 10 days — so that’s a lot of adults and children receiving critical dental care. But there’s a unique twist in how Smiles for Hope helps these people.

Skin in the game

The dental care isn’t provided as just charity. Patients are required to pay from $1 to $3 per treatment, which is actually quite a large sum in a place where the average per-day earning is $1. The money is to make sure they have “skin in the game” — making them even more invested in their own dental health.

The difference in the attitudes of the children attending the dental clinic is striking. In the Dominican Republic, children waited calmly and respectfully for their turn to see the dentist or the hygienist — while the children in places where dental care was pure charity were sometimes less than polite or grateful. The Dominican Republic children were clearly impacted by the skin-in-the-game attitude of their parents, which served as an excellent example as these children grew up to have their own children.

Paying it back

What’s even more interesting is how these patients — mostly mothers — have been able to earn the funds to care for their families, and become self-reliant. Many are getting microloans from Esperanza International — an organization founded in 1995 by a former major league baseball player to provide these loans to impoverished families and businesses to improve economic development, and pull communities out of poverty.

In the Dominican Republic, the average microloan is about $200, and is provided to those who come up with viable entrepreneurial business ideas. The interest rate on these loans is 21 percent. This may seem high, but that interest rate allows Esperanza to send instructors to these communities to teach budding entrepreneurs about running a business, paying taxes, and growing their businesses — thus getting more than just monetary value from the microloan.

One great example is a mother who borrowed her first $200, purchased a standing shade tarp, and opened for business as a hairdresser. Another local woman had borrowed (and repaid) more than 15 microloans — which ultimately put her in a position to develop several buildings, including a church, a strip mall, and a clinic for dental students — all for the betterment of her community. Esperanza International has a 98.5 percent loan payoff rate!

Teaching to fish

The well-worn saying “Give a man a fish, and you feed him for a day; teach a man to fish, and you feed him for a lifetime” couldn’t be more applicable here.

This, then, is the difference between giving a hand up instead of a hand-out.

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Originally published at medium.com