I would like to start off by thanking those of you who have either commented directly on this blog or wrote me separately about my last entry. I believe strongly in the power of people and participation to change the course of health and development in Africa and the rest of the ‘developing’ world. In the last blog I wanted to get some of my frustrations down on paper and to hopefully engage you, the reader, in a ‘dialogue’ about this issue because it is very important. As a recent news article recently told me,
“Donors are expected to give the Global Fund [to Fight AIDS, TB, and Malaria] at least $9.7 billion over the next three years, 57% more than they gave over the past three years. The pledges made at last week’s Global Fund Replenishment Meeting in Berlin, chaired by Kofi Annan, constituted the largest single financing exercise for health that has ever taken place.”
- Global Fund Observer, Sept. 30, 2007 (source: http://allafrica.com/stories/200710151899.html)
Now, while this is not a completely horrible thing, the article then points out that the “‘demand’ in the form of well-crafted proposals ready for funding still falls far short of the ‘need’ of efforts to confront these three diseases and the more general health crisis confronting Africa and the world.” Ok, so we have all of this money available, but not enough projects to put it towards. What of the 2.2 million people that die annually from water related illnesses or the millions of children who grow up stunted or developmentally challenged because of malnutrition? Can’t we put some of that enormous amount of money towards those efforts?
Well, as it turns out, to really make a difference almost no funding is required. In fact, all that is needed is a handful of dedicated staff who believe strongly in the power of health education and the capacity of the people receiving that education to engage themselves in an exercise of self-reflection. I just returned from a trip to Zimbabwe where I had the privilege to review and observe the work of thousands upon thousands of Community Health Club members organized by the NGO Zimbabwe AHEAD. The concept is simple: community members (mostly women, but there are a good number of men as well) are invited to join health clubs that then engage in a process of self-reflection, learning, and enhancing social capital over the course of 20 weeks (the length of the health education component) and beyond whereby each week they are presented with a new health issue (from water, sanitation and hygiene to malaria, bilharzia and common skin diseases). Through participatory methodologies and a simple membership card, these adults are provided the one thing that has eluded them for so long: knowledge. The knowledge gained is standardized but the context changes from community to community, for what really matters is that the club members agree on what they are learning and how to contextualize it. From this knowledge springs forth changes in health and community norms (especially as the number of health club members in an area increase over time) and ultimately the confidence to challenge the status quo and seek out solutions to the problems/challenges that they have identified in their lives.
I have now witnessed the different stages of these health clubs, from their infancy when women arrive on time (even early) and cleanly dressed to sit for hours to talk, learn and encourage each other to implement the new practices they have been taught. Skeptics sit to the side, deriding them by saying things like, ‘you ladies are wasting your time sitting under that tree gossiping all day’. What they don’t know is that these ladies, the innovators in their community, are at the head of a wave that will soon engulf up to 85% of the community. At first the women have to ask permission from their husbands to attend these meetings, but over time the husbands begin rushing them out of the house to ensure that they are not late for the next installment. As the weeks progress, the women don’t tire of the 2 hour meetings and the husbands don’t complain of their wives laziness. In fact, their numbers keep increasing, their excitement seems to increase and in some cases the husbands begin to join them. Back home changes can also be seen as toilets are built with little to no assistance from ‘experts’ from the West or Baraza stands are developed to hang leaky tins from (informal hand-washing stations) and to lay ones hoe by for cat sanitation (feces burial). Compounds become cleaner, kitchens begin to transform and diets change, all through a simple process of health education that includes, encourages and is driven by the participants as opposed to viewing them as empty vessels to be filled with knowledge. As the club members learn more, their households begin to change and their family members become healthier, the skeptics begin to copy those things that on the surface are easy to replicate. However, the benefits are not accrued because they do not know why they are doing these things, at least not until they too decide to join the club.
Graduation is a joyous occasion whereby the members can celebrate the fact that they made it through 20 weeks of education and now have the means to improve the health of their family and friends. There is lots of singing, dancing and dramas portraying the new behaviors they have learned and the attitudes of those who have yet to ’see the light’, as well as plenty of sadza (corn meal) and relish for everyone. Interestingly, in these hard times in Zimbabwe where the city folk cannot find milk or meat on any of the shelves of their supermarkets, the club members are cooking enormous pots of sadza with chicken or guinea fowl and offering their guests bottles of milk as a sign of respect and admiration. This is because many of these members have already begun to build nutrition gardens, the next phase of ‘development’ for the health club members. Included in these nutrition gardens are a variety of 30 herbs, including dandelion, thyme, rosemary and lemon grass, all of which have both nutritional and medicinal attributes. After a short training, most of these ‘gardners’ are then able to self-diagnose (based upon their health training) and treat (herbal training) the commonest symptoms and illnesses. Many will take on live stock and keep the cleanest pig-sty’s you will ever find. Others will begin bee keeping, which requires the planting of trees, both woody and citrus, to allow the bees to thrive. The seed has been planted and the field will grow as their fellow community members also join so as to harvest the simple, but powerful benefits that club membership offers. Community solidarity, a sense of ownership and mobilization towards self-identified goals.
When we visited those who graduated from clubs over 7 years ago, the changes were amazing. The kitchens were transformed into polished works of art. In fact, the women, who dominate in this domain, but for years were socially required to sit on the floor on a mat while their husbands perched above on a stool, bench or chair, have redesigned their kitchens so that they now sit eye to eye with their husbands. Areas that were once dry and brown are brimming with new, green life, all planted and meticulously managed by club members. In the most amazing example of the power and motivation of club members, two wards (lowest political division) with a strong history of club activity identified their need for a community market and meeting center. In response, during one of the hardest economic and political periods in recent Zimbabwean history, when people were fleeing and fretting about the future of the country, these community members were quietly building a beautiful community kitchen, a 15 stall marketplace with bedrooms for those women who needed or wanted to sleep over ,and a beautifully crafted communal hall for meetings, trainings and a krush for the children. Included in the buildings was a workshop for paper making and other activities, but unfortunately soon after construction a fire whipped through the area and destroyed the entire building, including the paper making equipment that we recently purchased. Everything except for the cement was provided for by the club members who constructed everything themselves after a process whereby they identified what they could and couldn’t do.
The story does not end there. In one ward, a counselor (local politician) who was unresponsive and creating roadblocks to the club’s progress was voted out of office and replaced with a club member who was obviously more sensitive to and supportive of community initiatives. In another ward, the counselor was under threat of losing his seat (and supposedly officially did lose his seat in the last election, but surprise, surprise, he’s still there) because of his stance against the clubs. Now…he is one of their biggest supporters and realizes that he has to recognize the club members as a social and political force of change in his ward. I also heard from a number of different sources, club facilitators, ZimAHEAD staff and ward counselors that clinical visits in the areas where clubs are active have reduced and would be willing to bet that the effects of these clubs contribute to mitigating the major health issues in their wards. In fact, another counselor who is openly living with HIV/AIDS told of how his club members, in a sign of respect and support for an ill community member, will weed his nutrition garden and farm once theirs are completed and have been treating him with the medicinal herbs in their own nutritional gardens. Amazing! HIV is so taboo in these areas, but club members understand and support those in need instead of shunning them and leaving them to die alone.
All in all…the process works. Social change and development can happen and can be stimulated simply through education. Knowledge to make health decisions. Knowledge to change ones life. Knowledge to increase the capacity of a community. Knowledge to lift an entire population out of the endless cycle of oppression and exploitation. I have seen it with my own eyes. It has worked in Zimbabwe for the past seven years for an organization with almost no budget, 4 dedicated and competent staff members (2 for the majority of the time), 2 beat-up and barely running vehicles and a belief in the power of people and participation. Now those communities that started 7 years ago are primed and ready to develop the projects they want (like this new Jatropha project being offered by a private company – a plant whose seeds can be used to create biodiesel, glycerine and soap) and effectively utilize the massive amounts of money that are flooding ‘developing’ countries these days. If only the Global Fund collaborated with communities and was flexible enough to allow community based organizations to decide the projects or health area they would like to focus on. If only the global health and development ideologs could see the tree through the forest and realize that communities that have been mobilized in this way are much better placed to effectively and efficiently use the money they so desperately want to spend in ‘developing’ countries.
For more information about the woman (Dr. Juliet Waterkeyn) and the organization she developed that I was traveling with, their methodologies and the work that has been done in Zimbabwe, Uganda, Sierra Leone and now Guinea Bissau and soon to be South Africa, please visit www.africaahead.com.
