CHAPTER 13 Back to AMREF Flying Doctors Service (1978 – 1986)
In mid-’78, at the end of my contract with Nairobi Medical School. I returned to AMREF to focus on the community-based end of the spectrum of health care. Enroute back from leave in US we visited Shanghai, China and Musorrie in India. Back in Kenya I started the Community Health Worker Support Unit (CHWSU) at AMREF. In this specific endeavor we served and collaborated with a variety of NGOs. We gradually built up a curriculum and a cadre of trainers. The cadre was multi-organizational, multi-denominational and multi-ethnic. Our courses were known colloquially as “TOT” (for Training Of Trainers of CHWs). Betsy graduated from RVA in 1978 and Gini in 1980. We continued to enjoy our “Chalet”. In the absence of our boys we turned the lower floor of the Chalet into a small self-contained apartment. This was home, short term, to a series of close friends, mostly in the development fraternity. Then in 1986 we left AMREF to join MAP and there continued the promotion of community-based health care.
LINKS to AMREF Flying Doctors and MAP publications by Roy Shaffer:
Dr. AMREF Radio Talks, AMREF, 1990
Community-balanced Development MAP International, East Africa Regional Office, 1993
- Shanghai and India
- Re-joining AMREF 1978
- Definitions and Acronyms
- Friends and colleagues in the development family
- Training sessions
- CMDA CME seminars
- Family and other travels (in this era)
- Shanghai and India
(While en route from US leave back to AMREF in Kenya. Oct 10 we flew westward Abuquerque-Tokyo, Oct 11 Flew Tokyo to Hong Kong, Oct. 11-18 in Hong Kong, Oct 19 Hong Kong to Canton & Shanghai)
Friend Dr Al Hinman from Albany County Health Dept. days had given us a reference to the President of Shanghai Medical School . Al had done field work with him in China. In correspondence he seemed welcoming and offered time in the field. But he seemed unable to sponsor a visa. We had a run-around in DC trying for visas. The Chinese embassy was very stand-offish because we were not part of a large group under official patronage. My uncle Wendell was friendly with a senior officer at US State. He recommended just going to Hong Kong and try for a tourist visa from there. This we did. We spent a week enjoying HK while awaiting the tourist visa.
We took the hydro ferry HK to Canton where we were met by a Chinese lady “minder”. She got us on the plane to Shanghai. We got ourselves to the Shanghai Medical School where we met the Professor. He was cordial, but seemed tentative on the planned days in the field visiting his community health programs. In the end we never got into the field with him.
While I was with the Professor his secretary took Betty to secure our bookings out of China onward to India. Trouble! Seemed that owing to a flood of US businessmen the Chinese air transport system was totally overbooked. We could fly out either the second day or not for two weeks. The delay would have upset many plans, so we had to greatly abbreviate our stay in China. For the first night the Professor put us up in a dormitory for foreign students.
Though elderly and infirm he trudged up three flights of stairs to visit with us in that place. Though he had a PhD from Hopkins he did not discuss his time in US. Understandable, since under Mao he had been a victim of the Red Purge and had spent years as a field hand. His secretary, also an MD had suffered likewise, and was still not allowed to practice medicine.
While in the foreign students’ dormitory we chatted a few hours with some Ugandan students resident there. They were very wary in their comments, but were obviously not at all enjoying their scholarships. Their most bitter complaint was over social ostracization.
While in Shanghai we bought a poster of attractive Chinese characters reading as a health statement. Back in Nairobi I hung it on my office wall. Later a friend, literate in Chinese saw it and kindly pointed out that I had hung it upside-down
Oct 22 Flew Shanghai to Delhi, India thence by train to Dera Dun where we met John Sale of Nairobi days. John was starting an Indian National School of Wildlife Management at Dera Dun. With John we drove up into the hills to Mussorie where John and Jennie lived. Mussorie is the home of Woodstock the well-regarded International School. It was also the childhood home of Prof. Carl Taylor an eminent leader in the field of health development in the Third World. We enjoyed his former home, the town and some rural outings with community health workers. For me the visit was hampered slightly by a bout of malaria. But otherwise it was a multi-faceted pleasure. Oct 29 Flew to Delhi and thence to Bombay. Oct. 31 Delay in Bombay because of the airport’s computer failure (in a nation of mathematicians!). We spent the night on the floor of the departure lounge. We then proceeded to fly to Nairobi and resumption of service under AMREF.
- Rejoining AMREF fall of ‘78
I started the Community Health Worker Support Unit at AMREF. This unit was funded by World Neighbors through its East Africa Director David Cowling. David had vast, friendly connections throughout East Africa so was a good mentor in inter-agency collaborations. Our unit based at AMREF headquarters coordinating the program of multi-agency teams going together to run TOT-type courses throughout East Africa. The program was a happy collaboration across lines of religion, governance, ethnicity and nationality.
- Definitions and Acronyms
Meaning of “CBHC” and “TOT”
Over the years we were involved in many field training sessions around East Africa.
These were usually five-day sessions. They were mostly held in collaboration with a mission hospital which shared the vision for what we promoted as “C-BHC” (Community-Based Health Care).
In philosophic terms “C-BHC”. was the logical, local/community end of the spectrum of “Primary Health Care” (as pontificated by WHO at Alma Ata in 1978). We emphasized the “community-based” perspective. We emphasized Mao Tse Tung’s dictum “Start where the people are at”. Our students were primarily mature mothers who were successful enough to be able to spare volunteer time motivating and training their neighbors in matters of home-preservation of health. The most important personal element was a spirit of community. Some of the best students were illiterate. A few were men.
The majority of these sessions were known as “TOT” for “Training of Trainers” (of CHWs or Community Health Workers). The training team was comprised of 4-6 members drawn from several NGO organizations such as AMREF, Catholic Health Services, Methodist Mission and PCEA (Presbyterian). We issued paper TOT “certificates”, but those certificates made clear that they represented no promise of emoluments or other favor.
- Friends and colleagues in the community development family.
Geraldine Huising had been head nursing tutor at Rubaga the central Catholic hospital in Kampala. She became tired of “re-cycling” children suffering from preventable diseases.
So, she left the wards to devote herself to community-based prevention of those diseases.
She came to Kenya to work with the Catholic Secretariat. She was one of the most important members of the multi-organizational team which pioneered the “TOT” courses.
Paget Stanfield had been on the Pediatric faculty at Makerere. Paget was my superior at AMREF and we got along very well.
Niki Blundell-Brown facilitated public relations for AMREF. We have remained in cordial contact ever since.
Dan Kaseje was a graduate of Nairobi Medical School. He was often part of the team going out to do TOT training in rural areas. Dan had close connections with the Anglican church so was able to facilitate liasons. He has since founded a development organization based in Kisumu, Kenya.
Onesimo ole-MoiYoi (Nairobi friend)
Ole was a bright Maasai kid who did well in the academic stream. He attended Ilboru HS and then Old Moshi (Tanzania) HS for “A-levels”. Whilst there he caught the attention of a film maker who gave him a role in a film promoting wildlife conservation in Tz. That eventuated in his getting into Harvard College and then Harvard Medical School. He came back to Kenya to do research at ILRAD, a prestigious international facility. While he was still in the US he asked Bill Eddy and me to fly out to his home “turf’ on the border between Kenya and Tanzania. There we met his mother and other family members. The mother was a remarkable personality. “Ole” (to friends) went on to become Vice Chancellor of Kenyatta University and then later Head of ICIPE (International Center of Insect Physiology and Ecology). MoiYoi’s wife Linda is a red-haired lady from Schenectady, N.Y. Her father was a popular radio or TV personality. Whilst the MoiYois were with ILRAD, (in 1981) Linda gave birth to their daughter Katrina at the Nairobi Hospital at the same time as our Carolyn was having Sandra there. So, our families have had many happy interactions.
- Training sessions (with both AMREF and MAP)
Space does not permit details on each session at each site. But each session was important for me, for the team and for the local participants. I trust enough readers will be interested enough in some of the specific places to justify including the listing alphabetically.
Training Sites in Eastern Africa
Where we did some form of training. (TOT, TOF. etc.) while with either AMREF or MAP.
Alale, Uganda Kilifi
Arusha, Tz. Marsabit
Asembo Mbale, Uganda
Brackenhurst (Limuru) Mityana, Uganda
Bunia, Zaire Monduli, Tz.
Cherenganis Moshi, (Tz.)
Dodoma, Tz. Mukutano
Ely Springs Nakuru
Gulu, Uganda Nyankunde, Zaire
Kagando, Uganda Rethi, Zaire
Kampala, Uganda Tenwek
- CMDA CME seminars
CMDA-CME seminars for Continuing Medical Education. These were for missionary MDs serving in Africa. In this intense ten-day period, they could accumulate the requirements for their professional status. This obviated the expense and time otherwise consumed from their furlough time in US. The seminar teachers were mostly doctors of eminent status in their specialties who donated their services. Also, a number of MDs from US volunteered to stand in for the missionary MDs (locum tenems) at their stations during the course. I led sessions in C-BHC.
Almost all the sessions were held at the Baptist Brackenhurst Conference Centre in Limuru, Kenya. I was the main speaker at the 2014 session and also taught at one session for missionaries in Asia held near Kuala Lumpur.
- Family and other travels (in this era 77-86)
Family on the Hurri Hills near the Ethiopia border.
Dan & Gretchen; Dave &Debbie; Marilyn & Steve and two kids- Arlene and Serena)
Mar 19- 28 (??year) Drive via Rumuruti to Karabara at the foot of the Hurri Hills
We as a family went to visit Herb and Ruth Anderson and Paul Robinson. We enjoyed an outing to the Ethiopian border where Paul was having an important baraza (public meeting) with the leading elders of the Gabra tribe. Paul wrote the Introduction to this memoir.
This institution was founded in Nairobi by Don Smith. It was a bold effort to establish a place for higher education that was both broad spectrum, Africa-integrated and Christian in philosophy. Some of the early faculty were on loan from Wheaton and Messiah colleges. On occasion I taught a course there in Community Development.
Jan 14 Overnight visit with Keith Foote on his farm on the Mau above Njoro. Keith was a member of the famous British Foote political family. I met him as a DO at Lodwar when I was looking into Hydatid disease. He had later taken up farming and was harvesting rape seed.
Sudan (Lirya Community Health Center). Feb 15 – Mar 2nd
This was a Community Development project led by Dr Chris Wood (AMREF deputy director) and funded by USAID. We were training southern Sudanese trainers of Community Health Workers. The site was a proposed Health Center (building just started). We slept under the stars. It was very hot. The operating motto tended to be “IBM”, being interpreted: I = inshallah (if God so wills,) B= bismallah (maybe, eventually), M= maalesh (nothing matters anyhow)
Feb 27 – Mar 4 CMDA’s ICMM (Int. Conf. on Missionary Medicine)
This was an international mission medical conference held at the Epworth (Methodist) Conference grounds in St Simons Island, Georgia on the Atlantic coast. I had a session or two explaining TOT philosophy and courses.
One of my “students” there was Jody Collinge (MD pediatrician). She has gone on to a distinguished career in the children’s part in Christian community development education around the world.
Apr 30 –May 18 Zimbabwe (Harare, Bindura, Chawanda, Buni Hills)
I went as assistant to Prof. John Bennet in a consultancy for WHO surveying Community Development in Zimbabwe. The “war of independence” had only recently subsided and so there was a lot of uncertainty.
June 4 Henry Moseley visit. He was from Johns Hopkins.
June 21 RVA Volley ball tournament.
Nov. 23 farewell mass for Sister Joan Devane
Dec 19 Messiah concert in Nairobi. This was an important feature of the musical calendar in Nairobi. It was always held at the Anglican Cathedral. Betty sang in it once or twice and I played violin once.
Dec 21 Arusha (Marilyn’s play), Monduli, KCMC
June 24-25 Ark (observatory). Elgon Caves (Ian Rosemond phot. Re. ebola).
Ian was a photo-journalist who was exploring the hypothesis that the Ebola virus might have some connection to these caves on the slopes of Mount Elgon. The connection was never verified.
After the caves, we took matatatu (jitney) to visit a site (Kafuma) where Kikuyu women were taught wool carpet making. From there we went for a night at the “Ark” game-viewing facility. This place was similar to “Treetops” which we had visited another time. Treetops was where Queen Elizabeth II was visiting when, a he death of her father she became Queen of England.
Sept 10 to US: DC, Ashville (Rices and Teasdales) ; CDC (Al Hinman); Champaign (Uof I) with Gini.
Oct 1-2 Wheaton Homecoming
Oct 4 Flew to Albuquerque.
Jan 28 –Feb 9 CMS CME seminar in Malaysia
Oct 8-11 Italy (National Service)
With Dr. Matamora I did some training of young Italian adults doing development work as alternative to military service. The venue was in Italy. One pleasant outing was a hike high in the mountain range separating Italy from France.
When our teaching of the Italians was finished Betty and I were driven to Genoa to visit former KCMC friends Michael and Jocelyn Popinchalk. Michael was then Head of the International School in Genoa. From Genoa we took a train to Florence where we enjoyed two days of “culture”. We then rented a car and drove southward to a tiny, ancient hill-top town in Umbria. We stayed with a friend with Sudan connections in a farm complex which dated back to the 900s. We then drove on to Rome where we enjoyed the usual historical extravaganza. Then back to Kenya.
Nov 8-22 Ethiopia TOT at SIM lakeside complex.
March 5-16 in US. Brunswick, Chapel Hill (Gin), , Albuq.
May 20 saw Dr Shah (eye) in Nairobi and flew to US for eye surgery (retina) on May 22nd in Lincoln, NE.
June 26-29 MAP Staff Retreat
Aug 15-31 Ethiopia TOT course. Abrupt return to Kenya and US for repeat detached retina. Sept 3 second retinal surgery in Lincoln, NB
Oct 1-3 in Wheaton. Video-taped a presentation at BGC (Billy Graham Center) media center.
Oct 6-26 at MAP in Brunswick.
Oct 26- NOV 8 Ecuador This visit was to exchange experiences with MAP staff in Ecuador (Richard Crespo etc.). Partnered and traveled with Dr ___ ____ a Columbian. He had gone to US to do a surgical residency, but had “converted” to community-based health development. We visited various projects scattered in the high altitude rural areas. Our base was Quito. Many similarities w E.Africa. i.e. poverty and survival skills.
Nov 9-15 Brunswick, Ga. with MAP.