Chapter 14: MAP (Medical Assistance Program) 1986-91
Dr. Chis Wood, Deputy Director of AMREF had recruited an outstanding Nurse-Trainer from the Ministry of Health. Her name was Penina Ochola and she was my deputy. Additionally, I had recruited Elkana Odembo who had trained in US. Thus, our Unit (CHWSU) leadership was well Kenyanized and I felt it time to move on. I joined the Medical Assistance Program (MAP) an American NGO just starting in Kenya. MAP wanted to broaden from “Relief” only to relief and “Development”. With MAP I more or less continued promoting the development of community-based health care through training of CHWs. Our TOT courses took us all over East Africa, including Ethiopia, Sudan and Zaire. During this time, we sold our Chalet home and moved to an apartment on the property of Navigators, still in Nairobi. From time to time I had voluntary relationships with Kijabe Medical Center (where I was born).
Training visits outside EA (to Ecuador, Ethiopia and Congo/Zaire). Moved Nairobi home location from the “Chalet” to Navigators Headquarters. Served as Chairman of the Board of Kijabe Medical Centre
- From AMREF to MAP
- Training Courses
- Acronyms for check-lists
- Outside East Africa
- Changing Our Family Home in Nairobi
- 7. Kijabe Medical Center
- From AMREF to MAP
AMREF placed a strong emphasis upon local leadership, whether at the village level or at the country level. By 1986 we had made good progress in “Kenyanizing” the Community Health Worker Support Unit which I headed. My first adjutant was Penina Ochola who had previously been a Senior Nursing Tutor with the Ministry of Health. Next to her was Elkana Odembo who had had training in US and with World Neighbors. So, when I was recruited from AMREF to MAP I felt I could leave AMREF with good conscience because the Unit was in their good hands.
I was recruited to MAP by Merrill Ewert. It was not a hard sell because I had been familiar with the organization since medical school days. The organization was in the process of broadening its mission. Beyond relief with medical supplies, they also wanted to be involved in development i.e. change. Bill Senn, a seasoned development worker (South America and Greece) was to be head of a new East Africa operation. He with his wife Hope was an inspiring manager/administrator.
Another colleague in MAP was Mary Jane Warden. Her husband had been the Southwest Area Director of IVCF (Inter Varsity Christian Fellowship) till felled by a drunk driver. After his death Mary Jane with three children came to join MAP Nairobi. She helped me run a TOT course at Brackenhurst Center. One of those attending was a single (divorced) American named Harry Clark, who headed World Vision’s program in Maasailand. From that contact, and others there grew a lovely partnership. Mary Jane and Harry were married at Narok, Maasai District in my childhood home environs. Their Christian wedding was, adorned with much Maasai culture (songs, dance, costume etc. by the Maasai staff of World Vision).
Walter Wamalwa, a graduate in pharmacy of Makerere U. was staff administrator under Bill Senn. He had extensive connections within the Anglican Church so was helpful in church relationships.
Merrill Long was completing field work towards his PhD from U. of North Carolina and so added academic scrutiny to our community-based approach. In later years he headed Compassion Int. in Wheaton.
- Training Courses
To a considerable extent my work at MAP was a continuation of what I had been doing at AMREF, mainly running training courses for Community Health Workers. These courses tended to be known as “TOT” courses (for Training of Trainers of CHWs). In practice, most courses were a combination, both of training of trainers and training of CHWs themselves. Most courses were run in collaboration with a local NGO (usually church-related) in rural areas, often at rural mission hospitals. The courses tended be comprised of a series of three one-week sessions spaced at three-month intervals.
- Acronyms as check-lists of important elements.
We constantly tried to keep our training simple and problem-based. I developed a number of acronyms which stood for important features of our approach. These had varying degrees of acceptance or utilization by the western-trained medical community.
Community-Based Health Care
C = an acquaintance-sized community.
B = based i.e. of, by and from that community itself, not outsiders.
H = health (We left disease diagnosis and cure to the clinicians.)
C = care through nutrition, immunization, natal care, water supply etc. activities.
LePSA is not a teaching method, but simply a reminder of good elements such as:
Learner-centered; Problem-posing; Self-discovering; Action-taking.
STARTER (not actually an acronym)
Starting a lesson with a problem. A well-posed problem could even be a “startler”.
The essential features of a good lesson starter: Short, Simple, Sensitive, Stimulating,Solvable, and NOT including the Solution. The learners discover that S for themselves.
Questions for de-briefing, after seeing a problem-posing starter. What did you See? What, specifically, was Happening? Is such Our experience What is the main reason or cause for this problem? What is the result if this problem continues unmet? What can we, here, now in this village Do about this problem?
Important elements of community-based development to bear in mind: The community’s own Knowledge; their own Attitudes (& hopes, expectations); Practicalities and environmental Conditions such as geography or hydrology; Habits (good or bad); Initiative-taking; Resource-raising; Responsibility-carrying; Relationship– improving.
In Rhodesia/Zimbabwe I visited a Salvation Army mission doctor (Jim Crowe). He was a genius in many ways. He had devised a splendid example of “appropriate technology”. He found a local gourd which grew two ball-shaped parts one large (1-2 litre) and one small (250 cc). They were on the same plant, but were ninety degrees angle to each other. Jim cleaned out the contents and suspended the gourd from a bush. He filled the larger ball with water. When he tipped the assembly enough, water ran from the large ball into the small one. The small one had a tiny hole. From this hole emerged a fine stream of water. That stream (250cc) was enough for a child to wash his/her face and hands. The benefits of this “Tippy-Tap”?: 1. Local materials 2. Simple, even for an infant 3. Fosters good hygiene habit 4. The used water can nourish a tree planted below the tap. 5. Conserves water i.e. the tap can not be inadvertently left running. 6. It allowed many individual face-washings before the big reservoir needed re-filling. In Kenya we had no such gourds. So I did a great deal of experimentation with throw-away plastic containers making a replica of the natural two-chambered gourd. I called it the MAP-TAP. it met with varying degrees of acceptance. (See Beyond the Dispensary page 82).
The booklet “Beyond the Dispensary” has graphics of other of my simplifications of health habits, such as: “Bottle Bunduki”; “4-F’s”; “Kibiriti Kit”; “Mix Colors”; “1-1-1 Diarrhoea mix” and “Sun-Safe water”;
While at AMREF I had written “Beyond the Dispensary” and “Doctor AMREF Talks” the latter being a compendium of 50 of the 100 health talks I had given on Kenya national radio.
While with MAP I wrote “Community-Balanced Development” and “Giving and Getting AIDS”. I also wrote dozens of monographs on community development and teaching methodology.
- Outside East Africa
We shared our vision and experience with various organizations farther afield.
Early in my time with MAP we spent time in rural Ecuador where they had development projects. The comparisons with rural East Africa were interesting. The problems were very similar. Interestingly the geographic equator ran through both countries. Our host in Ecuador was Dr _____, a Columbian doctor who had left surgery training in US to focus on community-based preventive development in Ecuador. Another kindred spirit in MAP was Evvy Hay. Before joining MAP, she had served as a nurse in a Sierra Leone mission hospital. She later was a Professor at Wheaton College, helping academia preserve roots in the realities of the Third World.
In collaboration with either SIM (once Sudan Interior Mission) or Food for the Hungry we ran TOT or TOT-like courses in Addis and in places like Nazareth and southward in the Rift Valley.
I also once paid a visit to a giant refugee camp run by World Vision. It was at a very high altitude so was very cold. Many thousands of famine refugees (victims of Ethiopian government population mismanagement) were living in hovels of blue 10’X10’ plastic sheeting. The nutritional care center itself was also made of plastic sheeting, but with better and larger support structure. This Ethiopian refugee disaster was chronicled around the world in a TV documentary titled “Africa’s Calvary”.
We collaborated with Dr Jean Marcuse of Africa Inland Mission, based at Rethi. Together we ran courses at Bunia, Beni, Nyankunde, Oicha, and elsewhere. Our language of teaching was “SwaFrAnglais” i.e. a combination of Swahili, French and English. This was after the troubles of the “Simba” rebellion and during the Mobutu era, but before the current Kabila era.
- Changing Our Family Home in Nairobi
By 1986 our kids were grown and gone (Some had “re-cycled” back to East Africa). So, we did not need as large a house. At about the same time the Navigators, a Christian organization we knew well, were needing a base for their Africa program. They were considering a property which included an apartment suitable to us. Under a mutually beneficial arrangement we sold our Chalet and moved to the apartment in the Navigators complex.
Our connection with “Navs” had originated when Mortimer and Mary Lane had hosted Dawson Trotman (founder of Navs) when he visited Wheaton College in recruitment visits in the ‘40s. Their son in law Johnny Streater, while in the US Navy, had been an early Navigator member.
That connection was strengthened when we started attending a Bible Study at the home of Bruce and Marg VanWyk in Nairobi when they were heading up Navs work there. Then we got to know Mutua Mahiaini while he was yet a student at Nairobi University. He went on to become the International Director of Navigators. It has been a blessed fellowship.
- Kijabe Medical Center (KMC)
I was born at Kijabe Hospital. My brother in law Bill Barnett had been Medical Director. We had collaborated with the hospital’s development initiatives. So, it was not surprising when I was asked to be Chairman of the Board. Those were difficult times in many ways: political, financial and in staffing. The hospital enjoyed the patronage of President Moi since he had been a constituent of the Africa Inland Mission. But, like all mission hospitals, KMC operated at a considerable financial loss. This despite the fact that almost all senior-level professionals (i.e. missionaries) were “free”, their salaries being paid from their home countries. But it was hard to recruit Kenyan doctors since the hospital could in no way match the salary and amenities of government service or of private practice. The hospital was nominally under the jurisdiction of the Africa Inland Church. It was an important enough institution to attract political attention. And many non-medical people had the very false assumption that the hospital was a “cash-cow”. When I left I handed over the Chairmanship to a Christian Kenyan pediatrician who had once been a medical student of mine. He had risen fast in the Kenyan government medical establishment. The hospital continues to broaden the spectrum of its medical coverage. It is an important light on the mountainside (the Rift eastern wall). Through a network of AIM/C dispensaries it influences the progress of health throughout Kenya and nearby countries.