Nick Harding (M 1994)
“Where you live shouldn’t define whether you live or die” (Bono U2)
CHE family with drying rack
In 1988 I joined the medical school at Birmingham University. I remember my interview as I had been prepared well by those around me, suggesting that if I was asked the question “why did I want to become a doctor” I didn’t answer “to make a difference for people” as there were lots of other professions that I should therefore go into and this may jeopardize my chance of getting into Medical School.
At the end of my first year I wanted to do something productive with my extended vacation. I came across an organization that was taking people abroad and got the chance to go and work in Tanzania for a Missionary Aviation Fellowship. Our role was to drive out into the country to isolated rural villages and clear the bush to construct airstrips to fly light aircraft that contained medical teams. I loved spending time with rural Africans but I found myself in difficult situations where sick children were bought to ourfor help. As a first year medical student I was deemed by our team to have more medical knowledge than anyone else and I had the impossible task of being presented children to make better who were likely to be suffering with malaria.
I didn’t have the knowledge or wisdom I have now to realize that without any medications and training there was little I could do (but now we are making a difference without medication!). This caused a deep desire to do something in Africa after my training in the future.
After finishing my medical education I began working as a GP in inner city Birmingham, as well as have a family. In early 2007 I had the opportunity to re-visit Africa on a 2 week trip as part of a church leader’s training team. The beauty of Africa gripped me and returning home 2 weeks later I was more determined than ever to try to make a difference for the people I had met. It seemed that there were a few options available to me. I could give some money to the projects thatI knew were ongoing in Malawi. However I had seen that often these projects were very well meaning but I couldn’t see long-term differences being made.
Malawi would always be in my thoughts but that didn’t seem enough. An option would be for us to move to Malawi as a family to serve the people, but actually I still enjoy delivering general practice in inner city Birmingham and the challenges that produces. So I was again frustrated by my lack of ability to follow my heart’s desire.
In late 2007 my wife and I took a trip back to Malawi to visit Tom and Ali Husbands, who moved to Malawi in 2002 to work there full time with their twin boys Jack and Joel and daughter Grace. They set up the Dalitso Trust, which has been successfully working in partnership with rural villages in Malawi. Their focus is on changing lives through sustainable development and they have shown that change comes through investing themselves in others, one person at a time, rather than aid projects.
They have a base in a rural village in Malawi called Malingunde and we were able to support them erecting a building that contains a rooms for training, community groups and office space. Together we spent 2007 researching healthcare, longing to make a difference in Malawi, looking at other providers in the country and seeing what projects they were delivering. Malawi’s government has a well thought through program delivering an Essential Healthcare Package that allows non-governmental organizations (NGOs) to supply simple medicines and vaccines to rural Malawians.
However what we saw was compatible with the report into aid in Africa commissioned in 2005 by the UK government, suggesting that many endeavours in this amazing continent have failed. Annual spending on health care is around £2 per person compared with the U.K., which is 1000 times higher. We were moved particularly by mobile clinics that were being run by NGOs, driving into the bush delivering good primary care to poor communities in great need of basic medicines. Despite them using the medicines associated with the Essential Healthcare Package, the mobile clinics have large running costs for staff and vehicles that are funded through large American organizations.
Our heart was to deliver a sustainable health program that created independence in local populations and this saw the beginning of Dalitso Health in 2008, working alongside the Dalitso Trust. Malawi has a population of 12 million with an estimated million people infected with HIV (National Aids Commission). Many children die before their first birthday due to Malaria, and diseases that can be easily prevented with personal hygiene that we take for granted.
Our research lead us to the Community Health Education (CHE) methodology that has been developed in Uganda by Lifewind International, and is a long term zero intervention program that is people focused. It is a truly holistic program designed to meet the needs of individuals and communities. It aims to bring hope and renewal to communities, no matter how difficult their circumstances, and empower people to become ‘village changers’ amongst their neighbours. It has been embraced as a preferred strategy by literally thousands of people working for many organizations around the world, all of them serving the world’s poor.
It uses simple education lessons to build local knowledge covering physical, emotional, social and spiritual issues. Our team is excited to be the first people to deliver CHE in Malawi. We are trialing this via communities, families and current organizational church structures. In order to implement the CHE program we were delighted to employ Chippo Chale who moved back to his home village of Malingunde in 2009. Chippo is a respected leader with good teaching experience and a strong vision for CHE (as well as speaking Chichewa and English which is vital for me!).
With his wife Janet and their 3 children Chris, Joy and Peace they are keen to see their village changed by improving basic health practices. Chippo and the team of 4 local Malawians spend their time visiting the families, churches or community CHE projects.
For the families they teach lessons on how to have a healthy home, as poor quality housing is generally accepted to be an important contributor to ill health (United Nations Centre for health settlements). A healthy home consists of 15 points
such as making sure you children are vaccinated, having a rubbish pit and clean area around the house, sleeping under mosquito nets, a separate place to cook and bathe, having a pit latrine and a dish drying rack and living at peace in the village. Dish drying racks act as storage off the floor for eating utensils keeping them clean, and also allowing the ultraviolet light from the sun to sterilize them.
In our program CHE families who simply built for themselves a dish drying rack have noticed a decrease in diaorrheal illnesses by up to 50%. In the community and organizational CHE program, similar lessons are taught but by a team from their own community as part of a committee. The committee members are chosen by their own community to give them ownership of decisions made and they then appoint Community Health
Workers who Chippo trains in CHE lessons and they in turn go and teach the lessons to other village members. The training of committee members finished in late 2010 and they are now beginning to go out and teach the health lessons themselves. The whole process takes time and relies on developing trust with the local people. The team are also involved in translating the CHE training materials from English to Chichewa.
Currently I travel to Malawi and meet with and encourage the team a couple of times a year. I can be in contact via email and Skype regularly to keep abreast of what is going on with the project. On a personal note, taking our children out to rural Africa has allowed them to learn about the challenging conditions that much of this world lives in, and my daughters personally know the team and some of the families we are helping, which is an amazing part of their education.
My trips involve teaching the team health related lessons that they can then hand on, and encouraging them in the work they are doing. The natural pull back to relying on aid is so strong in Malawi and a constant battle, which we try to discuss. I get to travel with some good friends who hold the vision for what we are doing. Meeting the CHE families is such an amazing privilege although Chippo has banned me from seeing the community and organizational CHE programs: he feels that my visit would ruin the work, as “they would wait for handouts as is characteristic of white people, rather than become self-reliant”. My colleagues at work are gracious to put up with me talking about Malawi at every opportunity and several colleagues and friends have come out with me to use their skills for the local people.
Everyone I know when thinking about Africa wants to see change happen there, and in my opinion most doctors went to medical school as they wanted to make a difference for society. Spending time in the developing world helps me ground myself in the realities of what is happening miles away from western daily life, as well as appreciate all the NHS has to offer in these current days of financial hardship.
Chippo and me
If you are keen to help us develop sustainable long-term partnerships between the UK and Malawi, providing ongoing practical support and resources we would love to hear from you. The web site iswww.dalitsotrust.org, or if you like to receive copies of our newsletters then please email us on dalitso.health@ googelmail.com