Mobilizing Societal Change
For those interested in community, global health settings, sustainability, research, non-profit, or humanitarian (Paul Farmer-esque) concepts: I think this will appeal to you, especially.
CHASE is a research-project-turned-community-organization headed by two Harvard doctors, Tony Earls and Maya Carlson. Well-known in the Moshi area of Tanzania, CHASE stands for “Child Health and Social Ecology”, and aims to empower children to have active roles in educating and leading their community in prominent health issues, such as HIV/AIDS and malaria. The program rests on the notion that individual improvements and self-worth can lead to a collective effort to change a society (also known as “collective efficacy”). The program began as a research project out of Harvard in 2002, and concluded in 2007. CHASE proved very positive results on the concepts of efficacy.
However, less than 10% of all community research continues into the community after it finishes—and thus Tony and Maya have established a sustainable continuation of the project (no research) as an official Community-Based Organization.
Seeing Tony and Maya “struggle”—and by that I mean many things in CHASE do not go as planned—makes me relieved. No, that’s not cynical. I mean, here are these two brilliant Harvard doctors that are working to implement really sustainable change within a developing country community, and they are met with obstacles at every turn. Nobody is immune. Sitting in a classroom, I always imagined public health interventions in a developing country to go well; us academics have resources to give—knowledge, materials, trained staff—and in a developing country they do not have these to the same extent. So, the plan is straightforward: go help. But I have learned very quickly that such scenarios are naïve daydreams. Nothing is linear.
CHASE has been met with rejection from local grant funders when in dire need of funds, miscommunications with locals, theft, and more. The system in which they work is often dysfunctional, and occasionally, corrupt. Tony and Maya get things done at all costs though—staying up late into the night with work, and waking early the next morning to continue.
Lorraine says Tony has told her many times: ‘you have an obligation to use your skills to further societal development.’ People like that are my role models. Undoubtedly.
Tony, Maya, and I arrive at the small CHASE office located in a local health clinic. The health clinic is a complex of three painted cement buildings. In the waiting areas, the benches are absolutely full. The building adjacent to ours is the maternal building, and there again, benches are packed with women and their babies in lap and arm. Many are waiting to get their babies weighed, measured, or immunized. For now, the local doctor that Tony and Maya work with is out of his office; he has business somewhere outside of Moshi for a few hours. His wooden office door is open, and patients have filled office chairs inside, and benches outside. They stare as we peek into the office. Tony says the wait for medicine in Tanzania is notoriously bad. You need to get to the clinic in the morning to have the assurance that you will be seen the same day.
Tanzania has a voluntary public health insurance program (there is private insurance too). In this system, you pay a minimum of 10,000 Tanzanian Shillings per year (approx. $6), and receive every service totally free. The rate is different based on family size. You can pay more if you wish, or not at all. The fees to visit a health clinic or office without this health coverage are 1,000-2,000Tsh per visit ($1 = 1600Tsh), one CHASE worker estimates. But the system doesn’t really work that well. If you are a healthier family, you might not need health services that often. And, if you’re healthy, the chances are higher that you are wealthier as well. Hence, you don’t attend the clinics, and don’t see the need to give money as it’s not financially worth it for your family. As we stand in one corner of the waiting area, Tony and I both marvel at these facts and system of health care together. Health is arguably the most vital component of a community, and deserves much attention.
What Tony and Maya are attempting to do with CHASE and community health is right. It’s community engagement and, more importantly, empowerment. They are setting up a system that will leave the starting line with training wheels, but they will soon be shed. The chain will churn, the gears will be adjusted as those riding see fit, and the community will move towards the goal of a finish line (although as another mentor of mine, Dr. Rife, always says: “There is no finish line”). The most important part? The community will take control and make their own choices about how health should be addressed with the help of all ages.
The TOMS book, Start Something That Matters, writes on a sustainable health non-profit called Surgeons OverSeas. Here’s how the founders, Dr. Peter Kingham and Dr. Adam Kushner describe it:
“As surgeons, we know how good it feels to go to developing countries and do a large number of operations, but we realized that if we could teach local surgeons, or even help local surgeons teach junior doctors in their own country, we could really make a difference. The local surgeons are the experts. We can assist with teaching materials, supplies, and moral support, but for the long term it’s up to them. It’s their country after all; shouldn’t they have the skills to care for their own population?”
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