The best moment as an educator is when your students take ownership over concepts they learn in class. Throughout multiple moments this week, I watched my students make Global Health and Social Justice issues their own.
The week started with our first visit to Project Hope and ended with a lively talk by Dr. Samu Dube, a public health New Strategy and Business Development consultant with Phillips and a part-time consultant with PATH.
Project Hope is a diabetes and hypertension clinic in a nearby township called Zandspruit. In a recent post I discussed laying the groundwork for this student experience by shadowing PH Community Health Workers as they searched for defaulting patients.
The night before our visit, three excited students came to my apartment to watch videos on heart disease and prepare questions for their day at the clinic. They were fascinated by the Renin-Angiotensin cycle and questioned whether this was a disease related to cultural diets. Despite the fact that they are busy students with research papers and exams due that very week, they were willing to spend 45 minutes on a Monday night studying extra Biology and reading articles. Their passion was contagious.
Early the next morning those same students crammed into my car, excited for a hands-on clinical experience. None of them had seen Zandspruit, the township where Project Hope is located, and were shocked at how close our school sits to such social inequity. To get to Project Hope you have to go down a road crowded with taxis and children who haphazardly step into the path of oncoming traffic. My tiny blue Sirion bounced through huge divots in the road and navigated around piles of trash, left uncollected by public services for weeks. We turned through the gates of Emthonjeni, hidden behind informal tin homes. The center itself is a green oasis, providing relief from the hectic streets outside.
First the students got a tour. They saw the garden where women from the community plant vegetables to sell. The center also teaches people how to save the money that they make through the garden. Then, the students rotated between the triage center, the cholesterol and creatinine testing room, the education desk, and the on-call nurse’s office. They asked provocative questions like how is diabetes racialised? Can this disease be prevented with the right education? How do you measure your outcomes?
For me, the best part of the day was peeking into the triage stations and catching a few goofy grins as my students were given the chance to measure blood pressures and calculate BMIs.
On our car ride home they remarked on how caring the nurses were towards their patients, a huge departure from their respective experiences with government hospitals. The students also noticed how important it was that all the nurses spoke the same languages as their patients. They felt like this kind of attention to the individual and understanding of the community being served was key to Project Hope’s success.
Now, they want to go back and so we are planning a follow-up trip where they will do health education with Zandspruit teens in early June. Stay tuned!
This passion carried into the next day. Dr. Samu Dube presented her hopes for healthcare reform in Africa to all four of my students plus six others who showed up.
Dr. Samu Dube works on advocacy for research and development with PATH, a Global Health institution seeking to ensure access to healthcare globally by delivering innovative programs and technologies for global health. She has had a prolific 15 year career in healthcare investing, program directing, teaching and research in Zimbabwe, Botswana, Swaziland and South Africa.
In our Global Health Journal Club, the students had been asking some hard questions about whether or not a capitalist market economy had space for health equity and health justice. Dr. Dube had answers.
She started her talk with the hard truth; governments have not achieved their Millennium Development Goals. She made a point that people on the African continent still die of hunger, pregnancy and diseases for which we have vaccines. She then drew a graph that showed a step-wise investment strategy.
First governments must invest in basic health care to raise the baseline standard of health.
Then they must invest in Research and Development. In South Africa where HIV rates are around 19% for people between the ages of 15 and 49, it struck her as ridiculous that not a single ARV, or CD4/Viral Load count machine is manufactured in the country itself (1). She related health inequity to a lack of investment in R&D infrastructure.
The next step is entrepreneurship. After raising Africa’s baseline healthcare and reducing the amount of imported medical technology being relied on, countries should start investing in entrepreneurial healthcare businesses. We have discussed entrepreneurship and health in the context of Echoing Green fellows like Dr. Dalwai and Noora Health.
The students got particularly excited when she made health infrastructure an issue of social justice: “Justice,” she said, “is fairness and equity of access to the poorest. And there is a difference between equality and equity. Equality says that we are all equal,” she held up two hands as if to simulate to groups of people who are on a level playing field. “But equity means starting off unequal and then needing to bring the disadvantaged up to an equal point,” she held her hands at two separate levels and then mimicked pulling the poorer hand up to an even level with that of the privileged one. Justice, for her, was a matter of recognizing the difference between these two terms. To achieve health equality, we must recognize a need for health equity.
Dr. Dube talked about the role of the doctor in this battle encouraging patients to make good decisions and holding them accountable. She told the students about a time when her supervisor sent her out to find the father of a young malnourished patient. There was so much hope her voice as she discussed how empowered she felt advocating for this young person.
The best part of the talk came at the end when one of my students, who had been particularly excited about her Project Hope experience, asked what she could do to hold governments accountable for providing healthcare for their people. In 2001 Abuja Declaration, African countries agreed to spend 15% of their government budget on health. Of the 54 African countries, 19 spend less now on health than they did in 2001. (2) To hold them accountable, Dr. Dube suggested looking at what your country currently spends on health and then lobbying for your governments to meet their Sustainable Development Goals.
Dr. Dube closed her inspiring talk with two thoughts: “In life there are so many injustices so, choose one and fight. Defend it with your life…[And] Leadership is all about people. Do not measure leadership in terms of wealth but, instead, focus on the suffering of people. Use that as your foundation.”