Report Author: Trevor Mattos
In October of 2010, Gordon College student Miranda MacKinnon and I began planning to do a small-scale development project in Togo, West Africa. We sought to connect Gordon College students with a non-profit organization called Clinics of Hope. Since 2004, Clinics of Hope (COH) has established and sustained several medical clinics in Togo. Local clinic staff provides essential medical services to remote communities, who would otherwise not have sufficient access to healthcare. Our vision was The Learn Africa Project, to prevent disease and promote education within a community where COH was working. We planned to supplement the COH model with support for disease prevention and education, and provide an opportunity to get students creatively involved with COH’s work on the ground, in Africa. We hoped to live within a Togolese community, in reciprocity with the people. The project aimed to facilitate discourse about development in West Africa by sharing life and work in community.
We chose a village called Ganavé in southeast Togo, where a COH clinic had been established the same year. The community was in dire need of a primary school, and healthcare initiatives to address intestinal parasites in school-age children. We planned to do three things in Ganavé:
1. Partner with community leaders to construct a three-classroom primary school.
2. Treat all school-age children with Albendazole for intestinal parasites, and effectively prevent infections from reaching the threshold of disease.
3. Concurrently conduct a village-wide research survey on health and education in Ganavé.
Meeting the educational needs of children in the least developed parts of the world is vital to breaking the cycle of poverty (Garcia, p.52). However, infrastructure remains a major barrier to achieving basic education in poor parts of the world. In a 2005 study, UNESCO confirmed “adequate infrastructure” is a major challenge to primary education in Kenya (Omwami & Keller, 2010). As nations in sub-Saharan Africa attempt to universalize primary education, existing pressures on infrastructure and human resources are exacerbated, and quality education is compromised (Omwami & Keller, 2010). “To expand enrollment without investing in infrastructure only causes the quality of education to decline” (Omwami & Keller, 2010). And to begin with, “The quality of the primary school facilities…their durability and functionality, is often abysmal” (Theunynck, p.2). Lacking infrastructure is discouraging children from finishing primary school and teachers from coming to teach (Theunynck, p.2). Therefore, one critical way to promote education is to partner in developing sound educational infrastructure.
This is what we did in Ganavé, where the situation was no different. Before leaving for Africa, we raised $6,000 to contribute to building Ganavé a three-classroom primary school. We worked closely with the village community to manage and participate in the school construction process. It was extremely difficult, frustrating, and challenging. As it stands now, the Ganavé School is without a roof. We are currently seeking funding to complete this project. Through the process we learned hard lessons about development, dependency, conflict, and resources in poor communities.
A related public health issue in West Africa, that affects education, is parasitic infection caused by soil-transmitted helminths (STH). There are 400 million school-age children infected by STH, which often leads to anaemia, attention deficits, learning disabilities, school absenteeism and dropout (WHO, 2006). Failure to treat children, who are more susceptible to STH infection (Kirwan et al., 2009), seriously inhibits childhood development (WHO, 2006).
A 2003 study in Cameroon proved that not only are children targets of STH infections, but that STH infections usually compound in children, involving more than one species, thereby increasing morbidity. High prevalence and abundance of parasitic infections raises serious concerns about morbidity in school-age children (Tchenté et al., 2003). As a result of intense STH infections in the Cameroonian community of Loum, “school children in Loum are subject to significant nutrition, education, developmental and productivity constraints” (Tchente´ et al., 2003).
But despite the harsh realities of STH, effective anthelmintic treatments, recommended by The World Health Organization, are available. “Regular treatment with…anthelmintic drugs in school-age children reduces and maintains the worm burden below the threshold associated with disease” (Bethony et al., 2006). More precisely, treatments with Albendazole successfully reduce prevalence and intensity of STH infection in children (Kirwan et al., 2009). And anthelminitic drugs (like Albendazole) can be used not only in cases of diagnostically confirmed STH infection, but also in large-scale treatment of endemic communities – significantly reducing child morbidity in these areas (Bethony et al., 2006). In 2001, “the World Health Assembly passed a resolution urging member states to control the morbidity of STH infections through large-scale use of anthelmintic drugs for school-age children in less developed countries” (Kirwan et al., 2009). The benefits of deworming children include improved iron stores, growth and strength, cognitive performance, and school attendance (Bethony et al., 2006). Moreover, children show signs of improved nutritional status and higher motor and language milestones in early childhood development (Bethony et al., 2006). In Ganavé, we distributed Albendazole to all school-age children (2-18 years) during our public health research survey. It is our hope that this initiative will improve childhood development, keep children healthier, and improve school attendance and student performance. In order to maintain child health and development, COH staff will need to continue distributing Albendazole to all school-age children at regular intervals throughout the year. We soon hope to officially establish this program along with others based on our research in Ganavé.
Prior to traveling to Togo we drafted a research proposal, informed consent document, and preliminary survey. After some revision, The Gordon College Institutional Review Board approved our research proposal, allowing us to conduct a survey in Togo. For our survey, we worked alongside 2 translators, Delali Degbeh and Sunday Olaniyan. We spent many days moving from home to home in Ganavé, and a number of neighboring villages. The experience was deeply educational, something I will never forget. Not only did we collect valuable information that could help COH be more effective in Ganavé (and distribute medicine to keep children healthier), we also greeted each family in the community, we learned their names and faces, and we heard many stories about life in West Africa.
The purpose of the research was to ask people in Ganavé how they understood their health and education needs. We planned to evaluate the relationship between the two, submit our analyses to Clinics of Hope, and help design programs that more effectively address the needs particular to Ganavé. We realized that not every village is the same, and we know very little about the day-to-day lives and decisions that Togolese people have to make. Our 2-month experience in Ganavé helped increase our understanding, as did our research.
A cursory analysis of our data would reveal that rates of malaria and malnutrition are high, in addition to the rate of soil-transmitted helminth infections. Also, social issues that have a bearing on economic (and physical) wellbeing include: polygamy and broken family structures. The role of women in the community, and related investment (or lack there of) in women’s health and education, is very low. Women’s disempowerment, we believe, plays a large role in the underdevelopment of these Togolese communities.
Our experience has taught us that prevention is the central tenant of public health. Programs must be effective and sustainable, and they must seek to eradicate the root causes of disease, not only their symptoms. Also, we must not overlook the relationship between social factors and physical health, as many social structures regulate access to healthcare and social services. More generally, we learned that with community development/health programs like this, you must be able to think on your feet, reassess, readjust, and learn from experience. Compared to the relative success we achieved with our STH treatment program, and our efforts to construct a primary school, our most valued achievement was real cross-cultural interaction and conversation. We made deep friendships and learned through the narrated experiences of our West African family. I remain humbled and grateful to our co-workers in Togo, for they have taught us much.
Links & Resources:
The Learn Africa Project – A collaborative Global Health and Development project carried out between Gordon College, Massachusetts and Clinics of Hope.
Clinics of Hope – Homepage of NPO ‘Clinics of Hope’
Bethony, Jeffrey, Simon Brooker, Marco Albonico, Stefan M Geiger, Alex Loukas, David Diemert and Peter J Hotez. 2006. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. The Lancet, 367: 1521-32.
Garcia, Marito, Alan Pence, and Judith L. Evans. 2008. Africa’s Future, Africa’s Challenge: Early Childhood Care and Development in sub-Saharan Africa. The World Bank: Washington, DC. 525 pp.
Kirwan, Patrick, Samuel O Asaolu, Síle F Molloy, Titilayo C Abiona, Andrew L Jackson, and Celia V Holland. 2009. Patterns of soil-transmitted helminth infection and impact of four-monthly albendazole treatments in preschool children from semi-urban communities in Nigeria: a double-blind placebo-controlled randomized trial. BioMed Central, Infectious Diseases, 9:20.
Omwami, Edith Mukudi, and Edmond J. Keller. 2010. Public Funding and Budgetary Challenges to Providing Universal Access to Primary Education in sub-Saharan Africa. International Review of Education, 56:5-31.
Tchuente´, L.-A. Tchuem, J.M. Behnke, F.S. Gilbert, V.R. Southgate, and J. Vercruysse. 2003. Polyparasitism with Schistosoma haematobium and soil-transmitted helminth infections among school children in Loum, Cameroon. Tropical Medicine and International Health, 8:11, 975-986.
Theunynck, Serge. 2009. School Construction Strategies for Universal Primary Education in Africa: Should Communities Be Empowered to Build Their Schools? The World Bank: Washington, DC. 257 pp.
World Health Organization, 2006. Schistosomiasis and soil-transmitted helminth infections – preliminary estimates of the number of children treated with albendazole or mebendazole. Weekly epidemiological record, 81: 145-164.
The Learn Africa Project: Public Health, Applied Learning and Research Internship
Report Author: Trevor Mattos