Volunteers working for social justice: community development for HIV prevention

Because HARAMBEE is a small organization, we can be quite flexible.  Each service trip to Africa is custom-designed, with a specific set of goals and just a few volunteers.  We have had medical students conducting education and research (see below), student lay volunteers observing and teaching oral rehydration therapy, craft teaching, and --in August, 2009 -- a professor from Chicago initiating collaboration with Kenyan medical schools for computer-aided teaching.  If you are interested and have a special idea you would like to pursue, please contact us!  We charge no service fee, although each volunteer pays his or her own expenses.  Total cost for 3 weeks, including airfare:  Approximately $2200.  We love to show volunteers the beauties of African wildlife, too.  Optional 2-3 days safari is a few hundred dollars additional. 

In May, 2006, Project Harambee sent a team of students (students) to Kenya to teach & hold counselling sessions with adults and adolescents on HIV/AIDS prevention, as well as nutrition, basic hygiene, & prenatal care.  The students learned far more than the Kenyans:  first, most of those we encountered knew as much about HIV prevention as we did.  Education is not the primary problem--is it lack of resources.  It is clear that community development and economic empowerment are tools essential for prevention of HIV.   

 MORE ABOUT STUDENTS, AFRICA, FROM JUSTIN LIST:

 

 http://purposeandpraxis.tripod.com/id16.html

 Below is a report on HARAMBEE's international medical education program, presented at Stanford University's 2007 international meeting of Unite for Sight. 

Model for a Regionally-based International Medical Volunteer Program to Resource-poor Areas.

 

Abstract:  Medical students are increasingly aware of global health care inequities and the medical needs of underserved populations. Recent years have seen an upswing in the demand for cross-cultural health studies and international service opportunities abroad (6). After such experiences, students report changed world views, heightened cultural sensitivity, increased community, social, and public health awareness, enhanced clinical and communication skills, more appropriate resource utilization, changes in career plans, and greater understanding of the challenges of working in areas with scarce resources (3, 6). These changes in attitudes and skills result in socially responsible physicians with increased awareness of social determinants of health and public health, a broadened global perspective, and greater self-awareness (8). They have more interest in volunteerism, humanitarian efforts, and working with underserved populations both in the United States and abroad (8). Moreover, students whose foreign field experience occurs during preclinical training years are more likely to maintain these interests (2, 8). Educational and volunteer experiences abroad offer potential for strong reciprocal relationships between participating international institutions and collaboration with colleagues in other countries (1).

Although expanding resources such as telecommunications and electronic banking make such programs more feasible, few opportunities currently exist that provide professional students with meaningful pre-clinical work that addresses social determinants of health outside the biomedical context. Programs typically charge substantial service fees, offer scant preparation for the volunteer mission, are rarely academically oriented, and are not conducive to follow-up collaborative initiatives either in the host country or after return to the United States.

We present a model for a regionally-based (Chicago, Illinois) program, administered by a non-profit organization, for an in-depth, comparatively inexpensive experience that benefits student volunteers while also empowering the resource-poor communities they engage. Because the program is geographically centered, it offers the advantages of regional multi-school participation, effective volunteer screening, cooperative fundraising efforts, and in-depth preparation and team-building. Mutual support and debriefing at the conclusion of the trip and post-trip follow-up are facilitated.

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Under the auspices of PROJECT HARAMBEE, a United States nonprofit non-government organization, a pilot volunteer group of seven students followed a three-week program in rural and urban areas of Kenya. Both academic and activism/service components related to public health, economics, education, and medicine were included. The rationale for this design is that students must display cultural competence and familiarization with educational and health care resources of the host country before they are considered reasonably qualified to serve in that country. Visits were scheduled to academic institutions, research laboratories, community based organizations, hospitals, and clinics (figure 1). Work at clinics included escorted visits to patient homes . Because of the scope of the HIV/AIDS pandemic in sub-Saharan Africa, particular attention was paid to issues and institutions related to HIV/AIDS."servant learner." It resulted in several predictable outcomes. (Indeed, a needs assessment survey in a resource-poor area is not complex: everything is needed, and in great quantity.) There were unanticipated outcomes as well. Because of the in-depth interviews, critical needs in communities became manifest and students engaged in activities to help meet them: e.g., a men’s group was begun to encourage discussion about attitudes and practices contributing to HIV spread. Particularly striking were lessons learned via conversations initiated by the survey questions. Some interviewees reported that it was the first time a foreign aid visitor had asked their name, the first time they felt genuinely heard. For students, a transformative lesson in the power of attentive listening resulted--unique instruction in the art of medicine.  

 

Service education modules (HIV prevention, hygiene) were combined with a health care needs assessment study aimed at both scholarly publication and community development. (See Unite for Sight poster by J. List et al.: The Pathology of Poverty: Health Care Needs Assessment Study in Selected Resource-Poor Areas of Kenya.) A brief nutrition survey was also included .

Pre-trip preparation included bi-weekly meetings for educational briefings, planning for fundraising, teambuilding exercises, and design of the needs assessment study and nutrition survey. Each volunteer carried donated items (e.g., non-prescription medicines, eyeglasses, shoes, sewing machines) as part of luggage allowance. Home-stay accommodations in Kenya promoted cultural insight, ongoing ties with Kenyans, and involvement of host families in local service activities. The trip concluded with a debriefing meeting and written evaluation.

This trip was designed with values and activities for the "servant learner." It resulted in several predictable outcomes. (Indeed, a needs assessment survey in a resource-poor area is not complex: everything is needed, and in great quantity.) There were unanticipated outcomes as well. Because of the in-depth interviews, critical needs in communities became manifest and students engaged in activities to help meet them: e.g., a mens group was begun to encourage discussion about attitudes and practices contributing to HIV spread. Particularly striking were lessons learned via conversations initiated by the survey questions. Some interviewees reported that it was the first time a foreign aid visitor had asked their name, the first time they felt genuinely heard. For students, a transformative lesson in the power of attentive listening resulted--unique instruction in the art of medicine. The survey provided a powerful window into the personal lives of those we wished to know and serve. It is a valuable tool of engagement and learning and will remain an integral part of the education/service program.

 

Future possibilities for this unique program include extramural funding and incorporation into a global health/development curriculum or course for academic credit.

 

 

 

References & Readings

1. Federico SG, Zachar PA, Oravec CM, Mandler T, Goldson E, Brown J. A successful international child health elective: the University of Colorado Department of Pediatrics’ experience. Arch Pediatr Adolesc Med 2006 Feb;160(2):191-6.

2. Godkin M, Savageau J. The effect of medical students’ international experiences on attitudes toward serving underserved multicultural populations. Fam Med 2003 Apr;35(4):273-8.

3. Haq, C, Rothenberg D, Gjerde C, Babula J, Wilson C, Bickley L, Cardelle A, Joseph A. New world views: preparing physicians in training for global health work. Fam Med 2000 Sep;32(8):566-72.

4. Imperato PJ. A Third World International health elective for U.S. medical students. The 16-year experience of the State University of New York, Health Science Center at Brooklyn. Community Health 1996 Aug;21(4):241-68.

5. Miranda JJ, Yudkin JS, Willott C. International Health Electives: Four years of experience. Travel Med Infect Dis 2005 Aug;3(3):133-41. Epub 2004 Nov 11.

6. Panosian C, Coates, TJ. The new medical "missionaries"—grooming the next generation of global health workers. N Engl J Med 2006 Apr 27;354(17):1771-3.

7. Riner ME, Becklenberg A. Partnering with a sister city organization for an international service-learning experience. Transcult Nurs 2001 Jul;12(3):234-40

8. Smith JK, Weaver, DB. Capturing medical students’ idealism. Ann Fam Med 2006 Sep-Oct;4 Suppl 1:532-7; discussion S58-60.

 IN-COUNTRY PROGRAM ITINERARY

WOFAK (Women Fighting AIDS in Kenya)

Africa Alive!, UNESCO-sponsored HIV prevention entertainment program in Nairobi slums

University of Nairobi School of Medicine, Tropical Disease Institute, HIV Research Laboratory

Mbagathi Infectious Disease Hospital, Nairobi

Catholic University of East Africa, Nairobi

Upendo Village Clinic, Naivasha (with home visits)

Nyumbani Home for HIV+ orphans, Karen

Lea Toto children’s clinics, Kawangware & Kibera (with home visits)

Mukuru Women’s Economic Empowerment & Health Co-Operative, Mukuru

Village of EmBulBul