An inspiring endeavor that will undoubtedly change the face of epidemiological research  is being completed by a student. Jonathan Smith is an epidemiology student at Yale University who recently completed his thesis research on the HIV/TB epidemic in South Africa. He not only collected quantitative research, but also took the time to learn and understand the community. He is putting his work into a documentary film, but needs more support in order to make it a reality. The stories that he has to share are deeply moving and have the potential to make a big impact beyond the communities where he completed his research.

Support the film’s production here on KickStarter >> http://kck.st/ocZ5rn

I interviewed Jonathan this past week over email:

1. As a student from a Western country, why do you feel it is your place to tell the stories
of South Africans?

I really like this question – I don’t feel like it is my place at all. I am showing these stories, not necessarily telling them. My role in this project is to be a vector for their stories to unravel by themselves – then to stay out of the way! I think often times people do not appreciate the contextual differences in disease – any disease – and think what solutions work for ‘us’ will work for ‘them.’

This became real to me when I was living with Mr. Mkoko. I struggled to make headway in HIV education, prevention, and testing, at first, but eventually broke through with some success. Not by imposing what I was learning from school on them, but by working together, understanding the cultural beliefs of the community, and taking those beliefs seriously (not casting them aside as ‘stupid’ or ‘wrong,’ although they were indeed dangerously misleading). Because of this, I was formally accepted as a ‘brother’ into their community – even given the tribal name Masheshay’nike. This meant I was no longer an ‘umlungu’ (‘white person/outsider’) and that they now would respect my views and thoughts as one of their own – I worked with their traditional healer in a pseudo-scientific, quazi-clinic capacity that promoted proper prevention strategies and testing without undermining their traditional practices. This was an intense amount of work,
but if I were to just go in there and say “this is right, you are wrong,” I would have been shut out immediately.

2. Since there have been many fully funded large scale studies completed by international organizations, how has your work been received coming from a student?

For the film, I think being a student really helped me. People were really willing to help since I was just a student. I think it made the industry executives and government officials a little bit more relaxed – i.e. this was ‘just a student project,’ as opposed to a mainstream film, if that makes sense. Several production companies let me use their studios for interviews for free, international universities accommodated me, and people favorably responded to interview requests all because, honestly, I think they remembered what it was like being a struggling student.

3. How has your work been received in the epidemiological community since you
are using a mixed methods approach as opposed to sticking with traditional
quantitative research?

So it’s a little tricky – there are two things occurring simultaneously, but independently: a research project and a film. I am simultaneously working on a mixed-method research study at Yale that incorporates both qualitative and quantitative measures to indicate contextual factors that lead to increased TB and HIV vulnerability among this population. In other words, what other forces are at work that increase disease vulnerability and allow this cycle of disease to perpetuate. The film itself, while technically independent from the research, further investigates the lives of people caught up in the very cycle that I am researching. So puts a face to this and hopes to shift the conversation away from the data and more towards the person. Hopefully combined, they will really demonstrate a need for change – the data will explain that this is a widespread and serious problem (i.e. not some crazy activist film), and the film will demonstrate that for each ‘number’ that we quantify in the research, the impact goes well beyond just the statistics. So one does not negate or undermine the other, they actually go hand in hand to augment each other.

As far as reception from the academic community, people have been very receptive to the idea. I work with a number of professors at the University, and we are currently trying to figure out how we can expand on this idea, how to replicate it in other issues, as well as metrics to gauge its effectiveness.

4. What impact do you hope to achieve with the completion of the documentary?
What will your research and documentary be able to do that “million dollar” studies have failed to do?

What I think any research project on this issue has yet to do is place accountability. I’m in no way against the million dollar studies – we need them to highlight the problem. But over the past few decades, we have used this research to define the problem now with surgical precision – we know what it is. We know why. We know what needs to be done. We know how to do it. We know certain methods will work. But nothing is being done. Why? Because there is no accountability. Its not just ‘big mining’ dropping the ball – its everyone. Governments, the industry, and the unions could do more.

Even researchers. Because rates of TB and HIV are so high, researchers now use the mining
population for cohort studies that have nothing to do with the population itself, they just know they will get the disease so it would be an easy cohort study. They are literally human guinea pigs for epidemiological research. We are dancing a fine line of ethics when we treat a population int his manner.

I hope the film will educate and empower civil society to place accountability on the decision makers to actually get things done – to make the appropriate policy changes or actually enforce existing ones. I hope to string together motivated individuals and organizations to say, “Now we are watching.”

With Hanukkah and Christmas in the past and Kwanzaa and New Years Day fast approaching holiday cheer and charitable acts are in full swing, along with the dollars fueling these two year end activities. Playing off of these charitable and cheerful feelings, the (RED) Campaign swings into full force at this time. The (RED) Campaign coordinates the marketing of “(RED)” branded products, such as Starbucks coffee merchandise, GAP t-shits and Nike shoelaces to “give up to 50 percent of their profits to the Global Fund to invest in HIV and AIDS programs in Africa.” In addition to the (RED) Campaign’s obvious ambiguity in regards to the amount of money actually given to the Global Fund, and the claim that the campaign is funding “HIV and AIDS programs in Africa,” without a clear description of what HIV and AIDS programs are actually being funded, the Global Fund is notorious for its lack of financial transparency. The Global Fund along with the (RED) Campaign is often questioned about its efficiency and efficacy, particularly in light of the huge media and marketing campaign that pulls in millions and millions of dollars from often clueless, though well-intentioned customers.

Not wanting to be totally Grinch-like, I must sing some praises of the (RED) campaign. For one, it has one of the most well known and ubiquitous charitable advertizing campaigns ever launched and sustained across a wide variety of products.  It has not only substantially impacted, and even changed the face of the philanthropic world, but has had an impact on the business world that fuels the campaign as well. And it cannot be denied that the campaign gives money to a large foundation whose goal it is to end HIV/AIDS, Tuberculosis and Malaria in African countries. And finally, buying a (RED) product will further benefit its stated mission in some way.

Regardless, there are two major things that make the (RED) Campaign inherently problematic. First, with such a powerful presence across a wide range of outlets around the world, shouldn’t the campaign do, give, devote, make, change, and affect more? And if it does, how do we really know?

And second, isn’t promotion of mindless consumerism ($200 iPods, overpriced T-shirts and Coffee, and running shoes made God-knows where by what age worker) contrary to the goal of public health in Africa, the ultimate goal of  the (RED) Campaign in the first place?

In fact, it may be true that goals and intentions of the (RED) Campaign are honorable.  But as consumers and producers in the developed world, we should be sure that our hard earned dollars, euros, yen and pounds, our charity to the less fortunate, and our holiday cheer make it to people and organizations that will use those things to the most effective and fullest extent. Although buying a red coffee cup, a red T-shirt, a red iPod, and red shoelaces are easy and fun ways to give, be sure of what you are giving and to whom you are giving it.

P.S. HAPPY HOLIDAYS!

P.P.S. Check out SCOUT BANANA’s own holiday campaign, TI(RED) for more information!

The Mo Ibrahim Prize for African Leadership hasn’t been given out since 2008, but the Mo Ibrahim Foundation has launched the Ibrahim Index as a measure for African countries and their progress. This is an interesting and important development as a number of the indicators for the index focus on health. Check out other interesting news from across the continent. Check it out for yourself!

Reducing poverty with water!

“Water is more valuable than oil, more precious than gold,” said Amy LoPresti, co-founder of Africa Water is Life. “It is the essential ingredient of our life, our culture, our history, and our future. Yet, 1.2 billion people in the world do not have access to clean, consumable water.” Unsafe water and a lack of basic sanitation cause an estimated 80 percent of all diseases in the developing world and together kill more people than all forms of violence, including war.

Modified bananas to fight child and maternal mortality

This is a story that really invokes our organization’s name. High rates of chronic malnutrition and micronutrient deficiencies of Vitamin A and iron among women and children remain Uganda’s most common malnutrition problems. However, an edible banana could solve this problem.

How fight against Guinea Worm was won

Africa Water News highlights a CNN article that suggests we are close to eradicating the disease. Once called the “forgotten disease for a forgotten people” the Carter Center believes that every country in Africa except Sudan will be rid of the disease.

Healthcare is a Moral Obligation

The ANC’s National Health Insurance scheme has yet again opened up the deep economic divisions in South Africa. The economic divisions are best represented by access and quality of health care. Doctors are very difficult to find in poor, crowded townships and settlements, but major towns with many wealth have centers for plastic surgery. 60% of funds for health services are directed at the 15% of the population which is covered by private health insurance. Only 40% of the funds are used to pay for the public sector that serves 85% of the population.

Medical Education in Africa to receive $1.3million in American Grants

Over the next five years and in partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the department is awarding grants to African institutions in a dozen countries under its Medical Education Partnership Initiative (MEPI), which works with U.S. medical schools and universities to form a network that includes about 30 regional partners, country health and education ministries, and more than 20 U.S. collaborators.

Ghanaian belief and Healthcare

This article is being featured because of the subject matter. Voice of America (VOA) has a habit of generalizing, especially in Africa and about African people. I suggest reading the interview transcript on how traditional beliefs guide health practices in Ghana, something that I studied during a 6 week study abroad covering disparities in health care. The US health care system could learn a thing or two from the Ghanaian health system.

Hope Expanded Protection Against TB

With a vaccine and drugs available to treat tuberculosis (TB), you would think that it should no longer be a problem. 1.3 million people worldwide died from TB in 2008, according to the World Health Organization most lived in Africa and Southeast Asia. Is this becoming another “forgotten disease for a forgotten people?”

Rwanda’s Public Health Care Option

With so much debate and controversy over providing adequate health care, one African country is setting an example for both “developed” and “developing” health care systems.

Doctors Without Borders utilizes World Cup to raise HIV awareness

Medecins Sans Frontieres (MSF) is working hard to bring greater attention to the serious cut in funding for HIV/AIDS. The US, especially, is taking heat for its decision to reduce the amount of funding. More:

• South African activists added their voices to the protest
• FIFA World Cup HIV campaign

UNICEF marks Day of the African Child with Somalia

The often unseen side of conflict is the toll it takes on health care systems. UNICEF has done well to raise more awareness for the greater need for investment in health care systems in the war-torn country of Somalia.

Zambia to be more Transparent with Health Donors

In a promising move, the Zambian President Banda told donors that more effort would be put into putting greater transparency and financial management in the Ministry of Health.

World Bank missed the boat on Tuberculosis

Thirteen years of funding a program tasked with advocacy and controlling tuberculosis has lacked serious evaluation and focus. The Change.org Global Health Blog offers greater analysis in how the World Bank has failed in the fight against Tuberculosis.

These are just some of the key highlights from the end of this past week. Follow on twitter: @scoutbanana to get up to date articles related to Health in Africa.