Village victories: new motivational techniques in Kenya and Zimbabwe.

PIP: The Institute of Cultural Affairs (ICA) in Kenya and the Zimbabwe Project in Zimbabwe are organizations working to promote local level development in their respective countries and a major challenge to these organizations has been how to change the attitudes and perceptions of the poor in ways that help them help themselves. ICA efforts are carried out in Kenya by several hundred volunteer staff, including 30 expatriates. Most are assigned to 1 of the 21 projects spread across southern Kenya. Since 1975 the ICA has launched projects in over 200 villages. Village clean up, public health, school construction, water development, and agricultural improvement are some of the project categories. Tangible results include starting demonstration farms, field terracing projects, building pit latrines and compost pits, constructing new pathways, roads, and schoolrooms. Many of ICA's efforts are funded by local companies and through Kenyan offices of development organizations. In the field of health, ICA provides training courses at the village level that emphasize preventive care, sanitation, hygiene, nutrition, family planning, first aid, and treatment of common illnesses. ICA's mobilization techniques are based on motivating villagers to help themselves, to "catalyze and energize" the resources at hand. The process begins with a "consult" in which 12 or more ICA staff conduct a 3- or 4-day meeting with villagers to reorient local thinking. A special effort is made to break old attitudes that have held traditional villagers back. The consult is also designed to confront traditional assumptions about what the longterm reality might be. For urban slum villages the focus is on the transient nature of community that serves as low cost housing for thousands of newly arrived migrants. Today the Zimbabwe Project (ZP) is working with former soldiers, although when established in 1978 in Britain its purpose was to assist refugees from the Rhodesian struggle who had fled to Botswana, Mozambique, and Zambia. The organization currently provides training courses and practical advice on how to start cooperative farms and small businesses. Its overall concern is to help ex-combatants become economically self sufficient. To date, some 32,000 soldiers have been demobilized. The idea was to give each soldier support while he was being trained or finding a job. As a group the ex-combatants ZP works with today are young, usually between 20-35. Although both ICA and ZP take motivational approaches, ICA is more inspirational and group oriented and ZP more pragmatic and individual oriented. The ZP is more concerned with cooperative economic processes and with fitting specific individuals back into socially useful roles. The approaches embraced by ICA and ZP can serve as models for local level development elsewhere.^ieng

Traditional medicine in East Africa: the search for a synthesis.

PIP: In East Africa 90% of the population rely on traditional healers. Such healers offer a blend of advice, solace, and therapy, delivered with an understanding of the patient's background. Efforts to synthesize Western medicine with traditional healers have been spotty and erratic, varying from country to country. In Kenya, traditional healers are held in ill repute by government leaders. Tanzania, however, sponsors a traditional medical research unit, a major laboratory complex for traditional medical research, and a chair in traditional medicine at the University of Dar es Salaam. Neither government openly supports traditional medicine for fear of encouraging exploitation, charlatanism, and malpractice. Herbal medicines are a growing business surrounded by secrecy, especially in rural areas. There is a vast difference between the holistic, metaphysical approach of the traditional healer and the scientific Western approach. Illness is ascribed to nonorganic, supernatural forces. Middle-income, upwardly mobile people usually mix Western and traditional remedies. The desire on the African doctor's part to diassociate himself from bush-doctors and be considered totally modern mitigates against synthesis. Kenya has a strong private medical sector and ambitions to attain distinction in modern medicine. Kenyan doctors performed the first kidney transplant in black Africa and launched the first official family planning program.^ieng

China's revolution in health.

PIP: Since the revolution and the overthrow of the Gang of Four, China has embarked upon a program of modernization, internationalization, and technological development. The sloganeering campaign for general health as espoused by Chairman Mao is as follows: 1) prevention, including immunizations and early illness detection; 2) serve the workers, peasants, and soldiers; 3) medical work integrated into all other modernization efforts; and 4) combine traditional and Western medicine. The mass campaign aims to involve individuals in improving their health care facilities at the same time they are involved in production of goods and services. Rural workers are mobilized in mass cleanup and prevention campaigns. Of the 8.7 million health workers, nearly 2 million are barefoot doctors, or other types of doctors serving at the lowest rung of paramedical service. Basic services are widely available. Costs are low, access is easy. For about 95% of illnesses the system works very well. Patients with illnesses requiring high technology care, e.g., organ transplant, cannot survive. Chairman Mao codified traditional medicine as a curriculum component for education; it is based on ancient West-Central Chinese practices, mostly from the Han people. The 4 main components are theory, diagnosis and prescription, herbal medicine, and accupuncture.^ieng