Friday, September 30, 2016

A Village Thrives in Zambia

By Taylor McNeil

A Tufts project demonstrates that when health-care initiatives help communities harness their own resources, the rewards increase exponentially

Before John Morgan and his team of dental professionals came to Muchila, a large rural community in southern Zambia, people who had toothaches simply suffered, mostly in silence. If it hurt badly enough, they would rinse their mouths out with diesel fuel or bleach, anything to try and stop the pain.

“In the U.S., we have one health-care provider to 390 people; in southern Africa, it’s one to 50,000 people,” says Morgan, an assistant professor of public health and community service at the School of Dental Medicine. And even when there are health-care resources in many of these African countries, they tend to be concentrated in the larger cities. People in rural areas are mostly left to fend for themselves.

That’s no longer the case in Muchila. Over the past five years, Morgan and his colleagues have trained a corps of 10 volunteer dental public health workers there who have now given oral health screenings to some 10,000 people. Because of the trusting relationships developed through the dental program, the Tufts team has extended its reach with other projects that benefit Muchila’s people, such as providing fresh water for the first time and starting micro-enterprises to spur economic development.

Listen to John Morgan, an associate professor at the School of Dental Medicine, talk about his work leading a dental project in Muchila, a village in Zambia.

And there’s promise of even greater benefits. “The idea with the Muchila project is to build a model that can help all of southern Africa, [with its] very poor ratio of health-care workers to population,” says Morgan. Tufts and the Muhimbili University of Health and Allied Sciences in Tanzania, which have been collaborating on public health curricula for several years, are working toward that goal, sharing a U.S. Agency for International Development (USAID) grant to adapt and test the Zambian model for developing sustainable health-care projects in Africa, starting in Tanzania.

Multiplying the Benefits

The roots of the Muchila project extend back to 2004, when Morgan, prompted by a couple of Tufts dental students who wanted to do a project in Africa, led a mission to Zambia. While working in a hospice in Lusaka, the capital city, the dental team met Max Gallaba, a Zambian former Catholic priest who was volunteering there. Gallaba understood how poor dental health affected people: children in school, he said, had a hard time concentrating because of toothaches, and worker productivity suffered for the same reason.

Gallaba suggested that Morgan and his colleagues go to Muchila, a farming village about an eight-hour drive from Lusaka. While “village” might bring to mind a cluster of huts, in Zambia the communities encompass a number of settlements, along with farming and grazing land. Muchila, for example, has a population of about 28,000 people, most of them farmers or herders. There is no running water or electricity.

Gallaba’s family had settled in Muchila when he was young, and though he now lived in Lusaka, he knew the village chief and elders. He set to work paving the way for the dental team to visit. “People from the village had not seen a dentist before, and they had not been visited by anyone from overseas,” Gallaba says. “I had to convince them they would be helped, and together with the village leaders and the medical staff at the rural health center, we managed to bring people together and the community accepted us.”
Morgan adds that “once they got to know us and we started taking care of some pain issues, all of a sudden they really wanted this dental project.”

The team, which includes dental school students and faculty, went on to make twice-yearly visits, and soon realized that the village needed a sustainable program to develop a network of health-care providers. “So we trained local dental volunteers to educate the communities about prevention and hygiene, and they continue the project in the absence of the team,” Morgan says. Gallaba points out that “the villagers now know how to organize themselves and develop the community on their own.”

In fact, the program succeeded well beyond Morgan’s expectations. He says he’s amazed that the volunteers the Tufts team trained now have reached thousands of people. “This model, with a multiplier effect, has great value in terms of building capacity at the village level. We think it is a good one to work with, to find techniques to apply to other health-care systems.”

The Project Expands

Once the villagers in Muchila became comfortable with the team, they came with a request: we need clean water. “If you want to improve an overall health outcome, you have to deal with the water contamination situation and its contribution to disease,” Morgan says. Soon he and Gallaba, through Maureen Lombard, the dental school’s director of clinic operations, contacted a U.S. Rotary Club that was doing water projects and linked it with similar organizations in Zambia. Two boreholes were drilled, and for the first time, the village had regular sources of clean water.

Another pressing community issue that the dental professionals took on was the large number of orphans who needed to be cared for. Among Zambia’s 13 million people are some 800,000 children who have lost their parents to the ravages of HIV and other diseases. In Muchila, as elsewhere, they are usually taken in by local families, which are often poor. So with support from their fundraising arm, Options for Children, Morgan and the other health-care providers decided to subsidize a farm that raises corn that is sold at market to benefit the orphans.

“It was sad,” says Morgan. “These orphans are overburdening so many families in the village, so we thought with the farm we could feed them and also sell some of the corn to buy shoes and enough supplies to go to school. We’d like to expand that program.”
Muchila’s chief then came with another request: to help start a small business venture for the village women. “They are the backbone of the culture,” says Morgan. “They have the babies, they raise the families, they work out in the fields.” The women decided to make baskets to sell to tourists, and the dental team now takes the baskets to area markets and brings the proceeds back to Muchila.

“When the women speak, they say they never thought they would ever be paid for anything in their whole lives, so this has been a big boost to them,” Morgan says. “This has given them a vision for what they can do.” Next, the dental team hopes to help the women branch out into jewelry making. Another task will be to improve the distribution of the goods so they don’t have to rely so heavily on the team to get their products to market.

A Natural Partnership

Even though the Tufts project is still centered on oral health, its success in other areas has been an eye-opener. It has shown just how far reaching health-care efforts can be when they help communities develop their own resources.

“We believe you have to embrace both the community and the local university to create the infrastructure and education required for development,” says Morgan. “The Zambia project is helping out a small community, but we learned that the community engagement piece is extremely important.”

When USAID put out a request for proposals focusing on partnerships between universities and African institutions to develop programs for rural, underserved communities, it wasn’t hard to decide on the next course of action. Tufts and Muhimbili University of Health and Allied Sciences (MUHAS) had already developed that symbiosis.

They received a six-month planning grant this year from USAID’s Higher Education for Development unit to develop a model for rural health care in sub-Saharan Africa. A team from Tufts—including Morgan; Mary Lee, J75, M83, an associate provost; and Patricia Campbell, executive vice president—went to Dar es Salaam in July to discuss ideas with MUHAS officials. Then, with the MUHAS director of planning, they went to Muchila to take part in a dental mission and get a better sense of how to apply the Muchila experience elsewhere on the continent.

“It was fabulous seeing how organized the community is,” says Lee. “They are clearly on the path for exceptionally strong community development—it’s a very effective program that we hope to adapt to other areas of Africa.”

In fact, Tufts and MUHAS are partnering to explore how to develop this health-care delivery and training model for other areas of rural Africa, starting with several villages in Tanzania.

Gallaba, who had been in the U.S. this summer and early fall raising funds for Options for Children, returned to Muchila in October. There he helped prepare the orphans’ farm for spring planting and for a visit from the dental team’s administrators in November. And he’s got another agenda: while visiting the Tufts team in Boston, he got certified in radiology for dental assisting. “Now he plans to pursue becoming a certified dental assistant,” says Morgan proudly.

Taylor McNeil can be reached at taylor.mcneil@tufts.edu.

This research is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the Higher Education for Development (HED) office. The contents are the responsibility of Tufts University and do not necessarily reflect the views of HED, USAID or the United States Government.

Posted November 11, 2009