View from The Appalachians

IT IS NOT HARD TO SEE THE ATTRACTION OF JOHNSON CITY, Tennessee, USA, especially in what Americans call “the fall”. The bright, optimistic, energetic city nestles between the tree-covered Appalachian mountains, boldly displaying the full panoply of rich autumn colours. The air is clean, rivers full and the bears, like the people, have a spirit of enquiry, sometimes venturing from their safe haven to investigate the riches beyond.

I am writing this blog from Dulles International Airport, Washington DC, en route for London after a few days as the guest of the Public Health College of East Tennessee State University (ETSU), in Johnson City. And for me, it was an experience far richer that the glorious scenery. I was there to cement friendships with the Dean, Randy Wykoff, Tim Baylor, who does an incredible job in placing students in locations including Munsieville, as part of their studies towards, bachelors, masters or doctoral qualifications, and students like Megan Quinn and Twanda Wadlinton, who have worked with us in the past and become true friends. I was also in town to deliver a public lecture as part of their “Leading Voices in Public Health” series, entitled “The End of Disempowerment and Dependency: Rethinking the Path for Africa’s AIDS Orphans”.

Why do we sometimes limit ourselves to the expected, though, when life blesses us with so many unexpected treasures, too! I fully expected a rewarding experience with the ETSU friends who have already demonstrated their commitment to The Thoughtful Path: Munsieville. What I had not expected was the many new doors of opportunity that opened up with many other parts of the university community.

Meetings with leading charitable foundations in the area; question and answer sessions with students in the Health Administration department; a meeting of minds with the Director of the University’s groundbreaking Graduate Program in Storytelling, to learn more about the evidence of the effectiveness of storytelling in the care of people living with HIV/AIDS in Africa; discussions about how we can work with students and faculty to develop targeted garden solutions for South Africa that can be developed so that shack-dwellers can grow specific crops to enhance the health of pregnant women, or under-fives; creative exploration into how to enlist the university’s best brains in the quest for a way to turn the garbage problem of Munsieville (and similar locations) into a resource-enriching opportunity .... it was a rare opportunity to be with a community of people who personify the truism about many Americans that they are people who will strive to discover a 100 ways to make something work, as opposed to a 100 reasons why it won’t!

But (and I am conscious is the irony of using the “B” word in the context of such thrusting optimism!!), such opportunity also presents its challenges. Martin Lafontaine, a good friend and previous volunteer in Munsieville (courtesy of his employers, GlaxoSmithKline), has constantly encouraged me with his belief that The Thoughtful Path would almost inevitably arrive at a “tipping point” – a place where we will no longer feel like we are pushing boulder up a hill, when it will have its own forward momentum. This visit to Johnson City is yet more evidence that if we have not yet reached the tipping point, at least on an operational level we are pretty close. The new and existing ETSU opportunities stack up alongside the invitations and requests coming into our UK offices almost daily, from people and organisations who “get” The Thoughtful Path concept, realise its huge potential for changing the landscape of orphan care in Africa and want to “be the change”. The downside, however, is that the financial and resource tipping point is lagging behind, so the whole management structure supporting the work in Munsieville is creaking at the seams.

I promised that my blog would be an honest, “warts and all” account of the process of creating a new paradigm for the care of Africa’s orphans and other vulnerable children, so hear you have it – on the one side, an avalanche of encouragement from those who can see that what we are doing holds the prospect of providing effective new models that challenge the bankrupt “status quo” of international charitable and governmental programming and replacing it with something that energises destitute local communities to provide transformational change that results in their most vulnerable children having the opportunity to grow into healthy, productive adults. And then on the flip side of the coin, real frustration that lack of human and financial resources mean that we are unable to seize some of the opportunities presented to us.

I am utterly convinced that The Thoughtful Path is the right path. I also believe that we will win and that the financial tipping point will be reached when partners and investors will see that the tiny amount needed to bring this venture to reality is just a drop in the ocean of the massive and sustained returns that such investment will generate. But for now, the struggle remains; the struggle that is akin to that of the leader of a string quartet who sees a percussion section being added, then woodwind, then brass and so on until, unexpectedly, he finds himself conducting a full orchestra, and then two, and then three orchestras .... all trying to play the same symphony.

All I can say is – we urgently need more brass!

Munsieville's BIG Issues

I have attended several meetings in the past week, where the big challenges that hold children back, have been discussed. Business leaders, community representatives, house-holders, pastors and, most important of all, children and young people themselves, all seem to agree on South Africa's BIG FIVE!

Poverty, child abuse, teenage pregnancy, drugs, and booze!

The super-sized beer can pictured here, towering over Betty Nkoana, Manager of The Thoughtful Path: Munsieville and dwarfing the shacks which house destitute families, just about sums up the drink problem of the township. It's massive, highly destructive and pervades every aspect of life in the community.

I once described alcohol as the cheerful destroyer - making people "merry" as it robs them of of their dignity, their health, their wealth and their future. But, in a place like Munsieville, it appears to go straight for the kill - you rarely see people enjoying the "happy" stage. You just see lives being wrecked; the lives of the drinkers, and the lives of those who share their space. (And in Munsieville's informal shack settlement, sharing space means living as a family in a tin hut with a dirt floor measuring as little as six or seven square meters.)

TIME TO CHOOSE
When Project HOPE UK started its journey down The Thoughtful Path, it was pretty clear that demolishing the walls of the "prison" which prevents the orphans and other vulnerable children of the community from becoming healthy, productive adults, was going to take a very long time. There were no quick-fixes, no short-cuts and no easy solutions. And perhaps most disconcerting of all for us westerners who imaging that if we can fly to the moon we can solve anything, it became abundantly obvious that if the transformation of Munsieville did not come from within the community itself, it would certainly not come from outside!

So, as one who lives, eats and sleeps Munsieville, but only gets to sit down with its people every few weeks, it is so indescribably exciting to see seeds of change germinating and sprouting through the hard crusty ground of this beautiful community, as very ordinary people take extra-ordinary steps on the path to a better future.

The government's strategy for Munsieville over recent years has been to try appeasing the anger of destitute communities by throwing huge sums into high-profile capital projects, like a new sports centre, the opening of which was accompanied by an announcement that from now on, those wanting to hold sports and cultural events for children would have to pay an impossible fee for facilities which had previously been free! In contrast, our strategy is to search for the seeds of change in the lives of the community, and then water them with encouragement, nurture them with mentoring and fertilise them with training.

Like the rest of us, the people of Munsieville are faced with a bewildering array of choices. There are many who continue to choose destructive "solutions" to their pressing problems. There are many who choose to wait for someone else to solve their problems. There are many who choose to stand on the side-lines, probably with a can of Castle Lager in their hands, and jeer at those who choose to be the change that they long for in their community.

And, from what I have seen in the past week, a growing band of people is making that brave decision - a businesswoman in her 80s with a longing to give shack-dwellers the opportunity to create productive enterprises; a fiery group of young adults totally committed to make Munsieville a zero-tolerance location for child abusers; a dozen women who have lived in poverty all their lives who have created "Heart Gardens" as their first step towards self reliance; a growing band of school children diligently constructing a plan to eradicate alcohol and substance misuse amongst their peers!

Another week here in Munsieville has reinforced my belief that even the biggest problems faced by a community start to diminish when people decide to be their own solution.

Small Steps to Massive Change

Model excellence to inspire change! That was always the clarion call of The Thoughtful Path: Munsieville, right from its earliest concept.

The fact is, as a small, hard-pressed organisation in a world of cut-backs and diminishing resources, to set about creating projects to provide essential services for tens of millions of orphans and other vulnerable children across sub-Saharan Africa would be no more effective than a sticking plaster over the sluice gates of the Three Gorges Dam!

Our aim for the entire programme, as well as for each of its many components, is to create models of excellence that are truly sustainable, measurably effective and deeply embedded in the community, so that others facing similar challenges will be inspired to change the way they care for children. Our aim is that people from communities right across Africa will come to the jaw-dropping realisation that if Munsieville can rise to the challenge of ensuring its children can grow into health, productive adults, so can they! It’s no longer about what we can do; its about what they can do with a bit of support and encouragement from us.

Ok, that may be a laudable objective, but, in the real world, how on earth can it emerge from Fantasyland and become a dynamic reality?
Firstly, by making sure that the fundamentals are in place and that the foundations are unshakeable. And the first of the foundation stones is a profound belief in the dignity and value of each and every child and those who care for them. For us, “child rights” does not start with their entitlements; it starts with their status – who they are! Christian and Jewish theologians would describe them as “made in God’s image”; to us they are worth the world and valued as ten-out-of-ten….. and it doesn’t get better than that!

Secondly, The Thoughtful Path: Munsieville is constructed on a belief that every solution we take into Munsieville from the outside is doomed to failure, but every solution we can help to be generated from within the community has a great chance of success, especially if we can fan the flame with sensitive encouragement, training and mentoring, to help take the energy, creativity and enterprise of the local people to the very highest international standard – without them losing control and ownership!

STARTING AT THE BEGINNING

Although the programme in Munsieville operates through seven themed service-delivery “Hubs”, in the early stages of this 10-year initiative we have prioritised the work of the “Early Childhood Development Hub” (ECD) in order to demonstrate to the others just how The Thoughtful Path: Munsieville works.

Long before we arrived in the township, over thirty crèches had been started, mostly as private, small enterprises. The crèches were set up in order to provide cheap day care for children cared for by adults who work elsewhere, or who are unable to care for the children. Sadly, few crèches had trained leaders, toys, books or any resources to stimulate the children, up to eighty of whom could be huddled in one small tin shack, roasting in summer and shivering in winter.

Children are placed in such establishments because it is thought to be safer than staying at home without supervision, or being shut out to fend for themselves on the streets. Personally, I have serious doubts about it being a place of safety: the infants may be protected from some dangers, but are exposed to several hours a day devoid of the stimulation essential to brain development. Countless children in Munsieville and other similar settlements are inadvertently being coaxed into a “zombie-like” state, leaving them susceptible to serious manipulation and under achievement in adolescence and adulthood.

But, by starting small and modelling excellence, a tide of change is beginning to sweep across crèches and child day care centres in Munsieville, inspired by a few pioneers. Funded by GlaxoSmithKline South Africa and in conjunction with our partners, Safe & Sound Learning Association, crèche workers are being offered a two-year professional ECD training package. Eight women have already completed their first eight-week residential induction course and have returned to make immediate and dramatic changes to their work with children.

Last month I had the privilege of visiting some of the crèches now in the process of converting to full Early Childhood Development Centres. The difference, in just a few short weeks, was breathtaking! Children were engaged in active learning through exciting, creative play, and staff are organised, motivated and eager to explore every opportunity to improve the lives of the children in their care. The facilities in which they work are still far from ideal, but already, small steps have been taken to make the environment safer and more suitable for purpose, and bigger steps are being planned to make major improvements.
Modelling excellence does not mean instant perfection; it means total commitment to getting it right and to making the many small adjustments that add up to massive improvements. In Munsieville, there is no finer example of this commitment than the brave pioneers who have stepped forward to accept the challenge of giving pre-school children the very best foundations for a healthy, productive life.

Rating Performance over Potential

The famous American statistician and consultant, W. Edward Deming, largely credited with the transformation of the post-war economy of Japan from the late 1940s, once said, “In God we trust, but all others must bring data”!

On The Thoughtful Path, we obsess about results and are building partnerships with universities around the world to help change the mindset of people to challenge communities, to empower them with the skills by which they can measure what they are doing and perfect the processes that lead to constant and never-ending improvements in the health and total well-being of orphans and other vulnerable children.

George Bernard Shaw observed, “The only man I know who behaves sensibly is my tailor; he takes my measurements anew every time he sees me. The rest go on with their old measurements and expect me to fit them”. In a rapidly changing environment like Munsieville, we recognise the importance of making the collection and analysis of data the foundation of every activity.

For far too long, “monitoring and evaluation” (fancy charity-speak for measuring and analysing impact) in many international development programmes has been soft-edged, narrow in scope and so slow that by the time it is processed, the whole situation has changed out of all recognition. In response, our aim with this “model of excellence” programme is to develop “real-time monitoring” so that, just like Shaw’s tailor, we always know the situation as it is today, rather than what it was a year ago.

This aspiration will take a while to bring to fruition, but every journey starts with a single step! Over the past two months, we have taken several steps forward in Munsieville. International Development Masters student, Candice Wallace, of Brunel University, UK, undertook a month of “participatory action research” on the issue of child sexual abuse, with focus groups of children and adults in the township, uncovering the alarmingly high number of incidents of such abuse and also demonstrating the importance of measuring the scope and impact of the problem as a basis for future community-led action.

Ten days ago, Betty Nkoana, our programme manager, and I led a community workshop for those working with us to deliver change under The Thoughtful Path. We were able to introduce delegates to Megan Quinn and Twanda Wadlington, both doctoral students with our highly-valued partner, East Tennessee State University, and deployed in Munsieville for two months to help push forward better data collection and analysis across the seven “Hubs” of the programme.

Workshop delegates immediately grasped the essentials as Megan and Twanda led a short Monitoring and Evaluation Basics class. “It’s not good enough that our children smile more than those in the township down the road”, said one local community activist, “We need a much greater understanding of the things that affect them, and then we must develop the programme so we can all be part of the change process”.

How quickly they have embraced the spirit of W Edward Deming, who said, “If you can’t describe what you are doing as a process, you don’t know what you are doing”.

Energy v. Inertia

Munsieville is a place of contrasts. Hope and despair. Gentleness and rage. Virtue and unbridled evil. Order and chaos. And from my experience over the past few days - energy and inertia!

I have been in South Africa for the past two weeks, visiting the signature programme of Project HOPE UK - The Thoughtful Path: Munsieville - and working with the many people in the community who share our passion for the health and well-being of orphans and other vulnerable children, to stimulate the essential changes that are urgently needed to free these children from the "prison" of poverty, abuse, lack of opportunity and despair, that prevent them from fulfilling their potential.

As ever (I am a regular visitor to the township, which is a stone's throw from Johannesburg), this has been time of rich and varied experiences. Despite the bitterly cold wind of the South African winter - or possible because of it - Munsieville has been pulsating with music and dance. A few days ago, thousands of young people packed a huge tent in the township stadium for the launch of a Provincial Government initiative to target employment opportunities on young people, promising "One Job Per Needy House for 100 Days".

The tent rocked with vibrant local music and African dance routines, and the star of the show was Portia, a teenager who gave an eloquent and passionate speech on the role of young people in defining the new South Africa. The Provincial Premier's representative responded by promising her funding for a university place and extended the offer to young people who work hard and excel in Maths and Science at school.

The following day, we held a workshop for people committed to working with us on The Thoughtful Path: Munsieville. Public health doctoral studies students from East Tennessee State University made a presentation on the basics of monitoring and evaluation, and witnessed the enthusiasm of those present for providing solid evidence of the impact of their activities. We also unveiled the Thoughtful Path Leadership Academy - fifteen of those present indicated their willingness to enrol and commit themselves to the hard work of raising their skills to meet the challenges ahead.

And then to Saturday. The Munsieville Tourism Association had organised a Festival of local arts and crafts and invited Project HOPE UK to attend as special guests - I was asked to bring a few words of greeting and to say why we had selected this community for our defining children's health programme. This was an event full of colour, energy, beauty and all that is good in Munsieville, a township within the UNESCO World Heritage Site, "The Cradle of Human Kind".

In my comments to the crowd I congratulated the township on taking the "Yes We Can!" message given in Soweto by Michelle Obama five days earlier, to a new level. The ordinary citizens of Munsieville have a different chant: not "Yes we can!", but "YES WE ARE!": so many in this community are already working to bring positive change. And that, above everything else, was why we selected Munsieville for our flagship project!

So, why, or why, is the initiative, urgency and determination of the "ordinary" people - most of whom do what they can without being paid - not matched by those employed, and well paid, in South African officialdom? There are many good people at all levels in local, provincial and national government, many of whom have bent over backwards in support of what we are doing in Munsieville. But there is a disease running through the system that saps and deflects the energy of those seeking to serve the most vulnerable members of the community.

Just as well, then that we, and our many brave and dedicated friends, will never take "no" for an answer. "When the going gets tough, the tough get going" ..... for yet another meeting in an official office, pressing the case until the vulnerable children of Munsieville hear a resounding "YES"!

The Impact of Despair on the Health of Children

I am not easily shocked these days. Disappointed often, but rarely shocked. I guess being involved in humanitarian work for thirty years leaves you a tad desensitised. But I have just been shocked and disappointed by something I have seen in Munsieville!

Two students from the Public Health College of East Tennessee State University (ETSU) have just arrived in the township for two months, on an assignment connected with their studies to become Doctors of Public Health. Along with Betty Nkoana, Project Manager of The Thoughtful Path Munsieville, and three local friends, I accompanied the newcomers on a tour of the three main sections of the township.

Our tour started in "old" Munsieville, the more established section, dating back to 1906, passing a dilapidated "safe house" where ANC activists were hidden from the police during the struggle against apartheid. Then past a row of simple, but not-unpleasant cottages, each with a shack or two in their yard, where other families live, contributing a small rent to the owner of the property.

And then across a dusty road to "Little Mshengoville", a collection of rusting shacks clinging to the side of a steep rocky hillside, each with its own wire-fenced courtyard where residents sit and chat, drink liquor and lament their poor social circumstances.

I have seen this site scores of times before but was encouraged this time by one family who were so proud of their disabled six-year-old son who was now able to walk a few tentative steps. When I met the family nine months ago, he was not even able to stand unaided. The change had come about simply because his family had been able to access local health services where the child had received physiotherapy and other support.

So, with a little help, big changes really can happen! With our spirits high, we turn the next corner and are hit by a stench that instantly had me gagging. We are confronted by the community garbage dump, a place selected by the residents to tip their rubbish, surrounded, not five meters away, by the shacks in which children are being raised. As we approach, a dog scurries away and a brace of rats dive for cover.

And worse still, right in the centre of the stinking trash, the solitary water stand pipe serving the entire cluster of shacks, home to several hundred people.

What we were looking at, with our hands to our sensitive noses, was not the result of ignorance; it was not the product of poverty of oppression; it was the manifestation of despair!

Each and every resident of that sad section of Munsieville knows better. Every time they stand amidst decomposing garbage to fill their water drums, they know they are exposing their families to disease. Yet no-one lifts a finger to improve their own situation. Hopelessness has sapped their energy and despair had robbed them of the belief that small steps on the right path can lead to massive change.

So, what can be done? Project HOPE UK could send a team to clean the area and at the least, make the water supply safe. It would take no more than a day. And, if we did, it would take less than half a day for the trash to start piling up again.

With The Thoughtful Path: Munsieville, we believe that every solution we bring from the outside is doomed to failure, but every solution we can provoke the community to find from within, is highly likely to succeed and to build confidence for further positive changes in the future.

With that in mind, Twanda and Megan from ETSU, supported by Betty, have already started the process of helping the community to see that change is within their grasp. First,they will throw bucket-loads of doubt on the negative belief that "nothing good happens here"; then they will encourage the residents to voice their own concerns about waste management and safe water, leading to a locally-owned action plan to inspire others across Munsieville that better health for all starts right now, right here!

Introducing The Director's Blog

My name is Paul Brooks, the Executive Director of Project HOPE UK, a well-respected UK-based NGO that is passionate about the long-term health prospects for children in developing countries.

Although, over the 17 years since we were founded, we have run successful health programmes in dozens of countries across four continents, in recent years, whilst honouring the commitments we have in other places, we have chosen to concentrate our resources on one of the world's biggest health challenges - the health of orphans and other vulnerable children in sub-Saharan Africa, where the United Nations estimates there to be 53 million orphaned children, and millions more, rendered extremely vulnerable due to their proximity to the HIV/AIDS epidemic.

Evidence from the communities in which we work suggests that statistically, children who are orphaned through AIDS have a tragically short life expectancy and are unlikely ever to contribute more to their society through taxes and productivity than they will take from it in social benefits and health care.

Traditional Western-led NGO initiatives, whilst achieving some short term benefits for the target communities, are rarely truly sustainable; charities and governments claim that they are, but the evidence is that most major programmes, unless supported by locally-generated funds, will collapse after the initial international grant has ended, typically after between two and four years. Furthermore, the old adage, "he who pays the piper calls the tune", means that, however it is dressed up, real authority, responsibility and control remains in the hands of the Western NGO or its funders, militating against the "empowerment" of the local community that oozes from the press-releases and annual reports of the organisations promoting the activities.

Something has to change! Firstly, there simply is not enough money in the system to provide the levels of care that 53 million orphans (plus the other vulnerable children) will need to overturn their poor prognosis and become healthy, productive adults. Secondly, because the old-style approaches of the West simply perpetuate a disempowering new-style colonialism, working against Africa's courageous attempts to take responsibility and emerge from oppression and poverty.

The Thoughtful Path is an initiative that unashamedly seeks to develop the sort of dynamic, international, culturally sensitive partnerships that will re-write the rule book and inspire genuinely sustainable solutions that will offer a real future for the children of Africa and beyond.

This blog is intended to offer comment and insights into some of the struggles involved in working with communities to effect transformational change, leading to marked and measured improvements in the long-term health and well-being of orphans and other vulnerable children, and inspiring others to think again about entrenched, ineffective operational structures that can perpetuate poverty of the mind and spirit, as well as the body.

This will not be a platform for charity "spin", but of honest, warts-and-all reflection on the path to a better future for the children of the world - the Thoughtful Path. I will share honestly and openly, a very personal view of the joys and frustrations of swimming against the tide, and hope that through it all, we can discover how we can, in the words of St Paul, "look not only to (our) own interests, but also (and especially) to the needs of others.