WiRED Launches Its Community Health Information Centers
in Kenya

BY WIRED DIRECTOR GARY SELNOW, PH.D.

 

Preamble

 

In the late 1990s, HIV/AIDS continued to frighten and mystify. It lashed out at populations around the world, but it hit communities in Africa especially hard. Entire villages were wiped out; in many places, only the very young and the very old survived, with the middle carved out by a disease most people could not understand. This cruel and seemingly indiscriminate illness rendered its victims frail ghosts of their former selves, symbols of an evil in towns throughout the African continent. While in the United States and Western Europe, AIDS was initially known as a gay disease,1 in Africa, the devastation to both men and women alike suggested to many that some other curse was at work.

 

It was against this backdrop that WiRED began discussions with the U.S. National Institutes of Health (NIH) about offering HIV/AIDS education programs in cities and towns throughout Kenya. The program we proposed had a distinctive feature: the training would be available on computers. For several years WIRED had been using computers for general health training in the Balkans; we learned a lot from that work and believed we could transfer the lessons to help East Africa drive back HIV/AIDS. Computers were unfamiliar in most regions of Kenya at that time, and that, we felt, would work in our favor; the computers themselves would draw people to our training facilities.

 

NIH asked why a computer-based program might be more effective than a brochure about AIDS education. After all, most AIDS education programs at that time relied on brochures that could be handed out and shared among members of a community. Computers were a radical departure from that model. Moreover, the concept of a go-to place for AIDS education had not been tried.

 

We explained that computers were new and exciting. People in Kenya had heard about computers, but most had never seen one. The draw would be especially strong to our target group — young people who were most vulnerable to AIDS. Our program would invite people to an innovation we called the Community Health Education Centers (CHICs2), where we would teach them how to use a computer, and, while we had their attention, we would offer them persuasive HIV/AIDS prevention messages. We argued that if you give people a brochure, you have their attention for two minutes. If you sit people in front of a computer, you have their attention for two hours.

 

The matter of attention is important, because the longer we held their attention, the more information, repetition and reinforcement we could provide. With focused user interest, we also could offer a much wider range of topics, including HIV/AIDS prevention, next-step information for people who thought they might have contracted HIV and guidance for those who knew they had the virus and wanted to control it.3

 

The AIDS epidemic was severe, the need for education was critical and the potential for effective computer-based instruction was strong.

The AIDS epidemic was severe, the need for education was critical and the potential for effective computer-based instruction was strong. NIH provided us with a developmental grant to design a training program and set up the HIV/AIDS education facilities — the CHICs — in several locations around Kenya. The Centers, open from 8 am to 5 pm, would be staffed by local people trained on computers, on teaching techniques and on HIV/AIDS details. Anyone in the community was welcome to stop in for computer training and use the computers for HIV/AIDS information. No money changed hands; all the resources were available without cost. (An updated version of the HIV/AIDS modules is available here: http://www.wiredhealthresources.net/mod-series-HIVAIDS.html.)

 

Eventually, the project ran in 24 communities around Kenya for three and a half years. With new computers, several CHICs continue to operate in Kenya today, covering not just HIV/AIDS but a wide range of health topics available in more than 350 modules. This concept of community health education was designed around HIV/AIDS but expanded into a comprehensive health education program. It proved to be extraordinarily effective and serves today in communities around the world using WiRED’s training modules.

 


 

In this article and the one to follow, I would like to tell a few stories about the people who have operated our Community Health Information Centers and the visitors who have used them. You can’t work in a complicated place like Kenya without interacting with caring and creative people who, because of poverty, politics and isolation face extraordinary challenges.

 

The Kids from Kiambu

 

As a condition for awarding the grant to WiRED, NIH said we had to demonstrate that we could train local people to manage the CHICs and teach others in their community how to run computers and how to access HIV/AIDS information. The entire project hinged on our capacity to assemble a trained team to operate the Centers. We had to demonstrate that we could do it.

 

“The test” would take place in Mombasa, Kenya, at a large HIV/AIDS conference sponsored by NIH. The organizers assigned me a group of eight young people from Kiambu, a small town north of Nairobi. They were in their late teens and early twenties, had never seen a computer and knew very little about HIV/AIDS. My challenge was to get this group from zero to 60 in three days — from never seeing a computer to teaching other people about computer basics.

 

On the third day, they had to demonstrate their newfound skills by teaching adults attending the larger conference how to operate a computer and how to access HIV/AIDS information on the computer. Like the young people from Kiambu, these adults, too, had never before worked with a computer. It was a tall order: in three days train complete computer novices to train other complete computer novices to operate basic computer functions and use the computer to access HIV/AIDS education.

 

We started with introductions over breakfast in a restaurant at the hotel where the conference was being held. I had been a university professor for 20 years at that point and was used to working with students in this age group. I saw that these were hardscrabble kids who knew poverty all their lives and enjoyed few of the advantages of my students back home. They saw this training session as an opportunity, and they were eager for the work ahead. We agreed to get started, so we walked to a room where four desktop computers were connected to large monitors and to a dial-up Internet link provided by the hotel.

 

We started with the basics. Switch on a computer by pressing this button. So far so good. We went through the steps so obvious to regular computer users that we never think about them. This is a program. This is how you access it. Here is the Internet. (It’s tough to explain the Internet). This is a search engine. Here is how you use the keyboard to enter your inquiry into a search engine. This is a mouse. Moving it correlates with movement of a cursor. Line up the cursor on a button and click the mouse and things happen. Clicking is when you tap this button on the left. Clicking the right button does something different.

 

An hour later, in groups of two, the students started working with the computers. I glanced over at one young man who looked at the monitor, then reached back on the right side of the computer, where, for some odd reason he put the mouse. He moved the mouse, then came back to look at the monitor. He did that a number of times. “What are you doing?” I asked. “Trying to get the cursor to line up on the button, so I can start the Word program.”

 

“Why are you going around to the side of the computer?”

 

“Because I ran out of space for the mouse and need to move the cursor up on the screen.”

 

That reminded me how quickly we fuse with computers; the mechanics of interacting with them become as routine as breathing. Obviously, my description of mouse moving wasn’t complete. “Why not just lift up the mouse and reposition it on the mouse pad?”

 

“Oh, you can do that?”

 

“Sure, it’s okay, you won’t hurt anything.”

 

I suppose that if you’ve never done this before, it seems reasonable to navigate the mouse around to the side of the computer. Nothing in nature resembles the relationship between a mouse and a cursor. Where else do we manipulate movement on two dimensions, but on different planes? I wrote in my notes that we had to add mouse moving to the curriculum.

 

I have always enjoyed introducing people to the Internet and watching their reactions to an instrument that allows them to connect with an unlimited number of resources anywhere in the world. It’s fun to watch the disbelief people express during their first exposure.

 

Internet searches were a critical part of our training curriculum. People today are used to the simplicity and effectiveness of Google, but in the year 2000, Google wasn’t well-developed or well-known, and the popular search engines, such as AltaVista and Yahoo, based queries on Boolean Logic. Thankfully, we no longer use Boolean Logic, but we did then, so we had to teach it, and that lesson took several hours.

 

Okay, eight people, four computers, teams of two, get ready, set, go! The clock started and the contest was on.

At the end of the Internet training block at sessions in the Balkans and now here in Kenya, I always arranged a contest. I gave students 20 tough questions and 30 minutes to answer them. (How high above sea level are the spires of the Golden Gate Bridge? From what single place on earth can you see the sun set over the Atlantic Ocean and see the sun rise over the Pacific Ocean?). The team getting the greatest number of correct answers would win the secret prize (a box of candy). I had run this contest in a half-dozen other countries with many groups, and it was always a lot of fun.

 

Okay, eight people, four computers, teams of two, get ready, set, go! The clock started and the contest was on. A few minutes later, I saw one young woman run over to another computer, explain something to the other team, then hurry back. I reminded everyone that they had to work with their partner only.

 

“No outside coaching, please.”

 

“Okay, okay, okay.”

 

Five minutes later, a young woman from a different team leaned over to the next group and apparently gave them a Web address.

 

“Whoa,” I reminded them, “you all need to stay in your groups for this contest to work.”

 

“Okay,” they said, “Okay, our own groups.”

 

Not two minutes later, one of the young men stepped over to another group and gave them some help. “Well,” I said, addressing this fellow, “This is a contest. How can we know which group wins if you all keep helping each other?”

 

With some uncertainty about how I would react, he quietly said to me, “This way, we all win.”

With some uncertainty about how I would react, he quietly said to me, “This way, we all win.”

 

Wow! This way we all win! What a lesson for a middle-aged professor who had been steeped in a culture of competition, where beating other people, edging them out, racking up more points, getting a higher score, fueled everything on playgrounds, in schools, on job sites, among siblings, neighbors and friends. It was all about being one step ahead, getting more publications, earning a higher salary. I know some people who compete on blood pressure readings and cholesterol scores.

 

My introduction to Africa and working with Africans was a remarkable and rewarding immersion in a culture that offered a perspective I didn’t know very well. We’ve all heard the phrase said to have arisen in Africa that “it takes a village to raise a child.” While the provenance of that statement is debated, its implications for cooperation are clear. Group efforts really can take everyone forward.

 

Then as people in one group finished, they helped the others. Before the 30 minutes was up, they had answered all the questions correctly, and at the end, took great pride in their group accomplishment; they also shared the box of candy.

Seeing how naturally the kids from Kiambu cooperated to complete the assignment gave me a new framework for viewing my efforts at WiRED. This will not become a sappy narrative about joining hands and singing songs in perfect harmony, but it’s important to acknowledge that on a very practical level, the Kiambu kids were right; I could see that.

 

I immediately rescinded the rules and let the groups interact to solve the 20 questions together. They divided up the questions. Then as people in one group finished, they helped the others. Before the 30 minutes was up, they had answered all the questions correctly, and at the end, took great pride in their group accomplishment; they also shared the box of candy. This class finished the quiz faster and more successfully than any class I had taught in prior years. In those other classes every group lost but one. In Kenya, they all won!

 

Final Test

 

The three-day training session was in preparation for the big test: Could we teach these computer rookies not only how to operate a computer — complete Internet searches, run through a health training module, draft a document in Word, set up a PowerPoint presentation — but teach other novices, in this case community health workers, how to do all this as well.

 

When a speaker stumbled on a detail or couldn’t answer a question from the floor, someone else on the team stepped in as seamlessly as if the handoff had been practiced.

The big test started in a large room already filled with serious looking adults who had been working all week on HIV/AIDS issues with NIH trainers. It was only 8:30, but already the air was heavy and hot on this humid Mombasa morning. My young students were nervous but charged, ready to teach the 50 health workers how to open an interactive training program, to move through it successfully, then to prepare a brief PowerPoint presentation and Word document report.

 

I introduced the eight young people to the group, then sat back to watch them like a nervous father watching his kids perform at their first piano recital. Earlier, they had divided up the lesson plan, and, in turn, these new teachers took to the podium to describe how things were done. When a speaker stumbled on a detail or couldn’t answer a question from the floor, someone else on the team stepped in as seamlessly as if the handoff had been practiced.

 


Two years later: Some of the training staff who operated the 24 CHICs across Kenya.​

Next, they divided the audience into four groups, one around each of the computers. The young people offered demonstrations, then challenged the health workers to try their hands at each of the tasks. I watched the older adults through the morning and saw how proud they were to have had success in their first encounter with a computer. They printed out information from their Internet searches, from their PowerPoint presentations and from brief reports they prepared in Word. They carried the printouts like trophies, and many carefully filed them in their notebooks to show to people back home. They praised the skills and the patience of the students. It was a remarkable few hours.

 

Officials from NIH observed all this, too, and at the end of the morning they told me they were convinced this would work and that they had their proof that we could train the trainers in a few days and get the Community Health Education Center project underway. Their confidence was well placed. During the next few months, we trained more than 80 local people to handle the daily operations and to manage a Community Health Information Center. Although with fewer facilities, the project continues even now as WiRED celebrates its 20th year.

 

 

This is the fourth story in a series about WiRED International. How it evolved; how it went from providing computers and Internet connections for towns and villages in underserved regions to focusing on medical and health education using computer technology. How it expanded its work throughout the Balkans to Africa, Central and South America to the Middle East and Eurasia. How WiRED’s training programs, carried by the Internet, have now become global resources, used by hospitals and clinics, schools, other non-governmental organizations and universities.

 

An element of WiRED’s operation that repeats in every story is that all of WiRED’s programs are run mainly by volunteers who have made it possible for WiRED to provide medical and health training programs cost-free to everyone. WiRED’s administration is volunteer, we have a volunteer board, and our writers and editors are volunteers. A small paid staff builds and shepherds the training modules through the production process, but even their work is augmented by that of volunteers. I’m proud of the people in the United States and abroad who donate their time and lend their talents to this organization’s efforts to provide people in low resource regions with some of the finest public-access, health training material available anywhere.

 

 

1 AIDS was initially called GRID (gay-related immune deficiency).

 

2 CHICs are now called Community Health Education Centers.

 

3 At that time the availability of anti-retroviral treatments in Africa was just beginning, so AIDS was almost always fatal. People could hope only to prolong their lives and live as comfortably as possible.

 

 

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