In January, 1996 three health educators from the Americas—Martín Reyes, Maria Zuniga and David Werner—went to Cape Town, South Africa to facilitate a Child-to-Child training-of-trainers course. Called “Participatory Methods of School Health Education,” this intensive oneweek course was part of the new Summer School Community Health Program at the University of the Western Cape. The Summer School is directed by Dr. David Sanders (co-author of our new book, Questioning the Solution.)

During the course we worked and played with a group of 32 adults and 21 school children. To bring three dozen primary school kids from a low-income resettlement area into the hallowed halls of a South African University was a jolt to many course participants. But Martín Reyes—who for years has been a roving Child-to-Child pedagogue throughout Latin America—is emphatic that when Child-to-Child methodology is introduced to a group of adults, it is essential that local children take active part. How can one learn participatory methods with children unless children participate as equals? Young and old contribute their perspectives and everyone learns from each other.

The adults in the Cape Town course (mostly community nurses, social workers, educators, and school teachers) were amazed, and in the end delighted, to actually work and learn together with children about problems that the children themselves defined. In spite of some challenging and worrisome concerns, all agreed that the course was a real eyeopener. And fun! Adults learned to listen to children and respect their problem solving abilities. And children, who were initially terrified to speak out, gained confidence in expressing themselves candidly among attentive adults. We feel confident that in their respective schools and communities, many course participants will introduce Child-to-Child in a discovery-based, empowering way.

Children’s community diagnosis In this learner-centered Child-to-Child approach in Cape Town, the children started with their own ‘community diagnosis.’ Through learning games that included even the shyest children, they drew pictures and listed what they saw as the biggest problems affecting their own and their families health and lives. After they had listed their problems, the children used small cut-out figures (faces, skulls, arrows) to analyze which problems were most important in their community, and how they interrelated.

The results of the children’s community diagnosis were deeply disturbing. Heading their list of “Problems Affecting Health” they put concerns such as Gangsters, Gun-shooting, Fighting in the Home and Street, Theft, Drug Use, Glue Sniffing, Drunkenness, Parents Fighting, Beating-up Children, and Rape. Even such wide-spread, underlying problems as “Not Enough Money” and “Empty Plate” (hunger) ranked second to the children’s concerns related to violence.

To our amazement, even the nurses and health workers, who we expected to focus on biomedical ills (diarrhea, undernutrition, etc.), also put violence as the biggest danger to children’s well-being. All agreed that “Violence is a national crisis.”

Paradoxically, especially in poor townships, violence in South Africa has increased since the official end of apartheid. This may in part be because repressive security measures have been lifted, yet abject poverty still abounds. The huge inequalities entrenched during the era of colonial rule are still largely in place and can only slowly be corrected. The millions who are homeless and jobless are understandably impatient. Violence is the barometer of inequity. Change in South Africa has only just begun. And children, more than most, continue to suffer.

Clearly, when school children identify violence as their biggest health-related problem, this adds a difficult new dimension to Child-to-Child. In the Cape Town workshop, participants grappled for possible solutions, or at least ways to cope with this overwhelming reality. “But what can the children do?”

Obviously, children alone cannot halt violence in their communities. Indeed, the adults were concerned that such a monstrous problem was a focus of discussion with school children. But, as Martín pointed out, it was the children who voiced concern Vulnerable as they were, they wanted to explore ways to respond. Indeed, one benefit from the course was to help the children to talk more openly about violence in their homes and neighborhoods, and to look for ways where they could take positive and relatively danger free-action.

The children proposed several actions they could take. To help keep ‘high risk’ youngsters from joining violent gangs, they had the idea of forming clubs or groups that do fun things, that get a kick out of helping people, not hurting them. They also suggested that they make a special effort to befriend children who are angry, sullen, abandoned, or mistreated. These are the children that tend to join street gangs and turn to crime and violence. They recalled one little boy, a loner who often came to school bruised and beaten. By age 10 he had joined a gang and killed a shop keeper in a robbery. “He seemed so mean and angry,” commented the children. “But maybe if we had tried to befriend him, talked with him about his difficulties, invited him to our after-school games” They talked about befriending some of the street children, the little ones whose homes are broken, whose parents can’t find work, or “who steal because their plates are empty.”

The last day of the Child-to-Child course, the children returned to their school where they led activities in 5 different classrooms, presenting ideas, actions, games, posters, songs and skits they had designed around their identified concerns. Where possible they tried to be optimistic, hopeful, to look for ways to make their lives and communities better by taking helpful, positive action:

In one classroom children acted out a variety of socially positive jobs or careers everything from “health worker” to “bread maker”—which children could aspire to and take pride in, rather than to hero-worship gangsters (which they frequently do).

In another classroom, children acted out a skit showing a young gangster (gang member) attacking and robbing a woman. A good policeman' arrests and jails the gangster, but then talks to him about why he robbed the women. “Because I was hungry,” answers the gangster. The policeman shows concern and the gangster expresses regret. In the end, the policeman releases the gangster so that he can be with the girl he left pregnant while she gives birth. (To give birth, the girl actor pulls out a doll from under her blouse.) In the end the gangster, removing his dark glasses, takes responsibility for the baby. Lovingly, the boy cradles the doll in his arms. This breaking of the stereo typed roll models brought shrieks of nervous laughter from the pupils. But the skit provoked intense discussion about new and healthier, more caring alternatives.

In yet another skit, a young boy, standing in an improvised ‘Parliament’ behind the national flag of the ANC, acted the roll of President Nelson Mandela. The child impersonated his manner and voice so exactly that everyone chuckled. Paraphrasing Mandela, he told the audience, “Today in the New South Africa our destiny is in our own hands. Each of us is free to become what we want, to pursue our own dreams, to join together in building a better world… for all of us!”

What was most wonderful in these activities was that, in spite of the violence which threatens their health and their lives, the children were able to look for and begin to chart a way forward, by working and playing together. Their youthful quest for a way beyond violence was an echo of their nation’s struggle to move beyond apartheid toward a fairer, more equitable and truly human society. They have a dream.

It was apparent that the discovery-based, participatory approach to children’s education can help nurture the collective self-determination needed for building that dream.

From Village Health Worker to International Child-to-Child Guru, and still a Village Health Worker at Heart: Martin Reyes Makes Good

To those readers who have read our Newsletters over the decades, Martín Reyes is a familiar name. Thirty-one years ago Martín, then a 14 year old village boy with very little formal schooling, began hanging around the Clínica de Ajoya. First he came out of curiosity, later to help out however he could. Eventually Martín became a very caring and capable promotor de salud (village health worker), then a leader of Project Piaxtla, the primary health care program from which grew the books Where There Is No Doctor and Helping Health Workers Learn. For several years Martín was also an advisor to PROJIMO, the community rehabilitation program run by disabled villagers.

Martín’s role in the evolution of Child-to-Child. In the early 1980s Martín, together with David Werner, was deeply involved in developing the concept and practice of Child-to-Child. Martín has since become an international promoter of what he calls a ‘liberating’ approach to Child-to-Child. The methodology he fosters recalls that of the Brazilian educator, Paulo Freire, author of Pedagogy of the Oppressed. Its aim is to enable school-aged children to define their own health problems, analyze causes, and take collective self-determined action to protect the health of themselves, their families, and communities.

We should explain that Child-to-Child began with more conventional methods, using exciting games, songs, role-plays and recipe-like ‘activity sheets’ to teach school-aged children ways to prevent and treat common maladies. The goal was (and in part still is) to hel them to meet the health needs of their younger brothers and sisters.

Little by little, however, Child-to-Child has been evolving from a prescriptive program to a child-empowering open-ended process. Its vision has become more transformative: HEALTHY CHILDREN IN A BETTER WORLD. Only when young people begin to make their own observations, draw their own conclusions, and stop obediently memorizing what they are told, is there hope for engendering effective participatory democracy: the key to fairer, healthier societies. Child-to-Child as Martín promotes it is part of this larger vision. It is founded on a deep respect for children’s own cooperative problem solving capacity.

In 1993 Martín was awarded a prestigious Ashoka International Fellowship to promote his liberating concept of Child-to-Child throughout Latin America. This he has done admirably. I (David Werner) have had the privilege to work with Martin in facilitating regional Child-to-Child workshops in Mexico, Nicaragua, and recently in South Africa and Bolivia. In Bolivia, where we visited in April 1996, 19 different non-government programs are currently promoting Child-to-Child as a result of Martín’s inspiring workshops during former visits. In Cochabamba we met with children who are promoting Child-to-Child in different towns, and we were deeply moved by their presentations. One girl told how a group of children who were being cruelly mistreated by school authorities organized, collectively confronted the authorities, and won better treatment and respect. As he hugged the girl, Martín said, “Congratulations! This is what Child-to-Child is about!”

Martín’s international Child-to-Child work is currently coordinated by CISAS in Nicaragua. Groups from many countries request Martín to lead regional training workshops. He agrees as his time permits, provided that th groups guarantee that local children will take part in the workshops and play an active and decisive role.

Altogether, it is an exciting and potentially revolutionary process. For me it is especially pleasing to see a villager with very limited formal education but with a wealth of practical community experience gain international recognition and esteem. With a few more Martíns, health and education policies might be geared more to the common people’s most pressing needs. Vulnerable groups might cease to be targets and become archers.

Theme of a Meeting of the International People’s Health Council, Cape Town, January 1996: South Africa In Transition: Will the End of Apartheid Make Way for Social Justice?

Confronting Persistent Violence of Poverty.

South Africa is struggling through a difficult transition. With Nelson Mandela at the helm, millions of people long inured to poverty and oppression look forward to a new society that gives those on the bottom a fairer chance. The police state has ended. Political prisoners have been freed. But many of the injustices and inequities of the past persist. The 15% of the population that is white still owns 80% of the land. One of six South Africans lacks housing. Black unemployment is around 50%. Although acute malnutrition in children is low (2%), 35% of children are stunted due to chronic undernutrition. Despite the new government’s allocation of $9 billion for education, 50% of people remain illiterate. In poor townships violence and crime are escalating out of control. People are growing impatient for promised changes. There is a swelling debate as to where South Africa is headed.

In January 1996 a small international group from the International People’s Health Council (IPHC) together with representatives from South Africa’s progressive health movement participated in an all-day workshop in Cape Town. The purpose was to place the current transition in South Africa within a global context. It became clear that different and conflicting forces are at work to shape the future of South Africa, both from within the country and beyond.

In 1994, the Mandela government launched an ambitious Reconstruction and Development Program to address the urgent social needs, especially for housing, education, health care, and employment. But the government is caught between responding topeople’s basic needs and to powerful pressure from the elite, both domestic and foreign. The International Financial Institutions (World Bank, IMF, etc.) insist on the privatization of government enterprises, including hospitals, thus increasing the loss of jobs. Progressive taxes (where the rich pay a much higher percentage) are being challenged, while non-progressive taxes (value added taxes or sales taxes on purchase of goods) are being increased.

Under such pressure, the ANC coalition government is having trouble meeting the common people’s enormous needs and demands. All in all, the government has done little to move toward the redistribution of income and wealth desired by many of its supporters. Angered by the slow pace of economic reform, the 1.6 million member Congress of South African Trade Unions (COSATU) called a selective work stoppage on December 19, 1995 and another in January, 1996.

At the recent IPHC meeting in Cape Town, participants felt that it is currently extremely important that socially progressive movements maintain a strong position, independent from government. They stated that organized pressure from below is essential to keep even the popular, elected government accountable and responsive to the needs of the population. The evolution of the new South Africa is at a watershed. If those who have struggled for a more just society are to realize their dream, now is the time to make a united stand.

Under the previous, oppressive regime, the progressive health movement was strongly united in its stand against apartheid. The “enemy” was clearly defined. But since the democratic ANC government took power, the progressive movement has become fragmented and to some extent lost the clarity of its course. Today things are less clear. As in Zimbabwe after the overthrow of colonial rule, a new black elite is in part replacing the white elite. Harsh inequalities remain.

Everyone agreed that now is the time when a coalition of progressive groups can still have an important influence on helping the country’s more idealistic leaders take a course of people-centered development. At the January meeting there was an enthusiastic move in this direction.

A Timely Quote

“If we truly believe that the right to food is the right to life, then this right should supersede other secondary rights, including the right of corporations to profit in the presence of hunger or famine. Similarly, the right of landless farmers to cultivate idle land to feed their starving families must supersede the property rights of the persons or corporations that may own that land. Imagine the agony of the landless worker peering over her neighbor’s fence, and seeing vast tracts of idle land to which she has no access."
—Tony Quizon, Executive Director of the Asian NGO Coalition at the 1995 NGO Workshop in Quebec, in preparation for the 1996 World Food Summit in Rome.

The Rapid Spread of AIDS in South Africa

AIDS in South Africa is spreading faster than elsewhere on the continent. and is having a devastating impact on people’s health and lives. Currently, the incidence of AIDS doubles every 12 or 13 months! Anonymous blood testing shows that one in 10 pregnant women in South Africa is HIV positive. The Mandela government has given AIDS prevention high priority. Yet campaigns to promote safe sex through condoms have had meager results. Most men refuse to use condoms. A sex worker who insists on using condoms is paid 1/10 as much as the sex worker who doesn’t.

Currently it is estimated that one in ten persons in South Africa is HIV POSITIVE.

Transmission of HIV in South Africa is mostly heterosexual. Since HIV passes more readily from men to women than from women to men, more women than men are infected. Many women fall ill with AIDS in their early 20s, having contracted the virus in their teens.

The rising death rate from AIDS will have a far-reaching effect on society. Educational and care-providing services will be hit especially severely since most nurses and school teachers are women.

The impact on children will be devastating. Already in some provinces recent gains made through Child Survival campaigns have been reversed because of AIDS. One of three babies born to HIV positive mothers contracts HIV and will die in a few years after prolonged illness, chronic diarrhea, and weight loss. Also, millions of children will be orphaned. Currently, NGO’s (non-government organizations) are trying to provide for AIDS-orphans, but NGO’s will probably be unable to cope with the growing numbers.

Paradoxically, some social scientists predict that the escalating AIDS disaster may spur a radical restructuring of society, with a return to the extended family and communal living. They suggest that the current high rates of youth violence and membership in gangs is in part a consequence of the dysfunction of the nuclear family. In the ‘modern’ nuclear family, introduced by the white ruling class, children are often left alone for long periods while both parents work (or look for work). There is a loss of community and peer support. Single mothers abound Lost to a large extent is the social fabric of caring and sharing of traditional African village structure, which provided a supportive communal environment for children. In the old days, several related families lived in a circle of huts and shared resources, food, child care, and other responsibilities with one another, like one big close-knit family.

The roots of such communal living run deep. Social scientists predict that the AIDS pandemic may, in the long run, forge the way toward a more caring and humane social order, one in which cooperation and basic needs are more important than competition and economic growth. Nevertheless the human suffering from the AIDS pandemic—with so much protracted sickness and death—will be tremendous.

Research and education campaigns are being conducted to slow the spread of HIV. The national Medical Research Council has been conducting a study with more than 2000 sex workers in truck-stops between Johannesburg and Durban. Because men resist condoms, there is need for an invisible safeguard against HIV, that can be controlled by the women. Trials are underway to determine the safety and effectiveness of a topical viricidal agent called N-9 that can be sprayed into the vagina. The thin coating of N-9 reduces the spread of HIV, both from man to woman and from woman to man. A new preparation with a biological adhering agent is said to provide protection for up to 24 hours.

Such technologies may be helpful. But sooner or later South Africa—like the rest of the world—will need to face the fact that technological fixes are not sufficient to cope with AIDS and other monumental problems whose roots are social and political. The spread of AIDS, like the growing violence, is linked to extreme poverty and gross inequality between classes, races, and gender.

The only long-term solution to the crises of our times will come through redistribution of resources, wealth, and power. The new South Africa—with the leadership of Nelson Mandela, and with a strong popular base born from the long struggle for racial equality—is in a better position than many countries to oppose the dehumanizing market-friendly model of development. It has the opportunity to embrace a model of development based on equity, which favors the needy before the greedy. It has the possibility to build a caring society which strives for the well-being of all through cooperation, rather than the prosperity of a select few through competition. In today’s troubled world such an alternative is sorely needed.

Achieving such a people-friendly alternative for development will not be easy. The globalized market is not kind to nations that put human need before economic growth. If South Africa is to succeed in turning the tide toward a more egalitarian paradigm of development, it will need support from a coalition of progressive grassroots movements around the world.

With this goal of building global solidarity from below, the International People’s Health Council in cooperation with the progressive health movement of South Africa will hold the IPHC’s 3rd International Meeting in Cape Town, January 1997. If you support the goal of a fairer, more sustainable world, consider coming. Or contribute toward making the meeting a success.