CDATA[Author: Chris Morry
Posted: Tue Feb 27, 2007 9:00 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


Hello,

It is now time to close our discussion on Using Clinical Pictures in HIV/AIDS Education. Those of us at Health e Communication want to thank Dr Edwin Mapara for taking on this moderating task in the middle of a very busy schedule. We also want to thank all of you who joined us with your thoughtful and candid comments. As with many such conversations ideas and suggestions for new discussions have emerged - whether on the balance between local, national and international response as we all search for effective ways to address this unprecedented global health crisis, the role of consultants, or how we evaluate the impact of our work and disseminate this knowledge in order to share important lessons - there is much grist for future dialogue.

I want to apologise for sending Dr Mapara's concluding remarks out under my name instead of his. This may have created some confusion and was a technical error on my part - the submit and send buttons both offer the danger of mistakes quickly and irretrievably made. This has been clarified on the website where such mistakes are more easily repaired!

For those of you who wish to revisit the discussion it is archived on the Health e Communication web site at:

http://forums.comminit.com/index.php?uber=5


Once again thank you all for joining us and please stay tuned for the next discussion in April. We will be sending you more information on the topic and moderator in the coming few weeks.


Sincerely,


Chris Morry
Health e Communication

***

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_________________
Chris Morry
Director: Coordination and Special Projects
The Communication Initiative
]

CDATA[Author: Chris Morry
Posted: Mon Feb 26, 2007 10:52 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188

Editors Note: This was sent from Dr. Edwin Mapara and forwarded to the forum.


Concluding Comments

As we draw near to the conclusion of the three weeks discussion on the use of Pictures in HIV/AIDS Education (PAIDucation), I thought that I would highlight some points. I have seen the close to 100 readers/members who have read or accessed the site to read, comment or to think about this ‘new’ approach to raising HIV/AIDS awareness in both the developed and the developing countries. Initially, I had thought that PAIDucation was best for the developing countries, but now believe it is for both developed and developing world.

For the developed countries, the conclusion has been drawn from the workshops that I have had with various audiences in London, that include General Practioners (GP), nurses, university students, teachers, high school students, health promoters and volunteers from voluntary organisers. Many people in the general community or public do not know about sexually transmitted infections, including HIV/AIDS. Many believe that HIV/AIDS only affects the Gay and African communities! You cannot blame them too much for this perception portrayed by the media. If I compare prevalence rates of Brent (UK), where I am based, and Lobatse in Botswana, former station, of HIV prevalence rates of 0.6% and 32% respectively, one can understand the levels of knowledge. Sadly HIV/AIDS thrives in such an environment of lack of knowledge!

I have also observed the 103 comments on the article on the link:

www.comminit.com/healthecomm/planning.php?showdetails=188 - 35k

I have received quite a number of requests for the actual pictures and slides used, “…for a better assessment” of the HIV/AIDS intervention strategy/method. I have responded to these private individual readers.

There have also been colleagues who have sent me several websites/links for other graphic clinical pictures and asked for my comments. I commented on some.

ON THE PICTURES USED IN AIDUCATION

A) Source of slides
I have used the Teaching aids At Low Cost (TALC) slides, from TALC St Albans, since 1992. In comparison with other slides, the TALC slides were at that time and even now simple, comprehensive, ‘user friendly’ and very African. I am biased and so stand to be corrected. I have seen several other slides from various sources that are strictly very clinical and technical, that I cannot picture with to the picturate community members.

The TALC slides at www.talcuk.org that we use for our sessions (Botswana and UK) are:
1. HIV/AIDS Virology and Transmission
2. HIV/AIDS Clinical Manifestations
3. HIV/AIDS Prevention and Counselling (Old set)
4. HIV/AIDS Parent to Child Transmission
5. Sexually Transmitted Infections.

These modules have 24 colour slides/images in each set. Our workshops have, in an ideal set-up spent a day on each of these slides and that is why it is a four – five days course. The course can be done in five days continuously as we (Athlone Hospital) did in Africa or weekly as we are doing it in Brent.

The pictures are used in a layman’s language during discussions, despite them being made for health care workers. The jargon is minimal. The pictures usually ‘talk’ to the participants and are easy to understand.

I strongly agree with the contributor who said, “…To me the challenge is how to access these materials, look at them and adapt appropriately so as not to re-invent the wheel in each of our different intervention areas”. This is further echoed by another reader who said, “…Despite current avalanche of information, the crucial ones are missed in the morass”. I believe that we can make an appropriate picture bank for raising HIV/AIDS awareness in our local communities, that all can access, instead of waiting for health care workers to come around.

B). Advantages of PAIDucation

As stated before, Pictures in HIV/AIDS Education (PAIDucation) have more advantages than disadvantages. The advantages mentioned by a number of you include:
• Provide specific information. No need for imaginations or cartoon diagrams or sketches.
• Language is not a barrier. In UK and Africa the picture ‘means’ the same thing or relays the same message
• Initiate taboo or sensitive topics ‘…challenge untouchable issues’ as said by another member of the discussion group
• Stimulate discussion
• Introduce or generate new ideas and solutions
• Make complicated concepts and technical issues easier to understand
• Allows talks to be tailored to a specific level for the participants, but with the same pictures. I have used the same pictures for primary and high school students, traditional birth attendants, faith ministers, university students, doctors and nurses.
• Facilitating empowerment of people to take action, usually positive action in addressing HIV/AIDS.

C) Disadvantages of PAIDucation

To be honest, I cannot think of any apart from a bit of gossip and rumour mongering about a possible HIV infection diagnosis. True, “…if used wrongly can reap the wrong results” as stated by another reader. The worst incident that comes to mind is of a drunken old lady who was almost assaulted as she made a ‘diagnosis’ of a neighbour who had shingles/herpes zoster of the face. The old lady in her drunken state told the neighbour, “…You must go and see Dr Mapara. He showed us pictures of your rash and he said it is an outward sign of AIDS. There was even one picture, just like you!” Sadly, this was true and the client was already on our register.

Now the question comes in - are Pictures doing good or harm and to whom?

PAIDUCATION – KNOWLEDGE, ATTITUDE, BEHAVIOUR AND ‘PRACTICALS’

It is said that ‘knowledge is power’. We went one step further and said ‘Self knowledge through pictures is power’. As stated before, the Athlone Hospital AIDS Awareness Programme (AAAP) played a major role in the history of the HIV/AIDS epidemic in Botswana. Athlone had a ‘comprehensive’ package while many organisations were still trying to find their feet. Through Pictures in AIDucation, the team was called many a time as national facilitators. Outstanding national duties that were supposed to be given to the Botswana AIDS STD Unit (ASU) or National AIDS Coordination Agency (NACA) were given to Athlone because of ‘lack of capacity’ by the national bodies “…and your (Athlone) proved track record”, quoting officials from very high positions. Some of the assignments were assigned by:
• Ministry of Health (Health care workers)
• University of Botswana (UB)
• Directorate of Public Service Management (Civil servants)
• Botswana Network of People living with HIV/AIDS (BONEPWA)
• Botswana Christian AIDS Intervention Programme (BOCAIP) – Faith ministers
• Teacher Capacity Building Project (TCBP).

It is no secret that AAAP was in a league of its own, from evaluation reports by local and international bodies. It was a leader! AAAP helped the above bodies to set up community programmes. People ‘pictured’ AIDS through Athlone’s Pictures in AIDucation Programme. The replication of the Athlone ‘…best practice’ Health Resource Centres nation wide is testimony to that effect. Pictures tell their own stories!

All the assignments were addressed with PAIDucation. In some cases the team was invited and reminded to “come with your pictures”. It was not possible for Athlone to share experiences or facilitate without pictures. I admit, I would fail as I would find it very difficult to talk, teach or share experiences without the PAIDucation.

As Vaja, another contributor to the discussion said, “like a prophet, everything you talked about is now happening”. It is very sad that it is happening. It could have possibly been avoided or minimised, had the system had a little bit of faith in its own local initiatives! To be likened to a prophet is promoting me too high! I am a mere mortal and all I did in 1990 was just to make a few predictions, using the HIV/AIDS experience (1983 – 1990) of Zambia. Sadly, all the predictions have come to pass. The only ‘positive’ prediction was of AAAP becoming a national programme in 1996.

I was fortunate to have had the knowledge I had of Uganda’s and Zambia’s AIDS Programmes, in the late 1980s. That was valuable. Recall that by then Zambia was second to Uganda in HIV/AIDS prevention, care and support initiatives. President Museveni (Uganda) and Kaunda (Zambia) laid strong foundations for the HIV/AIDS Programmes in their respective countries. We owe it to them!


HOW ARE PAIDUCATION’ PICTURES USED?

I would not like to put down strict rules or criteria for PAIDucation. The major issue is creating a rapport or a dialogue with the participants and showing them the ‘reality’ of HIV/AIDS. It is about effective communication.

Some tips/hints/pre-requisite:
• Having lived in an area with HIV/AIDS and actively participated in HIV/AIDS prevention, care and support projects or programmes is a very valuable experience or pre-requisite
o I have had the fortune of twenty years clinical medicine and at the same time twenty years of public/community health medicine with twenty years PAIDucation in both. Remember the Athlone Health Resource Centre (AHRC) of 1999. That is the principles it was built on of Preventive and Curative medicine through PAIDucation.

• Knowing the culture of a people is also very important, especially where sexual intercourse, sexuality, relationships, sex education and death is concerned
o I deliberately ventured into the intimate culture of Botswana in the early 1990s as the silence on HIV/AIDS was very loud! As a foreigner who ‘did not know’ about the culture I introduced the pictures to make ‘invisible’ HIV/AIDS visible. Seeing is believing!
o Whereas oral sex might be a ‘normal’ sexual intercourse in Europe, many African cultures find it ‘abnormal’ as stated before by an elderly woman in a PAIDucation workshop, “What are you children doing eating vaginas and penises!?” Talk of dental dams might be a very contentious issue.
• Language should be not be a barrier with PAIDucation
• Medical terms ‘jargon’ to be avoided
o Best done by you using the participants’ words or language. Meaning that the participants must be heard more than you the facilitator
• Remember the rule of PAIDucation, “80% of talking is by participants and 20% (Better still 10%) is by YOU the facilitator/teacher/doctor/nurse/social worker/peer educator/faith minister.
o This is the FOUNDATION for a successful, community owned programme
• Let the pictures ‘talk’ to the audience. The audience will then talk to you. You will then talk back to the participants at the end, from their knowledge or lack of knowledge! As it is said that sometimes “little is more!”
o As the Batswana people say, “Nkosi oja morago (The chief eats at the end!), unlike in the West, where the guest of honour or guests at the high table are served first! As another contributor to the discussion said, that he uses proverbs to get the message across
• Time must not be an issue or hurried. Be generous with time. We have to create time as HIV/AIDS dictates. People at the grassroots may need an extra day or two just to understand that HIV/AIDS is real and we all have a role to play in looking after ourselves and our community.
o I recall the first time in 1992 when I asked for three days workshops on HIV/AIDS. I was told that it was too long! In 2001, Athlone was running five (5) days pictures in AIDucation programmes.

PAIDUCATION AND CONSULTANTS

I believe that HIV/AIDS management is about networking, being honest, transparent and looking at reducing new HIV infections. I have no problems with genuine consultants. My quarrel is with the dubious consultants. I have worked with a few while in Zambia and Botswana. Some were honest and admitted that they were deficient, but nonetheless they were paid their thousands of pounds/dollars.

In 1990, some international consultants branded AAAP and Pictures in AIDucation as “a dream…too ambitious…cannot work…shock tactics”. In 2000, the same programme was now documented, “…one of the best practices in Botswana” and was even worth mentioning at Barcelona 2002. Imagine the possible preventable new infections, the preventable deaths and the preventable potential orphans in those 12 years! What a missed opportunity!

We cannot put all the blame on our leaderships. They were unfortunate in that they listened more to the foreign consultants, than their own ‘hands on’ people. The exceptions have been President Museveni (Uganda), President Kaunda (Zambia) and President Mogae (Botswana).

Conclusion
In every single PAIDucation workshop held to date, close to two hundred, knowledge has been imparted through PAIDucation, experiences have been shared through PAIDucation, stories have been told through PAIDucation, attitudes have been changed through PAIDucation and positive responses/behaviour have been observed through PAIDucation.

I thank The Communication Initiative and Health e Communication for having given me a voice to tell the world, that Pictures in AIDucation is a viable, workable HIV/AIDS intervention strategy. I have lived the Zambian epidemic, the Botswana epidemic and now the UK epidemic through Pictures in AIDucation.

***

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Should you want to read more on this or other health communication related issues visit the Health e Communication web site at:
http://www.comminit.com/healthecomm/
_________________
Chris Morry
Director: Coordination and Special Projects
The Communication Initiative
]

CDATA[Author: Dr Edwin Mapara
Posted: Sun Feb 25, 2007 9:41 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188



Editor's Note: For technical reasons we are forwarding this comment from 'basilb' to the forum as it was submitted as a page review.

I refer to the 3 comments made by Anonymous, Vaja Ntingana and Doug Storey related to an important issue that Dr Mapara has raised relating to some \'ignorant\' and \'misguided\' foreign consultants and interventions that are bought to our continent to\'HELP\'. In my view understanding this issue is so important that it represents a focus that should now be debated as a specific topic on DRUM BEAT. Doug Story says there is plenty of blame to go around and he is right. However this should not reduce the importance of what Dr Mapara is raising. In defining the steriotypes the issue is nicely articulated for us to all better understand. To compliment what Doug Story raises is our own responsibility as Africans in the tragic issue raised. By allowing what is presented as \'ignorant experts\' and imposed dysfunctional interventions free reign to intervene on our continent we have all participated in the disaster that is now unfolding. To support this views from our own experiences in the nutritional field. What we see as stereotypes in this field is extreme ignorance incorporated into many interventions from school feeding, to health interventions that become part of our problem. The vested interests that are often incorporated and which become the imposed resource that is implemented into many programs is the steriotype that we all MUST STOP especially when \'good\' known science show us it cannot work.

To help us all address this PROBLEM - we believe that we must all raise a FLAG and filtering system called AFRICAN SOLUTIONS for AFRICAN PROBLEMS. Dr Mapara\'s approach using pictures is one such good example. Only by ourselves evaluating the needs of interventions with our knowledge on the ground supported by foreign resource and state of the art known available science in the context of our own African solutions will we all be able to manage the \'land mines\' of \'vested interest and imposed foreign solutions that will fail\'. Interventions must be designed for our own situations using our own understandings of necessary parameters that we must dictate if we want successful intervention that we can therefore proudly describe as an AFRICAN Solution.

In using this approach we all as Africans have the opportunity to first define the needs necessary for success. This process will hopefully help stop ignorant untrained inexperienced so-called \"experts\" creating havoc in our communities. It will also help stop the rationalised interventions that are dictated by outside ignorance or vested interests or even local corruption and personal agendas that ensure programs fail and which will result in our communities staying in poverty.

To understand what this all means we can all re-look at failed interventions (real live cases). A clear analysis based on the needs of an African Solution will showup and highlight the steriotypes as defined by the anonymous person and supported by Vaja Ntingana and Doug Storey who includes our own participation of allowing these dysfunctional interventions and allowing through \'silence\" local corruption dictated by individual personal agendas.

I have many such steriotype examples in the field of the STERTILE Nutrition DEBATE that seem to enjoy following 40 years of failure after failure. Hopefully soon I will have the opportunity to share on DRUM BEAT these real life nutritional examples and experiences of how the \'so called\' good guys are just promoting and ensuring \'all will fail\' and that we remain the basket case we all need to now take responsibility for and which we must NOW STOP.

In the words of a PASTOR I work with - we all must now learn to HATE this thing called poverty so badly that we stop it NOW.

***

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]

CDATA[Author: dstorey
Posted: Tue Feb 20, 2007 5:14 am (GMT -8)
Topic Replies: 3

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188



Anonymous expresses some gross stereotypes. Being an "outsider" is no more a guarantee of ignorance and rapacity than being "local" is a guarantee of wisdom and generosity. Some of the worst villains in the history of development have been those who prey on their own people by exploiting knowledge of local culture. There is plenty of blame to go around.

Doug Storey

***

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Should you want to read more on this or other health communication related issues visit the Health e Communication web site at:
http://www.comminit.com/healthecomm/
]

CDATA[Author: DiborNative
Posted: Tue Feb 20, 2007 3:34 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


Hello everyone,

Thanks for all the contributions we have been reading on this network.

My small production team will be in SOuth Africa from the 22nd of Feb. 2007 for 2 weeks. During that time, we will really love to work with any Consultant from this forum in the production of video specifically to do with health care Hiv etc. Pls, contact me by email if you are interested.

I have been greatly inspired by the work of the entire communication initiative and also video volunteers.org. We believe that by working with and interviewing Consultants, we will be squarely positioned to capture a lot that others can use in their work.

Thanks

Austin Okechukwu Dibor and Ethel Dibor (Dr.Bosman)
Live long and prosper

***

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Should you want to read more on this or other health communication related issues visit the Health e Communication web site at:
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_________________
The world will benefit from more opportunities for Natives to be involved in communication expecially in the area of health which has to do with their home countries.
Their input will greatly enrich planning and implementation strategies.
]

CDATA[Author: vaja
Posted: Tue Feb 20, 2007 3:26 am (GMT -8)
Topic Replies: 3

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


I totally and honestly support the anonymous person about the message so full of truth. You can not understand the situation of HIV/AIDS in Africa unless you live in Africa. What is been writtern by the hired consultants, who come to Africa, sit people around the tables and present the problem they have come to address in Africa and ask people what they feel is the problem and make their own conclusions, then submit their report without even coming across a patient of HIV/AIDS to really appreciate the magnitude of the pandemic i think is murder. That 'foreign consultants" and even locals who have ripped millions of money from poor people who might have benifited from the money in the fight againgst HIV/AIDS is a well known fact. We have seen companies and even individuals with no knowledge of HIV/AIDS, who mushroomed over night to cash on the pandemic. I wonder what people like Dr Mapara who if my memory serves me well have been in this fight since 1991 when i first heard him talk, teach, live HIV/AIDS has to get from this. To DR MAPARA, each time i think of you i remember when people used not to believe you, this was when it was taboo to even talk about HIV/AIDS, I remember one day you said to somebody," wait until its your relative then you will understand what i am talking about". Like a prophet, everything you talked about is now happening. So honestly speaking, in Africa "seeing is believing"

Vaja Ntingana


***

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_________________
VNA
]

CDATA[Author: Dr Edwin Mapara
Posted: Tue Feb 20, 2007 12:21 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


A little bit more of my teaching or rather more of listening style of sharing experiences. I notice that quite a number of readers have downloaded the first article of pictures.

Would love to hear your comments.
 
Edwin

***

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http://www.comminit.com/healthecomm/
]

CDATA[Author: Chris Morry
Posted: Mon Feb 19, 2007 11:41 am (GMT -8)
Topic Replies: 3

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188

Moderator's Note: This note has been forwarded to the discussion by the moderator.

Dr Mapara has brought out an issue that has been of concern to those who have been able to realise what has been a misdeed to the plagued and poor masses of Africa in the disguise of so called "foreign consultants", who have lived off the millions of dollars paid to them in the name of developmental consultancy. Imagine pretending to know and yet you cannot tell the difference between HIV and AIDS,that is unacceptable. I am glad that Dr Mapara openly points out that he had nothing to learn from them than for them to learn from him. Some of the so called consultants (in what they do not know) are to my opinion frauds and killers of the drive that some African pioneers in the HIV/AIDS campaign like Dr Mapara have been trying to bring forward. My Ethology & Wildlife lecturer once told me that one living outside a community cannot relate let alone write anything of that community. In wildlife documenting, you cannot produce factual documentation of any wildlife until you have studied its life patterns but must also take into account your interference,so you have to blend in. In short no one can talk about AIDS in Africa unless they have lived it,with the plagued,for at least 5 years to the most I believe. Indeed, is it that nothing good can ever come out of Afica? lets put an end to this rape.

Anonymous


***

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_________________
Chris Morry
Director: Coordination and Special Projects
The Communication Initiative
]

CDATA[Author: Dr Edwin Mapara
Posted: Fri Feb 16, 2007 12:28 pm (GMT -8)
Topic Replies: 3

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188



Having reviewed the discussion so far and listened to some of my colleagues I feel I have to give you some insight into my personal experience working with foreign HIV/AIDS Consultants in Africa, and to elaborate on the views on Pictures in AIDucation held by consultants I have met - some positive but unfortunately many negative.


ATHLONE HOSPITAL AIDS AWARENESS PROGRAMME (AAAP) AND CONSULTANTS

My experience with most of the consultants was not good apart from Noerine Kaleeba (Former TASO Director. Now with WHO) in June 1995 and General Rawlings’ (UNAIDS Eminent person) entourage in April 2002. The rest we could have done without. If anything they were not value for the money paid! They, themselves in their heart of hearts know that they gained more from Athlone Hospital’s AIDS Awareness Programme, than Athlone Hospital did from them!

NOERINE’S VISIT AND PREDICTION

Noerine’s visit to Athlone was very memorable and it gave an impetus into the AAAP. The team heard first hand, her life experiences and how TASO was formed. The team could relate with her easily, as they had seen her in the videos that TASO had made, which we had in our library. She was full of praise for AAAP and she saw the Ugandan and Zambian elements in AAAP. She told us that AAAP was destined to be a national and international programme. She said she could see “…the strong foundation…the integrated… comprehensive…community… multisectoral approach that you have taken!”

True from THE AFRICAN CONSULTANT FROM TASO, AAAP became a national programme and one of the ‘…best practices in Botswana’ (UNDP/SIDA/ASU Report 2000).

A little bit of history for you, AAAP was born in 1990, two years before the Botswana National AIDS STD Unit (ASU), which was born in 1992. There was even a time when AAAP had more audio-visual resources than ASU. That is to show you where I am coming from! As Sam Kolane, in an earlier input said, you cannot miss the trial if you go to Lobatse or simply ask about Dr Edwin “Zambia” Mapara and his team that included Vaja (Pronounced ‘Baya’) one of the original AAAP team members and contributor to the discussion!

JERRY RAWLINGS’ ENTOURAGE

During his tour of African countries had hit by HIV/AIDS in April 2002, it was only the Public Health doctor in Rawlings team, who saw the AAAP project of Social Sciences (Preventive and support) and Medical Sciences (Curative, care) in one programme. He was the first who had no problem understanding AAAP, in AAAP’ twelve years of existence. Is it a coincidence about African and Western Consultants view points!?

WESTERN CONSULTANTS’ VERDICT

Can you imagine that the same AAAP was said to be, “…not practical…too many uncoordinated elements…a dream…not realistic…not going anywhere…shock/scare tactics have never worked…has no direction”, by WESTERN CONSULTANTS? Some of these consultants did not even know that there was a difference between HIV infection and AIDS!

The Athlone Hospital Team knew when I was putting a ‘consultant’ to the test. Along the way during discussions, I would ask the ‘consultant’ about The AIDS Support Organisation (TASO) of Uganda, The Chikankata Salvation Army Hospital’s AIDS Programme or GRID! Some of these consultants got zero out of three! That is consultants for you Africa! It is like a supposed renowned international football coach telling you that he has never heard of David Beckham (England), Pele (Brazil) or Diego Maradonna (Argentina)!

Sadly, our leaders give these ‘consultants’ red carpet treatment, that Edwin can never get. If anything Edwin is a radical, “…he is very uncooperative!”

NOTHING FOR ME IN TERMS OF KNOWLEDGE GAINED

Personally and frankly I never learnt anything from the foreign consultants. Most of them, with due respect, were novices in the field. They had more to learn from me, than I from them.

Remember, by then I was still a very young and enthusiastic Zambian young doctor and I read up everything on HIV/AIDS up to international journals printed the month before! Also note that by 1986, Zambia was an international pace-setter through Chikankata Salvation Army Hospital AIDS Programme which many countries did not even know about.

That is why it was so painful for me, that on going to Botswana in 1990, I could not implement some of these programmes. I had to wait for seven years! But like I said before, you could not put all the blame on our leaders/programme managers, as they just towed the line of foreign consultants ‘expert advice’ and these bilateral donor ‘criteria’ agreements.

What has happened to Botswana, should not have happened!!

ZAMBIAN HIV/AIDS BACKGROUND

I have been dealing with HIV/AIDS since 1983, when I was a student under my mentor, Prof Anne Bailey, at University Teaching Hospital, Zambia. She was and still is an authority on kaposi’s sarcoma and HIV/AIDS. She was talking HIV/AIDS while most of us were still asleep and in some cases of these ‘consultants’ not yet born!

When you have passed in her hands, you can stand on any international stage and talk about HIV/AIDS! That I can say with pride with my experiences at the University College London, Cambridge University Medical School, World Health Organisation (WHO) and at London City Hall. I talked with Pictures in AIDucation and had no problems.

DAMAGE CONTROL

As Botswana and Uganda are now fertile ‘study grounds’ for HIV/AIDS socio-economic impacts, I have been doing a bit of ‘damage control’ in the UK. It is fascinating to sit in the lecture theatres where researchers and ‘consultants’ say all these negative things about Africa and present their papers for their doctorates. I have always noted the comments and at the end I introduce myself and put the facts right about Botswana and Zambia. Some even made mistakes talking about AAAP! They naturally got a lecture from the pioneer!

It is unfortunate how ‘consultants’ are deceived about providing solutions from Europe or America for Africa. Africans live with HIV/AIDS every single day! It naturally follows that some of the best solutions have been devised by the African communities themselves. Experience is the best teacher, in HIV/AIDS management.

HIV/AIDS IS BIG BUSINESS AND MONEY SPINNING VENTURE FOR CONSULTANTS

Thousands of consultants have lived off HIV/AIDS money, while millions of people living with HIV/AIDS are barely surviving. The other day, 9th March 2006, I attended a meeting at Canary Wharfs, hosted by the Fabian Society. These are young budding politicians 31 years old and below.

The guests were The MP and Secretary of State for Department for International Development (DFID), Hon. Hilary Benn and Max Lawson, the Senior Policy Advisor for Oxfam. They gave powerful presentations of what the UK has done for developing countries in terms of aid, cancellation of debts and advocacy for this and that…! Impressive!

Question time came. I was the third person to ask a question. My question was naturally on Consultants:
1. Who asks for consultants and who chooses consultants to go to Africa on HIV/AIDS matters/programmes?
2. How much are these consultants paid for the jobs/consultations that they do in Africa?

Hilary Benn looked at Max, and Max answered after taking a deep breath! “…I will start with the second question. Last year, in 2005, £220 million was paid to consultants!” You could here murmurs in the audience! I stood up again and said, “Max, did you say £220 million ONLY that was supposed to have gone to Africa came back to the UK?!” Poverty alleviation for who?

To me that is criminal!! Imagine what that money could have done for Africa in terms of:
- Clinics
- Immunisation programmes
- Sanitation
- Bore-holes
- Schools
- Walk in centres for HIV/AIDS clients
- School fees and uniforms for the orphans and vulnerable children
- Income generating projects
- Pictures in AIDucation resources for the health resource centres! One set of TALC slides (100 colour slides/pictures) costs only £25 for a hospital or health facility!

To add insult to injury, there was one of these ‘young consultants’ in the audience, who tried to defend the £220 million bill. After he introduced himself, he commented and addressed me as “Dr Mapara”, yet I had introduced myself as “Edwin”. I met him after the meeting as I was keen to find out who he was and how he knew my surname! It later dawned that this was one of the consultants that had been employed by the Botswana government to come and make HIV/AIDS messages for us in 2001, for the Antiretroviral Therapy Programme that was to start in 2002 at the initial four sites of Gaborone, Serowe, Maun and Francistown.

I could not recall the name or the face, until he said “We went to the Family Health Division (FHD), where you came to teach us on AIDS with those pictures from Lobatse!” It then clicked! I could see him now in the classroom as I taught the consultants to teach us what I was teaching them! Poor Africa!!

STEPHEN LEWIS IN LONDON

One of my memorable stage performances was when Stephen Lewis came to London City Hall, in June 2006 as the guest of honour. He talked about HIV/AIDS in Africa and touched on Botswana. He was the first GENUINE CONSULTANT I have heard speak positively of the initiatives and efforts in Africa, including in Botswana. He even talked about the positive attitude of Dr Ndwapi of the ART Programme in Botswana, despite the many short-comings. I stood up four times to speak about Botswana, in support of his Stephen Lewis’ remarks.

(IM)MORAL ISSUE

These bilateral ‘donor’ agreements must stop reaping off African countries in the name of sending over ‘Consultants’ and bilateral aid with all these strings attached! There are some genuine consultants, but for me the experience has been, that I could count them on my hands. No! I could count them on my hand!

Remember that in Africa, we have at least one Tsunami every month, due to HIV/AIDS or three ‘twin tower’ deaths every day!

Who has not seen the pictures of these recent disasters? How many have been taught on HIV/AIDS using pictures? What double standards!!

It is only today in our first day of the five (5) day PAIDucation course, of 2007, that one Health Advisor said in her evaluation form; “I have been taught about AIDS, but not like this. I thought that I knew about AIDS. I have realised that I did not! Look forward to next Thursday.”

Food for thought!

Edwin


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CDATA[Author: Dr Edwin Mapara
Posted: Fri Feb 16, 2007 7:47 am (GMT -8)
Topic Replies: 4

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum from the co-moderator Dr. Edwin Mapara. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188

***

PICTURES IN AIDUCATION CONTENT

To put those who have not seen the Teaching AIDS at Low Cost (TALC) pictures in the picture. Here we go on the introductory set of DAY 1: [to review these please click on the attachment above]


Good day.

Dr. Edwin M. Mapara - MBChB, DTM&H, MSc.

Community Health Promotion Officer,
Brent and Harrow Community Health Projects,
Room 10-11 Moran House,
449-451 High Road,
Willesden
NW10 2JJ

Tel: 02088303392
Email: ');document.write('aemapara');document.write('@');document.write('aol.com');document.write('');//-->, ');document.write('Edwinbhchproject');document.write('@');document.write('aol.com');document.write('');//-->
]

CDATA[Author: vuyo
Posted: Thu Feb 15, 2007 11:11 am (GMT -8)
Topic Replies: 1

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188

It has been a long wait for something like this to come to the world audience projecting what has been in some sectors a "need to know basis"
issue.

I came across the use of TALC in Botswana,Lobatse in 2002 and have ever since appreciated having seen those pictures. Not only did they make sense in the understanding of HIV/AIDS but also gave better visual knowledge what signs one can take note of in relation to the disease.

Use of such tools I believe give better understanding of the disease as it not only cuts across the language barrier but substantiates "What I see I will always remember". War survivors do not forget the attrocities, and I know one would never forget what has plagued Africa after they see the slides.

I recommend their use in any forum that is about addressing this disease.

Lameck

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]

CDATA[Author: lillian
Posted: Mon Feb 12, 2007 5:14 pm (GMT -8)
Topic Replies: 4

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


Dear Colleagues

When I first saw the brief information on dates to attend the first meeting of Aiducation, I was not so sure of what was it precisely. I had my own intrepretation because BHCHP was dealing with cases of HIV/AIDS and I was having clients I was supporting. I was expoused to their fears and their reactions For those who had relatives they still cared about, they wished something to be done for their relatives to be well informed about this dreadful condition, but their state of affairs were such that at that point and time it was not possible for him them to do anything but resign.

When I attended the training at BHCHP last year seeing the slides, vedio pictures and hearing personal testiminies from people who were HIV/AIDS positive, it was so fitting that a lot more has to be done in terms of educating people using pictures to let people have informed choices about their sexual patterns because seeing is beleiving.

When you see the pictures and you relate to your ownself or relative or anybody you never wish any person to experience such a devastating condition. You will think of rescuing or prevent the spread by education and benefit mankind spiritually, economically and empower people to take care of the situation.

The pictures made sense to me because I took into consideration how a person so intimate with her /his body, and the consequences that follow after being infected with HIV/AIDS. The disability that follows in in relation to personal care and other activities of living experienced by a person with the condition. I felt that it can be humiliating and traumatic emotionally. That is why the education part is very important and pictures must be used because they give a punch of real life degenerating if measures to prevent the condition are not taken seriously. I would recommend to use the pictures anywhere and to any audience starting from the adolcence.

I was made to understand more about HIV/AIDS, its impact and my role as my brother's keeper as the Bible refers. We are a community, we need each other, a better community is an informed community and I would recommend other organisations to use the AIDUCATION approach, highly comendable.


Lillian


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CDATA[Author: Dr Edwin Mapara
Posted: Mon Feb 12, 2007 10:59 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


The first week has indeed been very exciting with all the comments and questions coming in. I also note the number of people who have commented and rated the article from all over the world, 95 to date. The majority have been positive.
Thank you for your support and comments.

This week we want to shift the discussion a little and look at things from a slightly different angle but one which connects well to the discussion so far. This week we want to ask:

Have you used clinical pictures in your AIDS education (AIDucation)? If so, please share your experiences and describe how and where you’ve used them. We are particularly interested in evaluation data, things that worked, and things to avoid.

As a way of moving us towards this new topic I wanted to share a few relections of my own.

It is fascinating to think that we are talking of Botswana with a population of 1.6 million people, and the Athlone Hospital’s Pictures in AIDucation (PAIDucation) programme being discussed is from Lobatse, with a population of close to 36, 000 people.

I thought it best to answer some questions and comments by giving more background to the Pictures in AIDucation (PAIDucation) intervention strategy, although there is a bit in my introduction of last week. It is a package, best understood by knowing the structure.

BIRTH OF ATHLONE AIDS AWARENESS PROJECT (AAAP)

I left Zambia in September 1990, for Botswana, after having set up the Livingstone Anti- AIDS Project (LAAP) in Zambia. LAAP took some ingredients from the Chikankata Salvation Army Hospital’ AIDS Programme that was formed in 1986.

LAAP (Zambia) and AAAP (Botswana) had similar structures/units:
1. Information, education and communication (IEC) – Foundation
2. Counselling – Slab
3. Clinical (Medical and nursing) care – Wall
4. Home based care and orphan care – Wall
5. Pastoral care – Wall
6. Administration and research – Wall
7. Integrated training unit – Roof

Those were the ‘houses’ built to engage and accommodate the communities. AIDS was in the village, the solution to addressing AIDS was in the village with the villagers.

The target groups or ‘windows of hope’ are almost self-explanatory looking at the units: – Schools, institutions of learning, media, social workers, health care workers, people living with HIV/AIDS, community members (Politicians/policy-makers, civil service, factories, uniformed and non – uniformed forces, traditional structures), faith groups and the training unit comprised the head of each unit. In short we began a multi-sectoral approach in 1989 to curb the spread of HIV/AIDS. It was everyone’s duty!

Problem was that not everybody understood or believed we had a pending catastrophe! It was difficult to talk, to explain or describe this ‘invisible’ disease, even to some health care workers who were sceptical!

So bring in pictures! Initially the Uganda set of posters and locally pictures from text-books and journals.

In 1992 in Botswana, we solved the problem of making HIV/AIDS visible! Athlone Hospital ordered the Teaching aids At Low Cost (TALC) clinical and non clinical slides from St. Albans, UK.

That was the beginning of the Five (5) day PAIDucation workshops:

Pictures had some of the following effects as noted by some of you:
- Addressed denial
- Made HIV/AIDS visible
- Stimulated dialogue
- Got rid of the witchcraft and myths
- Made talking of sensitive issues such as sexual intercourse and death easier
- Brought out the ‘inner circle’ sexual cultures
- Language barrier broken and medical jargon was less
- People related with these images
- HIV/AIDS was no longer ‘foreign (Westerners’ disease)’
- Initiated mature debates and discussions
- Other response are in the introduction.

A typical workshop in Africa and Europe was and still is:

Day 1: Social Intercourse
• Introductions. Fears, hopes and expectations
• Overview of global HIV/AIDS statistics
• TALC slides: Sexually transmitted infections
• TALC slides: Basic HIV virology, transmission and prevention
• Video

Day 2: Clinical manifestations
• TALC slides: Clinical manifestations of HIV/AIDS in adults
• TALC slides: Clinical manifestations of HIV/AIDS in children
• TB and HIV co-infection
• Video:

Day 3: Counselling and emotional support
• Sex: An African Perspective
• TALC slides: Prevention of the mother to child transmission of HIV/AIDS
• TALC slides: HIV/AIDS Prevention and counselling
• Testimony of person living with HIV/AIDS
• Video:

Day 4: National HIV/AIDS programmes
Day 5: Community mobilisation

In 2007, the format has not changed much for the UK community. The only difference is the addition of the antiretroviral therapy (ART) and with the videos, our key to African communities in UK and especially the faith communities has been “What Can I Do?” The video of a positive Ugandan pastor called Pastor Gideon Byamugisha. Doubting or not involved faith community leaders have been ‘converted’ instantly after watching the 43 minutes video!

PRESENTATION STYLE

True, our presentation styles were also above average. The AAAP Team were national facilitators. We believed that we should work ourselves out of employment by empowering grassroots people. We listened more and talked less! We let the pictures talk to the audience/community members.

The visits to Athlone Hospital By local, national and international visitors, which were very frequent, boasted our morale. Almost every visitor to Botswana was brought over to see the Lobatse AAAP, as it was a ‘national prize’. Some memorable visitors included Noerine Kaleeba, Founder of The AIDS Support Organisation (TASO) of Uganda in June 1995, who correctly predicted that AAAP would be duplicated nation – wide. This came to pass.

EVALUATION(S) ON AAAP

1. Ministry of Health and AIDS/STD Unit evaluated the programme in 1997. In the same year, based on the evaluation report, the AAAP Team was assigned by the Permanent Secretary Ministry of Health the national task of “…helping establish similar programmes, like yours (Athlone hospital) in the other health facilities.” The assignment involved three referral hospitals and nine district hospitals. The team was on the road for six (6) weeks, spending three days in each health facility.

At the end of the six weeks, AAAP concluded, that there was an impending national disaster. That is how the idea of the Health Resource Centre was hatched. The plan was for a ‘school’ on HIV/AIDS for the other institutions. Unfortunately the government would not fund it, so AAAP raised funds from the ‘faithful’ Lobatse community and opened the FIRST Health Resource Centre in Botswana in 1999.

2. In June 2000, the Athlone Health Resource Centre (AHRC) was documented ‘…one of the best practices in Botswana…’ in a report by UNDP/SIDA and AIDS/STD Unit.

The second Health Resource Centre was opened in Maun in October 2001 and I wrote the official opening speech for the Permanent Secretary Ministry of Health. It had been ready since 1990!

Unfortunately when USD 2 million was made available for the Replication of the health resource centres nation wide, Athlone Hospital did not see a cent of it! In fact the donors talked of the Health Resource Centre Project at Barcelona 2002, but again remembered to forget to mention Athlone Hospital. Still in the same vein, the donors forgot to mention that the AAAP Team was called to facilitate at the August 2002 “Health Resource Centres Experience” workshop in Gaborone because Edwin was leaving for the UK three weeks later. If anything it was Edwin and his team, teaching the participants(Referral and District Hospital Management Teams) on the AHRC for their future Health Resource Centres that were still to be developed, as there were only three at that time, of the anticipated 22 for the 22 districts

3. In 2001, the Brazilian delegation that came to see the feasibility of Botswana providing ART to its people, documented Athlone Hospital as one of the sites that was “…very ready”.

The secret to these ‘…best practices’ was PAIDucation! That was the ‘engine…heart…and soul’ of Athlone’s success story.

INTERNATIONAL VISITORS

Athlone Hospital had visitors to the programme from America, Canada, France, German, Netherlands, Spain, United Kingdom, Belgium, Italy, Ghana, Uganda, Kenya, Tanzania, Malawi, South Africa, Namibia, Swaziland, Zimbabwe and others.

Will not mention names or organisations, to avoid embarrassment as some of these ‘visitors’ advised government(s) wrongly, especially on the Athlone Hospital AIDS Programme.

Talking of “disappointed”, my biggest disappointment has been how African leaders were misled and are still misled by some of these “consultants” on managing the HIV/AIDS epidemic in Africa. It is also sad on how our African leaders have so little faith in their professionals. It is sad on how programmes are designed in air-conditioned offices in America or Europe to go and be implemented in Africa.


COMMUNITY EMPOWERMENT

Time is definitely not on our side and with Pictures in AIDucation, it was all about community empowerment with the meagre resources that AAAP had at hand. I think like one of you said again, it is possible to run a good programme on small/meagre resources.

With only 5, 000 hospital beds in Botswana and an estimated 200, 000 people living with HIV/AIDS, AAAP had a vision of ‘shifting’ the hospitals into the community. Who would be the nurses and doctors? Community members themselves! So why not empower them with pictures?

There are millions of people living with HIV/AIDS and being nursed in the homes.
These include patients with kaposis sarcoma (KS), TB, cancers, pressure sores, gangrene, meninigitis….the list is endless! Some even asked why the hospitals could not conduct euthanasia (Mercy killing) to “…end the suffering of the patient…”who was alive and had maggots coming out from the wound in the ‘rotting’ leg.
For quite a number who saw the pictures, they had worse in the homes and they could narrate their very sad emotional stories in the workshops. Many also asked, why they were not taught with pictures in the early days of the epidemic.

Death is in the thousands everyday in Africa.

As time and money is not our side, one thing that we have in abundance in Africa is ‘ubunthu (humanity)’ and that will and is playing a major role in addressing HIV/AIDS.

Not all picture stories are sad. AAAP had patients coming in for early treatment of HIV related conditions after the picture sessions. More KS patients came for treatment, knowing that it was not ‘witchcraft’.

The most inspiring life-story for me was of a patient in 1992, who was supposed to have had his KS ‘elephantiasis’ legs amputated. The wife remembered me saying in one of the community hall PAIDucation workshops that ‘..KS is treatable’. She refused the amputations and brought the husband to me for ‘…your treatment’. We first did the HIV test. It came out negative! Could not believe and I ran to the lab to confirm. It was true! Today (2007) as we discuss pictures in AIDucation, that patient is very alive and on cytotoxics in Lobatse and wears shoes! The patient tells folks that he ‘walks on Edwin’s legs!’ The power of pictures!

YOUR EXPERIENCES OF USING PICTURES

This is where I stop and remind you again of the second question.
Have you used clinical pictures in your AIDS education (AIDucation)? If so, please share your experiences and describe how and where you’ve used them. We are particularly interested in evaluation data, things that worked, and things to avoid.

Thank you.

Edwin


***

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]

CDATA[Author: Morley
Posted: Mon Feb 12, 2007 4:38 am (GMT -8)
Topic Replies: 0

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188



Dear Colleagues, 

I was fortunate in that I was in touch with Edwin soon after he left Botswana and was much impressed with his approach. TALC started distributing colour transparencies, in the 1960s these were so popular we distributed 7 million.
 
TALC's contribution to this approach was to print 12 of the TALC pictures on a leaflet with questions to initiate discussion and a guidance leaflet with answers to common questions,
 
Anyone wishing to see a sample leaflet should contact TALC

');document.write('info');document.write('@');document.write('talcuk.org');document.write('');//-->
fax  +44 (0) 1727846852

or write TALC,  
POB.59,  St Albans,
AL1 5TX, UK.

and ask for 'Edwin' s colour sheet and guidance notes' giving a postal address and they wail receive a sample.   Bulk supplies can be purchased from TALC.
 
David
 
Prof. David. C.Morley.  MD. CBE.
51 Eastmoor Park,
Harpenden.
AL5  1BN.   UK.
Phone/Fax 44 (0) 1582 712199


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]

CDATA[Author: skolane
Posted: Mon Feb 12, 2007 1:51 am (GMT -8)
Topic Replies: 4

This is a contribution to the 'Pictures in HIV/AIDS Education' discussion forum. The forum is sponsored by Health e Communication and moderated by Dr. Edwin Mapara who has spent 20 years using such pictures in southern Africa and the United Kingdom. For more details see:
http://www.comminit.com/healthecomm/planning.php?showdetails=188


Moderator,

I have read with interest the current debate on the use of pictures in HIV/AIDS education. As a public health practitioner with a strong interest in research, I can understand where Sue is coming from- empirical evidence is a very important (but not the only) step in showing that a programme yields results. Having personally worked with Edwin in the Athlone Anti AIDS project in Lobatse, Botswana, I have seen the difference made by using such pictures. When Edwin first introduced the method, I was a bit uncomfortable considering our cultural background and norms on what may be deemed acceptable or not acceptable. I am very happy to say Dr Mapara, with of course the help of his team, broke down the barriers of open communication on matters of sexuality- something I am pretty sure, we would not have achieved quickly without the use of such pictures.

This method of intervention works and if Sue wants to have proof, there is one way (as a researcher) she can find out. All you can do is initiate
conducting a study in Lobatse to measure the impact. Although some members of the Athlone Anti AIDS Project team are no longer in Lobatse, they left a trail that cannot be easily erased.

Dr Edwin I say, "All Hail, Zambia!". You have done, and are continuing to do a fabulous job that all (researchers and all) should emulate and encourage. I am currently organising a training programme for a certain group of health professionals and I have no doubt in my mind that such pictures will come in handy.

Thank you

Sam Kolane


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