Katy Gabel and Verna Rainers
28 May 2008
interview
Nairobi — Kenyan health care advocate, activist and academic Dr. Miriam K. Were is in Japan today to receive a major new prize established by the Japanese government, the Hideyo Noguchi Africa Prize, in recognition of her work to promote community medical services.
In this interview with AllAfrica's Verna Rainers and Katy Gabel, she discusses her passion for community work and the Uzima Foundation, a youth advocacy organization she co-founded with her husband, Humphreys R. Were.
Tell us about the Hideyo Noguchi Africa Prize?
I was nominated by the Government of Japan and a Kenyan professional colleague. The colleague saw the website a day before the deadline and suggested nominating me…. The difference between this award and others I have received is that others… provided recognition but not support…. Real, financial support is essential and an important motivator.
You won the prize for your lifelong work to promote community-based medicine. Why do you think community care is being recognized now?
… I think that people have come to realize that my focus on community-based medicine is actually the best kind of care you can give somebody. You can help someone keep healthy, prevent disease, and get first-line care as close to them as possible. I actually worked out a scheme that would have had all of Kenya covered by 1995, including budgeting for it. Every community would have been covered by empowered health workers.
Health at the community level doesn't cost nothing – but it doesn't cost as much as disease. Many professionals felt before that health at the community level was second-class care. At least now we are catching up with reality.
A lot of my work, then, has been looking at communities. Even in Uzima, we are looking at a community-based approach to youth empowerment. So I see this award not only as recognition for me and my work, but of the importance of communities and community-based work.
Verna Rainers/AllAfrica
Humphreys R. Were and Dr. Miriam Were (right) at the Uzima Foundation headquarters in Nairobi.
How did you first get involved in health work?
I started out as a schoolteacher in a high school. I enjoyed teaching, and I enjoyed interacting with youth. I started out teaching in girls' boarding schools in the rural areas. Boarding schools are very well looked after.
But then I got married and my husband and I came to Nairobi. In the colonial period, most high schools were boarding schools, but in Nairobi there were some day schools. In the colonial period we had schools for Europeans, for Asians, and for Africans. I was assigned to work in a national school, which was just integrating.
I started teaching in Nairobi in 1968, and the school was just bringing Africans and others in to mix the races. It so happens that the children in the school in which I was teaching were from the low-income areas and quite a number of them were very sick. I would send them with little notes to the city health clinics and I'd tell the person there that the child has a wound on his leg, or a temperature – but they always came back with aspirin.
By this time, I was already a wife and mother. My own daughter was getting sick. She had childhood fevers. I would take her to the doctors and ask them: "What is the problem?" and they would say, "You don't need to know. Just give her this." I felt I was not being treated with respect. I thought, "Why can't people tell me what's wrong with my child, and what is this I'm giving her?" So I was feeling personally frustrated.
I was also frustrated when dealing with the students. No one was treating them. I think there was just carelessness in the way that doctors handled their patients. Sometimes the students were not even examined… There was kind of a condescending attitude towards children's health. So I thought that this had to change.
It so happened that the University of Nairobi had established a medical school in 1967. I just went and picked up the forms and said, "I want to apply to go to medical school." Well, they looked at me. I was 28. In those days, that was very old. So I took the forms home and my husband and I laughed about it, because in those days the University of Nairobi did not accept wives. If a girl got pregnant while she was a student at the University, she was sent home. A number of my friends lost their places in that way. So we thought, well, they probably won't take me. But they did.
Then I had the real challenge of my life: what do I do now that they've taken me? I had to give up my job, my salary, and the like. It sounds heroic, but what really pushed me was the fact that I couldn't even get decent treatment for my own daughter.
In those days there were not many African doctors. Most of the doctors in the clinics in Nairobi had been trained in Bombay… I was in medical school for five years… By the time I joined, I had decided to go into public service. My preoccupation was to push access to health care.
What drove you to work with youth?
I felt, as I progressed in my career, that we were not taking our young people along as we developed. These people are our future leaders, so they can wait their turn to make decisions. But there are so many ways they can decide to lead now. In Africa, our young people who are between the ages of 10 and 30 are the most educated group; they are the most exposed group. So one of the things I tell them is, "You can't afford to be the leaders of tomorrow – you have to be the leaders of today."
When Africa has very high levels of poverty – with more than 60 percent of the population below the poverty line – most of the young people are below the poverty line. Sometimes people make the mistake of thinking that if you are poor, you are stupid. But there's no relationship between poverty and stupidity, especially if you've grown up in a disadvantaged environment without opportunities.
So the challenge is how to bring out the strengths and contributions of everybody, including our young people. Our young people are more than 65 percent of the population. Sometimes we talk about our women being 50 percent of the population, and they are ignored. But when you are ignore both young men and young women, you are ignoring more than 65 percent… in some countries, 70 percent.
I also found in my dealings with young people that they were more open to possibilities. They could look beyond what they have now, the relationships they have now, to what is possible. And we need that aspect in our development in Africa also – the broadening of the horizon from which you can make decisions… When you open up possibilities for people, things happen faster.
In Kenya, we have not always had universal education – universal primary education. In fact, it only became a reality in 2003. So when we started the Uzima Foundation in the 1990s, there was no free access to education. So you find 14, 15-year-olds who are nowhere. They are in their homes, but not in any directional lifestyle beyond housework, if they are girls. And we have even more problems with young men who are not in family situations – they are not in school, and they are not employed.
So you find a lot of young people just loitering on benches in markets, looking for work, feeling bored, helpless and idle. How can you blame them for getting involved in crime? Living in this blanket of hopelessness was what concerned me. If I imagine my life without having gone to school, having a job, having anything, I become very scared.
How did you form the Uzima Foundation?
We didn't originally imagine starting an organization. We wanted to work with existing groups like church groups and so on so that we could support their young people's work… But even our own church groups were not prepared to deal with that. They said, "Oh, no, we cannot let young people take part in decision-making. We'll just tell them what to do." When my husband and I started talking to young people about it, we remembered we had been saving some money for a rainy day, as we called it, but so many young people were in the rain.
We wanted our young people to get involved in decision-making. At the same time, we don't think it's best to have a completely trial-and-error situation, because if they make terrible mistakes, it will shut even more doors for them from the adult world. As the saying goes, "Wise people learn from their mistakes, but wiser people learn from other people's mistakes." So we wanted them to be involved, but under the guidance of adults, so long as those adults realize that young people have potential, give them an opportunity, and act like their sounding board. So it became a partnership between the youth, who are the majority, and a few adult leaders.
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