Brother Asima and e-collegues,
Please be encouraged Asima. I am here to support you. I love it when I see all of you coming out of your shell from the 'primp, proper, and polished style' to the 'rough and tough hard knuckles and taking the bull by the horns style' of what is really happening to you and others on the ground. You took almost 10 weeks to let us know what is really happening while I sounded alarm from day 1 and got hammered for that. Your note was quite feisty....enjoyable and hit the bulls eye.
I miss seeing your picture on the e-forum. You know Asima if we write to each other we need to also show our human face not that gray ugly thing. I have a hard time relating to that inanimate gray thing. All of you are handsome and cute in your own unique way. You are quite an interesting character.
So, do I get it you right if I may boldly take this couple notches higher, that we should overhaul the CCM with a new breed of young people? That will be high energy and excitement and not only that... they will bring a renewed energy to the GF because they have not been molded in the culture of "C' . Things have not been "jelled up and set in stone yet that it can't be undone. The GF needs to reinvent itself and needs a serious image change and facelift....
"Many people are living of malaria where mosquitoes are not willing to bite.". I don't want to make any conclusions but... wondered what you meant? I read a research study from Uganda that the mosquitoes bite women more than men, and bite when they are pregnant and in their menstrual cycle. There were 19 couples in the room and that was so funny and quite interesting. Please elaborate on why the mosquitoes aren't willing to bite. I can't imagine those mosquitoes being so different in terms of their behaviour or is that just that the prevalence of malaria is so high that just about everyone is already infected and the mosquitoes know who is already infected. That is very bad news then...
You brought forward a very serious point about the disconnect that exists between the grassroots organization and CCM. I have detected that without too much travel to a number of the respective countries represented in this e-forum.
I think if I have to personally evaluate the CCM performance my standards will be too harsh and most will flunk it and will not survive.
Don’t underestimate my training in Quality Assurance, Utilization Review and Health Care Risk Management (medical law) and have a Public Health and Nursing background. In addition, I study the socio-political situation in the country because I am a political scientist. Due to the extreme plasticity (the ability of the brain to change itself) of my brain in specific areas I can learn anything that my mind wants to master without setting foot in a classroom or waiting for a degree which I don't have time for. So I developed an extraordinary skill in April 2000. I didn't know my brain can do such complex things by the way. I had never seen a HDR (UNDP) report in my life eventhough my professors referred to it since Fall of 1998 when I got admitted. I decided it was time for me to see what it was so I bought my own copy then started reading all the indicators and interpreted them according to my knowledge in Anthropology, Nursing, Public Health, Education and Political Science. Then I studied the country socio-economic political history and political climate and then I give you a fairly accurate situation what is going on in the country. My professor, Prof Gusto Aguillar was the Dir of the School of Economics at the University of Costa Rica and was on a Post Doc Fellowship at USF. He told me that the class was advanced Economic Development of Latin America and there were about 6 pre-requisites. I had never in my life seen or touched an economics textbook but refused to drop the class because as a woman I believe only cowards do such things.
To make a long story short I studied Economic Development of Latin America, wrote a comprehensive country development report and got an A-. Never being satisfied with mediocrity, I told Prof I will not accept the grade so he told me, since I was a big girl now I have to defend my paper dissertation style with (3) very difficult questions infront of the whole class. Mind you all of them were Accounting/Economics majors except me. I told him I will take the challenge and jump in the ring to proof that I will not be defeated and that I can train my brain to do anything at anytime and become good at it. Well, the day came and I defended my paper on the demographic transition theory and its relationships to literacy and life births. I had little preparation and didn’t know what Prof was going to examine me on. Even though I had cold sweat, I proceeded and answered the questions and passed with a straight "A" in one of the most difficult courses I ever took in my life. The Dept of Economics threw a big farewell party for Prof and the class of 30 students was invited. As I walked in he stood up to give a speech. What brought tears to my eyes is when he said that I was the most outstanding student he met in his career of 25 years and the #1 in his class and that I will be heading the UN because he has learnt so much from me during the time I was in his class. (I don’t know about the UN thing).
Asima, do you know what I did with that knowledge? I cross transferred it and cross fertilized it and cast it into Africa that I was studying all along in different courses and now the sky is the limit for me. All of you reading this have that potential but you have not explored it. It’s there waiting to be aroused from a deep sleep.
As a result to me teaching myself and reading the HDR I can interpret all the critical indicators out of my head. When it comes to the Literacy statistics Angie Joy I hope you are reading my submission. There is a difference between being literate, being functionally literate, being illiterate and being functionally illiterate. I also know what falls in the illiteracy spectrum with descriptors of semi-literates, or those that relapsed into illiteracy. I have this down packed to a science and can tell you with the drop of a hat what is going on in communities around the world.
By the way, no one in the world distinguishes any such in the illiteracy-literacy spectrum and that is why I hammer them severely at international conferences. I don’t care whether you are the President of what ever or a country or a Minister...these are things you need to know and not talk blindly about who is literate. As far as I am concerned Kenya did a very good survey and of 35 million people ...only 29.6% adults can read at the desired mastery of literacy skills and competencies. Now I’m telling you as the global expert in the functionality of literacy through worldview transformation...the rest of East Africa is not any better.
The GF has CCMs in a lot of countries and we are eternally grateful to those that have done their job conscientiously and well and have not been involved in "C". There are some CCMs however, that have left the impression of being good bureaucrats, very mechanical interms of operationalization and short sighted. They lack vision and needed to do a proper country development report through a good needs assessment in order to get their priorities straight. I am wondering now who has been advising the GF? Who has been doing the needs assessment for the GF? All of them need to be scrutinized.
The people the GF serves are mostly in the Illiteracy spectrum. The CCMs should have recommended from the beginning that functional literacy is a pre-requisite for effective service utilization and functioning to be able to meaningfully participate in social, economic and political processes. This will liberate and transform their lives so they will have good patient outcomes when the GF delivers services and also know at what levelof the foodchain "C" is occurring. This should have been instituted by the government in a contractual agreement in collaboration with donors/IGOs and others. These policy recommendations should have been made to the GF to coordinate with UNESCO and others on health literacy.
The respective government's fiduciary responsibility is to provide basic functional literacy ...not just basic literacy. There is a huge difference between the two.
(1) Bacchus (2001, modified 2003) defines adult literacy as the acquisition of skills to learn the written and spoken form of one’s mother tongue and/or national/official (colonial) language, and the attainment and demonstration of a measure of proficiency in communicating and integrating language and numeracy skills into the home, village, town, or formal setting thereby expanding one’s worldview.
(2) Bacchus (2001, modified 2003) defines illiteracy as an individual’s inability to acquire the written form of one’s mother tongue and/or written and spoken form of the national/official (colonial) language, and is subsequently incapable of manipulating the modern world.
(3) Bacchus (2001, modified 2003) defines literacy becoming functional as the dynamic interplay between traditional/indigenous and secondary knowledge systems that produces cultural learning and a new knowledge system thereby creating a synergistic effect resulting in an emerging socio-cultural transformation.
(4) Bacchus (2001, modified 2003) defines functional illiteracy as a demonstrable lack of the individual’s attainment in the acquisition of the written form of one’s mother tongue and/or written and/or spoken form of the national/official (colonial) language, thereby lacking the ability to translate education into practical information that transforms his/her worldview, attitudes, behaviors, and practices.
(5) Bacchus (2003) defines orality as a means of communication, dissemination, and inculcation of a people’s history, knowledge, and cultural content which is passed on from one generation to another without this being reduced to writing.
Let me teach you guys some basics. The acquisition of literacy is the acquisition of foreign content and a new culture. Around the world in developing and underdeveloped countries, mostly literacy is provided. In general, neo-literates are not taught and mentored to function within the new literate culture, (the new language, the new way of life) because it is taken for granted that it is an automatic process. The way learners learn is by adding their own meaning, interpretation, understanding and idiosyncrasies to the subject matter (new construct). This is step 1. Neo-literates need to learn to apply the newly acquired constructs in their day-to-day activities for it to become knowledge. They cannot successfully apply and integrate new constructs for them to become knowledge unless their worldview is in transition. With other words literacy is becoming functional as the worldview is going through transformation processes. This process can take from between 2-5 years if my methodology is followed and also depending on the learner's level of interst, intensity of coursework, community involvement and interest that will support the mother and if their mother tongue is reduced in writing.
Now, Asima and I hope Asish is paying attention, if you follow Daswani's writings (and he is correct) it takes a generation or more to transform the worldview. (Daswani, C. (1994). Literacy and Development in Southeast Asia. In Verhoeven L. (ed). Functional Literacy: Theoretical Issues and Educational Implications. John Benjamins Publishing Company, Amsterdam, Philadelphia).
There is currently no programme in the world that utilizes the worldview transformation paradigm and has this built in into all its models and modules. It must have a flexible base which is culturally adaptable.
The Freirian philosophy is a very slow process and is used in the Reflect Model, but it falls short in terms of taking neo-literates to higher functional literacy levels which are required to achieve and master health literacy (this deals with cause and effect issues).
If the GF wants to spend it dollars, pounds and Euro's it most do things cost efficiently(utilization management) and should not fear to be held accountable how it spends its monies. The CCM is not exempt of this either because they are key decision-makers regarding the priorities the country has to focus on. CCMs you not God, Judge and Jury. You are dealing with real people not inanimate objects. You are there to serve the interest of the poor, faceless, nameless and disenfranchized people not your own interest, you clan or political party. No nepotism or favoritism either.
If you people keep putting bandages and bandaids on things you are just playing with people's lives. This is a matter of life and death. The matters we are dealing with are really mostly preventable health conditions, that due to ignorance and being in the illiteracy spectrum, people have become infected with Malaria, HIV/AIDS, TB and other STDs and don’t know they could've prevented this by taking appropriate measures. As I explained in earlier correspondence, traditional people's worldview doesn’t incorporate concepts of preventative healthcare. Hence, once someone is infected, depending on what stage we find our patients with TB and Malaria it may be cause for very serious pathology or worst yet mortality. The latter of course increases the cost of treatment. But once infected with HIV/AIDS there is no turning back...this infection can't be reversed and it is most costly to treat. The Health, Social and Economic impact are severe.
I need all of you to listen up and know that you should very seriously rethink your strategy and learn from the huge mistakes that have been made. Governments aren’t taking a conscientious and active role to transform the lives of the citizenry. To keep them dumb is to their advantage so that they can continue ruling and no one will oppose them, question their actions or take drastic action to remove them out of office.
You have a social, moral and ethical responsibility and obligation to set your priorities right and how you will engage governments to take their fiduciary responsibility very seriously and hold them fully accountable. ...I'm afraid that millions and millions of people paid the price with their lives for our bad social policies. Africa's perceived democracies are among a number of monstrous "failed states". Hence, we need to get our house in order in terms of overhauling key mechanism that will have to take on a critical role when the government is miserable failing and we will be seeing more failed states slipping in rankings. The hand writing is on the wall and I did receive the Foreign Policy Bulletins this week. This is public information. Governments call for “democratic elections” and when or before they loose they announce that they aren’t stepping down for anyone. When we talk about "failed states in Africa" Prof Moghalu can confirm the situation in Nigeria, Uganda, Gabon, Kenya, Sudan, Burundi, DR Congo, Zimbabwe, Somalia...just to name a few. A few countries have improved in ranking, but many have slipped in the abyss. The new role of the GF and CCMs in helping ordinary citizens managing their lives will be going through the most critical test of your life and the legacy you have to leave behind for many generations to come. For that reason we need a new breed of CCMs who is highly versatile, knowledgeable and able to lead when the government fails.
In closing, don't be fooled by the high literacy rates in Southern Africa...it doesn’t imply all those people are all functionally literate either. Prof Kader Asmal (former Min of Education in RSA) asked me why do educated people become infected by the HIV virus? There are many answers for this I gave him a number of answers and also said: You can be educated, but that doesn’t imply that your worldview is transformed or you know how to apply your education to protect yourself. For example, there are African women that come from countries where Pharonic circumcision is 99% mandatory. When some of them come to the West and get a PhD and return to their homestead they continue the same practice. Even highly educated women living in the West for many so long, educated here with good jobs, take their girls home to be circumcised in an African country. Look at Sierra Leone...during the war, the President's wife rounded up 600 girls and circumcised all in the name of Bundu society.
I hope you all are listening because this is no child’s play for me to write a letter for 6 hours when my fingers are all injured and hurting me. We need a drastic shift in paradigm. CCMs we need to see more innovation and creativity with limited funds, less talking and more working, less spending on planning meetings that don't give us any better outcomes. You can have e-meetings and don't waste sparse resources. Meetings and meetings that are poorly time managed and coordinate haven't improved the patient outcomes and neither your performance. We need more meetings in rural communities especially where the problems we are seeking to address are of high prevalence. We need all this to be implemented through a new breed of versatile, highly knowlegable CCMs that are mandatory representative of a cross section of the communities being served. We need more thinkers and doers. We also need healthcare riskmanagement models that address multiple serious health conditions that can be treated effectively with small changes in the cost factors in terms but will have a much stronger impact in terms of prevention. It will provide value added benefits to the participants and the entire program for better patient outcomes. Those models are already designed by me.
Please people explain your abbreviations for those that don't understand the process and would like to participate. Jane I am kindly asking you to explain the abbreviations also. Not everyone is up to our speed and we need to be inclusive.
Fenna E. Bacchus