In this article, Sumaiyah Moolla interviews Dr Nicolas Lemay-Hébert, senior lecturer, International Development Department, University of Birmingham. Articles in the Impact: Global Poverty Series have thus far focused on researchers seeking to have a more direct impact on aspects of poverty alleviation policy or practice. This article focuses on teaching as well as research contributions by a group of Canadian academics working with teachers and students in Haiti. Read more of our Impact Interviews.

In 2010 Haiti was devastated by an earthquake of epic proportions. More than 300,000 people lost their lives, countless more were injured and an estimated 1.5 million were left homeless, their communities reduced to rubble. Haiti’s plight was witnessed on a global scale, as shocking images of human suffering and destruction were disseminated in the world’s media.

The impact of the earthquake on the country’s education system was devastating. Many universities were severely damaged or destroyed, including the newly christened campus of Quisqueya University. There, researchers from Quebec had been supporting the development of an urban studies programme through the Precarious Neighbourhoods and Sustainable Urban Development in Haiti project. ASAP spoke to programme participant Nicolas Lemay-Hébert about his ongoing work in Haiti and the struggles that Haitian academics and their students face as recovery continues.

What motivated you and your colleagues to go to Haiti?: The Precarious Neighbourhoods and Sustainable Urban Development in Haiti project is led by three senior researchers from the University of Quebec at Montreal (UQAM): Jean Goulet, Paul Bodson (both urban studies) and Paul-Martel Roy (economics). They have a longstanding history of collaboration with Haitian institutions, stretching well before the earthquake. The project started in 2007, and I joined in 2010 in my capacity as adjunct professor of economics at UQAM. They were looking for an additional colleague to supervise graduate students in Haiti and to teach specific seminars on post-disaster reconstruction and humanitarian action. As a scholar interested in humanitarian affairs, peacebuilding and statebuilding, and with increased interest in these themes among Haitian students, they asked me to join their team. I also think they approached me because of my flexibility as a (still fairly) young researcher; there are not a lot of lecturers who are ready to spend their Spring breaks teaching under a tent in Haiti! Personally, it provided me with the opportunity to see Haiti for the first time, and to extend my expertise from Kosovo and Timor-Leste to the newest focal point of the ‘aid caravan’. This research interest further developed into a passion for me, as I have now visited Haiti seven times since the earthquake.

What was the original aim of the project? The initial goal of the project was to support local institutions with the aim of strengthening networks of local organisations and enabling them to intervene effectively and competently in poor neighbourhoods in Haiti. Training and support structures offered under this project have been designed and implemented in partnership with local actors, in particular, the Research and Technological Exchange Group (GRET) in Haiti, a French non-governmental organisation (NGO), which is active in poor neighbourhoods.

Images of the aftermath of the earthquake that struck Haiti on January 12 2010 have been all over the media, revealing the vastness of the destruction in several cities, particularly Port-au-Prince [Haiti’s capital city], but also the precarious conditions in which the majority of the urban population live. Yet, these same images also revealed another reality: they showed mechanisms of local solidarity, which are crucial to understanding these precarious neighbourhoods. Faced with a growing structural shortage of available housing, as well as the absence of coherent government urban management policies, these populations have provided themselves with housing and urban services which they deemed essential to their own specific community. The aim of the project was certainly not to teach Haitians ‘what to do’, but rather to help them build from existing resources and support them in the process of setting up a department of urban studies at Quisqueya University (UNIQ). Obviously, the earthquake – and the death toll associated with it, for students as well as for faculty members – increased the need for supervision and teaching on our behalf. Sadly, the university had inaugurated its new campus a few weeks before the earthquake; it was completely destroyed by the earthquake, killing many students and teachers.

How did the partnership between UQAM and UNIQ come about? The partnership between the two universities officially started in 1997, but there is a longstanding history of collaboration and exchange between Haitian and Quebecian universities. It is mostly due to the special relationship that the Quebecois have entertained with the Haitians since the 1970s. Montreal is home to one of the biggest Haitian Diaspora communities, and we have many well-established scholars, artists and civil servants of Haitian decent (including the 70,000 Haitians living in Montreal – almost two per cent of the city’s population). Hence, I presume that the partnership between the two specific universities made sense from the start – especially if we take into account the linguistic affinities between the two countries. This project was enabled by a grant from the Canadian International Development Agency, under the University Partnerships in Cooperation and Development programme (www.acdi-cida.gc.ca).

Describe the scene when you first arrived in Haiti. This likely betrays my western culture bias, but I immediately thought of the images of the bombing of Dresden during the Second World War. It was probably the sight of the Port-au-Prince cathedral, with only its lower walls and its façade standing after the earthquake, which made me think of the images of Dresden Cathedral after Allied bombing. In any case, the cathedral was clearly a landmark in the city, and images of its destruction came to represent the extent of destruction caused by the earthquake (on par with the National Palace, home to the president) for news agencies. It is also quite telling that the design for the new cathedral, to be rebuilt in the same spot as its predecessor, will integrate the façade of the collapsed building – an important marker both on the road of reconstruction and of the necessity to remember the traumatic experience and the deceased.

I also realised the extent of the destruction by accompanying my colleagues on their visits to various precarious neighbourhoods. With the overpopulation of Port-au-Prince and its vicinity, the poorest segments of the population were progressively forced out of Port-au-Prince’s nicest areas to the coast, the slopes, the ravines and the central areas, a product of the deterioration of older neighbourhoods. As Solidarités Internationales notes, it is not only 30 to 40 per cent of the urban population that live in these precarious neighbourhoods (as in most Latin American capitals); in fact, the vast majority of Port-au-Prince citizens live in a self-constructed, self-organised district.[i] It is important to understand that these neighbourhoods respond to a specific way of spatial organisation, articulated around mechanisms of local solidarity and needs arisen from the informal economy. At the same time, this spatial organisation exposes the population to environmental risks, especially in the slopes and ravines area. In one such area (Canapé Vert), I saw a lorry literally dropping bricks from the top of a hill down into the valley. It was also disheartening to see inhabitants pulling buckets of rubble to the top of a hill – one bucket at a time. The topography of these areas makes them almost impossible to access by car – let alone by truck – which makes rubble removal a very difficult operation.

If the earthquake killed more than 300,000 (many Haitians buried their relatives privately without notifying the government, which makes official estimation a tricky business), signs of the human catastrophe were not immediately visible on my first trip, six months after the earthquake. Port-au-Prince was a gigantic pile of rubble (the equivalent of 10 World Trade Centre sites), but you become de-sensitised to the sight of collapsed buildings after a while. Also, people with mental or physical disabilities suffer widely from stigmatisation and marginalisation in Haiti, which results in them being kept out of sight in the central areas of Port-au-Prince; consequently, the most blatant signs of the earthquake’s human toll had been removed in the first few months. However, I still remember vividly the first conversation I had with my colleagues at UNIQ and the State University of Haiti, describing their own ordeal during and after the goudougoudou (Creole for earthquake). I also remember seeing little things that reminded me of the sheer human cost of the earthquake: drafts of documents scattered where the United Nations headquarters once stood, a testimony to the suddenness of the event; people digging in the rubble to find the bodies of loved ones; babies’ shoes lost in the middle of piles of debris – a reminder that the earthquake had spared no one.

It is thought that a large proportion of Haitian higher education institutions were damaged or destroyed in the earthquake. What are conditions like for Haitian students? It is difficult to say, since my personal experience derives from my involvement with one specific university – moreover, a private university. However, one thing appears clear to me (and my colleagues in Haiti): universities in Haiti suffer from a structural phenomenon where the best elements (students and faculties) are hired by foreign universities and institutions (external brain drain) or by international non-governmental institutions (internal brain drain), weakening governmental agencies in the process. While this is a situation that may appear advantageous at first sight, especially for students (who is not looking frantically for placement opportunities for their students in these tough economic times?), recruitment conditions are not always optimal, and most students discover that their degrees are not recognised abroad and subsequently have to retrain. This is especially true for healthcare and engineering graduates. It is difficult for us to make any judgement, as we obviously don’t have any legitimacy in commenting on this process. I have lived, studied or worked in Canada, France, the United States and now the United Kingdom, so who am I to judge the personal choice of many colleagues in Haiti, leaving their home country for better working conditions – a choice I have myself made multiple times? One thing appears clear though: if the personal choice and motivations behind each decision to leave the country cannot be disputed, it compounds to a collective disaster for Haitian universities and institutions. Hence, the situation of the higher education institutions cannot be understood by looking only at the institutional destruction of the earthquake; one has to look at the structural factors which have marginalised and weakened higher education institutions in the past decades. At the same time, it is not a situation that is specific to higher education institutions; it has to be understood within the wider story of the progressive weakening of Haitian state institutions. There is an inherent tension between the conscious policies of many western governments at attracting the most promising segments of the Haitian society in their ‘chosen immigration’ schemes and their pledge to support local ownership and strengthen national capabilities in Haiti. However, it\’s not all gloom and doom, as there are positive signals emerging from recent developments, including the inauguration of the Roi Henri Christophe Centre for Higher Education in Limonade (northern Haiti), or the continued excellence of scholars associated with UNIQ and Haiti’s State University resisting the siren song of expatriation.

What response have you had from your Haitian students? What knowledge or skills do they most want to learn? They are so eager to learn and make a difference, it is just amazing. When you see the conditions in which they are forced to write their essays – relying almost exclusively on excerpts of books available on Google Scholar (rarely full chapters, which in turn forces the students to show imagination in completing the author’s arguments) or the grey literature available online – you can only be amazed by how resourceful they are. I have taught two intensive seminars as part of the project: an advanced seminar on qualitative methods entitled “Local-International Interactions in the Reconstruction Process of Precarious Districts” and one on “Emergency, Reconstruction and Rubble Removing”. The students were particularly eager to learn how to conduct interviews and write articles or reports. I thought it was important to make them understand the ‘rules of the game’, to make them aware of what was considered an ‘authorised discourse’ and, in the process, break the cycle of reproduction of certain discourses (‘Haitians cannot take care of themselves’ type of narrative). As an assistant editor of the Journal of Intervention and Statebuilding, I deal with the rejection of articles and the reproduction of a certain knowledge on a daily basis. My students have also shown a marked interest in past experiences in Kosovo, Timor-Leste, Iran (Bam) or Indonesia (following the tsunami). I guess it helped them put the Haitian situation into perspective.

How do your Haitian students apply the knowledge that’s passed on? Most of them work full time during the day and attend university in the evening, so they have an opportunity to apply their knowledge right away. They are also in high demand by the aid community, looking for locals to contribute to the reconstruction efforts. I am also currently working on the publication of three outstanding essays written by Haitian students, which hopefully will send a signal to the other students that it is possible to publish and make your ideas well known outside of Haiti.

Do you think that providing assistance via knowledge transfer is as effective as offering practical help in the field? It’s not an either-or situation. Practical help was clearly needed in the aftermath of the earthquake, especially in the first few months. However, there was indisputably a tension between reconstruction efforts conducted ‘from the outside-in’ and strengthening local capacities and local actors. The tension is not as much actor-driven per se (as any international NGO will employ locals, for instance) as it is a by-product of a specific mindset – the ‘we do it ourselves’ mentality that plays such a crucial role in humanitarian action. As former Haitian Minister of Heath Daniel Henrys once said, “Haiti has lived in a state of urgency for the past two decades”. So, I would argue that knowledge transfer and strengthening of local capabilities is – and should be – a crucial element for every international intervention. Quite honestly, I think it is an opinion that has become quite consensual in policy circles and in the specialised literature, despite the fact that there is actually no consensus on how to implement a significant modification of current mindsets. Hence, we end up following the same patterns of intervention, while labelling these patterns differently.

Haiti is considered one of the poorest countries in the western hemisphere – how can knowledge transfer and improving research methods facilitate in alleviating poverty? Certain scholars (Jeffrey Sachs, among others) are preaching for the establishment of a Marshall Plan for Haiti – mirroring the postwar reconstruction effort of Western Europe through American funding (and lending). The Marshall Plan represented two per cent of French gross domestic product (GDP) over a period of three years. Yet, Haiti received an average of eight per cent of its annual GDP in aid in recent years, representing nothing less than four Marshall Plans per year.[ii] There needs to be significant change in how aid is disbursed in Haiti, and how local actors are included (or not). There is certainly a need for ‘alternative’ development schemes, focusing on local capabilities and knowledge transfer. There is a need to address the root causes of the fragility of the state in Haiti – and like it or not, that also means conducting an analysis of the role played by international actors in the marginalisation process of state institutions. I don’t believe that international factors are the unique cause of the stalled economic development in Haiti, yet I question the seriousness of any analysis leaving international factors unexamined.

What academic capabilities are in need in Haiti? Without romanticising the local, so to speak, I find the Haitian production of articles and books is outstanding. Most of my Haitian colleagues are both innovative and highly productive. Most of them are already well integrated in the knowledge production fields, especially through French connections, so I feel slightly uncomfortable with the assertion that we should strengthen their academic capability in one way or another. However, other social scientists are operating under the radar, mostly because they are producing research using alternative frameworks. Personally, I think that what is lacking is a better integration of these alternative frameworks into the global field of knowledge production. This is mostly a joint responsibility – meaning that it is our responsibility in western institutions to open our minds to unconventional analyses and research, and it is the responsibility of researchers to submit articles and books using the accepted format and following the ‘rules of the game’. In these difficult economic times, and with the current crisis of neoliberal capitalism, I believe it is more relevant than ever to look for alternative conceptions of social integration, new frameworks and new ways to approach intervention.

How can academics and researchers who do not specialise in disaster recovery/management get involved (either in Haiti or in other disaster-struck areas)? It is a common misconception to believe that development is only for development specialists (ie, social scientists). While there is a continuous need for locally-sensitive, energetic and hard-working aid workers (I am based in an international development department, after all), international and local organisations are also looking for engineers (especially agricultural engineers), urban planners and physicians (eg, Doctors Without Borders). So, I would suggest to anyone interested in an experience overseas to look at the websites of the major aid organisations.

What can teachers and researchers learn from teaching abroad? Would you encourage others to join projects overseas? I would certainly encourage colleagues to teach overseas, even for small stints. It is a fabulous way to reflect on your own research, among other things. I know it sounds clichéd, but I have learned a lot from my students, discussing how they see the future of their country, how they are dealing with the everyday, with their international colleagues and so on. It is also a great opportunity for social scientists to develop new research projects, extending their stay for seven to 10 days to conduct a first round of interviews, for instance. This can considerably strengthen a research proposal. The most difficult aspect is probably being away from your loved ones for a while – but here again, most organisations understand these particular constraints and suggest intensive seminars over two weeks to limit the negative impact on your family and work.

What inspires you to keep returning to Haiti? Several factors: first, I have to mention the resilience of the Haitian people, their ability to focus on positive aspects and to keep their morale up, even in difficult times. Working on and in Haiti might sound depressing; actually it is far from it. People are continuously smiling and welcome you with open hearts, and you rarely feel in danger in Port-au-Prince. Second, there is the Haitian culture, including visual arts, music and theatre. Haiti might be poor in global economic terms, but culturally speaking, it is a tremendously rich nation. Third, I also have to be honest and say that for someone interested in local narratives of resistance to international interventions and the political economy of aid and peacebuilding, Haiti is a particularly stimulating environment. Finally, I am inspired by local success stories, made of local initiatives (and sometimes empowered by visionary international actors) and anchored in local communities. I have participated in a short documentary on one such initiative (available online at: http://vimeo.com/18668506). For me, it means that there is no determinism in the current debate over the limits of aid in Haiti and elsewhere, and alternatives routes to sustainable development exist.

Some overseas opportunities for academics are detailed at the following websites:

UK Department for International Development

United Nations Development Programme

The European Commission Community Research and Development Information Service

European Commission EURAXESS

European University Institute Academic Careers Observatory

[i] Simon Deprez and Éléonore Labattut, La Reconstruction de Port-au-Prince: Analyses et Réflexions sur les Stratégies d’Interventions en Milieu Urbain, Report for Solidarités Internationales, October 1 2011, Available online at: http://reliefweb.int/sites/reliefweb.int/files/resources/mission-d\’appui-retour-quartier-rapport-final-deprez-labattut-version-finale-doubles-pages-light-30-12-11.pdf

[ii] Nicolas Lemay-Hébert and Stéphane Pallage, “Aide Internationale et Développement en Haïti: Bilan et Perspective”, Haïti Perspectives 1(1), 2012, p 14.

Articles in the Impact: Global Poverty Series have thus far focused on researchers seeking to have a more direct impact on aspects of poverty alleviation policy or practice. This article focuses on teaching as well as research contributions by a group of Canadian academics working with teachers and students in Haiti. In 2010 Haiti was devastated by an earthquake of epic proportions. More than 300,000 people lost their lives, countless more were injured and an estimated 1.5 million

As a young boy, Sukhadeo Thorat felt humiliation when an upper caste child slapped his face for inadvertently touching the communal well. As a teen-ager, he felt anger when he and other local dalits (former untouchables) were slurred or socially shunned at gatherings, and excluded from religious temples. As one of India’s leading economists and public intellectuals, Thorat has felt compelled to put caste discrimination on the mainstream research agenda, as well as to seek to influence policy and social movements with hard evidence about the ways in which tens of millions of persons remain ‘blocked by caste.’

The caste system (and its reflection, untouchability), with thousands of subcastes, is like so many stinking ponds which have polluted life for all those who came in contact with them. What we want is a flowing river with fresh and pure water.
(Sukhadeo Thorat, “Passage to Adulthood: Perceptions from Below\”)

As a young boy, Sukhadeo Thorat felt humiliation when an upper caste child slapped his face for inadvertently touching the communal well. As a teenager, he felt anger when he and other local dalits (former untouchables) were slurred or socially shunned at gatherings, and excluded from religious temples.

As one of India’s leading economists and public intellectuals, Thorat has felt compelled to put caste discrimination on the mainstream research agenda, as well as to seek to influence policy and social movements with hard evidence about the ways in which tens of millions of persons remain ‘blocked by caste.’**

Thorat was reared in humble circumstances as a member of the Mahar dalit group in Maharashtra state, northeast of Bombay (Mumbai). By long tradition, Mahars and other dalits in villages across India have been forbidden from living alongside upper-caste residents, and from holding any but low-status, or dirty jobs. In his autobiographical essay, “Passage to Adulthood”* Thorat describes the daily indignities to which Mahars were subjected in his home village. He also tells of a social awakening for himself and others, beginning in the 1950s, under the inspirational leadership of B.R. Ambedkar, the architect of India’s constitution and himself a Mahar.

After struggling to acquire a primary and secondary education in various Christian missionary and other schools that would accept dalit pupils, Thorat enrolled in Ambedkar’s Milind College of Arts in Aurangabad, Maharashtra. There, he joined a student body composed almost exclusively of dalits. He deepened his study of Ambedkar’s writings and Buddhism – a religion to which many lower-caste Hindus converted at Ambedkar’s urging – and assumed leadership roles among dalit student activists. He also became determined to pursue further study on caste discrimination.

In a recent interview at his home on the expansive south Delhi campus of Jawaharlal Nehru University (JNU), Thorat recalled the difficulties he faced in actually bringing his student activism, and his personal understandings of exclusion, to bear in his economic research, beginning in the 1970s. His initially proposed PhD thesis topic, on untouchability and occupational linkages, was declared by JNU’s Economics Department as too far outside the mainstream to be acceptable, he recalled.

He was later accepted for doctoral studies at JNU’s Centre for the Study of Regional Development, but only to study a more traditional topic in agricultural economics. “I joined that center, but I was not able to do research on issues that I wanted to work on. … So, I lost 10 years.”

It was not until he served as a visiting faculty member at Iowa State University from 1989-91 that Thorat had the opportunity to pursue theoretical and empirical studies on economic discrimination, which shaped his research on economic of caste and the problems of excluded communities in India. There, he had access to North American literature on economic discrimination, in particular that directed against African-Americans, as well as some studies of caste discrimination by non-Indian authors. From those sources, and his own intensive study of Ambedkar’s writings and related material, he began developing an approach to market economics that could take appropriate account of caste discrimination.

Ongoing efforts have involved developing concept of caste and untouchability based economic discrimination through market and non market exchange, and its consequences on unequal opportunity and the poverty of the dalits. He also has strived to persuade other economists, as well as grant-funding bodies, that caste discrimination affects economic outcomes in significant ways. In a study on market discrimination in rural area sponsored by the International Labour Organisation, for example, Thorat provided evidence of discrimination faced by dalits in the sale of milk, vegetables, fruit and other farm goods.

In developing and refining measures of untouchability, Thorat and colleagues have conducted similarly fine-grained field research, measuring exclusionary patterns in village schools, primary health centers, shops and in daily activities. A study sponsored by Thorat’s Indian Institute for Dalit Studies revealed that “Private doctors, for example, often avoid visiting or entering the houses of the untouchables. And often the health service providers avoid touching the untouchable child. They ask the untouchable mother to hold the child and do the treatment from the side.”

As Thorat’s work on caste and economic discrimination deepened and became more influential in academic circles, so was he able to exercise some influence over policy. He was instrumental in persuading the Indian government to recognize that the privatization which accompanied the country’s greater economic openness in the 1990s could be a blow to lower-caste persons who had climbed some rungs on the employment ladder through policies of affirmative action. Because such policies were focused on public jobs, the privatization of public enterprises could mean huge employment losses for dalits.

Thorat and colleagues organized workshops on the issue, gave testimony and met with high-level officials. Thorat himself shared his concerns with then-Finance Minister (now Prime Minister) Manmohan Singh.

He also was instrumental in helping to develop affirmative action policy in India’s private sector. “The private sector says ‘we don’t discriminate, we go merit and efficiency.’ Through proper research, we provided the evidence of discrimination in hiring.”

A series of studies followed, including ones which involved sending job applications to private employers that were identical except for different applicant names. Some surnames were associated with Hindu upper castes, some with dalits, and some with Muslims. The dalit and Muslim candidates were invited to interview at far lower rates.**

Ultimately, research, testimony and opinion pieces by Thorat and collaborators was crucial to the development of government-backed, incentive-based affirmative action program for private firms, as well as caste-sensitive policies on government procurement. Thorat noted both as important steps forward, but he also said that recent reviews have found private-firm compliance with affirmative action policies uneven, and that more pressure likely will have to be brought to bear.

Besides impact on government policy, Thorat has made significant contributions to broadening the study of societal exclusion and supporting civil society groups with research. In the early 2000s, he took leave from his duties as a JNU faculty member to develop the Indian Institute for Dalit Studies in Delhi, along with dalit NGO leaders from the National Campaign on Dalit Human Rights (NCDHR). Backed by a grant from the Ford Foundation, initial efforts were focused on providing a research base for the campaign, which sought formal United Nations recognition of caste discrimination as a human rights violation. The NCDHR continues to call attention to caste-based exclusion across India.

Thorat remains integrally involved with the Dalit Studies institute as its Managing Trustee, conducting and facilitating numerous major research projects with Institute members.

Further, as chairman of India’s main higher-education funding body, the University Grants Commission, from 2006-11, Thorat oversaw the creation of 32 Centres for the Study of Social Exclusion and Inclusive Policy at universities around India. “I could see that there was a huge interest now around these subjects, and a group of scholars who wanted to do work but could not find space to do it. Now many of these researchers have opportunities to undertake research on issue related to exclusion and problems of discriminated communities” he said.

Thorat appreciates now how much progress has been made in bringing caste into the mainstream of academic research in economics, which in turn has provided a knowledge base from which important policy concerns can be raised.

“There was nothing by way of economic data much when I started in the early 1990’s,” he said. “The data organizations used to publish only few isolated report on dalits and adivasi [tribal groups] … There were many issues that we were not able to address. So we had to really provide an empirical base.”

—

Sukhadeo Thorat has written more than 70 articles and written or edited 19 books on social exclusion and dalit and other excluded groups, with Oxford University Press, Sage and other international publishers.

*Sukhadeo Thorat. 1979. “Passage to Adulthood: Perceptions from Below,” in Sudhir Kakar, ed., Identity and Adulthood (Delhi: Oxford University Press), 65-81.

**Sukhadeo Thorat and Paul Attewell. 2010. “The Legacy of Social Exclusion: A Correspondence Study of Job Discrimination in India’s Urban Private Sector,” in Sukhadeo Thorat and Katherine S. Newman, eds., Blocked By Caste: Economic Discrimination in Modern India (Delhi: Oxford University Press), 35-51.

In this article, Sumaiyah Moolla interviews Professor Alan Fenwick of Imperial College London about his work leading the Schistosomiasis Control Initiative, which delivers cures to diseases afflicting a huge proportion of the severely poor globally. Read more of our Impact Interviews.

Malaria, tuberculosis, HIV/AIDS – all are highly ‘visible’ diseases, well-known on a global scale. Lesser known are a set of parasitic and bacterial infections, referred to collectively as neglected tropical diseases (NTDs), which afflict over one billion persons worldwide.

NTDs are found almost exclusively in the poorest and most deprived regions of the world, where residents face unsafe water, poor sanitation and limited access to basic healthcare. The afflictions form part of a vicious cycle, in which ill health resulting from NTDs helps to anchor millions of people in long-term destitution. Some 500 million people – two-thirds of Africa’s total population – suffer from two or more NTDs and require regular treatment.

The Schistosomiasis Control Initiative (SCI) works with ministries of health in numerous countries to develop, fund and implement in-country control programmes. It aims to manage and eventually eliminate the seven most prevalent NTDs from sub-Saharan Africa, including schistosomiasis (bilharzia), river blindness, roundworm and hookworm infection, and elephantiasis.

Since its inception, the initiative has successfully treated scores of millions of patients in Africa, often dramatically reducing the proportion of those afflicted by NTDs. In Uganda, for example, fewer than three percent of school-age children now suffer from schistosomiasis, compared to more than 26 percent before SCI’s campaign there. We spoke to SCI Director Professor Alan Fenwick about the origins of this tremendously effective impact effort, and the challenges he and his team have overcome and continue to face in reaching those who need treatment.

Q: What motivated you to want to undertake an impact intervention such as this?

A: My motivation was that I had worked in several African countries where I had visited many schools and seen children desperate to learn, and yet I was aware that they all suffered from parasitic infections which hampered their development and affected their health. I also knew that two drugs – praziquantel for schistosomiasis and albendazole for intestinal worms – were available and inexpensive (US 8 cents and US 2 cents respectively in 2002). I therefore wanted to fill the gap – offer as many children as possible access to these drugs and set up ministry of health and education facilities for delivering the drugs on an annual basis. If we could achieve this and monitor the impact, there would be many publications to be written on the results at a never-before-reached scale.

Q: How were you able to launch the initiative?

A: I applied to the Bill and Melinda Gates Foundation in 2001 when I heard about the money available for tropical diseases. I pointed out to the foundation just how many people (200 million) were infected with schistosomiasis (a parasitic disease) and that a drug was available at a reasonable cost. When the foundation agreed to fund the work, I approached Sir Roy Anderson (a leading British expert on epidemiology), who agreed to chair the SCI Board and sponsored me into Imperial College.

Q: What would you say are your most significant successes in the project?

A: The fact that 15 countries now have SCI supported intervention programmes and that we can claim credit for assisting delivery of over 95 million praziquantel treatments and well over 100 million deworming treatments. Most countries now have an NTD master plan which donors have bought into.

Q: What were the most significant challenges you faced in the early days of the project?

A: After receiving funding, the first tasks were to select the countries to benefit from the funding and then to agree memoranda of understanding with the countries’ ministries of health. Then we had to get the ministries to prepare proposals. I convened a technical committee to scrutinise 12 proposals and selected six countries: three in East Africa and three in West Africa. The next challenge was to obtain good quality praziquantel (used to treat infections caused by parasites) at a reasonable price.

Q: What are the most significant current challenges?

A: The current challenges are several and all different. The first is governance: so many African countries seem to have a tendency for civil unrest, which always disrupts health programmes. The second is how to hand over ownership of the programmes to the countries and yet ensure that there is good accountability of donated funds. The third is the expansion into problematic countries, because in order to retain credibility, we have to be reaching out to assist the Democratic Republic of Congo, Nigeria and Ethiopia – all of which present massive challenges.

Q: What do you see as the key to actually making an impact? How do you go about trying to influence policy, and otherwise make it possible for a project such as yours to make a positive difference?

A: We won over and received fantastic support from the World Health Organization. I am passionate in delivering a simple message: 200 million people are suffering from an infection which can be safely and effectively treated for just US 50 cents per person per year. All we need is the drugs and the political will combined with the expertise and logistics to ensure timely delivery.

Q: What would you say to those people – whether they be administrators, academics or others – who say that academics should focus on research, not seek to make direct interventions on specific issues?

A: Mostly they are right, but having an academic institution behind me has helped enormously to give me credibility when approaching governments. Academic research is important, but so is implementation of the results. Research had found the two drugs mentioned above, but no one was delivering them, so we filled the needed gap.

Q: What advice would you offer to an academic who wants to make a more direct contribution?

A: Provided that the project offers something unique, think hard about the mechanism of funding and the home – whether to remain as I did in an academic institution or establish an independent non-governmental organisation; both have advantages and disadvantages.

Q: If you could have done something differently at any point in the project, what would it have been?

A: When I was offered funding from Legatum and Geneva Global, I routed it through the Global Network for Neglected Tropical Diseases, because I felt that the network had something special to offer. The network does offer advocacy now, but that particular funding suffered from too many layers of bureaucracy and I should not have introduced that extra layer, because it proved to be top heavy. I think I lost a bit of management credibility with that decision.

Q: Next steps for SCI?

A: Our project has achieved a lot in terms of saving millions of lives and improving the health of millions more. Now SCI needs to switch from morbidity control to elimination. To achieve this we need to introduce clean water and better hygiene and sanitation in the areas where we offer treatment.

Read more of our Impact Interviews.

Here is the latest in a series of profiles of academic difference makers produced as part of ASAP’s Impact: Global Poverty project. In this article, project Contributing Editor Sumaiyah Moolla interviews Professor Alan Fenwick of Imperial College London about his work leading the Schistosomiasis Control Initiative, which delivers cures to diseases afflicting a huge proportion of the severely poor globally. If you would like to nominate an academic to be profiled in the series, please contact Luis Cabrera at a.l.cabrera@bham.ac.uk