News and notices. Comm Eye Health Vol. 17 No. 49 2004. March 01, 2004

The community is my university – a voice from the grass roots on rural health and development

By Selina Maphorogo and Erika Sutter
Edited by Jennifer Jenkins, Kit Publishers 2003

Many of our readers will know of the pioneering example of community-based trachoma control, the Care Group Project in South Africa, starting in the late 1960s. Dr Erika Sutter, an ophthalmologist working from Elim Hospital, aimed to move the focus of trachoma prevention out of the hospital and into the community. This of course would not have been possible without a strong partnership with the community, facilitated largely by Selina Maphorogo over 28 years of sustained involvement. Within three years of the founding of the Care Groups, the prevalence of active trachoma had decreased by 50%, and some years later the disease had almost disappeared from the area and the Care Groups were concerning themselves with other aspects of health and development. The movement has now grown to approximately 250 groups with about 10,000 people actively involved.

How did all of this come about? The Community is my University provides a rare insight into a community health promoter’s perspective on bridging the gap between biomedical professionals and local communities. The first author, Selina Maphorogo, was the link between the hospital and the community and found herself in the position of ‘translator’ for both sides, not only of language, but of perceptions, capabilities and sensitivities. This gave her a unique insight into what makes community projects succeed or fail, and an opportunity to develop skills in how to motivate and maintain community engagement. At the same time, she was encouraged to go further with her formal education; poverty had forced her to leave school early, and it was not until her contact with the ‘Trachoma Team’, that she was given opportunities for more training, culminating in travel to Manchester and London. Over the two decades, a remarkable partnership between the doctor and the community worker grew, building the trust and confidence which is evident in the co-authoring of this book.

There is, therefore, a personal story to tell as well; this is not a dry text book. Selina Maphorogo begins by charting her personal story: from domestic worker to community health promoter. What follows is a description of how the Care Groups grew from the early beginnings to a more organised structure with a stronger voice. From chapter 4, the book becomes more reflective about what makes Care Groups work (from leadership to project financing) and the importance of building relationships within village structures. In Chapters 6 (The joys and frustrations of being a Care Group Motivator) and 7 (Motivating and Mediating) Selina Maphorogo describes what she has learnt about her role, and then goes on in Chapter 8 to make suggestions based on lessons from experience. We pick up again on the most recent developments of the Groups in the final chapter which describes their response to the AIDS epidemic. Erika Sutter’s postscript provides an analysis of Community Based Health Care within a global setting and discusses policy issues for community participation in health.

The book is written in simple ‘spoken’ English derived from interviews, and is rich in examples and case stories. A number of pages are dedicated to photographs, presenting the story of the Care Groups in vibrant colour. The authors hope that the book will be useful to people working in health or development projects, or training and supervising community workers, helping them to avoid mistakes and move more rapidly towards the goal of establishing truly community-based projects.

The Community is my University is available from Kit Publishers, P.O. Box 95001 1090 HA Amsterdam
ISBN 90 6832 722 4
Price: Euro 22.50 (£15.00)

News and notices in Comm Eye Health Vol. 17 No. 49 2004 –