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Where others see catastrophe, Bill Bicknell sees hope. Take, for example, his work in Lesotho, a small, poor, landlocked country in southern Africa where more than a third of the adult population is infected with HIV.
In 2003, Bicknell, a professor of international health in the School of Public Health, came up with a revolutionary idea for Lesotho, one of the forty-some countries he's worked in over the years. While many were working to contain the HIV/AIDS epidemic, Bicknell wanted to look beyond, "toward the time when AIDS and the epidemic wanes," he says. "Will Lesotho then be a basket case, or will it have the critical elements, especially the human resources-electricians, policemen, teachers, nurses-so it's poised for continuing socioeconomic development?" The solution is "to take a long-term strategic perspective. What will work? What makes long-term sense and meets immediate needs? And when systems are put in place, with some outside support initially, can they really be supported and sustained?"
He told the head of the Dreyfus Health Foundation his hopes and quickly received funding, $172,000 for three years, to implement a program called Problem Solving for Better Health. Instead of buying into the idea that solutions have to come from the outside-be it central government, donor agencies, or experts-Problem Solving for Better Health seeks to show that people with problems have the capacity to solve them; they just need encouragement and a framework to do so. In this case, it means getting local people together to try to make health care work better, the first step in the process of getting systems in place for Lesotho to survive.
"We wanted to get people at every level, from senior government officials down to village chiefs, working on an AIDS-related problem that's in their day-to-day life, whether it's personal or professional," Bicknell says. "We've run five of these Problem Solving for Better Health workshops so far, trained well over 250 people. We tell people in advance to come with a problem they think they can solve. They always come with too big a problem, one that requires government to change, etc. We narrow it down and say, 'what is the real problem?' "
Bicknell cites an example of how the workshop helped identify the real problem and worked toward a solution. A nursing assistant in charge of tuberculosis control at a small hospital reported that ever since the ministry changed its drug supply system, they weren't getting their tuberculosis drugs. A woman at another hospital said they had no problem getting the TB drugs. "Why was it working at one and not the other?" Bicknell says. "It turned out that the problem was the pharmacist sent in the order without talking to the nursing assistant who's running the program, and the nursing assistant didn't talk to the pharmacist." The group helped her make a plan to get the right information to the pharmacist, "and she left ecstatic." And sure enough, when the participants reported in six months later, the woman "said she solved the problem. Now, that's not a national problem, but in fact, the TB program wasn't working because of it."
These aren't, as Bicknell agrees, earth-shattering changes-and that's the point. They're incremental, with a better chance of longer-lasting results because of that. They can also cross many sectors of life. When Bicknell met with the Lesotho deputy prime minister, he was told that a priority amid the epidemic is to keep teachers alive; without them, the future is indeed bleak for post-epidemic Lesotho. So an HIV/AIDS clinic was started at the local College of Education, and its teachers and students were invited to Problem Solving for Better Health workshops. "They were very enthused by it," Bicknell says, and now the program is set for expansion. "They will use it internally for improving curriculum, and when they graduate, the students will hopefully teach problem solving in primary and secondary schools," he says. "It looks like the original Dreyfus contribution will result in institutionalizing a mechanism that will introduce a culture of problem-solving throughout the educational system and other sectors as well. It's a success story."
The work funded by Dreyfus is part of a larger effort that Bicknell is heading-a partnership between Boston University and Lesotho that began in 2003, somewhat akin to the partnership between BU and the city of Chelsea, Massachusetts, to run that city's school system, though on a smaller scale.
Still, Bicknell says, "it's quite possible that our single biggest contribution will be the introduction of effective problem-solving at the level of the individual in Lesotho."
—Taylor McNeil |
