Making a little go a long way


Icross is not your usual team of development workers. Joe Humphreys finds out what makes it tick

The recent G8 development plan for Africa announced by George W. Bush and Tony Blair was greeted with euphoria by many aid workers but not Dr Mike Meegan.

A veteran of the frontline war against malaria, tuberculosis and Aids in sub-Saharan Africa, Meegan has seen grand plans for the continent come and go.

"We don't have a sustainable health system in Ireland. We know it takes 20 or 30 years to implement any policy here that will bring about change. Yet every couple of years we reinvent the programme for Africa, and we expect instant results.

"Turning Africa into a western economy is not tenable," he said. "It would be nice if it happened but you have to lift it instead into its own economy; that is achievable. To lift people into a simple, sustainable life will not take much if it is put in the hands of the local tribes rather than governments."

A graduate of Terenure College and Trinity College, Dublin, Meegan is field director of Icross (International Community for the Relief of Starvation and Suffering), one of the most unusual, yet many would say, effective aid agencies in Africa. As well as engaging in development work with poor, marginalised communities, the organisation documents and researches the myriad health problems facing Africans, including HIV/Aids which is estimated to claim 6,000 lives each day.

Much of this work is done in collaboration with the Royal College of Surgeons in Ireland (RCSI), whose senior lecturer in biostatistics, Ronan Conroy has become a devoted advocate of Meegan's "low-tech" approach to development.

"Mike came through the door about 12 or 14 years ago, and said he wanted to do a study on plastic bottles of water left out in the sunlight," recalls Dr Conroy. "He said, 'We think by disinfecting the water this way it might help to reduce the rate of diarrhoea in children. Can you tell us how to do the study?'"

The technician travelled to Kenya, where he helped to run three successive trials to prove Meegan's hunch about "solar disinfection" to be true. The results would have come back quicker "if we had used ex-pats to do the study but we didn't," Dr Conroy noted. "We used the Maasai field workers to gather the data. Everything happened in Maasai. The result was that the local community knew what was going on. It was their people who were doing the trial. So when the results came people took them on board and put them into practice. And now it [ solar disinfection] is pretty widespread all over Kenya because it started off among the people itself."

Almost as an afterthought, the results were published in The Lancet, he adds. So what? "The Maasai don't read The Lancet," he says.

"We are designing studies so the people who participate in the research benefit from it."

The trial is a model for numerous other research projects in Kenya and elsewhere. Low-tech, evidence-based, sustainable solutions are the hallmark of Icross's developmental approach.

"You have to build infrastructure without people in four-wheel drives coming in to maintain it," says Meegan, a multilingual epidemiologist who was inspired to move to Kenya in 1979 after seeing the work being done in remote desert communities there by Dr Joe Barnes, a doctor with links to the RCSI.

"You can't do anything until you know the way in which people are getting sick, and the way in which they are dying," Meegan says, citing Aids as a case in point. "The cause of HIV is not so much sexual behaviour as the nature of how the disease is transmitted. The real belts of HIV are where there is squalor, deprivation, and a severe limitation on resources."

Icross and the RCSI have collaborated on more than half a dozen major research projects, and more are in the pipeline.

"There is a perception here that the College of Surgeons specialises in the diseases of the rich and over-insured. We are a valuable antidote to that perception," says Conroy, adding that the RCSI has plans to develop medical education in Africa, including the establishment of sister research institutions.

He is returning to Kenya this week with an undergraduate from the college to assess the results of a pioneering female circumcision harm-reduction programme. The study began after six years' of "oblique negotiations" with the Maasai, which led to them accepting the use of "safer" circumcision methods, involving sterilised equipment. One of the changes involved an alteration to a pre-circumcision ceremony in which the operation knife was anointed with the "blood, sweat and tears" of other women.

Meegan persuaded the Maasai to instead "anoint" a scalpel in a sealed foil pack and "no one had any objections". Thus, said Conroy, the risk of infection had been reduced but "the significance of the ceremony was maintained. Small changes like that are at the heart of progress."

The Icross/RCSI research team is sceptical of western solutions to Africa's problems, be it bed nets for malaria, anti-retroviral drugs for Aids, or antibiotics for trachoma. To tackle the latter, it has instead developed an easy-to-make fly trap, which villagers can assemble from household waste.

"Instead of imposing western solutions like antibiotics, which are completely inappropriate for a variety of reasons, we need to ask why trachoma vanished spontaneously from Europe, and learn from that. It was eliminated here by the end of the 14th century, simply because flies went and the horse went and water became more available.

"What we have to do in Africa is trap flies and make water slightly more available and, with trachoma at least, we could do wonders."

As Meegan puts it: "All you have to do is tilt the world a little bit and you can make a huge difference."

For further details on Icross contact: (01) 676 1711 or see