Category: Global health

  • Online learning around Ebola so far

    Online learning around Ebola so far

    This is the third in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

    “The responsible use of technology in humanitarian action offers concrete ways to make assistance more effective and accountable, and to reduce vulnerability and strengthen resilience. Distance learning and online education are good examples of technology supporting these goals” (World Disasters Report 2013:10).

    There have been a number of online courses organized by humanitarian organizations as well as by higher education institutions. International organizations have developed e-learning courses such as MSF’s Ebola ebriefing and WHO’s Health Security Learning Platform, or leveraged existing online training packages such as IFRC’s scenario-based simulation modules on public health in emergencies.

    Some of the transmissive online courses around Ebola
    Some of the transmissive online courses around Ebola

    American, British, Dutch, and Swiss universities are amongst those who have produced open online courses distributed on MOOC (Massive Open Online Course) platforms such as Coursera (Ebola Virus Disease: An Evolving Epidemic), Futurelearn (Ebola: Essential Knowledge for Health Professionals), and France Université Numérique (Ebola: Vaincre Ensemble!). All of these have focused on the transmission of information about the Ebola virus disease for general and/or specialist audiences, including those based in the field and in affected communities.

    MSF’s Keri Cohn, writing from the Bo-Ebola Treatment Center in Sierra Leone, provided an account of the challenges she faced in using one such course due to access difficulties.

    As an expat doctor, I have found your course […] to be excellent. Our national staff, who are local Sierra Leone nurses and clinical officers, have enrolled in the course on their mobile phone. However, because Internet is poor or not available, they have been unable to attend the course or [view videos]. In turn, with the help of MSF, I have been able to download [the content] and, together, in a group of around forty people, we have completed your course.

    This is remarkable testimony with respect to the potential (as well as technical limitations) of online learning to disseminate reliable information to health workers, the ability of organizations to overcome technological barriers in the face of urgent need for information, and the high level of motivation of field-based health workers to acquire new knowledge.

    But why should learning be a one-way street? What of the knowledge developed by Sierra Leone nurses and clinical officers through collaboration and engagement with people from the affected communities, peers from neighboring countries, and international staff? There is undoubtedly a massive amount of deep, continual learning happening in such a group through practice and experience, not to mention human bonds of friendship and solidarity, forged in the face of adversity. Learning – whatever the medium – cannot be reduced to the one-way transmission of information.

    Many of the online learning technologies of the recent past have been modeled after top-down, legacy training systems. In their basic approach and use in practice, these are heavily weighted to the transmission of centralized knowledge from the center (headquarters, the capital city) to the periphery (the community, village, or clinic). They are frequently ineffective, as the transmitted knowledge is often abstract and decontextualized, while the value of existing local knowledge, practices and understanding is not recognized or incorporated into the learning experience.

    Transmissive learning
    Transmissive learning

    Transmissive learning remains the dominant mode of formal learning in the humanitarian context, even though everyone knows that such an approach is ineffective when it comes to teaching and learning the critical thinking skills that are needed to deliver results and, even more crucially, to see around the corner of the next challenge. The moral economy of such transmissive education and training demands unquestioning compliance in the face of authority, lack of critical autonomy, and an absence of responsibility. Learners are treated as passive knowledge consumers rather than active knowledge producers, clearly out of alignment with both the spirit and practical needs of a humanitarian health crisis and processes of human capacity building in local communities and institutions. Such approaches are unlikely to foster collaborative leadership and team work, provide experience, or confront the learner with holistic complexity of specific sites and cases. In other words, they fail the crucial test of grounded relevance to improved preparedness and performance.

    What can education contribute?

    What can education contribute to the shape of future global health crisis response? What is the role of technology, beyond improving the efficiency of the transmission of information? Education research in many fields, including humanitarian work, has shown that significant learning, even transformative learning, is usually grounded in and builds upon experience. The educator’s role is to scaffold self-understanding, and to facilitate expansion of that self-understanding.

    In our volatile working environment, what we know (usually thought of as content-based knowledge) is replaced with how we are connected to others. That is how we stay current and informed. Learning nowadays is about navigation, discernment, induction and synthesis, more than memory and deduction. Memory has become less relevant in a world where so much knowledge is within reach within seconds. Networks are a powerful problem-solving resource that people naturally turn to when they need help. We rely on small, trusted networks to accelerate problem-solving (learning).

    Many new learning practices – through both formal and informal networks – develop organically, in the face of sometimes extreme circumstances. Often, it is exceptional leadership qualities in individuals (and sometimes their organizations) that make up for gaps and limitations of existing learning methods. Nevertheless, although humanitarians may initiate and lead change through their own learning, organizations must create facilitative structures to support and capture learning in order to move toward their missions (Yang 2003:154).

    In Thursday’s blog post, I’ll share the experience of a pilot course that sought to overcome the limitations of transmissive learning to support knowledge co-construction by people with experience in humanitarian operations.  

    References

    Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015. http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/.

    Sharples, Mike. “FutureLearn: Social Learning at Massive Scale.” presented at the Learning With MOOCs II (LWMOOCS), Columbia Teacher’s College, October 3, 2015. http://www.slideshare.net/sharplem/social-learning-at-massive-scale-lwmoocs-2015-slideshare.

    Vinck, Patrick (Ed.). World Disasters Report: Focus on Technology and the Future of Humanitarian Action. Geneva, Switzerland: International Federation of Red Cross and Red Crescent Societies, 2013.

    Yang, Baiyin. “Identifying Valid and Reliable Measures for Dimensions of a Learning Culture.” Advances in Developing Human Resources 5, no. 2 (May 1, 2003): 152–62. doi:10.1177/1523422303005002003.

  • Why learning is key to the strategic shift in how the world manages health crises

    Why learning is key to the strategic shift in how the world manages health crises

    This is the second in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

    “Whereas health is considered the sovereign responsibility of countries, the means to fulfill this responsibility are increasingly global, and require international collective action and effective and efficient governance of the global health system.” (Stocking 2015:10)

    “Effective crisis management for health”, writes the World Health Organization in its management response to the Stocking report, “requires a series of strategic shifts” (Chan 2015:5). Calls for substantial modernization of emergency management capacity and preparedness have focused on resources to ensure rapid mobilization for the provision of logistics, operational support, and community mobilization. Yet, “the primary lesson so far has not been about the need for new response methods, but about human resources and coordination”, wrote Anna Petherick in The Lancet in February 2015. “Building new treatment centres,” she concludes, “was an easy task [sic] next to training and supervising people to staff them” (Petherick 2015:592). In other words, how we learn is key to the strategic shift in how the world manages health crises.

    Learning is the implicit process required to achieve the capacities sought. In-service training, the most prevalent form of formal learning, is only the tip of the iceberg. Every time we ask “how do we change the capacity of individuals and systems?”, we are asking about how we learn (pedagogy) and how we know what we know (epistemology). For example, learning, education and training (LET) are not mentioned at all in the 2005 International Health Regulations (IHR). Learning is the implicit process required to achieve the capacities described by the Regulations. And yet, we leave tacit the processes (the “how”) which enable the acquisition and sharing of knowledge, skills and behaviors (competencies) needed in order for the health workforce and affected communities to face a health crisis.

    In Wednesday’s blog post, we’ll review online learning around Ebola so far – and examine whether such initiatives can contribute to the strategic shift in human resources and coordination.  

    References

    Chan, Margaret. “WHO Secretariat Response to the Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, August 2015.
     
    Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015.
     
    Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. https://doi.org/10.1016/S0140-6736(15)60075-7

     

  • Lessons learned from Ebola

    Lessons learned from Ebola

    This is the first in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

    The unprecedented complexity and scale of the current Ebola outbreak demonstrated that existing capacities of organizations with technical, normative culture, methods and approaches are not necessarily scalable or adaptable to novel or larger challenges. Large and complex public health emergencies are different each time. Each new event poses specific problems. Hence, traditional approaches to standardize “best practice” are unlikely to succeed. What are the appropriate mechanisms for learning from each of them? More broadly, how do we change the capacity of individuals and systems to learn?

    “Huge praise is due to those who have responded to the Ebola outbreak in West Africa. At the same time, the retrospective analysis that is just beginning has already revealed several glaring lessons to be heeded next time” (Petherick 2015:591).

    I believe that we can and should mobilize education and the affordances of technology that support it to tackle three questions:

    1. How do we ensure that lessons learned include the experience and expertise of communities on the frontline of the crisis?
    2. How can we ensure that lessons learned are retained, adapted and used by individuals, teams, and organizations?
    3. How close to the village can an online, distance learning initiative reach?

    If we improve access, inclusion and retention of lessons learned, we can then help address the following questions:

    1. What humanitarian health standards and normative guidelines are needed and how can they be developed to stay relevant in the face of increasingly complex crises, when every outbreak is different?
    2. How do we foster an organizational culture of improved coordination, leadership, and preparedness in and between organizations, governments, and local communities?
    3. How do we develop a global workforce with the surge capacity to respond to crises?

    These questions have an educational dimension that is not being addressed by current efforts. This is compounded by the fact that current humanitarian health education is mired by transmissive approaches that cannot allow for learners as knowledge producers – and that lessons must first be generated before they can be learned. This is why we urgently need a new education paradigm, supported by affordable, practical learning technologies and pedagogies, to strengthen humanitarian health response and preparedness.

    Tuesday, I’ll explore why learning is the hidden key to the strategic shift – called for by the World Health Organization – in how the world manages health crises.

    Reference: Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. doi:10.1016/S0140-6736(15)60075-7.

  • Colonialism and disease: tuberculosis in Algeria

    Colonialism and disease: tuberculosis in Algeria

    Tuberculosis in Algeria as part of colonization: high death rates and false explanations

    During French colonial rule in Algeria (1830-1962), tuberculosis became a major killer disease.

    The French brought this deadly sickness with them when they invaded Algeria.

    Before the French came, tuberculosis was not a big problem for Algerian people.

    The disease spread quickly through Algerian communities during colonial times.

    By the 1930s and 1940s, studies showed that tuberculosis infection rates were very high.

    In 1938, about 5 out of every 100 Algerian people got infected with tuberculosis each year.

    By 1948, this number was still about 4 out of every 100 people.

    Around 300 out of every 100,000 Algerians got tuberculosis each year before independence.

    Why tuberculosis in Algeria spread so fast under colonial rule

    The French colonial system created perfect conditions for tuberculosis to spread among Algerian people.

    The colonial government took away good land from Algerians and forced them to live in crowded, poor areas.

    French policies of displacement, starvation, and impoverishment made Algerian society very weak.

    People lived in terrible conditions without clean water, good food, or proper housing.

    French colonial reports show that Algerians died from tuberculosis at much higher rates than French settlers.

    Although the number of infections was small compared to the French colonists, the death rate among Algerians was high.

    This happened because Algerians could not get proper medical care and lived in much worse conditions than the French people.

    During periods of drought, locusts, and famine, many Algerians had to move toward cities like Algiers.

    They carried diseases with them because they were weak from hunger and poor living conditions.

    The French authorities put them in shelters and prisons, but this did not stop tuberculosis from spreading to French areas too.

    False colonial explanations for tuberculosis in Algeria: blaming Algerian people

    French colonial doctors and officials did not want to admit that their policies caused the tuberculosis disaster.

    Instead, they created false explanations that blamed Algerian people themselves for getting sick.

    Colonial doctors said that Algerians got tuberculosis because they were naturally inferior to French people.

    They claimed that Arab and Berber people had weak bodies and minds that could not fight disease.

    French medical writings described Algerians as lazy, criminal, incompetent, and prone to bad behavior.

    They said these supposed character flaws made Algerians more likely to get sick.

    Colonial doctors also claimed that Algerian culture and religion made people vulnerable to disease.

    They criticized traditional Algerian healing practices and said that Islamic beliefs prevented people from getting proper medical care.

    French medical officials argued that only Western medicine could help Algerians, but they made sure that most Algerian people could not access good medical treatment.

    Some French doctors wrote that the “inferior populations” of Arabs and other non-European groups naturally weakened the health of everyone in Algeria.

    They used racist theories to explain why tuberculosis spread so fast, rather than looking at the terrible living conditions that French policies had created.

    The French colonial medical service was set up mainly to protect French settlers, not to help Algerian people.

    Colonial doctors saw their job as keeping French people healthy and safe from local diseases, not as caring for the Algerian population that suffered the most from tuberculosis.

    Independence and the fight against tuberculosis in Algeria

    When Algeria became independent in 1962, the new government inherited a serious tuberculosis problem.

    The disease was still killing many people across the country.

    But instead of accepting this situation, Algerian leaders decided to fight tuberculosis with scientific methods and strong public health programs.

    Early steps after independence

    Right after independence, Algeria faced many challenges.

    The country was poor, and the health system was very weak.

    Few doctors remained in the country, and there were not enough hospitals or medical supplies.

    Despite these problems, the new Algerian government made tuberculosis control a top priority.

    In 1964, Algeria established the Tuberculosis Office (Bureau de la Tuberculose).

    This office began organizing a national fight against the disease.

    The government also started working with the World Health Organization to learn the best ways to treat and prevent tuberculosis.

    Between 1966 and 1967, studies showed that tuberculosis infection rates were already starting to drop in Algeria.

    The annual risk of getting tuberculosis fell in different regions, showing that the new approach was working.

    The national tuberculosis control program

    In December 1972, Algeria launched its first National Tuberculosis Control Program.

    This program had clear goals: to integrate anti-tuberculosis activities into all health sectors nationwide and to create a unified, systematic approach to tuberculosis control.

    The program also standardized evaluation methods so doctors could monitor and assess tuberculosis prevention and treatment efforts effectively.

    Algeria also established a National Tuberculosis Control Laboratory, which became the national reference center for research on tuberculosis.

    This laboratory played a key role in strengthening tuberculosis diagnosis and research, helping the country fight the disease more effectively.

    Pierre Chaulet and the tuberculosis revolution

    One of the most important figures in Algeria’s fight against tuberculosis was Dr. Pierre Chaulet.

    Chaulet was a French doctor who had supported Algerian independence and stayed in the country after 1962 to help build the new health system.

    Chaulet worked at Mustapha University Hospital in Algiers and became a leading tuberculosis researcher.

    He met with international experts and learned about new treatment methods that could cure tuberculosis much faster than old treatments.

    In the 1970s, Chaulet and his team tested new drug combinations that could cure tuberculosis in just six months instead of the years of treatment that had been needed before.

    These shorter treatments were much easier for patients to complete, which meant more people got fully cured.

    Amazing results: how did the rates of tuberculosis in Algeria drop so fast?

    The results of Algeria’s tuberculosis program were remarkable.

    The World Health Organization reported that tuberculosis rates in Algeria fell dramatically after independence:

    • 1975: 78 cases per 100,000 people;
    • 1981: 60 cases per 100,000 people;
    • By the 2000s: Below 26 cases per 100,000 people;
    • 2016: Below 17 cases per 100,000 people;
    • 2023: Only 9.4 cases per 100,000 people.

    In 1980, Algeria adopted the six-month tuberculosis treatment as standard care across the entire country.

    This treatment approach became a model that eradicated tuberculosis in Algeria and was later copied by other nations around the world.

    Key factors in Algeria’s success

    Several important factors helped Algeria succeed in fighting tuberculosis:

    Free healthcare for all: Algeria established free healthcare that allowed access for most of the population.

    This meant that poor people could get tuberculosis treatment without paying money.

    BCG vaccination program: Algeria started vaccinating all newborn babies with BCG vaccine, which helps prevent tuberculosis.

    Within one year, they achieved nearly 90% vaccination coverage.

    This large-scale immunization effort greatly reduced tuberculosis risk, especially among children.

    Better diagnosis: Algeria expanded microscopy laboratories, which improved tuberculosis diagnosis by enabling doctors to confirm the disease in 85% of new lung tuberculosis cases.

    This advance meant more accurate detection and treatment of infectious cases, reducing disease transmission.

    Standardized treatment: Algeria adopted a six-month treatment regimen for all forms of tuberculosis across all health sectors.

    This standardized approach, following global recommendations, significantly improved treatment outcomes and patient recovery rates.

    Training and education: The government trained many health workers in tuberculosis care and prevention.

    This created a network of skilled staff who could identify and treat tuberculosis cases throughout the country.

    The contrast: colonial failure versus independence success

    The difference between tuberculosis control under French colonial rule and after Algerian independence is striking and clear.

    Under colonial rule (1830-1962)

    • Tuberculosis rates were extremely high (around 300 cases per 100,000 people);
    • Algerians died from tuberculosis at much higher rates than French settlers;
    • Colonial policies created perfect conditions for disease spread through poverty, overcrowding, and malnutrition;
    • French doctors blamed Algerian people for getting sick rather than addressing the real causes;
    • Medical care was designed mainly to protect French settlers, not to help Algerian people;
    • The colonial system lasted 132 years without solving the tuberculosis problem.

    After independence (1962-present)

    • Tuberculosis rates dropped dramatically in just a few decades;
    • Algeria achieved nearly complete tuberculosis eradication by international standards;
    • The government addressed root causes through free healthcare, better living conditions, and comprehensive public health programs;
    • Algerian and international doctors worked together using scientific methods;
    • Medical care was designed to serve all Algerian people equally;
    • Major progress was achieved within 20 years, with continued improvement over 60 years.

    What the evidence shows

    The historical evidence proves several important points:

    Colonial rule made tuberculosis worse: The French colonial system created the conditions that allowed tuberculosis to spread rapidly among Algerian people.High infection rates, poor living conditions, and limited medical care for Algerians were direct results of colonial policies.

    Racist explanations were false: French colonial doctors blamed Algerian culture and supposed racial inferiority for high tuberculosis rates.

    This was completely wrong.

    When Algerians gained control of their own healthcare system after independence, they quickly brought tuberculosis under control using the same scientific methods available to French doctors.

    Independence brought real solutions: Once Algeria became independent, the government was able to address the real causes of tuberculosis: poverty, malnutrition, overcrowding, and lack of medical care.

    By fixing these problems and providing free healthcare to all people, Algeria achieved what the colonial system never could.

    Scientific medicine works when applied fairly: The same medical knowledge that was available during colonial times became much more effective after independence because it was applied to serve all Algerian people, not just French settlers.

    Lessons for today

    Algeria’s victory over tuberculosis teaches important lessons about health, colonialism, and independence:

    Health problems have social and political causes: Tuberculosis spread in colonial Algeria not because of Algerian people’s character or culture, but because of unjust policies that created poverty and poor living conditions.

    Racist explanations hide the real problems: When health officials blame sick people for their illness instead of addressing unfair social conditions, they prevent real solutions from being found.

    Public health requires political commitment: Algeria succeeded against tuberculosis because the independent government made it a priority and committed resources to serve all people equally.

    International cooperation helps when based on equality: Algeria worked successfully with international health experts after independence because these relationships were based on mutual respect rather than colonial domination.

    Algeria’s experience shows that with proper political commitment, adequate resources, and scientific methods applied fairly, even the most serious health problems can be solved.

    The country transformed from having one of the world’s worst tuberculosis problems to achieving near-eradication in just a few decades.

    Bibliography

    1. Bentata, K., Alihalassa, S., Gharnaout, M., Bennani, M. A., & Berrabah, Y. (2025). Algerian Tuberculosis Control Program: 60 Years of Successful Experience. Cureus, 17(6), e86357. http://dx.doi.org/10.7759/cureus.86357
    2. Guedim, T., 2024. History of epidemics and preventive medicine in Algeria during the modern and contemporary period: Infectious diseases and quarantine as a model. ijhs 8, 376–386. https://doi.org/10.53730/ijhs.v8nS1.14783
    3. Chopin, C. A. (2015). Embodying ‘the new white race’: colonial doctors and settler society in Algeria, 1878-1911. Social History of Medicine, 28(4), 735-752. http://dx.doi.org/10.1093/shm/hkv066
    4. Clark, H. L. (2016). Expressing entitlement in colonial Algeria: villagers, medical doctors, and the state in the early 20th century. International Journal of Middle East Studies, 48(3), 445-472. http://dx.doi.org/10.1017/S0020743816000587
    5. Stafford, N. (2013). Pierre Chaulet. BMJ, 346, f571. http://dx.doi.org/10.1136/bmj.f571
    6. Velmet, A. (2019). The making of a Pastorian empire: tuberculosis and bacteriological technopolitics in French colonialism and international science, 1890–1940. Journal of Global History, 14(2), 279-300. http://dx.doi.org/10.1017/S0022050719000639
    7. Gallois, W., 2007. Local Responses to French Medical Imperialism in Late Nineteenth-Century Algeria. Social History of Medicine 20, 315–331. https://doi.org/10.1093/shm/hkm037
    8. Chaulet, P. (1989). Tuberculosis: a six-month Cure. World Health Forum, 10(1), 116-122.