Malaria, HIV and COVID. What’s changing with health in Kenya?

Kenyans are used to dealing with illnesses that threaten their well-being.

Malaria is ever-present. I figure that malaria poses a much greater threat to me as a visitor than COVID as I visit Kenya and I take daily prophylaxis to protect me. Malaria can cause fever, malaise, muscle aches, headache and sometime death. Better medical management choices, rapid tests for malaria, and recent introduction of immunization for infants will soon reduce the prevalence and morbidity in Kenya (and other tropical countries) from malaria.

Africans have also been living with HIV for over 20 years now. Although HIV/AIDS was devastating a few years back it has become manageable with education and effective management. New cases of HIV are now much less common.

Preexposure Prophylaxis (PREP) and Postexposure Prophlaxis (PEP) are now available and medical management of AIDS has come down to one pill a day and an every six month checkup at a local health facility instead of 10 pills daily on a regimented schedule and monthly visits to a special clinic that is not close to home. A test and treat model whereby newly diagnosed cases are immediately put on antiretrovirals rather than waiting until their health indicators are deteriorating has reduced morbidity has made a huge difference.

When I traveled here in 2004 the prevalence of HIV was over 40% in one of the communities I frequently visited. Today I am told that new cases are much, much less common and most of the patients with HIV are long-standing and receiving effective ongoing care. In 2004, Kenyan life expectancy was 48 compared to Canada’s 81. Today it averages 68.

What about COVID? The recent COVID pandemic has disrupted the Kenyan economy and health as it has around the world.

During tHe height of the pandemic last year Kenyan Public Health authorities instituted a strict lockdown. Schools and most businesses were closed for over a year. There was a curfew imposed from 7pm to 6 am for over three months with the penalty for breaking the curfew being arrest. Hand washing and masks were required, along with frequent temperature checks before entering indoor establishments or stores. Gatherings for funerals or weddings were restricted. Masks were required in all public transportation including matatus (the ever present taxi vans often stuffed to the brim with 14 passengers) Vaccination was delayed but gradually became available (AstraZeneca) in mid to late 2021. Pfizer boosters have recently become available but, as in Canada, calling it a booster rather than a third scheduled shot to complete protection is making it seem optional to many and uptake is less.

Dan rolls up his sleeve to get his Pfizer “booster”.

There has been no easy way to determine how many were infected. My friends tell me that older folks were dying of short catastrophic illnesses but there was no way to know if it was COVID because testing was not readily available.

Businesses and individuals who worked in the hospitality/tourism sector suffered financially. Small street vendors were limited in how they could sell their wares or foods. There was no financial social assistance. It was a struggle.

Now, in September 2022, things look like they are returning to normal. Some people tell me that they think they probably had COVID as they had the common symptoms but no one really knows for sure. I have seen no one wearing a mask in the week that I have been living in this rural community. When I arrived there were a few masks in the airport and on the plane. This was requested but not required. No one talks about COVID unless I question them.

Higher income countries have an older demographic. Look at the map of Old Age Dependency ratio, the darker areas having an older demographic.

Western countries, Have an older demographic and have more diseases associated with aging like heart disease and diabetes and cancer. More people in these countries will require intensive management of COVID or even die from it because of the increased vulnerability caused by advanced age or co-morbidities. These cases do exist in Kenya, too, but they are difficult to diagnose because of lack of testing and little management that patients could access (ventilation or even oxygen therapy) unless they are well-off and live in a larger urban centre.

World death statistics from COVID show much lower death rates per 100,000 population for Kenya (in blue along the bottom) than the western world. Is this because the deaths are just not being identified or because the lower average age means less severe illness, or both?

So Kenyans have a couple of things going for them in terms of COVID. The much younger population are not as likely to become severely ill and if they acquire COVID at school or in the community they will develop natural immunity that might be boosted with recurring mild infections. They also have a warm climate here and folks spend most of their time outdoors. Weddings and funerals and other gatherings are mainly outdoors and homes have open doors and windows much of the time to improve ventilation. Vaccination is now available to them as well. The challenge now is how to encourage them to get it . The poorer uptake of the “booster” is mainly due to thinking it is optional rather than the resistance seen in North America by folks who think it is impacting their “freedom”.

(Video) Socializing after church outdoors. Some get a COVID booster under a tree while others remain inside to sing some more.

What’s next? There has recently been a small outbreak of Ebola in Uganda and another suspected case in Kenya. The border between Kenya and Uganda has been closed. Hopefully, this will be contained as in the past. We have seen how HIV and COVID can insidiously invade a community.the fear is always that Ebola will become more difficult to manage as well.

To end on a cheery note, here is the hibiscus I have been looking at this afternoon beside the porch at Dan’s house as I write this post.

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S.P. Geddes School in Osiri Village, Kenya

In 2011 I met Meshack Andiwo who lived in a small Kenyan village near the Luanda K’Otieno ferry that takes passengers and cars across Homa Bay to Mbita Point. He told me that small children in his community were struggling when they went to Primary School because they didn’t have the basics of English and arithmetic. They were too young to walk the distance to the nearest Primary School. Once the were old enough to walk the distance to school they were behind many of their peers and they became discouraged and lagged behind. He wanted them to have some early childhood education so they would not struggle or be discouraged and quit when they were old enough to walk to school.

I told my late Dad who was about 92 at the time,about this challenge and he offered some financial support through the CanAssist African Relied Trust to start to build a school for the community and it began with one small tin classroom and a latrine. And so it began.

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* video Come, come, come. Come to SP Geddes School for a better foundation. A young child will grow and grow and later become a doctor/teacher.

I visited the school today. There are several buildings now, a kitchen, clean new latrine, a fenced playground and a small office. There are currently about 50 kids at the school from preschool age to grade 4. They are learning the basics and being fed a breakfast of porridge and a lunch of beans or rice and vegetables, sometimes their only nutrition in a community that struggles with food security.

*Video* How wonderful is this welcome?

When we formed the CanAssist African Relief Trust in 2008, we determined that it’s mandate would be to provide sustainable tangible infrastructure and not programming or management costs (like teachers’ salaries or feeding programmes. This is for two reasons. One is that it would commit for a longer term and limit the number of communities that CanAssist donors could help. It also would foster reliance on outside help and May might foster dependency rather than encourage financial planning and self sufficiency. The latrines, classrooms, water catchment, text books, solar panels, fencing etc are tangible gifts to give the building blocks for running a school or clinic or community sanitation programme. Responsibility for managing and funding the programming is up to the recipient.

Feeding these kids two meals a day is an important motivator to have them attend the school and ensures that they get some sustenance.

.Food supplies for the fifty kids at SP Geddes school cost about $15-$20 per day. Parents pay a small fee to cover the cost of the food but by the end of the week, they sometimes run out and Meshack and Caroline have to dip into their own means to support this. I plan to send a bit of money every so often to help them with this expense. If you want to help a bit with this, let me know as even a couple of dollars a week would be of great value to sustain these beautiful kids.

* video Children at the SP Geddes School washing their hands before lunch.
In addition to early academic education they are taught other life skills.

Caroline and Meshack’s grandson was named “SP” in recognition of my Dad’s generosity and the school was named the SP Geddes School. I met SP as an infant several years ago and what a treat it was to see him again today. He is now 9 years old.

Reuniting with young SP, named after my Dad.
Meshack and Carolinr

Meshack and Caroline take good care of the children at SP Geddes School

Visit to a rural Kenyan Elementary School

This morning, Dan and I dropped in to the Ramula Primary School, a rural public school that has about 700 pupils from grade 1 to 8. Although I am no longer a Trustee with the CanAssist African Relief Trust, the CanAssist board asked me to look in on a few project partners while I am here in Kenya.

The purpose of Dan’s visit to the school this morning was to sign an MOU with the head teacher of the school to confirm the building of an 8 stall pit latrine for the boys. Last year CanAssist built a girls latrine at the school and also supplied some much needed desks.

Dan Otieno, CsnAssist’s African Field Representative signing an MOU for a new boys latrine with the Head Teacher, chairman of the school board and chairman of the PTA of Ramula Primary School.

You would not believe the state of the current boys latrines. They are old and in very poor condition (I won’t disgust you with photos.) I watched as three or four boys opened doors looking for a stall that was useable. Toilets that are collapsing and I’m poor repair are not uncommon in Kenyan elementary schools. Although these schools are publicly run, there seems to be no money for many basic needs, like text books and sanitation. CanAssist has helped several schools in East Africa over the years to help with water collection, sanitation and other infrastructure.

Girls’ latrine built last year at the Ramula Primary School.

CanAssist does not work on a cookie-cutter mold. Every project is different and tailored to the needs expressed by the school or hospital or community. This morning a young woman in grade 8 asked if they could have a couple of cupboards for books – essentially asking for book shelves. I told her that I would pass on this request to the CanAssist trustees. And one of the teachers who teaches language and English asked if they could get some storybooks in English and Swahili to help with reading and literacy.

Literacy teacher Frederick Kolanyo
Student Lucy Atieno

For the past few years the Ontario Teacher’s federation has generously funded purchase of requested books for two or three schools annually through CanAssist. Dan usually asks the teachers what they need and the books specific to their needs are purchased from local booksellers. I am sure that when this funding comes through later this year he will be asking this teacher for his recommendations. (Thanks OTF for your ongoing support.)

We were received warmly. The students, the teaching staff, the Chairman of the school’s Board, and the head of the Parent-Teachers Association all expressed appreciation for the gifts that Canadian donors make to the school through CanAssist.

I was happy to bring greetings from Canada on behalf of the donors and trustees of the CanAssist African Relief Trust.

Arrived in Siaya District, Nyanza Province, Kenya

 After a long day of travel (my Kenya Airways Flight from JFK in New York direct to Nairobi was almost 14 hours!) I am now comfortably ensconced at Dan Otieno’s place near Ramula, Kenya. We are quite literally on the Equator.  I can cross the equator, changing hemispheres back and forth within an half hour’s walk along the road.  I haven’t (yet)  done the test to see if water drains in a different circular direction in the North than in the South.

Morning coffee in bright African sunshine.

I have known Dan since 2004 and have see him one place or another in East Africa almost annually up until the COVID pandemic shut down international travel. We are like family. I am not sure who adopted whom. I have been to this homestead three times previously. The last time was to attend his marriage to Mercy, who is a Clinical Officer at a clinic about three hours away. His 4-year-old daughter is named Heather Maddie. We have quickly become fast friends, bonding over Paw Patrol. She speaks pretty fluent English with a Kenyan accent and will soon learn both Luo and Swahili as well. She looks at books, turning the pages and taking in the photos and when she closes the book she says “and they all lived happily ever after.”

Reacquainting with my African “granddaughter” over Paw Patrol.

Like my family at home, they all call me Dedo here.  I took on that name when first granddaughter, Maddy, was born 21 years ago. I was working in Bosnia at the time and wasn’t quite ready to be “Grandpa” so I took on the Bosnian name for Grandfather, Dedo. It stuck.  Now adults and children alike here in this household call me Dedo.

Dan has hired a young fellow from Kisumu named Evans to help make food when I am around so he and Mercy won’t be preoccupied with meal preparation .  He is working in a little kitchen area that is just outside the house. It is quite common for Kenyan homes, in addition to an indoor kitchen, to have an separate building with a wood-burning stove that they use for cooking. It is a bit of a throwback to the traditional ways of preparing food.

Evans preparing our lunch in the separate kitchen

I was amazed to hear that this building was actually made out of mud. To build it, a frame was made out of wood and mud from the yard was packed into the frame and allowed to harden for two to three months during the dry season. Another layer was later applied and smoothed and than the outside was painted. It looks like stucco and feels firm. The paint protects against rain damage and termites. It is not expensive and reasonably durable. Rainwater from the roof of the main hose supplies all the water.



The finished mud house kitchen

Tomorrow I am going to show Evansf how to make focaccia!  He works as a cook in Kisumu so he can return with a recipe for Focaccia to impress his friends.  We are having lots of fresh fruits including pineapple that we picked up at a street market on our way here. It was picked yesterday and is ripe and sweet and totally unlike the pineapple we get from Costa Rica in Food Basics.

There are chickens in the yard that produce a few fresh eggs.  There are also a few goats, a couple of geese, a stray cat and some vervet monkeys in the trees.  

Network coverage in this very rural setting is a big hit and miss so posting might be more of a challenge than I anticipated.  Hang in.

Life imitating art. Or is it the other way around?

I got an unexpected and sad reply from a friend in Africa when I sent him a birthday greeting this weekend. And it all resonated particularly harshly because of the theatre piece I saw last night. 

Tobias is the Beach Management Unit Chairman at the Kamin Oningo beach on Lake Victoria, a small fishing community in Kenya where I have visited several times.Through The CanAssist African Relief Trust we have been able to build up a small school there. The school, in fact, is named after my Dad as is one of the kids in the community!

Tobias responded to my cheery birthday note with the sad news of the death of two relatively young people in the village.  

Now I will take one step back.

Last night, I attended the Theatre Kingston performance of What a Young Wife Ought to Know.   The show was really well produced and there were some very funny and intimate moments. The general theme was a tough one, however.  It centred on the desperation of young women in Canada in the early 1900’s to limit their family size .  Living in relative poverty put them at increased health risk and they were simply not able to care for either themselves or their children adequately.   Their family planning choices were limited and sometimes the only choice was abstinence, a solution that strained their marriages. Desperate attempts to terminate the pregnancy were life-threatening and distressing. The show was dramatic and intense and personal and, for us in Canada now, it was “historical”.

Well in some parts of the world it is not history. 

One of the deaths at Kamin Oningo was a 35 year old woman who already had four kids and who delivered the fifth two weeks ago.  She must have been anemic during the pregnancy or, like many there, had some post-partum bleeding that was not fully addressed.  Like many African mothers, there really was no time to recuperate and she had to take up the usual household tasks immediately.  Apparently she had been given some iron tablets for the severe anemia  but she collapsed on Saturday and died at home.  Three of the older kids go to the SP Geddes school from pre-school age to grade 2. The husband, a fisherman with a meagre and unreliable income, is left with this young family. 

So this news drove home the message of the play even more (not that it needed any more driving home).  It was not that long ago that this conundrum was being played out in Ottawa.  It still is a concern in Africa and with people I know there. And women die. Less than two years ago, another young mother that I know died with a post-partum hemorrhage.  The baby survived but without a mother. 

The other fellow who passed away in the community this week, a 32 year old fisherman with three young children, died of what sounds to me like an Upper Gi Bleed.  Here, he would likely have had access to the medical care to prevent or manage this.  In Kamin Oningo there is no medical care in close proximity and most people can not afford transport to the nearest facilities that can deal with this or the meagre fees that are charged for health services.  So they leave it too late.  

Tobias has reached out to his friends for financial help so the families can achieve  release of the bodies of these two community members from the mortuary and to help to provide a funeral and burial for them.  I struggle to imagine what it is like to lose your wife, have a newborn baby at home and four other children and not have enough money to retrieve the body from the mortuary. Of course, the families will also be distraught by the deaths and suffer even more financially.

If anyone feels they want to reach out in support, I will be pleased to receive any donations and forward them directly to Africa where they will be used in support of these two bereaved families.  Even $10 will help.   An online transfer is best (john.a.geddes@gmail.com) or give me ten bucks when you see me next.  I promise that every cent will reach this community and the grieving families.

(This is not a CanAssist request, by the way, but a personal one from me.)

I would also recommend you seeing What a Young Wife Ought to Know at the Baby Grand – playing from now until February 16. And when you see it, realize what many women/families around the world are still going through and how it is not that long ago that this was the situation here in Canada.

The Kamin Oningo fishing community is suffering this week more than usual.

A stroll through Mbita town

I really enjoy strolling through Mbita town on the shore of Lake Victoria.  I have visited Mbita, Kenya about a dozen times in as many years.  As you can see from the photos, I am the only muzungu for miles around.  I get many greetings and stop to talk with vendors or pikipiki drivers.  I feel very safe and welcomed.  I love the vibrant color that surrounds me there.  The town also has special signficance for me which I will note at the end of this post.

The photos can speak for themselves.

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Below is one other reminder of my special connection to this town. In the middle of the local hospital grounds, now behind some trees, is a water tank bearing my name.  It was the first infrastructure project that I tackled in Kenya in 2005 and the benefits it gave to this clinic led me to establish the CanAssist African Relief Trust in 2008.  Since that time, CanAssist has provided more than a million dollars of infrastructure support to communities throughout East Africa.  Little did I know, in 2005, what a profound effect that water tank in Mbita town would have on my life for the next several years.

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Ramula Shopping Centre – photo gallery

 

Situated right on the Equator, Ramula is a colorful, little, rural Kenyan trading centre that  I love to wander around and take photos.  So much character. Friendly people living what appears to be simple lives but that are really quite complex given the challenges they face getting from day to day.

Here some photos of some of the shops that operate in this rural Kenyan “shopping centre.

 

This dilapidated van has been sitting here for the last five years, looking like this. In front of the “Palace” kinyozi (barber) hardware and beauty salon.

This fellow makes wooden tables, doors and cabinets using all hand tools. I contracted him to make a crib out of cyoress wood for little Heather Maddie at a cost of 6000KES ( $80 Can)

I asked these guys who were the other nine of the top ten.  There were no others.  Guess that makes this one number one.

The fellow hidden in this kiosk cage also can make deposits and give money from your Equity Bank account.  In his spare time he does construction and cuts hair.

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This is where the fellow above gives haircuts.  The little sticker in the upper corner says “Trust in God”.  Advice for clients who may not feel his skills are up to par?

And for the ladies…

 

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The Place Pub, complete with smoking zone outside.

An African basketball story

Last year, while on a safari with other CanAssist supporters, Kingston teacher Nancy Grew was drawn to the small community of Ramula in Siaya District of Kenya. In addition to several others, the safari group visited two schools there, St Catherine Primary School and the Ramula District Secondary School, both having been beneficiaries of CanAssist support in the past.

Nancy is also a dedicated basketball fan and had brought basketballs and school supplies donated by Truedell Public School and a few uniforms from Kingston Impact for the kids at the schools. She was astounded to find that they had heard little about basketball and did not know how to play the game. Fortunately, one of the teachers at St Catherine school was keen to learn and over the next while he coordinated with another coach in the district to start to introduce the sport to the Ramula community.

Knowing that sport was a great way to develop teamwork, discipline, strategic planning and physical fitness in students, Nancy decided to encourage the community to develop a basketball programme for students in the district. She corresponded with coach Donald and was supportive, both financially and through encouragement, of a Ramula district basketball initiative.

Students of the very rural St Catherine school were joined by others in nearby communities and formed a team. Nancy learned that they had the opportunity to participate in a tournament in Kisumu, about 90 minutes away from “the rural”. She wished that she could go to see this game and to encourage the development of basketball in the district, but thought that was a pipe dream.

But pipe dreams can become reality. Nancy applied for a brief leave of absence from her teaching position with the Limestone District School Board and was grateful and delighted that it was approved – for five working days. This gave her a week to make the 14,000 km trek to Kisumu to see her team play in the tournament, have a brief visit to the community, and return home.

I was planning a trip to review CanAssist projects in Kenya and Uganda so I arranged for part of my safari to overlap to include the basketball tournament, too.

On Saturday January 14, we had the pleasure of watching these kids compete. The tournament was similar to any junior basketball tournament in Canada. It was held on an outdoor court at a Muslim school in multicultural Kisumu. The temperature in the sunshine on the court was about 32 degrees C. Despite this, the kids were energetic and motivated. There were five local teams and the games were for half the usual regulation time. The Ramula district team was entered with the name “Kingston” and our team sported donated Kingston Impact uniforms. Balls used for the games had been supplied by the Lakers Basketball Association of Kingston.
I know little about basketball but Nancy was impressed by the level of skill of these players, on all the teams. We were also pleased to see that one of the teams was made up of teenage girls – a reflection that girls and women in this country are being encouraged, at least in some circles, to be empowered to have equal opportunities.


We were delighted to cheer on the Kingston team and watch them win their first two games. Then they won the semi final game and advanced to the finals. Prior to the final game, the kids were all given a big lunch. The outcome? The Kingston team won the tournament, collecting a little trophy to take back to the rural Siaya District community.

What does this all prove? Anything is possible. These rural kids, through hard work and perseverance were able to learn enough in a few months to perform competitively. Nancy, also with determination and support was able to attend the tournament, half a world away. She is now even more motivated to continue to encourage the Ramula community by helping to set up a local league at two schools in the next year. She will look for support to build two sports pads that can be used in the community for basketball and other outdoor sports activities. She hopes that the lessons learned through participation in sports activities will benefit the kids throughout their lives. Stay tuned to see how this story ends.

Nancy has blogged about her mission and her recent trip to Kenya at bballstorygrew.blogspot.com

Watch Catherine’s news report about the tournament here:

Parts of this story appeared in the Kingston Whig Standard on Thursday January 26, 2012.

CanAssist tries to do no harm.

Primum non nocere – first of all, do no harm”  was a dictum that I learned in medical school and always tried to apply in day to day practice.  I remind myself of this principle, as well, in my role as a trustee of  the CanAssist African Relief Trust, an African charity that has consumed much of my energy over the last few years.

There are two schools of thought about providing development aid to some struggling parts of the world.

unknownPeter Singer puts forth the argument that we are morally obliged to help. If we see someone straining to survive and helping them would be of little significant consequence to our own well-being then we must.  Most of us would not hesitate to wade into a shallow pool to save a drowning child, even if it meant getting our new leather shoes wet and dirty.  Taken more broadly, giving up the cost of a night out at the movies to help vulnerable children in Africa follows the same moral responsibility.  A life saved is a life saved, whether in a Canadian water park or a Ugandan village.

Other writers wonder whether some forms of developmental aid are doing more harm than good.  A recent  documentary, Poverty Inc, refers specifically to the tons of rice that poured into Haiti after their disaster in 2010. This aid was certainly helpful for crisis relief but it continued to flow into Haiti after the crisis was over.  Free rice, bought from suppliers in the US and subsidized by the US government to provide “aid”, caused the farmers in Haiti who previously sold rice locally to go bankrupt.  Who would pay for rice at the market when you can get it for free?  This ongoing supply undermined the local economy and increased dependency while American suppliers were being paid.  There is a difference between humanitarian aid and ongoing developmental funding.

This debate challenges me to think about what we do through the CanAssist African Relief Trust.  How can we satisfy our moral obligation to help struggling communities but not create or foster dependency?  Like the primum non nocere dictum, it is partly what we don’t do that is important.

1-2First of all, CanAssist does not send goods; we send money.  We don’t flood the East African market with materials purchased in Canada and shipped overseas at great cost.

CanAssist does not deal with large multi-layered governmental departments but directly with individual schools, support groups and clinics. We don’t go to a community to promote our own agenda or ways of doing things.  We let the community, school, health facility come to us with their ideas of what sustainable infrastructure we can fund that will improve their well-being.

We don’t send unskilled volunteers to Africa in a “voluntourism”  holiday to build a school or do  other work that can be done more effectively by Africans. Our supporters don’t rob jobs from local carpenters and masons who need that work to pay for their family’s schooling or health needs. Instead, our funding stimulates the local economy, albeit in a small way.

dsc05459We don’t provide money for programming, staffing or other individual support. Once a donor starts paying for school fees for a young child, for example,  the student  becomes dependent on the benefactor’s help to finish secondary school, and beyond.  It becomes difficult to stop this individual aid.  And only one person benefits from this well-meaning generosity.  CanAssist provides communities with funding for sanitation or clean water, or for classrooms and furnishings at rural schools.  The materials are purchased locally and construction done by employing local workers, both men and women.  If parents are healthy, better educated and have work available, they can earn the money to look after their children.  CanAssist project funding, therefore,  provides two benefits – temporary employment for local people and infrastructure improvement to the community, benefitting many rather than just one or two.

CanAssist’s administrative expenses in Canada are about 5% of our budget. For some other development programmes, a large proportion of the claimed development funding stays in Canada, paying for salaries, airfares, office space, fax machines, hotels and computers. CanAssist does have obligatory administrative expenses like bank fees, Internet  access, postage and liability insurance and some unavoidable professional fees we can not get pro bono. All other goods and services are purchased in Africa.  We pay no Canadian salaries.   We provide casual employment to some Africans to help implement our projects but this, too, provides initiative to them to work to earn their money. It is not a handout.

We don’t fund  one group indefinitely.  CanAssist attempts to give a school or community a kick-start to help their development but ultimately they must figure out how to manage their own operational and infrastructure needs.  The goal is self-sufficiency and this would not be attainable if the group could rely on CanAssist support indefinitely.

For these reasons, I am convinced that that CanAssist can continue to provide help without harm African communities.  We are grateful to our many generous donors who participate confidently in this mission with us – knowing that they can help without fostering dependency.

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