Revamping health education curriculum in Uganda

Professor illustrates the value of teaching about environmental health

Two million people die each year from diseases related to smoke inhalation. And, thousands of people die daily from uses related to polluted water, most of them in Africa.

The lack of clean drinking water and waste removal are among the many serious threats to public health and hygiene throughout Africa—and Warner School Associate Professor David Hursh has set out to tackle issues related to health with Uganda’s top education officials.

After working with teachers in Uganda last year to pilot educational initiatives around renewable energy, Hursh was invited back to Africa this summer, but this time to focus his attention on the environment and health issues. Teaming up with two University of Rochester second-year medical students, Scott Walter and Nick Zinn, Hursh spent the first 10 days of his three-week trip working with educators and teaching environmental health to second- to sixth-graders at Circle of Peace School, located in Makindye. He believes a hands-on experience is vital in teaching science subjects, particularly in developing countries. That is why Hursh and his team took Ugandan students outside the classroom to teach them about the dangers from air and water pollution and how to reduce these risks.

The second half of Hursh’s trip consisted of visits to the Millennium Villages Project and two local universities. During his five-day stay with the Millennium Villages, an initiative organized by the Earth Institute at Columbia University and the United Nations Development Program that works in 14 sites in 10 sub-Saharan countries to lift rural African communities out of extreme poverty while also improving education, health, gender equality and environmental sustainability, he met and worked with interns from around the world and sector heads. He also embarked on a two-day tour of all the different projects. His goal during his visit with the Millennium Villages was to see how education might fit into the larger picture. Hursh also met with researchers and leaders from Kampala University and Makerere University to exchange ideas for reforming teacher education to focus on sustainability and supporting efforts already taking place in the Millennium Villages.

We sat down with Hursh to discuss his recent trip to Uganda and his commitment to improving education and environmental health over in Africa.
 Last year’s trip to Uganda focused on teaching students about energy. What was the overarching goal of your trip this time around?
H:  My mission was, and continues to be, to improve education at both the K-12 and university levels to support goals around issues of sustainability, so health was a big part of it. We also focused on energy, water, agriculture, and food security. Our goal was to see how we can incorporate all of this into what people are already learning, either through formal education—at the elementary and secondary levels and at the university level through teacher education—or through informal education by working with communities so that both adults and children can learn these skills in a school setting or through informal meetings in rural communities.

Did you successfully accomplish your mission?
H:  We are still trying to figure that out. I was pleased that everybody I talked to was open to revamping all aspects of education to accomplish this goal. It’s still hard to do given that the education system is historically set up so that students aren’t expected to do much critical thinking—it’s still very much focused on memorization and recall, so how do you change that? Everyone I spoke to realizes that this is a problem. It’s a problem in the way teaching occurs. I met with the Dean at the local University, and we both agreed that the problem with doing these reforms is that students are only asked to do recall. We then discussed how we can change this approach to teaching and the system in order to get students to do more critical thinking. I was more than pleased in terms of everyone’s understanding of the problem and their willingness and desire to improve education. I came away with a plan for how we can set up a new campus and transform the curriculum so that students focus more on solving real issues in their communities, rather than learning out of textbooks and answering questions at the back of each chapter. In terms of whether or not this was a success, we are talking about a long-term process that’s going to take decades. On the other hand, I was overwhelmed with the support and interest in the ideas that we shared.

Why is it so important to teach Ugandan children about environmental health today?
H:  There is pollution everywhere. For example, in Uganda, they don’t have garbage pick up, except for maybe downtown Kampala, so everybody burns their own trash, which leads to harmful toxins in the environment. Additionally, in the rural areas, 95 percent of the people cook using what they call the “three-rock method,” where you take three rocks, place fire wood between the three rocks, and balance your pots on the rocks. They use this method to cook within enclosed spaces, contributing to numerous diseases. And with years and years of this, they have deforested most of their land. At this point, they are running out of wood to continue this process. How do you change to some other kind of energy that’s sustainable and affordable? That’s the big question. Currently, they are setting up photovoltaic systems to power buildings in rural communities as an alternative, so their goal is to eventually replicate these models throughout the country, but this will take a lot of time, money, and resources.

What trends trigger the most concern for you, and are these common in other countries?
H:  Yes, the deforestation, in particular, and the health risks associated with that are common across many developing countries. Not only are they running out of wood but women are the ones collecting it. It’s risky for them to go away from home—they’ve been attacked so there are huge problems with the whole processes that exist and it’s only getting worse. They have to go further and further and it takes them more time to collect wood. They also send their children out to help, which often means that they in turn skip out on school, so this is a global problem in developing countries and everybody is trying to figure out ways to solve this. What we’re trying to do is figure out what are the models, both in terms of education and infrastructure, that can solve this.

Why is hands-on experience vital to teaching science subjects in developing countries?
H:  The two medical students and I taught students about their hearts and lungs. They learn about the human body in books, but they don’t fully understand what these organs do. In fact, I was surprised that most students did not know how many lungs they have. We showed them photos and x-rays of lungs and hearts, and demonstrated to them how the human body works. We also brought stethoscopes for students to listen to one another’s hearts and lungs, as well as their own, which gave them a real appreciation for how the body works. They would have used the stethoscopes to listen to each other’s lungs for hours, so they really enjoyed the hands-on learning. They also learned how to check their pulse when resting and  after an activity. This type of learning helps them to fully understand how their body works. Again, they’ve had lessons on this, but unless you have them pay attention to and talk about their own breathing and how their lungs breathe air in and out, they don’t fully understand it. To demonstrate to students how much air pollution they are breathing in, we did experiments with petri dishes swabbed with petroleum jelly and collected particles in the air from fires on school grounds, and the students were very interested in learning about that. We also showed them photos of healthy lungs and photos of smokers’ lungs, so that they could see how different they were and understand that what you do affects your health. We also talked about ways to keep their bodies healthy through nutrition and exercise. So, we basically tried to be proactive around those kinds of health issues.

What do you view as positive steps in reducing health risks and deaths in Uganda? And how can education play a role in this?
H:  We are trying to demonstrate that this preventative process can be a part of school and that Ugandan students can take a proactive role. First, we have to demonstrate how this can be integrated into the curriculum. Our next steps are to work with pre-service and in-service teachers in developing a curriculum—which we’ve nearly completed—and to expand on this curriculum and present it to other pre-service and in-service teachers so that they can bring it to their own schools. This is how we begin to make changes in how children learn.

What are some of the trials facing Uganda’s education system?
H:  There are many. First and foremost is the huge teacher student ratio they have. I was at a school that had 10 teachers and 840 students. Their student enrollment is doubling, especially as the school continues to provide free lunches now that they have vegetable gardens on school grounds. So you have huge classes and you have a national curriculum, but you don’t have textbooks or the kinds of resources children need to learn. During my visit, I took some third-graders aside to evaluate their reading skills, and I learned that they were not even beginning readers yet. The fact that they made it to third grade without anyone detecting it, I knew something was wrong. But, it’s very difficult for teachers to do individual assessments when you have that many students in a class. One of our goals coming out of all of this is that we hope to introduce computers and the Internet at the Circle of Peace School and other schools, so that we can develop a curriculum on the Internet that evolves. Eventually, other teachers will also have access to it and can make accommodations for their local schools as well as their communities. We envision a process where teachers will be able to receive feedback and suggestions from others so that they can enhance the curriculum. Ideally, it will become more than just a static curriculum that’s printed and handed out—it will live and evolve on a website. It will also encourage teachers to study and experiment with new effective classroom practices. In Uganda, students are accustomed to copying notes off the board into a composition book, so we’re trying to steer away from that approach to make learning more interactive and engaging for children. We also talked about developing a curriculum for after school since a lot of students have no place to go once the school day ends. That’s another way to further enhance and expand their learning through informal education.

What were the outcomes of your visits with the Millennium Villages and local universities?
H:  My goal was to collect information about what people are doing and how they are building on what’s already been done in the past. I wanted to learn what’s currently taking place in the Millennium Villages in terms of education. The main thing I learned from my visit with them was their value and importance in trying to develop and integrate these different projects together so that improving health requires improving access to safe and reliable forms of energy. So, everything just fits together. If you want people to have good health, then you need another source of energy other than cooking with the three-stone method. People now spend an hour and a half a day collecting water that’s polluted, so how do we change that? If we want to improve health, we need to go through schools to educate people. Schools need to become the center of the community—to do more than just educate children. Schools exist to educate students who show up for class, but if we could educate adults and make it a community resource center as well, that would be entirely different. My goal for my visits with Kampala University and Makerere University was to share ideas on how we can do things in school to try to connect education with the larger issues of sustainability and how we can connect universities with projects, like the Millennium Villages, to help make these efforts and changes sustainable. When I visited the local universities, we brainstormed ideas for supporting teachers as they stay after school to work with both children and adults on some of these environmental health concerns. At the universities, I met and worked with researchers, who study energy use for cooking, and administrators, who are interested in reforming the structure of their institutions to address issues related to health. Both universities are eager to reform teacher education to focus on sustainability, and I’ve agreed to help out with this.

What is next for you?
H:  I have a book coming out on teaching environmental health to children that I co-authored with Camille Martina. The book, Teaching Environmental Health to Children: An Interdisciplinary Approach, is expected to release in September and will be published by Springer Publications. Additionally, in the near future, I plan to return to Uganda to continue my work in promoting environmental health through education.