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Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

What if we could "leapfrog" over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve "mentor mothers" have been using the tablets since March. As you'll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we've gotten was that a lot of the mothers being counseled said, "You know, you've been using phrases like 'balanced diet' for many years, and I didn't quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains." Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they're very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention... It's really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they'll be used next in Guatemala... We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that's why it's so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal... We tried to show a variety of different fruits and vegetables without specifically showing that "this is a guava," because a guava might not grow in other parts of the world.

You're also working on a community health app and open-access online library of these videos. What impact will that have?

Fifteen years ago in South Africa, everyone was waiting for a landline telephone, and the government was not serving that capacity, so people waited for years. Then all of the sudden the technology advanced, and everybody could go into the mobile phone shop and buy a flip phone and load it up with some minutes. I predict that a similar thing will happen, where maybe ten years from now everyone will have a smartphone, which is a powerful resource in terms of the education we can deliver in parts of the world where there have been major failures in education over many, many decades. We can leapfrog that barrier by putting technology in the hands of people who are going to use it responsibly.

How have your own experiences and passions influenced this work?

I have a deep connection to South Africa. I was raised there and my mother is South African, and I've been involved with a clinic there for almost 12 years now...

I'm also fascinated by the power of online learning to help people who may have missed out on critical chunks of basic health literacy. Two and a half years ago I launched this massive open online cooking course for parents in the U.S. It had almost 200,000 parents involved and enrolled in the course, and that was just to teach parents to move away from processed food and go into the kitchen and make simple meals. I found there is such a need and desire to just have access to information that's presented simply enough for people with, say, an 8th grade level of education to really understand and gain something.

Using this technology in South Africa really challenges us to simplify everything. I think the educator has to put their ego aside; it's not about showing what we know anymore, but presenting the most useful information in ways that make sense to those receiving it. I feel like South Africa is a country that has gone through so much and defied the world's expectations by making a peaceful transition out of the apartheid era; if we can be a part of solving its current problems, then I think we can sleep well at night.

For more information, this short video documents the project. Funding and support comes from Stanford Medicine's Charles Prober, MD, and Paul Wise, MD, MPH.

Previously: Project aims to improve maternal and newborn health in sub-Saharan AfricaWhere is the love? A discussion of nutrition, health, and repairing our relationship with food, and Free Stanford online course on child nutrition and cooking
Photos courtesy of Maya Adam

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