At the beginning of this academic year, four new fellows joined the East African Health and Behavior Fellowship Program in the Department of Social Medicine at the Medical School for the collaborative training program with the universities of Dar es Salaam, Tanzania, and Nairobi, Kenya.

The Program, supported by grants from the Carnegie Corp. of New York, is now in its eighth academic year. It is based on the premise that a comprehensive interdisciplinary (social science and medicine) approach to health problems is essential for their solution, especially when these are associated with global and local inequalities in distribution of resources and with complex societal changes.

The Program fosters a collaborative bond between social scientists and physicians. Each year, four senior East African faculty members -- two from the social sciences and two from the medical faculties -- spend 10 months at the Department of Social Medicine in a specially designed academic program to facilitate their own research projects and to further social science and medicine collaborations at their home universities.

This Program was organized in response to the serious health problems in Africa that reflect social and behavioral influences. An estimated 34 percent of the "Global Burden of Disease" is due to behavior-related problems, such as violence, diarrheal diseases, sexually transmitted diseases, including AIDS, and motor vehicle and other unintentional injuries.

African nations face a triple burden of morbidity: persisting high rates of infectious and parasitic diseases; a growing toll of chronic diseases; and a pandemic of health-injurious behavior (smoking, substance abuse, STDs, etc.). These health problems are embedded, on the one hand, in exploitative patterns of economic development and, on the other, in the erosion of social institutions and cultural forms in the face of rapid social change. Therefore, medical research in the developing world (no less than in the West) must apply the methods and concepts of the social sciences if that research is to lead to an understanding of illness behavior deep enough to design interventions capable of producing positive change. The standard biomedical and public health approaches must be complemented by social science in order to understand the social sources and consequences of ill health and methods for prevention and treatment. Yet social scientists and physicians knowledgeable about interdisciplinary research are limited in number on the African continent.

The Carnegie Corp. support has enriched the Harvard community through the participation of the Fellows in teaching, seminar presentations, and other interactions not only at the Medical School but also at the School of Public Health and its Faculty of Arts and Sciences. In return, it is now evident that the program provided by Harvard has contributed to the formation of a significant corps of professionals at both East African universities competent to formulate comprehensive research, analysis, and policy recommendations for the complex sociocultural and biomedical factors associated with health problems.

The Carnegie Corp. has also provided "health and behavior" institution-strengthening grants to both universities to support the fellows in carrying out interdisciplinary activities once they return home. Collaborative networks have been formed between social scientists and physicians at the University of Dar es Salaam and Nairobi. Former fellows, with students and other faculty whom they have influenced, are teaching and conducting seminars and workshops using the perspectives obtained at Harvard. In addition to the basic Carnegie funding, a number of other foundations are supporting specific research proposals.

Professor Kris Heggenhougen is the program's academic director and is responsible for coordination and day-to-day activities which draw on faculty from the Department of Social Medicine and also on scholars from throughout the University. The overall program is under the general direction of Arthur Kleinman, Presley Professor of Medical Anthropology in the Departments of Social Medicine and Anthropology, the program's principal investigator; and of Professor Mary-Jo DelVecchio Good as associate director of Harvard's Center for the Study of Culture and Medicine. Heggenhougen and other Harvard faculty visit East Africa at least once each year to work with the Fellows on their home ground.

Each spring, the fellowship culminates, collaborating with the Department's Freeman Fellowship Program, in a two-day Conference on Social Change and Health in Africa & Asia at the Medical School focusing on presentations by the fellows which have attracted a great deal of interest both from within and outside the University. Since September, a total of 28 fellows have completed the program and four new fellows joined the Department this September.

The 1997-98 Carnegie Fellows are as follows:

James Machoki M'Imunya of Nairobi is an OBGYN physician examining the role of social, cultural, and medical factors associated with male fertility and virility among infertile couples as seen at Kenyetta National Hospital in fertility clinics.

Joyce Olenja of Nairobi is a medical anthropologist interested in women, health and development. Her research will focus on morbidity and mortality of women during child-bearing years.

Yohana Mashalla of Dar es Salaam, is interested in medical ethics and human rights and will be researching those issues as they relate to the provision of health care and the promotion of human rights to the prison population in Tanzania.

Peter Kopoka of Dar es Salaam is interested in public health issues in the context of poverty, population growth, and development.