Questions with...
Assistant Professor Matthew Jukes
Getting Wise About Sick Students
He's
worked in Gambia and Kenya, India and Tanzania. And no matter how unique
each of these countries is, Assistant Professor Matthew
Jukes says one thing remains constant: when kids are sick, they
don't do well in school, either because they miss classes or
because the long-term effect on their cognitive skills is devastating.
In a paper he recently co-published on the long-term effect of malaria,
for instance, he showed that children who are not protected from malaria
in the first five years of their lives have poorer cognitive skills
and drop out of school earlier. In October, about a month after he
joined the Ed School, Jukes sat down with Ed. magazine to
talk about disease, why we're not doing more to help, and how
a lap full of worms got him motivated.
Q: Disease affects education (sick children don't learn as well) and education affects disease (knowledge can prevent children from getting sick in the first place). Can we fix this catch-22, or is it too hard a cycle to break?
A: The answer to both health problems and education problems is solving the question of poverty. We're all trying to find ways to shortcut to that. It is a catch-22, but I don't think it's one we've really understood in great depth, or one that we've tried to tackle, until recently. I think it's only in the last decade or so that the evidence and the techniques have been there to combat diseases in school children that impair their learning. The programs to tackle them are still growing across Africa and other continents. Let's hope this jolts us out of this vicious cycle.
Q: What's the number one health problem right now for children?
A: Most of the work I've been involved in looks beyond the number one disasters or diseases in the world and looks at the ones that don't have the most devastating eff ects, but have an impact on everyone's daily lives and are incredibly prevalent. Half of all children in developing counties have anemia. Half are so malnourished that they're stunted in growth. A third have worm infections. If you think that all of these kids are feeling a little bit sick and maybe, in most cases, it's having a direct impact on their mental development, cumulatively that's a huge impact across the world.
Q: Why aren't we doing more?
A:There's no disease that's having a major impact on children in developing countries that can't be prevented or treated. There's a whole host of complex answers depending on the disease, but taking the example of giving a couple of doses of vitamin A [to cure night blindness], one of the problems is, you need someone to give that dose. For the most part, the infrastructure of health systems isn't strong. Drug distribution is a real problem. A lot of the work I've done is on school health programs. This is where a real strength is -- using the educational infrastructure to deliver drugs and training teachers to give simple treatments, which means you don't have to rely as much on the health system. Typically, the kids who need this the most are the ones furthest from urban centers, the ones furthest away from health centers, but they usually go to school, so it's a great way to reach the most needy kids.
Q: Can you give an example of a health campaign that worked?
A: Most of my interest has been with HIV/AIDS prevention and sexual behavior. Our record on the whole with changing sexual behavior hasn't been great. People fail to understand the communities and the reasons for the ways people behave. Before they start, they fail to engage communities. You need to give people realistic and specific targets for behavior change. Abstinence is a good example of something that isn't particularly feasible or realistic for most people. I worked in western Kenya with a group of researchers. One study informed girls of the increased risk of getting HIV/AIDS if they had sex with older men. That managed to change their behavior to having partners that were younger. If they have a feasible alternative, they're willing to act on information to change their behavior.
Q: How did you get interested in all of this?
A: I started off as a teacher in the Gambia after college and I wasn't much use. I wanted to return and try to be of some use. I got interested in the health stuff when I got a job working on a deworming project in Tanzania after I finished my Ph.D. In the early days of the project, I had a little puppy that threw up and I had a lap full of intestinal worms. Watching them wiggling around is quite a good way to have a tangible enemy.
About the Article
A version of this article originally appeared in the Winter 2007 issue of Ed., the magazine of the Harvard Graduate School of Education.
photo by Mark Morelli
