meningitis
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- Nov 17, 2010
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wakuu wanajf kwa wale wasomi,wadau mbalimbali wa masuala ya elimu ningeomba muipitie hili andiko halafu tujadili bila kuweka ushabiki wala matusi.
The merits and demerits of private and public education have been debated the world over. Covering primary schools to universities, the voluminous exchange is as yet far from any resolution. I recently taught at a private university, and then at a public university in Tanzania. My experiences in the two settings were, on a crucial dimension, so sharply contrasting that I am compelled to put my thoughts to paper. Perhaps, there is still a lesson to be learned.
Lecturing at the AKU
In April 2006, I had the opportunity to teach the Master of Medicine (MMed) degree students at the newly established Agakhan University (AKU) in Dar es Salaam. The class had three first year and three second year students, all qualified doctors now specializing in family medicine. With two decades of dealing with students at this level behind me, it should have been a straightforward task. Sadly, it was not.
It began with a visit I paid, upon the suggestion from a colleague, to the director of the MMed program at the AKU. The campus is adjacent to the Agakhan Hospital, in a pristine beach side environment, shielded from the grime and bustle of the city. Though my visit was unannounced, I was received well, and told that I had come at an opportune time. For it was in biostatistics and epidemiology, my area of expertise, that the MMed study program had not made much headway. Even the second year students, who were about half way into their training, had not had so much as a lecture on it.
I was a little bit surprised. Biostatistics and epidemiology are not core subjects in basic medical training. But for any postgraduate qualification, be it in surgery or pediatrics, they are key subjects, started from day one and stressed throughout. The students have to read and critique a host of research papers, design and conduct their own research, and later as consultants, keep up with the latest in their field. Without a good grasp of epidemiological and biostatistical concepts, not only can they not undertake sound research, but, when reading current journal papers in general medicine or their own specialty, they essentially become semi-illiterates.
Feeling that the students deserved better, I volunteered to help out. The director expeditiously organized a meeting. Present were himself, two AKU instructors, an American professor cum consultant, and myself. After initial introductions, I was handed a draft of the syllabus for the subject. That was my next bit of surprise. The half a page document was more a copy of the table of contents of a standard text than something crafted with effort or thought. In this era of email and the Internet, how difficult is it to secure, borrow or copy a decent, detailed syllabus? How can a postgraduate program even begin without one?
Keeping my impressions to myself, I talked about how the traditional approach to teaching biostatistics and epidemiology yields poor results. Unduly crammed with formulae and numbers, it is not integrated with the clinical matters a doctor learns. Biostatistics has to be contextualized within medicine and public health. It has to be infused with relevant examples so that the students appreciate that without basic quantitative concepts and statistical logic, their comprehension of other subjects is deficient. The traditional approach breeds a class of bored students, who memorize this and that, and forget them once the examinations are over. A good biostatistical and epidemiological training, on the other hand, produces critical thinkers able to evaluate the validity and relevance of the plethora of information on medicine and public health doctors come across in their professional lives.
The immediate issue was: What was to be done for the current AKU MMed class? It came to pass that I would give a series of lectures (once a week for an hour and a half), to jump start the teaching of the subject, to give a sense of direction, and as well to provide a model, for the instructors who would take over, to build on. I was more than happy at the prospect. Teaching is my passion in life; give me a student and I am ready to roll.
As part of the preparation for my first class, I inspected the classroom. It was a well kept, small but right sized, air-conditioned room with fine furniture and the teaching aids I would need. The material for photocopying was efficiently produced by the secretary. I was shown a cabinet full of books in her office, and an adjacent room with the latest issues of important medical journals. Unfortunately, there was not a single book for my subject, and it was not clear how much access the students had to all this material. But on the whole, the stage seemed set for a fruitful pedagogic exercise.
On the first day, and as is usual for me, I was early. While I was mulling over how to start my lecture, the two AKU instructors came. After a while, the students started to trickle in. Twenty minutes past the start time, five of the six were in. I normally start on time. But this was the first day in a new place, and I wanted all to have the same foundation. So I began late. Aiming to review basic concepts as well as discern the general state of knowledge of the class, my lecture was more didactic than usual. The ensuing discussion was satisfactory. At the end, I gave out the reading material for the next class, and urged all to come in on time.
The handouts for the second class were efficiently produced as well. Again I went early.
This time one student, one instructor and the director were there by the start time. Again the other students slowly trickled in; after twenty five minutes, four were finally there.
One who was absent the last time was now present, but two who were present then were now absent. Though my blood pressure had risen a few notches, I started as I normally would, asking questions about the last lecture, and quizzing the class about the article on field evaluations of the polio vaccine that I had given them to read. To my dismay, only one student seemed to have taken the trouble to read the whole article.
At this stage, I expressed my annoyance in a forthright manner. This was not what I expected from postgraduate students, I said. And this was not the Kariakoo Market where one did what one wanted. Late arrival, absence without permission, beeping cell phones, etc., were unacceptable in my class. And reading the material given was mandatory, not optional.
The class seemed taken aback at my firmness; but this is how I teach. I put in a lot of preparatory effort to teach as well as possible. When needed, I extend additional assistance. But no matter where or who I teach, my standards and expectations are invariant. Work hard and you are rewarded; else, you face my wrath. Any diligent student will find that my evaluations are fair, yet upto to the required level.
Then I proceeded with the lecture. In a hurry, I covered what I had planned to, and dealt with some queries at the end. Again I assigned an article to read for the next class, noting the points they needed to reflect on. Later, I expressed my concerns to the director. His told me that these students were like that. It was as if they were doing everyone a favour just by coming to class and doing any work at all.
A week later, with the notes and more handouts ready, I went early. This time, the classroom was full, but not with the people I expected. Someone had reserved the place for the day for a team of external consultants. Undeterred, I barged in, and told them that they had to leave in two minutes. And that, with a wry face, they did.
Sometime later my audience started to trickle in. First, it was the director and the instructors. But no students! It was twenty minutes before the first one showed up. He did not seem apologetic. He said that his colleagues had been given the task of orienting a group of new interns. So he was unsure how many, if any, would come to class. One other student did pop in later, but soon popped out. And then the two American consultants arrived.
We were more than half way into the class time. I was plainly dejected. My firmness had come to naught. Even in the presence of the director, the students seemed to be taking matters too lightly for my taste. A teaching hospital must clearly plan the clinical duties and educational sessions for the residents and postgraduates, so as to avoid such conflicts. How can one teach in such a chaos? And who was at fault, anyways?
With just a single student present, I lost all the incentive I had to give my lecture. I was about to leave when the director said, "Since the professor is here, let us pick his brain to see what advice he can give on student research." The student at hand was interested in undertaking a research project related to the WHO guidelines for the treatment of asthma.
One of the external consultants had already advised him on the matter. So a discussion on how to proceed with it began. To put it mildly, the cart was being put miles ahead of the horse here. When after one and a half year's into their training, the core subject that prepares students for research had hardly been taught, and when my efforts to correct that shortfall had gone no where, how could one talk about doing actual research? Or about getting research funds? The basic subject had to be taught first, period. There was no other issue. Yet all seemed oblivious to that elementary proposition. Tired, I just mumbled a few words, posed a question or two, and called it a day. When I walked out, it was with a silent vow not to put my foot into that door again unless I had firm evidence that things had changed for the better at this university.
Lecturing At MUCHS
My experience at the AKU had left me crestfallen; for the first time in a teaching career spanning three and a half decades, I felt I had achieved nothing; it had been a waste of time, for me and the students. Perhaps I was too old; maybe my skills had dulled over time; maybe this was the time to retire from teaching. But a few months later, I taught short courses, also to medical postgraduates and research fellows, at the University of California, Los Angeles, and at the University of Oslo, Norway. At both places, the courses were a resounding success (and I am not bragging). The feedback I got from the students and the course organizers was very positive.
My spirits revived, I was ready for another plunge into the challenging tendrils of the Tanzanian academia. That I did in February 2007, when I got a chance to teach at the Muhmibili University College of Health Sciences (MUCHS) in Dar es Salaam. The class had 32 first year postgraduate medical, pharmacy and dental students. The medical students were in fields ranging from internal medicine and pediatrics to surgery and microbiology.
Their level was the same as those at the AKU. Over a six week period, I was to cover similar material, that is, the basic aspects of the design, conduct and analysis of clinical trials. They had had some lectures on biostatistics already, as I came in at the end of the semester.
When preparing for my much larger class, I was told that funds for photocopying any material but the examination papers were not there. The usual thing to do was to give one copy of each handout to the class representative, and everyone would make his or her own copy. I did that for some of the papers. But for the main class notes, I made 16 copies of each set at my own expense (so two students shared a copy). Also in my talks with the previous instructors, it was not clear exactly what topics had been covered thus far. The physiology laboratory served as the class room, just adequate, but with too small a writing board. The needed books were in short supply; the library only had old titles. Nevertheless, I was ready to roll.
My first class began, as at the AKU, in an exploratory fashion, seeking out what the students knew and what they did not, covering basic concepts, and framing general issues to motivate them. Twenty nine students were present, but some had walked in late, and some seemed not to be paying much attention. I ended, as usual, with an emphasis punctuality, reading the class material, doing the set assignment, and putting in the necessary effort.
A week went by. The second session did not begin well. Only 17 of the 32 students came in, and some, a bit late. Only a few had done the assignment I had set, and their answers showed they had not put in much effort. As I questioned them, I found that not many had read the article set (the same I had given to the AKU students), and those who had done so had only read it superficially. Predictably, I turned livid and thundered that I would not tolerate such behavior in my class. We were not at the Kariakoo Market. Since I worked hard to teach them, I expected them to do the same. As at the AKU, the students were surprised at my outburst. Here they were, qualified doctors and future specialists, being bullied like primary school kids!
But now they became attentive, and the session proceeded in earnest. We parted our ways after the material and tasks for the next week were given out. At the next class, I was earlier than usual. This time a few students had preceded me, and in no time the room had 28 fully attentive students. Many had read the material given, some posed thoughtful questions, and a fruitful discussion ensued.
The MUCHS students responded as mature students should, and began to clean up their act. From then on, the lectures went as they should. At the end, I gave a test and set questions for their final exam. Despite a shaky start, progress was made. Despite my sternness, the students were respectfully grateful that they had learned things that were important. When that exercise ended, I was ready to redo it at any time. In a subsequent discussion with the principal of MUCHS, my opinion about the quality of the students at MUCHS was elicited. My response was unequivocal: they can compete with those in any part of the world provided we, their teachers, take the time and trouble to teach them well, and lay a solid foundation.
Why the Difference?
The AKU is a well endowed institution. The MMed class size was small enough for productive individualized instruction. Though recently setup, it is an extension of a larger and older medical training facility in Nairobi. And the latter is linked to the prestigious
Agakhan University in Pakistan, which in turn has academic ties with a major Western university. The AKU students in Tanzania, moreover, get comparatively high stipends, enabling them to pay more attention to their studies.
At MUCHS, the resources for teaching were scarce. The class size was not only much larger but had doubled in recent years. The lecturers had valid complaints about the additional work load. Here too, I found a lack of coordination in teaching and an initial lethargic atmosphere in class.
In one place, my efforts to remedy the situation backfired; in the other, the students came to their senses. At the AKU, I walked out dejected; at MUCHS, I was elated. At MUCHS, the students and staff appreciated my efforts; at the AKU, I am not sure if I was missed at all. How does one explain the difference?
The typical answer blames the students, as I heard at the AKU. At MUCHS as well, some lecturers talked about disinterested, unresponsive students. If there is truth to this claim, one has to ask why they are like that. Only ineffective teachers and poor administrators blame the students as a group. Students will always be students: a few work hard and excel, some hardly care, but most invariably fall somewhere in between. To blame them as a group is not an explanation for, nor a solution to, any fundamental problem in the academia.
While there is no simple answer, the key I think relates to having a sound academic tradition and accountability. At the AKU, I did not encounter either. That in the director's presence the students got away with what they did spoke volumes about the structure and standards of the postgraduate program. There seemed to be no incentive to adhere to basic academic discipline. If the prevailing sense is that you will pass and get the degree, secure research funds, etc., with minimal effort, then why bother?
At MUCHS, the students got the message; if they continued to play around, there would be consequences. A sense of academic responsibility prevailed. And they came to realize that matters of value to their professional lives were being taught. If someone was taking the trouble to teach that, they were willing to play their part.
Let me be clear: I do not want to romanticize the situation at MUCHS. It is a vast institution; my current experience was a limited one. It too has major problems. In particular, the attention on, and the resources for, teaching are far from adequate, and need definite enhancements. The level of academic integrity among the students is not satisfactory. Two students in my class did behave in a somewhat inappropriate way. But when I noted that, they were truly sorry and apologized. Despite such problems, a sound academic tradition four decades in the making is alive at MUCHS. At the AKU in Dar es Salaam, I just did not find it. That in a large way explains why my experiences in the two places were so distinct.
Privatization in Perspective
The AKU is a private university; MUCHS is a college of a large public university. Are there any implications from my saga for the debate between private versus public university level education. Generalizing from a limited and selective experience is perilous. As a statistician, I am well aware of that. But even such a specific event, if placed in context, may allow the expression of words of caution.
This context is the era of privatization we live in. Privatization is the answer to one and all problems of Africa. State interference is the root of all evil. When everything is finally privatized, an economic paradise will descend on this planet. This is an indisputable truth; if you doubt it, you need a psychiatric check up. For that is what the powers based in Washington, D.C., and their minions elsewhere have decreed.
Nevertheless, I have my doubts, expecially for education in general, and university education in particular. Many of the large public universities in Africa began about half a century ago, to quench the dire need for highly educated manpower at the time of independence.
In their heyday, they delivered, even by the august Western standards, quality education. Mainly due to absence of mechanisms for democratic accountability, failed World Bank inspired economic policies, the consequent brain drain, and political debauchery, they underwent a precipitous decline. While a few are showing signs of recovery, most still face considerable hurdles.
Their problems are not intrinsic to them being public universities as such. But it is often presented as if that is the case. As their enrollment rises markedly, the funds and facilities do not. As students face more problems, the complaints of the lecturers rise. As the institution secures more negative verbiage, the effect is seen as the root cause, and a self-fulfilling prophesy is on the way to realization. That is what I fear most. In the zeal to develop private universities, the public ones may be starved, and Africa will lose the fine intellectual heritage and academic tradition that has grown up with and produced by them.
Another unsavory ingredient of privatization is corporate style showmanship. In the name of public relations, significant attention is paid to creating and maintaining an elegant public image. Private and even the public institutions, in education or other sectors, are falling under the spell of that management ethos. In the haste to be viewed as marketable or reputable entities, the image overshadows reality, and a corporatized facade, with the glitz and glamour of superior education, emerges. A sophisticated image under which style subordinates substance replaces rigorous training. Students get degrees but not a quality education. But no one complains; students have what they desire; the institution acquires prestige and more students; the donors, owners, and the public are satisfied as well. It takes a while for the reality to sink in. Eventually things begin to fall visibly apart; and rumors abound. When, for jobs with skills and responsibility, the graduates from elsewhere seem to be preferred, people wonder why?
At the AKU, this is what I observed: an inkling of a corporatized education. On the surface, things were immaculate and efficient. But the pedagogic reality beneath was another story. With an intake of three to four students a year, it is not a big deal, for example, to provide each a good textbook on biostatistics and epidemiology. If a key subject is not being taught, it fills a part of the vacuum, and gives the students something they can cherish for years. With about three hundred dollars a year, order the books through Internet, and have them delivered to a UK, Canadian or US address. A visitor from there, and the AKU has plenty, makes the physical delivery. Easy, but the necessity of the task has to be realized first, and the ground work done.
This is my view: while a teacher is the guide over an arduous terrain, the main part of education is one's own work. Education is about books and practice; burning the candle through the night; thinking and doing, thinking and doing, over and over. It is demanding work, reflecting on complex issues and learning the tough tasks, be it in law or physiology, medicine or engineering. Theory and practice integrating the distinct skills and strands of knowledge; and even pondering on the limitations of what one is learning: that is the ABC of real education. No computer or gadget can replace that. If a scholar or an expert has to emerge at the end, education has to occur the old fashioned way [1].
Those are the two dangers associated with privatization that I worry about (i) even more neglect of public universities, and (ii) of university education being trivialized under the spell of a corporatized, American influenced, ideology of showmanship. Additionally, let us not forget that in the name of privatization, the wealth of Africa is being plundered, left and right, by foreign firms.
Since independence, Africa has educated hundreds of thousands of its daughters and sons in all areas of science, technology, social science, medicine and the arts. Yet, in more ways than one, this remains an era of intellectual servitude for Africa. The educated generation of the past, for the most part, did not live upto its historic challenge to break that bondage. Hence today what the"donors" and international bankers say to
Africa is the final word on matters of health, agriculture, industry, communication, trade, governance, and also education. This word is never about making fundamental changes but about small solutions here and there which do not disturb their dominant position. The educated in Africa then sing the tune of the "donors," for the most part. We then go from one crisis to another, one temporary fix to a bigger problem, and remain mired under an endless cycle of mass poverty, disease, ignorance, alienation, and eventually, societal violence.
It thereby is an era that cries out for bold thinkers and experts from within Africa. In tandem with the people, they have to innovate and develop the directions and strategies to take us out of this quagmire, and struggle for their realization. Our own universities, public and private, have the urgent and basic responsibility to produce them.
So I am not arguing against private educational facilities; they are here to stay. Well run private universities do exist, even in Tanzania. There is room for cooperation between the private and public universities as well. For the sake of the students, I hope that the situation at the AKU has improved. But taking care of that is the job of the parent organizations. They must ensure that when a place is called a university, it does function like one.
As a long time member of the public, I blow my trumpet for the public universities. As a student at the University of Dar es Salaam four decades ago, I struggled under a rigorous and demanding curriculum. It was an exhausting venture, but eventually worth it. There was a concern with relevance to local conditions. Remedying that deficiency was under way when the place (like the nation) was beset by one crisis after another. Now it needs to reclaim that glory, and achieve even loftier goals.
In conclusion, our public and private universities need to uncompromisingly strive for academic excellence at the same time as they produce professionals, experts, writers, and thinkers to address the major health, educational, economic, social and other problems facing the continent. They need to be nurtured and valued, and held up to a high standard of scholarship and relevance. In particular, in the zeal to privatize, let us not neglect our public universities. Let us not conflate image with reality, or confuse a cheap imitation with sound academic training. If we do, it will be at our own peril, as we may then end up with the worst of both the worlds.
Notes: [1] For an erudite and sobering account of how computers can miseducate, see
Clifford Stoll, High Tech Heretic: Why Computers Don't Belong in the Classroom andOther Reflections by a Computer Contrarian, Doubleday Books, New York, 1999.
Prof. Karim F. Hirji is an itinerant academician, medical statistician and seasoned writeron educational issues.