Pearl Nwashili
NigeriaFellow since 1991

When Pearl Nwashili saw more cases of AIDS showing up in the private test labs she processed as a microbiologist than the national government admitted existed in all of Nigeria, she launched her current campaign to contain the spread of AIDS among high-risk populations. It is the first step of her lifelong mission to bring health education and service to everyone, especially the marginalized.

#Health economics#HIV#Nigeria#Public health#Sexually transmitted disease#AIDS#Health#Health care

The Person

Pearl was sensitive, from an early age, to the plight of people who had limited or no access to the established health care system. As a child she brought home small children who were chased way from a nearby clinic because they could not pay for treatment. She washed their sores and used scraps of sewing material to dress their wounds.In school, she was a leader on the debate team, and decided to enter the health care field to satisfy her "personal ambition to serve humanity." She studied microbiology, which led to her subsequent job in a testing laboratory.When Pearl was confronted with the country's hidden AIDS crisis, her underlying fire and values led her out of the lab and onto the front lines.

The New Idea

Pearl wants to help stop the AIDS epidemic in Nigeria before it wrecks the country. She knows all too clearly the human and developmental disaster that is striking much of Central Africa, where, as everywhere else, awareness is lagging far behind the danger.She has focused on the motor parks first, both because they are already AIDS pockets and because they are major centers of transmission. Working initially in several big motor parks in Lagos, she has worked out a successful approach that she is now ready to spread along the motor routes up and down Nigeria and eventually across West Africa. She is just now opening her work in the north at a motor park in Kano.Pearl's organization, STOPAIDS, organizes the people of the motor parks to teach themselves about AIDS and other sexually transmitted diseases (STDs) and organizes immediate, on-site basic health care and referral services. She is now beginning to learn how to reach out to school dropouts and other vulnerable groups.The key to Pearl's approach is that she gets those at risk and their organizations to do the job themselves. In the motor parks where STOPAIDS is located, the organization works through the powerful transportation union network to spread AIDS education. In turn, union leaders and members provide feedback about health issues and needs among their people, thus enabling STOPAIDS to target its effort expertly.Pearl's approach goes way beyond the union leaders. She has recruited as "health workers" many of those at the bottom of motor park society, the out-of-school youths hanging out the rear door of a bus, hustling for additional riders by day and leading the fast, drug-filled life at night. As they go through her training, they often clean up and begin to dress better as befits their new role. Although Pearl's first target is stopping AIDS, her vision is much broader. She wants to help all of society, especially the marginalized poor, develop a culture of health. She is developing strategies to take on lack of sanitation in public places, unhygienic hospitals, the broad abuse of both curative and hallucinogenic drugs, and a number of other health hazards.

The Problem

Nigeria's health care system has not been able to provide effective health education or services to most of the country's 120 million people. Important parts of the population have been marginalized. For that matter, so have many important public health issues. The government's early denial of the AIDS problem is one example.These failures are not the result of ill will. They are, generally, reflections of a harsh reality: the Nigerian government has very limited resources to bring to bear. That is why Pearl is working to build a self-help, preventive health care alternative.The motor parks are a tough but very important proving ground for her approach. Motor park drivers, vendors, and others who are intimately associated with them represent a major high-risk population. Moreover, the nature of their work, especially that of the long-distance truckers, keeps them away from their families for extended periods, which makes them vulnerable to exposure to multiple sex partners across the nation and beyond. The conditions and lifestyles of the motor parks are not conducive to good health, and the people who work in the parks are not likely to seek health care in clinics or hospitals because of the time and cost involved.

The Strategy

"STOPAIDS can't do the job itself. We are catalysts: we can motivate others and accelerate action. But we can't do it ourselves." As these comments suggest, Pearl's core strategy is to get society's existing institutions to take up her campaign to move Nigeria to a culture of health.She has started with the motor union and with truck touts, but she is already working on other potential allies. She would, for example, like to engage such disparate but important groups as the market women associations, farmers' meetings, local governments, and the military. She sees in these institutions the ready structure and influence to disseminate her message quickly. Although she is focusing on AIDS and closely linked STDs, Pearl is thinking about changing the name of her organization to convey her broader long-term goals.