Miriam Were – Retired champion of public health is far from tired

What started as a childhood passion — ensuring basic hygiene was observed —gradually evolved into a life-long career. From her days as a high school teacher tovher stint at the United Nations, Professor Miriam Were has been at the forefront of thevwar against preventable diseases, despite its less than glamorous status in medical circles. She has also championed youth empowerment through Uzima Foundation, making a difference in the lives of many. Poise and grace are the defining features of Professor Miriam Were. Her trademark
long kitenge, trim figure and matching turban belie her mid-70s age.

Words of Wisdom

• For Kenya to survive and thrive there must be willingness to sacrifice for somebody’s well-being.
• We have to build both our men and women so we don’t have disempowered people.
• The main obstacle to companionship and happy marriages is disempowered partners.
• I hope we can raise a generation of young people who understand that when you give, God does not forget you.

Were’s life and work are strongly influenced by biblical principles, learnt in the Quaker Friends Church as she was growing up. The church emphasised communal living, simplicity, temperance, hygiene and peace with no domestic violence. The church-appointed Bora Afya (public health) personnel made sure every family in the village where she was raised dug a pit latrine, drank water from protected springs, and washed and sun-dried their dishes. This hygienic living greatly contributed to community health within her village, unlike in neighbouring villages, where many children died. Were’s first experience with death in her village was when she was 15, she says. Self-effacing, Were attributes her success not so much to her abilities but to the opportunities she had. “My two older sisters were very bright, but there were no high schools for girls, so they could not further their education,” she says. Her dream of becoming a doctor stalled because the high school she attended had no laboratories for chemistry and physics which she needed to qualify for medical
school. However, she would volunteer to wash children’s feet and faces during church camps and the missionaries determined she would make a good health worker. They therefore organised a scholarship for her to study sciences.

Were became the first African to attend a pre-medical programme at the William Penn College in Iowa, in the US. She found basic terminology in physics and chemistry confusing. When the professor realised she had not studied the subjects in high school, he gave her textbooks to help her catch up. She ended up being the top student in her Bachelor of Science class. After graduating, she started a degree in medicine, but homesickness prompted her to abandon the course and return home in 1965. Her mother had died earlier. “I feared
my father would also die,” she says. Although she wanted to study medicine at Makerere University in neighbouring Uganda, the government needed more science teachers so she took up education. She reported to her first teaching post just after the mock exams. The girls had failed the chemistry and biology papers. “We are going to pass,” she assured them. Three months later, they all passed their final exams. Were debunks the myth that girls are weak in sciences. “If the teacher is a man who dismisses women as not understanding science, what do you expect?” She personally enjoyed teaching the sciences and physical education. She remains physically active,
taking regular walks with her husband. While teaching at a boys’ secondary school, Were noticed that many students were often too sick to learn. She would send them to City Council clinics where they were always prescribed aspirin.

Tired of seeing sick children treated so casually, Were quit teaching and enrolled for medicine at the University of Nairobi. Balancing family life and study would have een a challenge, but for her experience in preparing lessons. Medical school was not as difficult as her first degree, she says. When she became Dr Were after graduating, she realised that doctors were overwhelmed with work. They were too few to meet patient demand. She wept for each patient that died. Every morning at the Infectious Diseases Hospital (today’s Mbagathi District Hospital), she had to sign death certificates of five or six children who had died during the night. She was distressed that most deaths were from preventable diseases like diarrhoea and malaria. Tired of signing death certificates, she decided to promote public health. She embarked on postgraduate studies in this field in the US. It helped that she had been the best student in medical school.

However, public health was frowned upon in the medical fraternity as not academically challenging, not prestigious and not lucrative. “People feel you’re wasting your life on malaria and diarrhoea.” Her response to this outlook is that she did not mind wasting her life if it kept children alive. She graduated and returned to Kenya where she initiated the first Master of Public Health programme at the University of Nairobi; the first class graduated in 1985. She rose to become the head of the department of community medicine at the university. An unexpected opportunity then arose. Her efforts to improve community health had been noticed by the United Nations Children’s Fund (UNICEF) boss, who recruited her as soon as her first class had graduated. “I explained to him that I was married
with five young children. He then offered my husband a position in their nutrition department.” The couple was posted to Ethiopia.
Were describes the UNICEF jobs as providential. Their firstborn had just finished her A-levels and they were wondering how to finance her university education. As civil servants, they had no savings and often took bank overdrafts to pay school fees. As UN staff, they were now eligible for education grants, which saw their children through their undergraduate studies.

She always believed in giving even when the family was experiencing hardship. With her qualifications, her salary was hefty, but her priority was to uplift others through better health and education rather than indulge their children. Were and her husband used savings from their UN engagement to found Uzima Foundation in the 1990s out of concern for disadvantaged youth, many with zero access to education. The amount was “princely” and could have bought three or four mansions back then. She shares that they neither felt deprived nor did they hesitate to spend their savings on educating youth in entrepreneurship, financial literacy, health and sanitation and conflict resolution. The Ford Foundation and the Rockefeller Foundation pitched in to help. When the Ministry of Youth was established, the couple thought the government would leverage on their successful model to do its duty towards the youth. However, she says, “It has been disheartening that interest in youth work has been very little.”

Still, Uzima has successfully worked with more than 100,000 youth in Nairobi, Nyanza, Western and Mombasa. But it has not been without its challenges. Were recounts how they were low on funds and discouraged by lack of support and pondered shutting down in 2007. The tenacity paid off. In January 2008, post-election violence erupted. Someone phoned Were to ask if she had read the newspaper. It turned out that in Nairobi, an Uzima girl, was applying her conflict resolution skills to help stop the post-poll violence. The scenario was replicated. “In different parts of the country, Uzima youth would stand in front of these wild, fellow youths and say, ‘Let’s talk. Please put out the flames.’” Were believes that youth have great potential, if nurtured. When she retired from the UN in 2000, Were chaired Kenya’s National AIDS Control Council (NACC) and the African Medical and Research Foundation (AMREF) for some years. Meanwhile, although the Ministry of Health had steadily increased funding for hospitals and clinics, mothers and children were still dying. Baffled, the ministry
formalised the Community Health Strategy, which she and fellow colleagues had been advocating for. It was now time for Were to support the government by applying her expertise for the health and well-being of Kenyans.

It is for this reason that Were considers 2006 one of her best years. “After 30 years of saying let’s make it official, the government finally sat up and took notice.” They began by creating a national curriculum for the training of trainers, who would, in turn, train at the county, sub-county, and village level. Village health workers would then educate men and women in disease prevention. They would also be qualified to treat certain acute illnesses on the ground. “Eighty per cent of our children die from diarrhoea and pneumonia. Nurses practising in villages can easily administer antibiotics,” she reckons. With her community-based healthcare background, Were’s professional journey has been to support the implementation of the adage, ‘prevention is better than cure’, by focusing on reducing the incidence of illness and death in the grassroots. She says that these measures have proved cheaper and eased pressure on health centres, enabling them to treat more complex, non-communicable diseases. She shares that “overstretched doctors tend to prioritise children in the queue, suffering from diarrhoea or vomit, yet these are highly preventable illnesses. It’s easy to overlook the child with undiagnosed congenital heart disease or leukaemia because 400 patients are waiting, and you can only give two minutes to each patient.” She feels that as long as medical practitioners are preoccupied with the preventable diseases, they can barely treat the non-communicable diseases.”
Women are a key solution to solving this health challenge, she says, as they are the custodians of families and villages. She adds that, as primary caregivers, they are responsible for keeping families healthy. As a mother, wife, educator and community health advocate, she says: “We mustn’t underrate ourselves. We can be who we want to be.”

Her husband has been a strong source of support for the champion health practitioner. She favours cooperation over confrontation and shows her husband deep respect through consultation. Teamwork in financial matters has kept their marriage strong, she says. The don cautions on the pitfalls of women-empowerment approaches that humiliate men. During her visits to the village, Were would notice that men always held back and thought they were either lazy or disinterested. Talking to them, she found they were shy. All efforts had gone into empowering women to the exclusion of men. She dreams of thriving families where couples support and build each other up and
help raise children to create strong societies. Were’s tireless efforts have not gone unrecognised. She is the recipient of many awards including the Elder of the Order of the Burning Spear (EBS) in 2005, the inaugural Hideyo Noguchi Africa Prize in 2006 and the Queen Elizabeth II Gold Medal for Outstanding Contributions to International Public Health and Supporting the Health Needs of Disadvantaged People in 2007.

She is still going strong in her service to Kenya, and has been serving as the Chancellor of Moi University since September 2013.

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