A New Milieu in St. Andrew

To the outside world, the Jamaican capital of Kingston is a chimera of irreconcilable differences, as gentle admonitions of "don't worry, be happy" waft across a landscape of poverty, decay, and violence. The gritty reality--children without hope, youth without a future, and wizened elders enduring a nightmarish existence in overcrowded shantytowns where the water is undrinkable and the sewers overflow--has become almost a cliché. The desperation is palpable in the disregard for schooling, the prevalence of teenage pregnancies, the unstable family relationships, the high unemployment, the poor hygiene, and the prospect of being consumed by violence or disease.

The East Central section of St. Andrew in Kingston is part of that patchwork of "unplanned and unchecked urbanization," as one observer characterizes it. Yet East Central, with a population of 45,000, actually straddles several communities. Within these, small pockets of vibrant business enterprise and enclaves of neatly groomed middle and upper class residences punctuate the otherwise bleak panorama.

It was the desire to turn the negative into a positive that led the Pan American Health Organization and World Health Organization (PAHO/WHO), with funds from the European Union, to attempt to stem the urban blight. By upgrading East Central's physical infrastructure, the three organizations hope to galvanize urban renewal, help alleviate poverty, and improve the health of the citizens by providing a safer, cleaner environment.

According to Dr. Richard Van West-Charles, then Country Representative for PAHO/WHO in Jamaica, "It was important to address the basic public health and public service issues facing this community, so as to minimize the risk of a disease outbreak and to help transform the general quality of life for the population."

The project's partners focused on several key areas: upgrading waste management systems, improving solid waste collection and disposal, increasing water supply and improving water quality, and developing community health education programs.

Project manager Victor Thompson notes that "while it was a very challenging exercise, we were able to complete the surveying, which in cases similar to this would have taken two years, in a matter of three months. And the facilities we built within the project period would have taken about five years under normal circumstances."

In many areas, community toilets and shower blocks were built, new wastewater absorption pits constructed, and pipes reconnected to water mains. These improvements were based on an engineering concept that permitted flexibility in matching the different infrastructure designs in each community. "This approach ensured significant savings since there was no need to develop a specific design for each area," says Winston Thomas, PAHO/WHO-Jamaica's environmental health advisor.

The transformation of East Central St. Andrew was accompanied by a community awareness program to help residents assimilate the significance of the changes occurring in their midst. Social worker Mary Sorum played a key role in the program, which involved the cooperation of the Jamaican Ministry of Health, the National Water Commission, and several other government agencies. The goal, she explained, is to make people aware of their new community responsibilities: "For example, in one 'yard,' there may be as many as 18 families. One person has been assigned to take care of paying the utility bills and encouraging other neighbors to make a minimal contribution to the overall cost. This gives people a lot more pride in their community as they come to realize that now they have a vested interest."

"The PAHO/WHO and European Union project has been one of the most practical expressions of community building," notes Dr. Peter Phillips, Minister of Transport and Works and Member of Parliament for East Central St. Andrew. "It took care of the most basic needs such as toilets and water supply and went beyond that to stimulate residents to appreciate the environment in which they live."

The citizens of East Central St. Andrew are buoyed by all the attention they've received from community groups, their government, and international agencies. It has given them the faith and courage to gradually rebuild their community from within.

South St. Andrew on the Road to Renewal

South St. Andrew in Kingston is also nicknamed "Zimbabwe" for the African nation where Jamaican reggae king Bob Marley triumphed as a performing artist and his song of the same name proved to be a tremendous inspiration to the victorious freedom fighters.

Marley also celebrated his early life on Second Street in South St. Andrew in his songs "No Woman No Cry" and "Trench Town Rock."

Street hustling, dilapidated vacant lots, gullies festering with solid waste, clogged drains, lack of water, and illegal electrical connections all posed a potentially explosive health situation. Warring youth gangs, the high crime rate, and sporadic political unrest further fueled the civic neglect and low self-esteem among the 50,000 residents.

Paulette Chavennes, the principal of Charlie Smith High School, described the community's sense of alienation this way: "It is as if in defiance of the withdrawal of civic and social services the people declared their own state, and adopted a spate of colorful international place names; hence, Zimbabwe, Angola, Mexico, Texas, Brooklyn, and Havana, for the various areas in their community." The real names of the areas--Arnett Gardens, Jones Town, Federal Gardens, Craig Town and Rose Town, found only on local maps--pale in comparison.

Yet buried beneath the urban decay and social unrest were the hearts and hopes of a people "yearning to breathe free."

It was this unfaltering energy that sparked the imagination and resolve of South St. Andrew's new Member of Parliament, Dr. Omar Davies--who is also Jamaica's Minister of Finance and Planning--to change the tide of events.

"If we are going to build good communities," Davies said during his 1993 election campaign, "then we must start with the health of the people and the state of the environment in which they live."

Davies was determined to make good on his promise. In 1996, he secured the cooperation of the Pan American Health Organization (PAHO) and the World Health Organization (WHO), along with funding from the European Union. This partnership, over a two-year period, would carry out a major upgrading of South St. Andrew's water and sanitation infrastructure.

Davies worked hard to sell the project to his constituents. "Germs know no boundaries, especially the imaginary political lines drawn between communities," he said at the official launch. "It's not only about the work opportunities that this project will provide. It's about a better environment for you and your children."

Dr. Richard Van West-Charles, PAHO/WHO Country Representative in Jamaica at the time, also hit a serious note when he said: "It is my hope that the project will serve as a bridge to peace, as well as being an important input for personal and community development, and that it will contribute significantly to the reduction of mortality and the improvement of the quality of life for people."

James Moran, head of the Jamaican delegation to the European Union, said the project was "a flagship operation" that would both benefit and involve the community, a sentiment endorsed by the then-Minister of Health, Dr. Peter Phillips, who called for an end to the waste of "community and talent."

Van West-Charles brought together a team of engineers, technicians, sociologists, and health educators, along with staff from the Ministry of Health, the community-based Vision Development, the National Water Commission, and Metropolitan Parks and Markets, which is responsible for Kingston's solid waste management.

By early 1999, some dramatic changes were taking place in South St. Andrew. Health indicators for the population have taken a positive turn, and a quiet revolution has set the community on a positive path to renewal.

Water, once a rare commodity, now flows at high pressure through the pipes into the homes of residents. Water leaks, which hampered the flow and turned streets into rivers, have been repaired. And hundreds of residents now have indoor toilets, some for the first time.

"We had to address years of neglect of the water, sewerage, and solid waste systems," said project manager Ian Gage, "and we carried out a health education program for residents who were used to disposing of their solid waste in open lots, gullies, derelict buildings, and open manholes."

The upgrades included repairs to and replacement of faulty pipes, the installation of a new well pump, the removal of debris blocking sewerage lines, the re-laying of sewerage mains, the reconstruction of manholes, and the replacement of damaged or lost manhole covers.

Health education programs reinforced the impact these physical changes would have on the community's well-being. Messages reiterating the rudiments of personal hygiene, good nutrition, a healthy lifestyle, and protecting the environment reverberated at health fairs and town meetings.

One project highlight was a series of weekly sessions held at the Charlie Smith and Trench Town Comprehensive High Schools that included interactive lectures and demonstrations with teen role models Grace Jackson, an Olympic Silver Medalist; former Miss Jamaica Cathy Levy; and beauty consultant Bev Cork.

Artistic expression was the focus for a summer camp, as youngsters, under the guidance of artist Colin F., threw their creative energy into a poster and T-shirt contest with the theme "Let's Keep Our Environment Clean." In addition, 18 teachers attended a workshop led by PAHO/WHO consultant Annett Wiltshire, who provided them with guidance in developing health education curricula for their students.

The feedback from the participants in these activities was most encouraging. "The nutrition session with Grace Kitchens was very stimulating," according to Grace Smith, the principal of Trench Town Comprehensive High School, "and students interacted positively. But they were particularly motivated by the grooming and personal hygiene sessions." And 15-year-old Kerry-Ann Thompson was so captivated by the dramatic performance of the Cathy Levy Players that she was rewarded with a scholarship from the theater group.

While it is still too early to predict the long-term impact of these initiatives, it is clear that the road in South St. Andrew now leads forward. The seeds have been planted, and as Richard Van West-Charles told residents, "the sustainable components call for the collaboration of every member of this community . . . to protect the gains of the project."

Bob Marley, if he were alive today, would see that, in Zimbabwe and other troubled areas that provided the inspiration for his art, indeed, "hope springs eternal."

---

Carmen Tipling is a writer for the Kingston-based Communications Consultants, Ltd., and served as education consultant for the South St. Andrew project. Dr. Richard Van West-Charles, currentlyPAHO/WHO Country Representative in the Bahamas; Winston Thomas, environmental health advisor; and Victor Thompson and Ian Gage, project managers; also contributed to the preparation of this column.