Month: July 2015

Wrapping Up

| Lucy Ramos
Turns out I had no problem staying busy for my time on site without the research team.
I got consultation from one of CLI’s resident obstetricians, who offered great feedback including the ever-looming “does the District Health Office know about this?” question. This, along with advice from my advisor, and 2014 conversations where I inquired about the need to involve the govt public health orgs, led to a field trip yesterday. After several stops at various DHO buildings and lots of help from a CLI surgeon/administrator, we had a parking lot meeting with Malawi’s Coordinator for Safe Motherhood. It actually left me feeling much more accomplished than the term ‘parking lot meeting’ implies.
 IMG_3098
I also found out that the CLI Maternal and Neonatal Mortality Committee I was proposing to be established already existed. !
And, that the Ministry of Health has, in fact, updated their maternal death audits recently. Which means changes for ours—but good ones, since the additions they made align with a portion of the information we included in ours.
Finally, I put together a ‘sustainability report’ that outlines what project management and resource alignment needs to happen to ensure that this whole thing doesn’t lose steam when I leave. This involved calculating what the project costs and how long my fundraising could sustain it.
Good news: The money I fundraised (plus some that I saved), is enough to support the maternal and neonatal mortality surveillance for 18 more months!
This is a significant amount of time. Long enough to plan for 12 and 18 month evaluations to see if the information collected is valuable enough to absorb the future costs into the regular expenses of the research program and continue with the surveillance. Since I’ll need to do a ‘final project’ to complete my MPH in a year, this could create a perfect opportunity for me to get some experience in public health program evaluation, which I’ve always had an interest in.
I spent my last day in the research office sending many emails of terrifying lengths, like a mom leaving for an extended vacation and needing to make sure you know how to set the alarm right and what to do in case you set it off anyway and also that the key to the shed for watering the garden (the half that needs watering, NOT the other half that gets all the rainwater from the gutters) is behind that lawn chair with the… you get the picture.
I’ve agreed to remain a resource for the team to be sure that the foundation for the system is strong. The CLI staff will take over all routine aspects of the system such as volunteer recruitment, training and kit distribution, case auditing and reporting.IMG_2816
It was a crazy last half of my visit, (especially with a safari weekend squeezed in the middle!) but I’m very proud of what I’m leaving the team with as I head back to the states. Thanks, again, to all of the moral and financial support from friends and family.
Zikomo kwambiri, and see you soon Ohio!

Adaptability Training

| Lucy Ramos
Got a big surprise on Friday:
Most of the research team including my preceptor Gladson will be in Lilongwe (the capital) for the rest of my time on site. They were able to schedule the training that was pushed back originally, so my relief of having lots of research team availability was a bit premature.

Continue reading →

A Day in the Life

| Lucy Ramos

When I’m not running around like a crazy person preparing for a meeting like yesterday’s, here’s what a typical day at the office looks like:

Morning

Breakfast with my roommates, Araseli the CLI hospitality manager and sometimes other people on site.IMG_2722

Eggs with beautiful yokes and indulgent toast is the norm.

IMG_2746

For those who were wondering, my coffee solution is perfect and is a hit with others on site.

Breakfast is sometimes rushed so we can hop across the site and get to our morning meeting at the clinic.

IMG_2771

Clinic and research staff attend to give updates, ask for feedback on upcoming projects, and raise any issues. There’s usually also a presentation. We saw two last week about malaria diagnosis and treatment. I like how the doctors and ‘superior’ staff take time to share what they learn about new standards and best practices with the broader group. For example, they shared doses for children taking first-line malaria treatment with everyone, even though only a few of those present had authority to prescribe.

Last Friday we used this time to get feedback on the volunteer guide, and the project as a whole, from the clinic and research teams.

IMG_2772

After the morning meeting we go to the office. It’s simple, I’ll call it an ‘open workspace’ concept with lots of sun. Everyone works diligently, as a group or quietly on their own, until lunch.

Afternoon

Mzungus eat separate from the rest of the staff, which is kind of a bummer. We do benefit from more variety of the kinds of foods we eat, but “doing as the Malawians do” was more of what I expected. I can’t complain though; they just want us to be happy, and the food is great.

IMG_2737Sometimes we are served Malawian food; the main staple being nsima, a white cornmeal kind of dough that you mold in your hand and dip in whatever it’s served with. That is usually “relish” which reminds me of southern cooked greens at home; and then sometimes another version with some kind of peanut flour or paste in it. They call it “peanut butter” flavored.

Everyone in Malawi gets a 90 minute lunch break: it’s actually the law. So depending on the day I check in on things back at the home front (hi ODEE!), take care of things in my room (like cleaning the shoes I filled with dirt on the walk to the market last weekend) or practice some yoga. It’s super sunny, every day this time of year.

Our afternoon at work is our chance to communicate with people in the states so sometimes we do some of that. The other day it took 30 minutes, two computers, and several phones to connect for a conference call which was still off-and-on connectivity that often required transcription on the typing section of skype while my advisor Alison spoke on her end. It’s an exercise in patience.

IMG_2721Otherwise, we just do more of whatever we did in the morning. In the afternoon there are fewer people around, as some staff get assigned to work outside the clinic.

Evening

IMG_2760We’ve often come back to the room to find Midnight on one of our beds, which is just like home for me. I recently found out that this was ‘against the rules’ though, oops.

Sometimes we work out before dinner. I’m sharing the room with an agriculture volunteer (Mackenzie) and a student researcher (Julika) and the three of us have done circuit training and running. Malawians, of course, think it’s funny that we exercise. I’m glad we can provide them some entertainment while we get some of that extra energy out from all the eating we do.

Sometimes after dinner we play games like bananagrams or puzzles. Usually we make calls home, do some reading and go to bed early. Like, lights out by 9.

That’s a (week)day in the life for me. It’s a nice routine with some wonderful people and a lot shorter to-do list than at home. I’m learning how to multitask effectively–loading a web page can take dozens of minutes and downloading a device driver has proven to take an hour or two. But with all the progress we’ve made already, I’m feeling confident about having a comprehensive system in place by the time I head home.

Zikomo kwambiri (thanks much)!

Lucy

Meeting the Volunteers

| Lucy Ramos

Today was our big volunteer meeting! 63 of the surveillance volunteers from the villages around CLI came to the clinic. We didn’t have a big enough space for everyone inside so we set up in a courtyard outside the research office.

IMG_2780

In the last week I’ve developed a community volunteer guide, which helped explain a little about the project and its purpose, the role of the village volunteers, and important information like contact info on who to report the deaths to. It also defines neonatal and maternal deaths to help them identify what a ‘case’ would be.

Check out the English Version | Chichewa Version

The volunteers got these guides, their t shirts, and volunteer IDs. They also got a round of training from my preceptor and the CLI research lead Gladson. The clinic’s head physician addressed the group as well, expressing his appreciation for the project and their involvement.

IMG_2787

As with any well attended meeting, refreshments were served.

IMG_2794

I had some really great interactions with our participants, even across the language barrier. It was fun getting to meet them in person after seeing their faces from the ID photos.

Planning the logistics of it all was pretty stressful. For our 1 p.m. meeting, attendees arrived anywhere from 11 a.m. to 2:30 p.m. But overall it was a great opportunity to get everyone together. The volunteers asked thoughtful questions and worked together to figure out solutions that fit their communities.

IMG_2797-1

The HSAs (CLI staff who act as liaisons in the villages) got some great face time with virtually all of the community volunteers for their areas at once, which was valuable too. Despite a long gathering, everyone was in high spirits at the end.

IMG_2790

In addition to returning volunteers we also had new participants, so now all of the villages in the catchment area should be covered. I’ll verify when the dust settles and the registration forms are compared tomorrow.

IMG_2791

My next step is to take a very close look at what happens after the community volunteer level reporting: how the HSA collects information for the audit, how it’s entered into the database, and how it’s analyzed for applications in clinic decision making.

These are just a few of the photos I was able to snap while helping carry on the meeting. I had a fellow volunteer come take more, so stay tuned.

Tionana (see you later!)

Lucy

Azungu Parade

| Lucy Ramos
   On Saturday we decided to venture outside the CLI walls and check out the market in Msundwe. It’s about a 90 minute walk on a single red dirt road.
DSC00060
I asked our chef Fred for advice and he said to ‘focus’ because of all the attention we’d get.
It wasn’t the first time I’d gotten caught up in a Mzungu parade, but this was definitely my most overwhelming. Over the course of the walk around 100 children joined us, shouting ‘Azunugu!’ (the plural version of Mzungu, ‘white person’) and asking for money, footballs, etc. I felt bad because it was disruptive to people trying to bike their loads down the road or taxi passengers between villages.
 DSC00061
Our new friends were sweet but it was a bummer that they seemed to perceive all white people as gift dispensers. The people who run CLI know about sustainable giving, but it seems like many of the visitors here haven’t really upheld that philosophy. We tried making friends with them and showing our human sides, connecting with them as best we could across the language barrier. But they were super persistent on asking for our bags, sunglasses, even a pen in Julika’s pocket. They broke off pleasantly, though, even after we held our ground. Julia told them ‘stay in school and you’ll get to buy your own pen!’ They seemed to really enjoy practicing their English with us.
When we got to the market some of the adults helped shoo away the children so we could have some breathing room. We said Zikomo about ten times and got to shopping. I immediately got a wrap to wear around my waist—the proper dress for Malawian women. I got help putting in on and struggled keeping it there the rest of my time there.
 DSC00062
I picked up some containers I needed for the site, some ‘fritters’— round donut-like things I saw our research team having for breakfast last week, and another cloth to wear as a wrap or put down in the grass to sit outside when I’m on site.
DSC00065
I loved seeing rows and rows of bikes, and a station with a welder who fixed bikes on the spot with a giant tank just standing alone all forboding.
DSC00066
The people were all nice and one woman saw me carrying the containers on my hip and insisted I put them on my head. I lasted around 30 seconds before bruising myself, and my containers were empty.
On the way back we stopped at the ‘beer garden’ which turned out to be a desolate, plant-less compound with a few men and their booze. They were a little too happy to see us and we knew we needed to make it quick. Araceli, the head of hospitality at CLI, told us there was a stout beer that was common in the area, and I wanted to try it. No stout, but there was Shake Shake, a brand of the “village beer” Chibuku. A man we passed at the market insisted we try his, and we politely declined but figured this was an opportunity to try it out.
IMG_2762
We started home and when the children broke off near the end of the trip, we took a break and tried it. I opened it and realized the connection to a ‘shake’ and why it might be in a carton. The beer was completely unfiltered, with chunks of the grain floating around in a gritty white liter of heterogeneous fluid. It actually didn’t taste as bad as it looked, it was quite sour and, as legend has it, supposedly had a pretty high alcohol content without the risk of a hangover. By the time we tried it though, it was shaken up from my walk and gotten warm. I poured the rest out and we carried on right before some CLI visitors happened to drive by and pick us up. With more than 2 hours of walking under our belts we were happy to give our dirty, blistered feet some relief.
For more information about Chibuku, I highly recommend these colorful reviews on Rate Beer.
Have a great weekend everyone, tionana (see you later)!

and the work begins

| Lucy Ramos

I made it! With almost all of my stuff and almost no plane sleep.

Which meant 11 hours of deep, deep sleep and waking up to the cleaning staff knocking at the door this morning. My roommate and I arrived at the same time and both slept in and missed the daily 7:30 meeting at the clinic. Oops. We’ll have to do the formal intros at tomorrow’s and hopefully everyone will understand that jet lag is real.

Accommodations are very hotel-like; the bathroom is much nicer than my own at home. The staff is amazing, food is great, and the site is gorgeous. I will take a walk around the premises this weekend to better illustrate in photos.

IMG_2710

And, there is a cat. A black cat named midnight who follows people around and commands attention like all great cats should. Malawi is known as ‘the warm heart of Africa’ and the people are living up to the name entirely. I am spoiled here.

In spite of my tardiness, I was pleasantly surprised by how productive my first day was. I got to sit down with the Health Surveillance Assistant who is our main connection to all of the community surveillance volunteers. We reconciled some long lists of participants and their villages that had a bunch of disparities. We have almost 50 volunteers trained, photographed and with IDs made!

I also made a guide for the community volunteers that’s more visual and less text-heavy. We’re going to meet with as many as possible this Tuesday so I’ll be preparing for that in the coming days. Another big project that was supposed to be taking off this month was significantly delayed, so I’m very happy to know that getting my work complete is actually feasible and that the people I need to work with have the availability.

Since I’m meeting with volunteers, I need to learn some Chichewa. Greetings aren’t bad:

Muli Bwanji – how are you?

Ndili bwino, kaya inu? – I am well, and you?

Ndili bwino – I am well

Zikomo – thank you

Ndapita – Goodbye

But things get scary pretty quickly:

Ndithandizeni – Help

Sindikumvetsetsa – I don’t understand

So, fingers crossed I understand everything and never need help.

 

Photos coming soon, I promise. Ndapita!

Independence Days

| Lucy Ramos

The 4th of July is a pretty good day to have your last day in the US before a long trip.image

Fun fact: I’ll get to celebrate Independence Day again when I land, as July 6th is the day Malawi attained independence from the British in 1964.

I’m about to leave New York for Johannesburg (kind of can’t believe a single stretch goes that far), with the volunteer IDs, some kwacha, a $60 unlocked droid phone that will work on the global network, all the luggage I could carry and then some.

Wish me luck getting myself and all my stuff to CLI without any himageuge hiccups! Thanks for everyone’s sweet well wishes I’ve received in the past week or so, can’t wait to get to work and share it all with you.