Filed under: Culture, Iguhu Health Center, Project: Emergency Responsiveness, Project: Landscaping, Project: Surveys | Tags: Africa, African Culture, AIDS, Arjun Khanna, ARVs, Comprehensive Care Clinic, Counselors, Development, Emergency Responsiveness, Foundation for Sustainable Development, Healthcare, HIV, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Landscaping, Sustainability, Volunteers
RECAP OF THE DAY: Woke up really early, had to rush off to work to make the training session at 8:00 am, got there, no one was there yet, I was really upset, then everyone randomly showed up at 8:15 am, we started, everyone came to the training, it was really good, I felt a little sick after so I went home, rested until after lunch, Peter and company came to visit to make sure I was okay (aaaw), we talked about my projects, went back to work, started typing up description of the training, worked on patient waiting time survey, the data collection is finished, now all we have to do is analyze everything and write the report, I posted a memo to the hospital about the waiting time survey, people seemed really interested in it, had an interesting discussion with Charles Aluvisia about the Comprehensive Care Clinic, came home, started working, going to sleep early because of training tomorrow morning, going to Kisumu tomorrow to get some equipment, hopefully the grant results and online fundraising starts soon, sleep.
REFLECTION
I’m glad to report that the emergency responsiveness training is off to a good start. People seem interested, especially the non-medical staff, so it’s looking good.
I had an interesting discussion with Charles Aluvisia today, a man I have come to respect greatly at the hospital. He’s an elderly guy who works as a volunteer in the Comprehensive Care Clinic. He is HIV-positive and has dedicated himself to counseling other people living with the disease, connecting people with the disease to form support groups, and ensuring that people with the disease adhere to their ARV treatment.
To overcome the cultural stigma associated with HIV is one thing, but to then dedicate one’s life to supporting others with the disease – all for no pay – is something else altogether. Charles and other volunteers at the CCC are the most spirited group at the hospital. In fact, during the patient waiting time survey, the CCC turned out flawless timecards and had almost 90% of their patients return them. Compare this to the 70% of patients who returned cards from the outpatient ward and the fact that half the cards we got were not filled out correctly. The only difference, really, is the mindset and the work ethic of the people involved. Charles is always excited to be at the hospital and is putting in a ton of effort into co-training with me.
Seeing someone I respect then talk to me about the discrimination he faces on a daily basis even within the hospital makes me really upset. He and the other volunteer counselors that work in the CCC are not allowed in the hospital kitchen; they related to me a story about how they were yelled at for getting a cup of tea from the hospital canteen, and they showed me a posted sign that prohibits CCC volunteers and patients from entering the kitchen. If this kind of ignorant discrimination can persist in a hospital, where people are fully aware of how HIV is transmitted, can you imagine what kind of treatment these people receive in the community?
I wanted to do something for Charles and his team of volunteers. My desire is to get them on the hospital payroll, something they deserve, especially since they serve more patients than most of the rest of the hospital staff on a daily basis and have positively affected more lives. What did they say when I asked them what they would like? A motorbike. Why? So they can travel to remote areas where HIV-affected individuals live to counsel them, make sure they adhere to the ARV treatment, and deliver medication.
We’ll ignore for the time being that these people – who probably need money the most of anyone I’ve met so far, given that they earn literally no money – asked not for money but instead for a tool to expand the scope of their public service. We’ll focus instead on the specific thing that they asked for: a motorbike.
As it turns out, there is a shiny new motorbike locked away in the hospital garage that has been there since I arrived at Iguhu and has not moved in the three weeks I have been here. Apparently, the Ministry of Health Services gave four of these things to the hospital a while back to use during public health trips. One of them is in use, and given that the hospital owns two large vehicles which are more often used for public health trips, this particular motorbike is never used.
I tell this to Charles, who knows about the motorbike. The thing is that the motorbike was given to the hospital for use by “the hospital staff.” When “they” got the motorbike, Charles tells me, the use of the motorbike by the CCC was out of the question, because he is not considered one of “them.”
I am outraged at this on many levels. Charles and his team of volunteers are single-handedly attacking a continental epidemic on no pay. They see dozens of patients a day, host counseling sessions, distribute ARV treatments, test CD4 counts, keep diligent records, connect patients with others, and more. It is outrageous to me that they are not considered hospital staff. I can identify ten individuals who work at Iguhu who do less work than anyone in the CCC but are paid. So it is ridiculous that CCC volunteers have to donate their time in the first place, but it is even more preposterous that they are denied the tools they need to serve the community better. It’s as if the hospital doesn’t even appreciate the time and effort that they put in. Let me tell you something – these people are pillars of public health in the community, absolute pillars. And at Iguhu, they are taken for granted and abused for no reason.
I get along with the Iguhu staff pretty well. I like everyone, and everyone is okay with me. There are a lot of things that I disagree with about the hospital, but I hold my tongue, keep my head down, and do what I can. But this is the battle I have chosen! I’ve decided to organize all of their data, analyze it, and demonstrate empirically how valuable the CCC volunteers are. I’m then going to present it to hospital administration and as many members of the Ministry of Health Services that I can. I’m also going to MAKE SURE that the volunteers are allowed to use the random motorbike that the hospital has. This cannot stand.
Even if you look at it from a “sustainable development” point of view, this is terrible. We’ve talked a lot about avoiding aid and moving toward development. Iguhu is relying on aid – donated, free time – to handle the AIDS epidemic that continues to rage across the country. That’s not sustainable. It’s time that everyone in the hospital affirms their dedication to fight the epidemic, not just those who have already been affected.
In other news, the border that I helped build in front of the hospital has begun getting painted. It looks good! Check out the pictures below.
Green and white border
...and more
...and more. Feel free to tell me how great this looks.
Filed under: Iguhu Health Center, Project: Landscaping | Tags: Africa, Clay Pot, Development, Dr. Bomji, Emergency Responsiveness, Foundation for Sustainable Development, Healthcare, Hospital Charters, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Landscaping, Patient Surveys, Plants, Sustainability
RECAP OF THE DAY: Woke up, worked out, heard massive commotion from my bathroom, it was a huge lizard, I calmly got a broom, tried to kill it, Mama Joyce joined in, laughing, she picked it up with her bare hands, went to Kakamega this morning, didn’t get ripped off on the way there, bought a bunch of notecards for the patient waiting time survey, went to Nicco creations, got quotes for printing large posters, bought a clay pot so I can have cold water, had lunch with fellow interns, bought paint from an Indian shopkeeper, I got a discount because I spoke to him in Hindi, I headed back to Iguhu, there was a general staff meeting, I talked about my three projects (hospital charter, patient surveys, training for emergency responsiveness), everyone asked questions, got home, heated my clay pot so it wouldn’t break, dinner, work, sleep.
REFLECTION
I decided yesterday to go to Kakamega after landscaping for the whole day and deciding that the bricks we laid around the small garden would look much better if they were painted rather than the “rotting brick” color that they were (is that a Crayola color? It should be). I made a list of things I wanted to pick up or do, which included the paint, checking prices on a poster printing service for hospital charters, a clay pot, and a bunch of notecards in order to take patient surveys.
The clay pot, incidentally, was on my list because of its astonishing ability to cool water. In fact, when I told Mama Joyce I would buy one, she said “OH! You mean a refrigerator.” Apparently there’s an interesting phenomenon that occurs whereby the pot absorbs some of the water that you put into it and then the device “sweats,” thus cooling the innards by convection. Angie recommended it, and I know that they do it in India, so I resolved to give it a shot. I have high expectations. Everyone I have spoken to thus far about the giant clay pot in my hands (the image apparently shocked and amused many locals) have almost immediately referred to its magical cooling properties.
Purchasing it was an interesting experience as well. I strolled into the market and met Mama Rosa (I must get a picture of her soon) who is my preferred mango vendor. I then attempted to buy someone’s pots that apparently weren’t for sale. Mama Rosa intervened and offered to abandon her shop and lead me to a good pot vendor. I thankfully agreed. She brought me to a woman who looked suspiciously like her and (as I later found out) charged me about five times the normal price of an earthen pot. Thanks, Mama Rosa and probable sister. I thought we were friends.
I then bought paint from an Indian vendor – it seems as though almost all of the merchants that deal with hardware of any kind are Indian here – and managed to get a discount by speaking in Hindi. At first he was shocked, he told me, because he thought I was white. My Hindi, being pretty good, was sufficient to convince him that I was for real; he was from Gujrat and gave me a discount of about 200 shillings. Brimming with happiness, I returned home.
At Iguhu, it was business as usual – tons of patients, not enough staff, etc. – but a general staff meeting had been called, which convened two and a half hours late but nevertheless was very necessary and useful. I was given the chance to address the entire hospital staff and explain my three projects to them. Though any kind of reactionary emotion was difficult to discern, the fact that I was “formally appreciated” was indication enough that the staff is excited enough for at least two of my projects to be huge successes.
I will explain my three projects presently. I should forward these descriptions by saying that they are based on an extensive collaborative needs assessment and draw heavily from a published list of guidelines for reform that the Minister of Health Services distributed at a provincial meeting previously.
The first project involves taking a series of surveys of patients in the hospital, including both qualitative investigations into patient feedback about hospital services and quantitative studies on patient waiting times. I have devised a system thus: As they enter, patients are given a card with their time of arrival printed on it, and as they move through the hospital, the various staff prints the time that they saw the patient on the card as well. At the end of the visit, the patient deposits the card in a box at the exit of the hospital. I have identified one woman in particular who has volunteered to partner with me in this exploration, thus inspiring ownership of the project. Furthermore, I have identified a translator to help me take patient surveys.
The second project involves printing large posters of the hospital and department charters. This is something that the Ministry has requested and would be helpful in that it will immediately inform patients as to the types and costs of services the hospital can provide. I plan on having someone in the hospital translate the entire charter into Kiswahili and Kiluya, as well as leaving certain parts variable, such as drug prices and staff names, as they are subject to change and should not require a redesign of the charter poster itself.
Finally, I plan on training the hospital staff on emergency situation readiness. I will train medical and non-medical personnel on how to be an EMT i.e. how to respond to a traumatic event that involves many people. I will also work with senior hospital administrators on an administrative plan concerning an emergency situation, and talk to local police to inform them that Iguhu is now the place to call for an emergency situation.
In terms of funding, I am severely limited by the small grant that FSD offers all of its interns because purchasing equipment for the hospital for emergency preparedness is both necessary and expensive. Having spoken to Angie, I will probably formally request funds from all willing donors back home very soon (as soon as my workplan has been finalized).
Apparently you have to heat the clay pot without water in it before you start using it so as to preserve its structure and function in the future, which is what I am busy with now. I have posted some before-and-in the middle pictures of the landscaping that I did yesterday at Iguhu. I’ll be sure to post pictures of the final product!
Tell me what you think of my projects! How might they be made more effective? What should I keep in mind?
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- A small plot of land to the right of the registration window before we began landscaping.
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- Construction started!
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- The machete is a valuable tool.
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- It starts to take shape…
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- Honestly, the staff did it all – OWNERSHIP!!!
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- The finished intermediate! It is to be painted soon…
Filed under: Iguhu Health Center, Project: Landscaping | Tags: Africa, Dehydration, Development, Dr. Bomji, Emergency Responsiveness, Foundation for Sustainable Development, Healthcare, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Landscaping, Plants
RECAP OF THE DAY: Woke up really late, worked out, went to work without drinking tea, forgot my water bottle, told myself I would just get it when I came back for lunch, got to work, started working on needs assessment, a nurse told me that Dr. Bomji requested that I travel to a place call Sigalagala to wait for him and then he and I would go get plants to plant around the hospital, I borrowed thirty shillings from the woman vendor outside, took my first matatu ride alone, got to Sigalagala, waited, had the same conversation with the same bodaboda driver several times, I could smell the alcohol from a meter away, it was 10:00 in the morning (reminds me of college…just kidding, mom!), got picked up after a half hour, drove down a really bumpy mud road for another half hour, went to the nursery of the college of agriculture, not enough variety, by this time I was getting really hungry and thirsty, we drove to a Pastor’s house where he ran his own nursery, we were educated about every single plant he owned, we deliberated and chose some, I was about to pass out, I was so hungry and thirsty, we started driving back, we stopped somewhere to get refreshments, I grabbed a soda without even looking at it (or maybe I was blacking out with hunger), drank it, it was black currant Fanta (really good, actually), he bought biscuits, I inhaled half of them, he looked a little surprised, we drove back, decided to plant the three hundred some-odd plants on Tuesday, I staggered home since I was dehydrated and hypoglycemic, I reached home, I drank a lot of tea and ate a lot of bread and nutella, I fell asleep for an hour, walked with Shide to Makhokho, got change for a 500 so I can ride the matatu tomorrow without the driver assuming a generous tip when I hand him 500 shillings, worked, promised that I would never again leave the house without water and a couple granola bars, sleep.
REFLECTION
Dr. Bomji and I went on an extended hunt for plants today; he is apparently more excited about landscaping than I originally estimated and would stop at nothing – not even my obvious signs of dehydration and hypoglycemic disorientation (I may or may not have started talking to him in Spanish) – to collect the variety of plants he was looking for. Couple that with the typical Kenyan relaxation with regard to time and roads that threaten to snap your car in half, and you’ve got yourself into a full day-long excursion on a day you expected to leisurely write up a report in the office with a generous lunch break in the middle. One must be prepared for anything here.
We ended up with about three hundred little seedlings to be planted at various aesthetic locations around the hospital. As the observant and dedicated reader will no doubt realize, this is the first guideline by the Ministry of Health Services, which is exceptional because it signifies that such memoranda are actually read, synthesized, and acted upon by at least one District Hospital Clinical Officer. This fits into a broader theme that I have come to realize – that in my experience, cynicism as an impediment to progress does not exist in Iguhu. Upon recommending that I take time out of everyone’s day for several weeks on end to train the staff on emergency responsiveness, I fully expected a less-than-enthusiastic reception; this was not the case at all – everyone I have so far talked to has been wildly enthusiastic about the plan. It is a particularly warming feeling.
