Wednesday, September 24, 2008

Oh...So You Don't Train Snake-Charming Chimps??

I’ve been trying to think about what to write about for a few days now, and I realized that I was having trouble because I have spent majority of my time since I got back from masai mara working. So then it hit me, makes sense to talk about that. I don’t think I’ve actually talked about what I actually do here, or where I actually work? And really, (as I reminded myself in the shower this morning) isn’t that the number 1 reason I’m here? I know many of you asked me before I left what exactly I was going to be doing – I remember my mom specifically asked me at least every other day, and my responses were usually limited to “ummm…uhhh…well…its like…” and then some random words that could describe anyone who sells ice cream to someone who trains snake-charming chimps.

So, I’m working at the Community Health Department (CHD) of the Aga Khan Health Service on the campus of the Aga Khan Hospital in Mombasa. CHD is a small organization, just under 20 staff and..well..no budget! Quite a drastic change when you come from an organization with 12,000 staff and a $1.5 billion budget. I have to bring my own pens to work with me here. Like many other NGO’s we are solely dependent on grants for our funding, and unlike some other NGO’s under the Aga Khan Development Network (AKDN) we do not receive any type of funding from AKDN or the Aga Khan Foundation (AKF). While being independent of AKDN/AKF is a source of great pride, it is also comes with some risk. You see, CHD is currently wrapping up a major grant that has basically been sustaining the organization for the past 4 years. It was a grant from the Rockefeller Foundation to implement a Community Based Health Information System (CBHIS) in one of the poorest districts in Kenya – Kwale District. Basically, we want to modernize the system from paper to electronic while also providing a comparison for the health information that is collected at a higher level. CHD has done a lot, kinda like the little engine that could. CHD has been instrumental in implementing health management information systems in Coast Province, and the model was subsequently implemented in a few other provinces as well with the help of the Danish International Development Agency (CIDA…where are you???)

If I had to describe the health care system here in one word it would be ‘archaic’. But thats where CHD comes in. We have community health workers going door to door collecting health data from ~ 38,000 people in Kwale and then we analyzed the data and develop evidence based interactions. Since I have been here, we have conducted focus groups on malnutrition and breast feeding, spraying campaigns to eradicate foot fleas, and educational sessions on health and hygiene (see earlier blog posts). I have also had the opportunity to visit and meet with District Health staff (government staff) in Kwale district and other districts and listen to the challenges they face. I have had the chance to take multiple trips out to rural villages from Malindi up north to Kwale down south. Let me tell you, the challenges the health care system faces here are challenges that I never imagined could even exist! For example, we recently attempted to improve drinking water through the distribution of water guards which is basically a liquid water purifier, but locals rejected it because of mistrust (some said it tastes funny, others said the colour of the water changes, others said the colour of the water doesn’t change so what does it really do?). I guess they want to continue drinking contaminated water.

Anyways, CBHIS wraps up Sept 30th and there has been a flurry of activity to wrap it up and ensure that we meet our donor requirements. I have been spending most of time assisting in various components of the wrap up like creating communication tools, policy briefs and now on a report to present our latest data findings. The learning has been incredible and the opportunity to contribute to this has been great!

But I mentioned ‘risk’ above, and the risk is – what comes next? The simple answer is – we don’t know. We have submitted a few proposals and are crossing our fingers (or as they say ‘inshallah’) we get them (including a smaller one to CIDA written by yours truly..CIDA you better come through!). Unfortunately, we recently received word that one of our larger proposals was rejected and as such we have had to cut staff. It is very unfortunate, but such is the life of an NGO. At the end of the day, it comes down to dollars and cents, or I guess I should say shillings (no equivalent of cents here). Any ideas that I propose are met with “where can we find the funding?” and then I’m back to the drawing board to figure it out. It’s a challenge, something I’ve never had to face before, but something I’m glad I’m getting the opportunity to do and see. With luck, the biggest grant we submitted (to the European Union) on reducing mortality and morbidity for pregnant women and children under 5 (2 very vulnerable populations) will come through – we find out on October 15th. If we get it, the wheels keep turning and all is well for the foreseeable future. If we don’t….well…I’ll let you know..

Wednesday, September 17, 2008

A Natural Wonder

Safari. It’s a magical word. Ever since I found out I was coming to Kenya, I have dreamed about going on a safari. I spent the last three days fulfilling that dream in the wonderous Masai Mara. Named for the Maasai tribe that live there and the Mara river that divides it, infamous across the world for its beauty and its offering of animals in the wild it was an awe inspiring experience that no words or pictures can really describe.

Sunday morning, 6:30am I left home for my flight. I was flying a very small airline Mombasa Air Safari to the Mara. It was the smallest plane I’ve ever been on, not more than 20 seats and a bit of a bumpy ride, but cool nonetheless. I was sitting in the departure lounge waiting to board when a staff came in and asked the British couple I was talking with to board the plane. I mentioned that I was also on that flight but was instructed to please wait. Ok – no problem. I waited about 10 minutes, wondering how long it takes 2 people to board when I saw my plane rolling down the tarmac. WHAT?!?! I instantly jumped up and started screaming “That’s my plane! That’s my plane!” A staff rushed over and asked where I was going to – I indicated the Mara (Ngrende airstrip) and he said “no problem” just wait. Uhhh..ok? Turns out the other airline that uses that small terminal Blue Sky Aviation and my airline have an agreement to share passengers and I had been switched over to Blue Sky. Ok…but would have been nice to know that in advance and avoid the minor cardiac. But, boarded the plane and after hearing the pilot inform us that “we need to take off now, bad weather is coming” (not what you want to hear when you’re on a plane that small) we were off.

Arrived safe and sound in the mara Sunday afternoon around 11am with the kind of excitement a school child has before his/her first day of school. I was meeting 5 friends there who had come on a different flight from Nairobi. Our accomodations were deluxe, we were staying at the Fairmont Mara Safari Club in our own luxury tents. Something about a comfy bed, hot shower, evening turndown service where they put hot water bottles in your bed so that its warm when you climb in, and a morning wakeup call in which staff come to your room with your choice of tea, coffee, or hot chocolate (and biscuits) that just makes the whole experience that much more enjoyable. Turns out the Fairmont has been voted as the top Safari lodge in the Mara and number 3 in the world.

So we all arrived and rested for a bit, and at 3:30pm piled into our Land cruiser for our first of 4 game drives with our driver Odgina (or Henry). Right out of the gate, I was wide eyed and just craning my neck everywhere. Through marshes, and open fields, swamps, and bushes we drove spotting game. The list of animals we saw included gazelles, wildebeests, zebra, giraffe, hyena, numerous birds (including 2 osterich’s mating…kinda weird) and all of the big 5 – lion, rhino, elephant, buffalo, and a very rare sighting of a spotted leopard! Something about being in the wild, surrounded by animals in an open expanse that just makes you realize what a small piece you are in a larger puzzle. To see all these animals in cohabitation doing only what nature intended – survive - makes you wonder about the issues that surround our daily lives. In that period, you just live in the moment, sit back and watch, and suddenly the rest just seems oblivious.

I went on this trip hoping to catch a wonder of the world – the wildebeest migration. The annual event where close to one million wildebeest make their way down to the serengeti. Unfortunately, our guide informed us that this year, not as many animals did the migration and in fact the best sightings of it had already passed and that our time was better spent viewing game in the park (it would be a long drive down to the mara river where the best viewing spot is). My dissapointment was very short-lived. As we approached the end of first game drive, very content with what we had seen, we stumbled upon a group of lions. As we watched and snapped pictures, more lions joined. And then all at once, the lions gathered and started walking. Our guide informed us “they’re hunting”. Twende twende! (let’s go!) About a dozen lions moved out from the bush in hunting form for their next meal. It took us a few seconds to see it in the distance. Buffalo. Three buffalo were walking towards the lion pact in the distance – I was not sure if they buffalo saw the lions or not, or whether they just were not afraid of them. The lions began to approach and the buffalo kept walking towards. We held our breath wondering if we would see a kill (a very rare sighting). The buffalo were huge, and the sole fact that there were 3 of them was probably what saved them. For an hour we watched a cross between a football game and a chess match as the lions tried to outsmart the buffalo and the buffalo fought back for their lives. Henry told us that the only way for a lion to kill a buffalo would be a sneak attack from the back and that an attack from the front could be deadly for the lions because of the buffalo’s large horns. So we watched, as each side strategized, the lions tried to circle one buffalo in order to attack. One move, that I thought was particularly sneaky was when 2 lions broke away in separate directions and drew 2 of the buffalo away, the remaining 10 lions circled the buffalo, however this feisty creature continued to fight them off. In the end, the buffalo’s lived to see another day (or at least, they were alive when we left), but it was amazing to see nature like this. At one point, we saw a few lions break away and start walking in the direction of our jeep and we got a little nervous that perhaps the lions had decided to go for an easier prey…not the case Henry assured us, but we still asked him to drive back a bit. We continued watching until dark, well past our scheduled 6:30pm return time, and basically kept watching until the lions broke away and we couldn’t see anything anymore.

We returned to our lodge tired, and a little cold, but nonetheless on a huge adrenaline rush after watching that and very excited for what tommorow would hold. The next morning we woke up, and piled into our land cruiser for our morning drive. We spent the next 6 hours around the mara viewing various animals and admiring a very scenic sunrise while singing songs and even throwing in an Indian guzzle here and there. After about 3-4 hours of game viewing, we had arranged to visit a Masai village and meet members of the tribe. We were welcomed with song and dance and spent time with members of the tribe learning about their history and their way of life. I’m running out of words to describe these kinds of experiences, so I’ll just say it was really cool. As they taught us their way of dancing, we wanted to teach them our way of dancing and decided to teach the masai trip the ancient art of bhangra dancing. We left the village to sight of the children jumping up and down with arms doing the ever so popular ‘screwing of the lightbulb’. We followed up in the afternoon with close encounters with rhino’s and a return trip to the masai village to show our appreciation for hosting us in the morning with shoes for the children, and a large sack of flour. I know that gift-giving needs to be done with the utmost consideration and sensitivity and we were hoping to give something that the village could use and would benefit from and not just something that would seem like charity. I feel that when I saw the looks on the faces of the children, especially the look of one woman when we pulled out the flour, we had hopefully struck the right tune.

So we continued with game drives, and viewing animals, and just soaking in the atmosphere and learning a lot about each animal. The final game drive was bittersweet, I felt as if I had seen what I wanted to see, but was sad to see the experience end. Funny thing on the way home Tuesday, I was told to be in the lobby of the hotel by 1:15pm for my ride back to the airstrip. Around 12:50pm I came to the lobby thinking I was nice and early to check out. I was told that the pilot was waiting for me – thinking that he was in the plane at the airstrip waiting. No – the pilot was there, at the hotel! I’ve never had a pilot come and personally pick me up for a flight. A bit of a mixup in the time I was supposed to be ready by, and a bit of delay in checking out, and as we walked to the jeep, my pilot informed us that we were now running behind schedule (we had 3 more airstrips to stop at in the mara before coming to Mombasa). A quick ride to the airstrip, and as we arrived the propellers started (by the co-pilot), my pilot noted “they were just waiting for us” so basically I single-handedly held up the flight. Sweet,…you should see what I can do to a hospital network.

All in all, I can easily say I have returned from the mara feeling refreshed, renewed, reenergized and relaxed. My mindset feels different, maybe it was 3 straight days of not having to think, or 3 days of fresh air and amazing scenery in a cool climate. Whatever it was, I loved every minute of it, and am so grateful I had the opportunity to do it. I truly saw the Africa of my dreams.

Thursday, September 11, 2008

The Good...

First off..i have to give HUGE ups to my fUHNatics dragonboat team on an amaaaaazing season! You guys are amazing. Paddling with you is something I missed terribly, and I can’t wait to join you guys in the boat next season. I loved reading up on your results and all the banter…Congrats on all your accomplishments….how you guys consistently broke the 2 minute barrier is beyond me, but I definitely have some training to do to catch up!

Anyways, about a month ago, as I was approaching one month, I wrote an entry in which I listed the things I miss from home. As I approach 2 months here (that was a quick month!) I thought I would talk about the things that I love here. Because its just as important – if not more so – to focus on the good here rather than whats wrong.

1) I love the windows in our shower. Taking a shower in the morning with sunlight coming through is a great way to wake up (no, they’re not transparent windows).
2) I love the picturesque moments. Walking through our neighbourhood, there are so many kids playing around and it cracks me up sometimes to see the things they do. I walked by a boy and girl bouncing a basketball, and I looked around and wondered where the hoop was. My question was answered when I saw the girl make a circle with her arms and the boy banked a shot off her face and into the makeshift net. Then they switched and the boy became the hoop…it was pretty funny.
3) The beach – Aside from the sun and the sand (and the incredibly salty water) I love just staring out into the Indian ocean, wondering if there is someone on the other side somewhere in India or Sri Lanka staring back at me.
4) Perfect Pizza - the pizza place we visit every Friday night. It’s become a ritual for us to go for pizza on Friday night, and I love the pizza they make!
5) I love the smell of the bakery that I pass by everyday on my matatu ride home. It only lasts like 5 seconds, but I’ve timed so I know exactly when to take a deep breath (although sometimes I get it wrong and end up inhaling a full breath of exhaust)
6) The learning – and there’s been a lot! To be in a totally foreign environment and learn something or realize something you never even imagined…that’s the main reason I’m here. And the amount that I’ve already learned is incredible, I think I’ve learned more than I will ever be able to contribute. I know I’ve complained about the pace, and wanting to be able to do more, but I think one thing I’ve learned more about is the idea of pace. Not only do they work at a different speed here, but they use a different speedometer altogether! So like, lets say I was a car, and I’m used to travelling at 100km/hr. Before I came, I knew I would have to slow down to like 20 km/hr. But my notion of 20km/hr is something totally different and so a good learning has been realizing what their idea of fast and slow is…but it still drives me nuts sometimes!
7) I love the people I work with. I may rant about the insurmountable problems in health care here, the complacency, etc. etc. but the people I work with are here, they are committed and they are not giving up. You can only admire that kind of drive. Plus, being a small organization, it feels like family here.
8) Debating with my supervisor. He is probably the most interesting, and knowledgeable person I’ve met here. A wealth of information, it is very fun to debate ideas and theories and the field of international development with him. Goes to show you that being physically worlds apart does not always mean that the thinking is different.
9) I love our porch swing. Set up perfectly to watch the sun set over the water as you rock back and forth (if only I could do something about those damn mosquitoes!).
10) My gym. The best medicine for anything thats ailing me and the only place i can take deep breaths in the city without causing severe lung damage

And finally…I love it when it rains. The weather here is a little odd, it’ll be sunny and hot most of the day, and then every now and then the clouds come in, the skies open up and it absolutely pours for like 20 min….and then its sunny again. I guess my favourite part is after the rain ends. The dirt is washed away, the streets are little emptier, and the air feels crisp, cool, and a little cleaner – even if only for a moment.

Thursday, September 4, 2008

Bringin down the hospital...one virus at a time...

Wed afternoon I’m sitting at my desk innocently working away as a productive member of the CHD team when our IT specialist comes to me and asks “have you been sending email?” my response was “no, not recently” wondering if they have the ability to read my emails (and praying that they don’t!). Our IT person responded “well, no one in the hospital is able to send emails right now and the hospital’s IT staff think you might be causing it.”

WHAT!?!?!

She says “how do I explain this?”. I say “I’m pretty computer literate, try me”.
“there is an open portal somewhere in the hospital’s network that is exposing the entire network making it vulnerable to any viruses, the network in response has put up firewalls which is preventing everyone in the hospital from using email or the internet. The IT staff in the hospital have been tracing this portal for quite some time now, and they have traced it to someone in this department and then they specifically traced it to your IP address”.

Now, I’m not the most technical person, I’m computer literate, but not technical, so I don’t even know if that makes sense so please refrain from any “that doesn’t make sense” comments.

But I did get the point and I asked our IT person point blank “so you’re telling me that right now I am single handily disrupting the entire Aga Khan Hospital network and that no one can send email or anything because of my laptop?”

“Yes”

Well…Mission Accomplished.

Ok, so I’m not an undercover hacker, and I didn’t come here to destroy the fibre optic network, or the Aga Khan Hospital. But c’mon…how often do I get to do that?? Especially without even knowing it?!

Anyways, my instructions were to disconnect from the network, do a complete sweep of my laptop (which was clean) and then let the IT people work on..well..whatever it is they do to keep the network running. A few jokes and comments about making my laptop “Kenyan compliant”…(whatever that means) later, and I’m good to go and that portal, or whatever it was is gone.

Maybe it’s the all white casing, maybe it’s the apple logo, but I guess something about my laptop raises suspicion. But the irony here, is that although I have a mac, I’m using the Windows OS – well I’m forced to since for some reason when I load Mac’s leopard OS I can’t connect to the network (any mac users out there who know why this is happening…help!!). so its really just the casing and the apple logo..the rest is all the same. Anyways, i hope i didn't raise any suspicion, we don't have our work permits yet, so my legal status in this country is questionable right now, and the last thing i need is accusations of espionage. I'm happy to report that i'm working off a new IP address so ha! just try and find me now!

Oh and today as I arrived to work, I came to find that again, our entire hospital network was not working – it’s a regular occurrence here and can happen anytime and our IT person assured me that it had nothing to do with me. I would think not considering my laptop was still in my backpack…but I don’t have to tell you who everyone’s fingers were pointing to…

Shoulda just stayed in bed…