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..