Zilinga?…How Much (Are Your Experiences Worth)?

Last week happened in a rush of greens and blues – mostly because I spent so much time in cars, going from one town to another. The highway here is a single paved road that connects each district in a long strip of land hugging Lake Malawi. It is more of an ocean, about three-fifths the size of the country itself.

First, we attended a mobile-health (mHealth) and health information system (HIS) meeting at the Center of Health in Mzuzu. I remembered my professors referencing such meetings during lectures: they are generally drawn-out and tedious, but a (debatably) necessary part of development. Perhaps because this was my first meeting, I found it all very exciting. Important people filed in and took their seats around my own. An important man opened the proceedings with a speech, to which another important man followed with his own speech. Needless to say, I felt as though I had just won the lottery and could not stop smiling like an idiot; it was all so important.
The first order of business was to discuss and edit a document that would become the backbone of a new HIS program to be launched in the coming weeks. Our job was to go through the entire piece, line by line, and determine where a standard operating procedure (SOP) should be written in. It was difficult, given that there were only two copies: one, floating around on paper and the other being projected onto the far right wall. Everyone took turns reading a paragraph aloud while simultaneously scribbling down any recommendations. At first, I felt lost and nervous, only able to focus on counting down the people until it would be my turn to read. The modification process was monopolized almost immediately by a handful of people, forming a sort of collective style of SOP recommendation: data breach, access, confidentiality. It was easy to pick up on, and my heart pounded when I had finally found my first SOP: should I say anything, what if they laugh at me? I’m just a nobody kid…
Twenty minutes later, my voice was chiming in frequently with those who had enough energy to join the discussion. We would bounce back ideas:

“Is there an SOP for when new staff join the hospital and have not been trained to work with the program… And what if someone forgets how to do something?”

“How about we create one for capacity training then?”
“What about an SOP for when a clinic feels that they are ready to upgrade from a paper-based system to the digital one, is there a sort of timeline for progression or process for confirming ability to shift record-keeping?”
“We will make an SOP for determining upgrade status.”
I had SOPs coming out my ears and people were actually listening! I felt as though I was back in class, offering up ideas for a project or hypothetical activity and the anxiety slid off in the excitement of mutual understanding.
Even if the plans made in that meeting do not amount to much in the coming year in terms of development, it was everything to me. In that moment, I felt confident that I belonged with the best of public health, that my ideas were valid, and that what I bring to the table is, well, damn important. I have a lot to learn, but I know that I am capable of becoming better. I guess I was not sure of my abilities before coming here; there was always this little voice of doubt in the back of my mind about making my dreams a reality. I chose to major in Global Health because I wanted to do something good for people everywhere (total Messiah-Complex, I know…).
Maybe this is God telling me that I can actually find my little niche in all of this. Hooray, I’m not a total wipe-out!
A few days later, the HIS team hopped the LIN mini-bus over the mountains (of cattle) to arrive in the district of Chitipa. From the boardroom to the classroom, it was time to put the mHealth and HIS meeting plans into action! There, we hosted a four-day training program that would transition the District Hospital’s (DHO) Outpatient Care Unit from a paper-based system to a digital one. It was exactly what we had been discussing a few days ago in Mzuzu. Now, I had the opportunity to be a part of the education component of development. You can imagine how annoyingly elated I was the entire car ride…
In my mind, it was going to be totally awesome, like the Lego Movie theme song, but reality was a bit less exciting, to say the least. On the first day of our arrival, we spent two hours unpacking and setting up the conference room. There were wires and delicate hardware materials everywhere, AKA a clumsy person’s nightmare! I almost stepped on an extension board and tripped on cables.
The next day, I became a waitress and spent nearly the whole day running back and forth between soda shops purchasing refreshments and returning the empty glass bottles. I would also help anyone who had a question or got stuck, but mostly I was passing out crackers and picking up trash. Michiko, one of the MPH interns, deemed us Managers of Logistics, but I am not positive that the fancy name helped at all. I think it showed me how absolutely terrible I am at serving people, I mean, I always thought that I was a kind and humble person, but a few hours of “logistics” really brings out a person’s true colors. Kevin, another intern and co-Manager of Logistics, and I felt pretty unappreciated and useless. After talking – complaining – together for a while, I realized what a terrible attitude I had. I don’t blame me, I mean I had spent thousands of dollars to fly here in order to learn real Public Health stuff, and here I was, trash lady. I promise that there is a reason to why I am spending so much time on this… not just venting ladies and gentlemen.
It was easy to get miffed at first, but then I realized, this is an experience that I could only get by being here. Logistics, as inglorious as it may seem, is actually pivotal to successful conferences. In Malawi, and perhaps anywhere, the quality of refreshment and service provided are a big political message. Most of the people in the program were physicians or nurses, and everyone knew the price of each item offered. In this culture, we would be insulting their status if we gave any old generic brand good or made them buy their own snacks. The attendees would soon become unhappy and unwilling to participate in this very important capacity training seminar. The snacks and therefore my duty may not matter in the long run of sustainability for the hospital, but they were the gateway to the information that is. The HIS training that the staff received is priceless, but to them at this point in time, it is an inconvenient four days of not doing their job at the hospital at the expense of patients. They can’t all see the benefit yet, but when free Cocopina and fresh samosas are on the table, the sacrifice is a bit more digestible.
So, this was field-work. Humbling and tedious and even physically demanding (those glass bottle crates can get heavy), but worth it. It is day-by-day and uncomfortable for westerners like myself. I had to step out of my culture and get real(ly dirty) before I could see the end of the program: hospital staff with a new skill that would save lives.