Working in a public health, management position, I have sometimes felt removed from the individual stories and struggles of the people I am here to serve. A few times I have prayed that God would bring some of these situations across my path, that he would break my heart. A dangerous prayer to pray, but sometimes I feel to removed or callous, so it wouldn’t be a bad thing.
This past week I met a 13 year old boy named David. I heard about him nearly a month ago. For the past two years he has had seizures, but he was never brought for medical attention; or if he was, his condition remained undiagnosed. It sounded like epilepsy and the small hospital in Foya said if this was the case, they could diagnose and initiate treatment then the clinic in his area could follow up and monitor the treatment.
Last week some of our staff traveled to his community – at least a 4 hour drive from Foya. The plan was to bring him to Foya for a day or two and then return him to the village. However, they found him emaciated. Last year he was thin, but not severely malnourished; it was a surprise and a much more critical situation than expected. They brought him to the hospital in Foya, but between his malnutrition and neurological problems – his case was too complicated to treat fully here.
On arrival, his hemoglobin level was very low at 2.2. After locating and purchasing blood – he received 2 units and was somewhat stabilized. I had heard there were inpatient feeding centers in the hospitals 45 min and 1.5 hrs away and suggested transferring him there (this was while I was still in Monrovia). When I arrived though, he was still in Foya. The Foya hospital had referred him to a town 5 hrs away by road! The next few days were a complicated series of encounters with the family and medical staff trying to arrange referral somewhere he could get appropriate treatment.
David’s mother is not in the picture. His auntie came with him to the hospital as his caretaker. His father attends school across the border in Sierra Leone. In most hospitals here, the nursing staff do not do any ADL’s (activities of daily living), this is the responsibility of the family. It is nice that family members are more involved, but it also creates many challenges. To refer and transfer David, he needed a caretaker, but being so far away, it was difficult to send a caretaker; his auntie has 5 children of her own and did not want to go.
David’s father responded to the news that his son was seriously ill by coming back from Sierra Leone and eventually to the hospital. We also checked out the feeding centers at the nearby hospitals. Several times we thought we had a good plan in place for referral, including the right hospital, caretakers and transport… but there was always a complicating factor. The feeding center nearby had no food supplies – none of the therapeutic milk needed to rehabilitate his nutritional status; the auntie wanted to go back home for a week before going anywhere else; the ambulances won’t take referrals across county lines; the ambulance will take him but needs to stop at every hospital in between; our car going by the hospital on its way to Monrovia was too full and liable to break down…and on.
It was a challenging situation. One night, before the father arrived, we went to bring some food and see the auntie. It was just supposed to be a quick visit as we were still waiting for the father and information on the other feeding centers. The auntie doesn’t speak much English, so a lab technician that spoke her language was also there. The medical staff starting telling the Auntie she needed to go to the hospital 5 hrs away with the boy. We had last told her that we were looking at a referral nearby. She did not like the idea of going so far, but the medical staff kept telling her she needed to go and raising their voices more and more – nearly cornering her. They told her this was her only option.
I felt so bad for her. I have heard about the local people’s distrust and dislike of the medical system here – as in many other countries. I totally understood as I watched this occur. I know the medical staff had the best interests of David in mind, I wanted the best for him and hated to see the state he was in due to the neglect of his family. But I could also see the auntie’s point of view. She had just finished telling me about the five children of her own. She would be leaving them to care for a child who was not her own and who may or may not survive. If I were her, I would be hesitating too!
Health care and social services are not perfect in the US, but we can be thankful for what we do have. That there are ambulances to respond to emergencies, and facilities that are adequately staffed. We can be thankful for health staff that are trained not just to treat patients medically, but to also care for their daily needs whether there is a family member present or not.
I have thought over again – what is the best in this situation. God cares for David and loves David, but what is best for David? And what is best for his family? What if they choose not to go and bring David home where he will surely die? What if we transport him and something happens on the way? Have we made the situation worse for the family and for David by trying to help? What happens if we send David and his father abandons him there?
I honestly don’t know how to answer these questions and to advise in the situation. I have been challenged to trust in God and seek his wisdom, to pray that the outcome ends up positive for all involved. The morning I wrote this, I helped put David and his father in the car for Gbarnga (5 hrs away) and I pray that I will see David again, fat and healthy.
After writing this, I have since seen David again. A few days after transport, we stopped in at the hospital on our way to Monrovia. He had been admitted to the feeding unit and was doing fairly well. He was eating, but then stopped so he is getting his nutrition through an NG tube now. His father was still there caring for him, and the nurses seemed to be as competent and as caring as could be expected here. They were evaluating him for underlying causes for the malnutrition – possibly extrapulmonary TB or epilepsy. Please pray for David – for his recovery and for the love and care of his family.
Monday, March 26, 2012
Tuesday, March 6, 2012
CCC: CDFs, CHE, and Canoes
Second post this week…I am going to try to write smaller entries and post pictures more often when things happen actually happen, rather than one big entry all at once. This week was a much quieter week than last week, which was nice. Mid-week I took a quick trip to Bopolu to visit some of the CDFs (community development facilitators). One of the tasks of the CDFs is the CHE training (community health evangelism/education). Previously, CHE fell under the ministry department, but due to the health content of the training, it is now being overseen by the health sector.
I love the idea of the CDFs and CHE. It is really the type of program that motivated me to go into public health. It is focused on teaching communities basic health information and through this sharing the love of Jesus. The CDFs are SP national staff who live in the community. They facilitate not just the CHE, but also the entry of other projects. These include WASH (Water, Sanitation, and Hygiene), ministry, agriculture, and literacy, just to name a few.
The great thing about CHE is that every community goes through the training. They select and train a CHE committee made up mostly of community leaders. They then train a group of community members as CHE (community health educators). They have been using the first year materials for a while, but there are now second year + communities who are ready for more information. The last couple weeks I worked to pull together some materials to start off the year two communities.
Liberia has one of the highest maternal mortality rates and high infant and under 5 mortality rates. The 2007 maternal mortality rate was 994 per 100,000 infant mortality rate was 71 per 1,000 live births, and the under 5 mortality rate was 110 per 1,000 live births. The under 5 causes of death are dealt with in the first year materials but there is very little information pertaining to pregnancy and women’s health. So year two we will try to focus on maternal health and give communities more knowledge on healthy pregnancy, preventing and recognizing problems, and caring for infants. This week I gave the first set of lessons to the CDFs in Bopolu and they were excited to have it.
I enjoyed meeting the CDFs for the first time. Though I had met them in passing before, this was the first time really spending time with them and I am looking forward to working with them more. There were three ladies at this site and they are all returning CDFs, so they know what they are doing. Their biggest concern….crossing the river to one of the communities. They go in a canoe, but this capsized recently and none of them know how to swim. We are hoping in the very near future to finish a new canoe so they can cross the river more safely, especially as rainy season comes. And hopefully to find some lifejackets and do a short swimming lesson…ie don’t panic and let the life jacket keep you afloat until you can get to shore!
Pray for the CDFs as they continue the CHE trainings – for both the old and new communities.
The picture below is the CDFs – Alice, Annie, and Ophelia.
I love the idea of the CDFs and CHE. It is really the type of program that motivated me to go into public health. It is focused on teaching communities basic health information and through this sharing the love of Jesus. The CDFs are SP national staff who live in the community. They facilitate not just the CHE, but also the entry of other projects. These include WASH (Water, Sanitation, and Hygiene), ministry, agriculture, and literacy, just to name a few.
The great thing about CHE is that every community goes through the training. They select and train a CHE committee made up mostly of community leaders. They then train a group of community members as CHE (community health educators). They have been using the first year materials for a while, but there are now second year + communities who are ready for more information. The last couple weeks I worked to pull together some materials to start off the year two communities.
Liberia has one of the highest maternal mortality rates and high infant and under 5 mortality rates. The 2007 maternal mortality rate was 994 per 100,000 infant mortality rate was 71 per 1,000 live births, and the under 5 mortality rate was 110 per 1,000 live births. The under 5 causes of death are dealt with in the first year materials but there is very little information pertaining to pregnancy and women’s health. So year two we will try to focus on maternal health and give communities more knowledge on healthy pregnancy, preventing and recognizing problems, and caring for infants. This week I gave the first set of lessons to the CDFs in Bopolu and they were excited to have it.
I enjoyed meeting the CDFs for the first time. Though I had met them in passing before, this was the first time really spending time with them and I am looking forward to working with them more. There were three ladies at this site and they are all returning CDFs, so they know what they are doing. Their biggest concern….crossing the river to one of the communities. They go in a canoe, but this capsized recently and none of them know how to swim. We are hoping in the very near future to finish a new canoe so they can cross the river more safely, especially as rainy season comes. And hopefully to find some lifejackets and do a short swimming lesson…ie don’t panic and let the life jacket keep you afloat until you can get to shore!
Pray for the CDFs as they continue the CHE trainings – for both the old and new communities.
The picture below is the CDFs – Alice, Annie, and Ophelia.
Tuesday, February 28, 2012
Malaria Training
Well, this blog has been pretty sparse in the last month and a half! Partially because I have been really busy and partially because I just don’t know what to write! While my facebook updates are more about the beach and weekend fun, most of my time is spent working in the Monrovia office, managing all the health projects. It is crazy busy and often stressful dealing with various donors and the ministry of health, and not too interesting to blog about.
The best part of the job is getting out to visit and monitor the projects. It reminds me why I am doing what I do. It is worth it when I hear how a child who is malnourished is slowly gaining weight, or I see a group of community health volunteers engaging in conversations about how to stop the spread of malaria in the community.
In January we had two trainings on malaria. The first was with the health professionals at the clinics and the second with the community health volunteers. I got to sit in on a bit of both trainings. The most encouraging moment was listening to the gCHVs ask questions. There were some interesting beliefs about malaria and how it spreads, but they really wanted to learn more to help their communities.
One issue that has been tossed around a lot in various meetings is how to motivate the community health volunteers. It is a challenge because they are part of the MOH health system, but so many NGOs are working with the same volunteers and giving various different incentives. Trying to standardize the incentive, in a way the MOH can continue to support without the NGOs, and will still motivate gCHVs to work…now that is a challenge!
I have yet to really spend time with the gCHVs in person, other than observing this training. I hope that in one of my visits coming up I will have more time to actually talk with them. Almost every project and department wants to use the gCHVs – nutrition, community health, TB followup, HIV… and yet they are only volunteers, often covering a wide area. It will be interesting to see how the issue of gCHVs and motivation continues…stay tuned!
TTM's singing at a clinic extension dedication
Practicing a home visit at the malaria TOT training
The best part of the job is getting out to visit and monitor the projects. It reminds me why I am doing what I do. It is worth it when I hear how a child who is malnourished is slowly gaining weight, or I see a group of community health volunteers engaging in conversations about how to stop the spread of malaria in the community.
In January we had two trainings on malaria. The first was with the health professionals at the clinics and the second with the community health volunteers. I got to sit in on a bit of both trainings. The most encouraging moment was listening to the gCHVs ask questions. There were some interesting beliefs about malaria and how it spreads, but they really wanted to learn more to help their communities.
One issue that has been tossed around a lot in various meetings is how to motivate the community health volunteers. It is a challenge because they are part of the MOH health system, but so many NGOs are working with the same volunteers and giving various different incentives. Trying to standardize the incentive, in a way the MOH can continue to support without the NGOs, and will still motivate gCHVs to work…now that is a challenge!
I have yet to really spend time with the gCHVs in person, other than observing this training. I hope that in one of my visits coming up I will have more time to actually talk with them. Almost every project and department wants to use the gCHVs – nutrition, community health, TB followup, HIV… and yet they are only volunteers, often covering a wide area. It will be interesting to see how the issue of gCHVs and motivation continues…stay tuned!
TTM's singing at a clinic extension dedication
Practicing a home visit at the malaria TOT training
Sunday, January 22, 2012
1/12/12
Visiting or working in health facilities in other countries can be a very interesting experience. I have had a few brief visits so far in Liberia, but this week was by far the most interesting. One of other expat staff got several phone calls requesting her to give blood. There was a patient at the hospital needing her blood type and there was none available in the blood bank . She had given at a blood drive over the summer so she was on a list. Because it’s Liberia and the quality of medical care is rather low, she was a little hesitant, but she decided to go if one of us would accompany her.
Being the nurse, of course I volunteered. It was late by the time we left, around 7pm. We drove to the biggest hospital in the country. Neither of us had been there, so we drove in the front entrance, found a parking area, then called her contact person. He was not there yet but would meet us at the front entrance. We couldn’t figure out where the front entrance was, so we asked two people and they pointed us to the emergency entrance.
We walked in the door and told the nurse we were supposed to meet this person to donate blood. She gave us a clueless look, so we said we would wait outside and call him again. We sat on the curb to wait. The nurse came out and said “I hope he comes soon, you are not allowed to sit on the curb, a car might come and hit you.” Luckily we saw a man walking purposefully towards us so we figured that was him and got off the dangerous curb.
We had thought this man was from the blood bank, since that is where the list is, but after a minute or two of conversation it became clear that he is the son of the man needing blood. He had somehow gotten the list and was calling the six people on it to try and find blood for his father. Crazy that 1) the family member has to do all the work to get the blood and 2) he somehow got the list.
The three of us walked down the empty, dark corridors to find the lab. Once there, my colleague had her blood tested to make sure she was eligible and was indeed the correct blood type. The blood was drawn right in the lab – with all the lab equipment and other samples lying around. We then had to wait about 10 minutes for the results so we chatted with the son. His father had already received blood just before Christmas but his count was low again. They do not know what was causing this drop, but needed to stabilize him for more testing. He had been waiting already for about a day, in the emergency room of the hospital, for the blood.
The lab technician came out with the lab result slip and motioned for the son to talk to him, they started whispering in the corner. My colleague looked at me and said – “Shouldn’t I be getting my own test results!” Yeah, definitely no such thing as HIPAA here. So we got up and walked over, all he said was – no problem – you can give blood. All the hepatitis and HIV tests are negative and your hemoglobin is above the cut-off. No confidentiality at all!
So then we moved into the next room where there was a place to lie to give the blood. The son then had to go purchase the supplies from the cashier before we could begin the process. So we waited, and while we did the lab technician took off, saying there was an emergency and he would come back. So the two of us were sitting there, just waiting, in the dark, empty basement of JFK hospital. The son came back with the supplies, but of course the lab tech was not back yet, so he went off again to find him. Eventually the son, a couple lab techs, and several observers were there and ready to start.
The other lab tech was the one who was to draw the blood. We made sure he had all new supplies, and he started to clean the area. However he was not wearing gloves. My colleague asked where his gloves were. His response – “We already tested your blood, it is negative so I don’t need gloves” – universal precautions???? I told him he should wear gloves anyways – to treat any blood as if it could be infected. He just kept smiling and looking at us and preparing. So my friend tried again – “I would feel more comfortable if you were wearing gloves.” He still just kept staring and smiling and working so I tried again “She would feel more comfortable, we would both feel more comfortable, if you wore gloves.” By now he had the tubing and bag out, so I reached out to hold the supplies for him to put gloves on. He says “You want to help me?” “No, I am going to hold this while you get your gloves on.” He finally got a pair of gloves and started.
The blood draw went fine and as my friend was resting before leaving, more family came in - another son and the wife. Both sons were so grateful and really wanted to do something – “what can we get you to build the blood back, candy bar, water?” So while they went to find some good blood building food, we chatted with the wife. Such a nice family! It had been a rough few days for her. Waiting in the emergency room was overwhelming . She explained how so much was going on around them, including the birth of a baby!
Eventually the two sons came back with chocolate and water. On the way out we stopped to say hi to the patient. He was grateful and we let them know we would be praying for them. What an interesting experience between the craziness of the medical system in Liberia and meeting the recipient. At home when you give blood you never get to see the person it is helping, so that was cool and it was a good reminder of the human face on the other side. Please pray for this man and his family as they try to solve his medical problems in a country where medical care is much more limited.
Visiting or working in health facilities in other countries can be a very interesting experience. I have had a few brief visits so far in Liberia, but this week was by far the most interesting. One of other expat staff got several phone calls requesting her to give blood. There was a patient at the hospital needing her blood type and there was none available in the blood bank . She had given at a blood drive over the summer so she was on a list. Because it’s Liberia and the quality of medical care is rather low, she was a little hesitant, but she decided to go if one of us would accompany her.
Being the nurse, of course I volunteered. It was late by the time we left, around 7pm. We drove to the biggest hospital in the country. Neither of us had been there, so we drove in the front entrance, found a parking area, then called her contact person. He was not there yet but would meet us at the front entrance. We couldn’t figure out where the front entrance was, so we asked two people and they pointed us to the emergency entrance.
We walked in the door and told the nurse we were supposed to meet this person to donate blood. She gave us a clueless look, so we said we would wait outside and call him again. We sat on the curb to wait. The nurse came out and said “I hope he comes soon, you are not allowed to sit on the curb, a car might come and hit you.” Luckily we saw a man walking purposefully towards us so we figured that was him and got off the dangerous curb.
We had thought this man was from the blood bank, since that is where the list is, but after a minute or two of conversation it became clear that he is the son of the man needing blood. He had somehow gotten the list and was calling the six people on it to try and find blood for his father. Crazy that 1) the family member has to do all the work to get the blood and 2) he somehow got the list.
The three of us walked down the empty, dark corridors to find the lab. Once there, my colleague had her blood tested to make sure she was eligible and was indeed the correct blood type. The blood was drawn right in the lab – with all the lab equipment and other samples lying around. We then had to wait about 10 minutes for the results so we chatted with the son. His father had already received blood just before Christmas but his count was low again. They do not know what was causing this drop, but needed to stabilize him for more testing. He had been waiting already for about a day, in the emergency room of the hospital, for the blood.
The lab technician came out with the lab result slip and motioned for the son to talk to him, they started whispering in the corner. My colleague looked at me and said – “Shouldn’t I be getting my own test results!” Yeah, definitely no such thing as HIPAA here. So we got up and walked over, all he said was – no problem – you can give blood. All the hepatitis and HIV tests are negative and your hemoglobin is above the cut-off. No confidentiality at all!
So then we moved into the next room where there was a place to lie to give the blood. The son then had to go purchase the supplies from the cashier before we could begin the process. So we waited, and while we did the lab technician took off, saying there was an emergency and he would come back. So the two of us were sitting there, just waiting, in the dark, empty basement of JFK hospital. The son came back with the supplies, but of course the lab tech was not back yet, so he went off again to find him. Eventually the son, a couple lab techs, and several observers were there and ready to start.
The other lab tech was the one who was to draw the blood. We made sure he had all new supplies, and he started to clean the area. However he was not wearing gloves. My colleague asked where his gloves were. His response – “We already tested your blood, it is negative so I don’t need gloves” – universal precautions???? I told him he should wear gloves anyways – to treat any blood as if it could be infected. He just kept smiling and looking at us and preparing. So my friend tried again – “I would feel more comfortable if you were wearing gloves.” He still just kept staring and smiling and working so I tried again “She would feel more comfortable, we would both feel more comfortable, if you wore gloves.” By now he had the tubing and bag out, so I reached out to hold the supplies for him to put gloves on. He says “You want to help me?” “No, I am going to hold this while you get your gloves on.” He finally got a pair of gloves and started.
The blood draw went fine and as my friend was resting before leaving, more family came in - another son and the wife. Both sons were so grateful and really wanted to do something – “what can we get you to build the blood back, candy bar, water?” So while they went to find some good blood building food, we chatted with the wife. Such a nice family! It had been a rough few days for her. Waiting in the emergency room was overwhelming . She explained how so much was going on around them, including the birth of a baby!
Eventually the two sons came back with chocolate and water. On the way out we stopped to say hi to the patient. He was grateful and we let them know we would be praying for them. What an interesting experience between the craziness of the medical system in Liberia and meeting the recipient. At home when you give blood you never get to see the person it is helping, so that was cool and it was a good reminder of the human face on the other side. Please pray for this man and his family as they try to solve his medical problems in a country where medical care is much more limited.
Thursday, January 5, 2012
Goodbye 2011, Hello 2012
Happy New Year!!!!
Over the holidays I kept thinking about the past year and where I have come. It was a pretty incredible journey with many challenges but God was so faithful through it all. I want to start my New Year thanking God for some of the amazing things he has done over the last year, specifically the three I prayed A LOT about over the last year.
1) My mom’s good health after going through chemo and surgery last year
2) My friend Emily is together with her husband after a long year of waiting
3) A wonderful job in Liberia after completing three long years of school
And after praising God for his work last year, I look ahead to his wonderful works in the coming year. My verse to begin 2012 is Isaiah 28:16
“ So this is what the sovereign Lord says: ‘See I lay a stone in Zion, a tested stone, a precious cornerstone for a sure foundation; the one who relies on it will never be stricken with panic.’”
Well, I have really not kept up well with my blog so far in Liberia – I apologize. So for my first blog of 2012 I want to recap with little tidbits and reflections since my last entry.
Nov. 24th – Happy Thanksgiving - celebrated with the American/Canadian/British expats with a big turkey dinner and all the trimmings My boss lady also announced she is expecting…exciting, but wondering what that means for me….
Dec. 1st – World AIDS Day – participated in a school program with our OVC staff which was great. The whole week I had been thinking a lot about birth and death. There were two kids who drowned in the ocean by our house and then we drove by a bad car accident where 4 or 5 people had died the day before; so much premature death here. But then after the AIDS day celebration we stopped to see a staff member’s new baby. During the program there were reminders that AIDS is real and it kills, but also the message about living positively with HIV. The events of the week reminded me that we don’t know when death will come, but we shouldn’t live in fear and despair. We should live positively the days that we do have, whether many or few.
Dec. 8th – Unexpected opportunity that rather frightens me - my boss lady is leaving December 23rd to return to the US for the rest of her pregnancy, leaving me in her position as health sector manager. I am sad and scared by this, but it is also an exciting opportunity. I have had a lot of ups and downs since then, but this quote from Abundant Living has encouraged me - “God is opening a fresh book through your character and life. If you do not respond, if you hold back and frustrate His purposes, that book will never be revealed – the world will be poorer and so will you.” I needed the reminder to let God use me in all my strengths and weaknesses – just as I am.
Dec 12th-16th – First Foya trip - though already planned, it was even more important for me to see the rest of the health projects in Liberia before I become the boss lady. It definitely got me more excited about the coming year. The biggest reason for the trip was to represent the SP health office at the graduation for our sexual and reproductive health project. It was great to see the community and people we are working with. The awkward part was handing out the certificates with everyone stopping for the typical graduation hand-shake – diploma-pass picture; I am usually on the other side.
Dec. 22nd – Christmas riots - had a great meeting about expanding some of our nutrition work, but our trip back took 2+ hours due to youth rioting in the streets. We ended up stopped for an hour pretty close to one line of rioters and the riot police gathering. It was definitely pretty intense, wondering whether the police would act, if the growing group of youth would get further out of control. Listening to the radio, we heard that they were blocking multiple streets due to not being paid for vacation work. The police eventually broke up the group in our area and we made it home. However, there were cars burned and other damage done elsewhere. The riots continued the evening of the 23rd as well, but so far the payments are going ok and it has been pretty quiet since then. The ironic part – we were watching the riots under several giant billboards about the peace in Liberia. Not saying they haven’t come a long way since the war, but there is definitely more to be done.
Dec 25th – Christmas in Liberia – very nice, I spent it with the few other remaining SP expat staff. Went to Christmas Eve and Christmas Day services, did some Christmas cooking and baking, enjoyed the beach in Robertsport, and continued learning to surf. It was a nice holiday. A Christmas thought from Abundant Living – “ I too must become the word made flesh. I must be a miniature Christmas.” What a great way to say it.
It’s been back to work in the office this week, with a lot going on, and just me in the health office now. So far it’s been pretty good, but I can use your prayers!!! It is going to be a very busy month, so not sure when I will get around to posting next.
Over the holidays I kept thinking about the past year and where I have come. It was a pretty incredible journey with many challenges but God was so faithful through it all. I want to start my New Year thanking God for some of the amazing things he has done over the last year, specifically the three I prayed A LOT about over the last year.
1) My mom’s good health after going through chemo and surgery last year
2) My friend Emily is together with her husband after a long year of waiting
3) A wonderful job in Liberia after completing three long years of school
And after praising God for his work last year, I look ahead to his wonderful works in the coming year. My verse to begin 2012 is Isaiah 28:16
“ So this is what the sovereign Lord says: ‘See I lay a stone in Zion, a tested stone, a precious cornerstone for a sure foundation; the one who relies on it will never be stricken with panic.’”
Well, I have really not kept up well with my blog so far in Liberia – I apologize. So for my first blog of 2012 I want to recap with little tidbits and reflections since my last entry.
Nov. 24th – Happy Thanksgiving - celebrated with the American/Canadian/British expats with a big turkey dinner and all the trimmings My boss lady also announced she is expecting…exciting, but wondering what that means for me….
Dec. 1st – World AIDS Day – participated in a school program with our OVC staff which was great. The whole week I had been thinking a lot about birth and death. There were two kids who drowned in the ocean by our house and then we drove by a bad car accident where 4 or 5 people had died the day before; so much premature death here. But then after the AIDS day celebration we stopped to see a staff member’s new baby. During the program there were reminders that AIDS is real and it kills, but also the message about living positively with HIV. The events of the week reminded me that we don’t know when death will come, but we shouldn’t live in fear and despair. We should live positively the days that we do have, whether many or few.
Dec. 8th – Unexpected opportunity that rather frightens me - my boss lady is leaving December 23rd to return to the US for the rest of her pregnancy, leaving me in her position as health sector manager. I am sad and scared by this, but it is also an exciting opportunity. I have had a lot of ups and downs since then, but this quote from Abundant Living has encouraged me - “God is opening a fresh book through your character and life. If you do not respond, if you hold back and frustrate His purposes, that book will never be revealed – the world will be poorer and so will you.” I needed the reminder to let God use me in all my strengths and weaknesses – just as I am.
Dec 12th-16th – First Foya trip - though already planned, it was even more important for me to see the rest of the health projects in Liberia before I become the boss lady. It definitely got me more excited about the coming year. The biggest reason for the trip was to represent the SP health office at the graduation for our sexual and reproductive health project. It was great to see the community and people we are working with. The awkward part was handing out the certificates with everyone stopping for the typical graduation hand-shake – diploma-pass picture; I am usually on the other side.
Dec. 22nd – Christmas riots - had a great meeting about expanding some of our nutrition work, but our trip back took 2+ hours due to youth rioting in the streets. We ended up stopped for an hour pretty close to one line of rioters and the riot police gathering. It was definitely pretty intense, wondering whether the police would act, if the growing group of youth would get further out of control. Listening to the radio, we heard that they were blocking multiple streets due to not being paid for vacation work. The police eventually broke up the group in our area and we made it home. However, there were cars burned and other damage done elsewhere. The riots continued the evening of the 23rd as well, but so far the payments are going ok and it has been pretty quiet since then. The ironic part – we were watching the riots under several giant billboards about the peace in Liberia. Not saying they haven’t come a long way since the war, but there is definitely more to be done.
Dec 25th – Christmas in Liberia – very nice, I spent it with the few other remaining SP expat staff. Went to Christmas Eve and Christmas Day services, did some Christmas cooking and baking, enjoyed the beach in Robertsport, and continued learning to surf. It was a nice holiday. A Christmas thought from Abundant Living – “ I too must become the word made flesh. I must be a miniature Christmas.” What a great way to say it.
It’s been back to work in the office this week, with a lot going on, and just me in the health office now. So far it’s been pretty good, but I can use your prayers!!! It is going to be a very busy month, so not sure when I will get around to posting next.
Saturday, December 10, 2011
November Nutrition Training
You are probably wondering what exactly I am doing while I am here, other than shaking hands with the president, roasting goats and fish, driving through mud pits… sometimes I ask myself the same question! In all honesty though – it has taken me a little while, and will still take some time – to figure out exactly what my role is.
A little about the CMAM (Community Management of Acute Malnutrition) project. The goal is to manage cases of severe acute malnutrition (SAM) in the community through existing health facilities. This week we trained health staff from 4 clinics to manage the OTP (outpatient therapeutic program) for uncomplicated SAM cases. After the 3 days of training, we went to each clinic to set up the site and start screening and admitting children. It went well and we admitted about 9 cases during the set up time.
The next training will be with the community health volunteers who will work at the community level to identify and refer cases of severe malnutrition. They will also be trained to share the essential nutrition action messages with caregivers in the community. The last training will be with one health facility that will treat cases of complicated SAM needing inpatient care. Hopefully more to come on these later!
Setting up and zeroing the scales during a practice session for OTP training.
The training participants, facilitators, and SP staff
First admission at Fish Town Health Center with her caregiver. I didn't get the full story, but her caregiver is her grandmother - her mother died when she was 3-4 months old. This has certainly affected her growth; she is underweight and has met the criteria for admission for severe malnutrition. She passed the appetite test and hopefully with the nutritional treatment can gain weight and stay healthy.
Screening at another facility using the MUAC tape. This little boy was admitted either for a small midarm circumference or a low weight for height. He loved me and kept trying to walk over to where I was, but his sister wailed everytime I looked in her direction!
Advantage of riding in the second land cruiser – you see what you are about to drive through; disadvantage of riding in the second land cruiser – you see what you are about to drive through. I haven’t decided which I prefer!
A little about the CMAM (Community Management of Acute Malnutrition) project. The goal is to manage cases of severe acute malnutrition (SAM) in the community through existing health facilities. This week we trained health staff from 4 clinics to manage the OTP (outpatient therapeutic program) for uncomplicated SAM cases. After the 3 days of training, we went to each clinic to set up the site and start screening and admitting children. It went well and we admitted about 9 cases during the set up time.
The next training will be with the community health volunteers who will work at the community level to identify and refer cases of severe malnutrition. They will also be trained to share the essential nutrition action messages with caregivers in the community. The last training will be with one health facility that will treat cases of complicated SAM needing inpatient care. Hopefully more to come on these later!
Setting up and zeroing the scales during a practice session for OTP training.
The training participants, facilitators, and SP staff
First admission at Fish Town Health Center with her caregiver. I didn't get the full story, but her caregiver is her grandmother - her mother died when she was 3-4 months old. This has certainly affected her growth; she is underweight and has met the criteria for admission for severe malnutrition. She passed the appetite test and hopefully with the nutritional treatment can gain weight and stay healthy.
Screening at another facility using the MUAC tape. This little boy was admitted either for a small midarm circumference or a low weight for height. He loved me and kept trying to walk over to where I was, but his sister wailed everytime I looked in her direction!
Advantage of riding in the second land cruiser – you see what you are about to drive through; disadvantage of riding in the second land cruiser – you see what you are about to drive through. I haven’t decided which I prefer!
Monday, November 21, 2011
Election Time and Travel to River Gee
Sunday 11/13/11
This week has just been jam packed with new experiences!
Sunday I shook hands with the president. It was crazy, I can’t quite believe it! After church I went out to lunch with a few people. It was the weekend before the run-off election and there were some campaigners near the restaurant. We went through the back gate and walked up to the door. That door was closed, so we went around front and they let us in. There were a lot of people in campaign gear and music playing, but this didn’t seem odd given the coming election. But once inside, we looked over, and there was the president sitting at a table. Someone told us we couldn’t be inside, but there was a table outside. So we went outside and sat down. I don’t know how we even got in the gate of the restaurant! The front gate was blocked off, as were both doors to get inside. We sat down and ordered lunch while the president was right on the other side of the window. While we were still waiting for our food, the president and her entourage got up and left through the front door, passing by our table. She stopped and someone at our table waved. She took a few steps towards us, so we all stood up and shook her hand! So crazy! Then she and all the campaigners left. We finished our lunch and headed home.
Monday was the day before the run-off. Leading up to the election, the opposition party was calling for a boycott and there was some potential for disruption of elections. The morning was quiet and I went to pick up materials for our training near downtown. On the way back we drove by the opposition headquarters. People were gathering and some UN and police cars passed us with their lights on and stopped there. It was a little scary because so many people were milling around and yelling, but it wasn’t too crazy yet. We got back to the office and went on with work. Later on in the day news was coming in that there was rioting, tear gas was being used, and shots were fired. It was strange to think it was right where we drove through just a few hours earlier. I was thankful I was back already! This event caused a lot of anxiety, especially for the local staff. The office emptied out pretty early, with people wanting to get home.
Tuesday was election day and thankfully that day was peaceful. We had the day off and the expat SP staff had a goat and fish roast. The event of the morning was the slaughtering of the goat which our Kenyan and Malawian expat staff carried out. It was interesting. The best part was listening to the kids comments – they were pretty funny. The one I remember is this “’What is his name?’ ‘Lucky!’ ‘He wasn’t very lucky!’” After some beach time and baking of cookies I went with some of the girls to buy and prepare the fish. That evening we had roasted goat and fish cooked in the pit, very delicious. That night a little after 10 there was a fire in the radio station on the compound. Some of the girls from the house went over to help out – somehow I slept/dozed through it. Praise God no one was hurt and it did not spread, but pray for the ministry as they assess the damage and the way forward.
Thursday morning, bright and early, I got in the car to head upcountry to River Gee. Up country is basically anywhere outside of Monrovia; River Gee is in the Southeast corner of the country, about 12 hrs by road from Monrovia. We had a training scheduled to start Friday morning, so we had to make it by Thursday evening. Our Wednesday departure got postponed for a variety of reasons and it was stressful working out the logistics of this trip to make sure our trainers and staff arrived in time for training! But praise God we did. About an hour and a half after our scheduled departure we finally had everyone loaded and headed out. The road wasn’t too bad most of the way, but we did have several stops for car trouble. The final hour was rough – the roads got very bumpy, it was dark, and it started pouring! We made it, and after a good night’s sleep, were able to start the training.
Friday to Sunday were long days of training; trying to coordinate smooth operations for the training and project implementation. It is now Sunday evening and I am sitting outside on the porch of the office. Fish Town, where there are no fish, is our base in River Gee. It is a very small town and I am enjoying being out of Monrovia. I went for a jog one morning and a walk this morning and it is very beautiful and green, though very hot and humid. The staff at this base is great and has been very welcoming. Also, it has been nice being closer to the community we are working with and spending more time with the local Liberian staff. Looking forward to the rest of the week here, finishing training and setting up some of our sites at the clinics.
That is all for now…next post more on the training, the project, and my job!
This week has just been jam packed with new experiences!
Sunday I shook hands with the president. It was crazy, I can’t quite believe it! After church I went out to lunch with a few people. It was the weekend before the run-off election and there were some campaigners near the restaurant. We went through the back gate and walked up to the door. That door was closed, so we went around front and they let us in. There were a lot of people in campaign gear and music playing, but this didn’t seem odd given the coming election. But once inside, we looked over, and there was the president sitting at a table. Someone told us we couldn’t be inside, but there was a table outside. So we went outside and sat down. I don’t know how we even got in the gate of the restaurant! The front gate was blocked off, as were both doors to get inside. We sat down and ordered lunch while the president was right on the other side of the window. While we were still waiting for our food, the president and her entourage got up and left through the front door, passing by our table. She stopped and someone at our table waved. She took a few steps towards us, so we all stood up and shook her hand! So crazy! Then she and all the campaigners left. We finished our lunch and headed home.
Monday was the day before the run-off. Leading up to the election, the opposition party was calling for a boycott and there was some potential for disruption of elections. The morning was quiet and I went to pick up materials for our training near downtown. On the way back we drove by the opposition headquarters. People were gathering and some UN and police cars passed us with their lights on and stopped there. It was a little scary because so many people were milling around and yelling, but it wasn’t too crazy yet. We got back to the office and went on with work. Later on in the day news was coming in that there was rioting, tear gas was being used, and shots were fired. It was strange to think it was right where we drove through just a few hours earlier. I was thankful I was back already! This event caused a lot of anxiety, especially for the local staff. The office emptied out pretty early, with people wanting to get home.
Tuesday was election day and thankfully that day was peaceful. We had the day off and the expat SP staff had a goat and fish roast. The event of the morning was the slaughtering of the goat which our Kenyan and Malawian expat staff carried out. It was interesting. The best part was listening to the kids comments – they were pretty funny. The one I remember is this “’What is his name?’ ‘Lucky!’ ‘He wasn’t very lucky!’” After some beach time and baking of cookies I went with some of the girls to buy and prepare the fish. That evening we had roasted goat and fish cooked in the pit, very delicious. That night a little after 10 there was a fire in the radio station on the compound. Some of the girls from the house went over to help out – somehow I slept/dozed through it. Praise God no one was hurt and it did not spread, but pray for the ministry as they assess the damage and the way forward.
Thursday morning, bright and early, I got in the car to head upcountry to River Gee. Up country is basically anywhere outside of Monrovia; River Gee is in the Southeast corner of the country, about 12 hrs by road from Monrovia. We had a training scheduled to start Friday morning, so we had to make it by Thursday evening. Our Wednesday departure got postponed for a variety of reasons and it was stressful working out the logistics of this trip to make sure our trainers and staff arrived in time for training! But praise God we did. About an hour and a half after our scheduled departure we finally had everyone loaded and headed out. The road wasn’t too bad most of the way, but we did have several stops for car trouble. The final hour was rough – the roads got very bumpy, it was dark, and it started pouring! We made it, and after a good night’s sleep, were able to start the training.
Friday to Sunday were long days of training; trying to coordinate smooth operations for the training and project implementation. It is now Sunday evening and I am sitting outside on the porch of the office. Fish Town, where there are no fish, is our base in River Gee. It is a very small town and I am enjoying being out of Monrovia. I went for a jog one morning and a walk this morning and it is very beautiful and green, though very hot and humid. The staff at this base is great and has been very welcoming. Also, it has been nice being closer to the community we are working with and spending more time with the local Liberian staff. Looking forward to the rest of the week here, finishing training and setting up some of our sites at the clinics.
That is all for now…next post more on the training, the project, and my job!
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