Red, sweet Red

After 36 hours in transit (an extra 8 in ATL, thanks Delta....), I'm home. Or, my body is home. My brain is slowly trying to catch up to whatever time zone I am in. My family is happy to see me; Red dog slept peacefully next to my bed. So far, I've eaten: a quart of slaw, a giant bowl of 3 bean salad, Kashi cereal, cherry yogurt, Chex mix, Shabbat cupcakes, veggie lasagna, a bag of spinach, goat cheese, Diet Dr. Pepper, baked potato chips, and some Hot Tamales. I took two hot showers.

It's good to be home.

A much-needed injection of dorky bliss

So, I know that monitoring and evaluation (M&E) are not thrilling words, and I know that I might well be my only reader who actually finds M&E interesting. That’s ok: It’s my job, likely not yours. Still, I think that everyone can understand the nerdy elation that stems from conducting a highly successful workshop. And, yesterday (Saturday), feeling sick as a dog and medicated to the nines, I led a 10-hour M&E seminar for the managers, coordinators, and senior staff at work. Not only did all 20 people who were suppose to show up actually show up on a weekend at 7am, but they even worked through their tea and lunch breaks to complete their tasks by 5pm. Granted, they were bribed with their usual “allowance” (fodder for another post); mollified with donuts; and numbed by constant provision of candy, but they participated actively, debated with each other, and provided amazingly constructive comments throughout the long day. Even the Executive Director noted that the day far exceeded his expectations (harrumph and yippee!)! End result: departmental planning frameworks and a forward-thinking strategic plan for 2010-2013. Plus, their end of the meeting wrap-up session comments made me feel like I am actually making a difference. Paraphrased, people remarked things like:

“It helps us take pride and ownership in our work to participate in a planning day”

“It helps me feel accountable for my work successes and failures”

“It was nice to help plan our M&E activities versus having our M&E activities planned for us”

“We really learned a lot and got to put your weekly M&E workshops into practice (special rush of happiness and pride!)”

I know this may seem like small potatoes, but this really does set my workplace and my work colleagues apart from 99% of all other health workers here in Malawi. Now, I can go home for Thanksgiving and be excited to come back to Malawi for the next 17^th months. International health folks: you know this is a coup! Hallelujah! I needed it.

On surviving the 7th month slump

In recent days, several of my local expat friends asked me how long I had been here. I wondered why that question kept popping up? On each occasion, I noted that I had been here 7 months (!!!). My inquisitors responded with something like, “ahhhh, the 6 month slump.”

What? Is there something new on my face (aside from the pimples from the heat and dust storms)? Do I ooze a well recognized scent of frustration (other than the sweaty smell of working in a hot office with 9 other people)? Am I holding myself in a new way (other than to accommodate the added pounds of the carb-infested Malawi diet and sedentary lifestyle of office work)? I wondered. I soul searched. I napped on it.

As it turns out, 6 months is an expat milestone of some sort. It is about the time the excitement and elation of being in a new place wears thin and the successful glow of conquering all the settling in tasks begins to fade -- leaving a dull, puffy-eyed look of exhaustion and disconsolation. The work becomes overwhelming (find $40,000 or people lose their jobs); the thrill of early work coups diminishes in the face of all the barriers to success (how to treat 10,000 new people on ART without any new staff); the sadness of life with Diet Coke becomes overwhelming (nationwide shortage).

Still, I love it here. I love my work, and I make sure to remember (or have Jon remind me) that all the little successes will eventually lead to some tiny piece of sustainable progress (still optimistic! Still idealistic!). In the mean time, I’m taking extra time for foster puppy licks; finding giggles in the street signs (read closely – first column); enjoying the flame trees in bloom in our yard (and in the country); trying to document the amazing birds that play in our birdbath (when the puppies are not bathing in it); and taking moments to watch blue-headed iguanas hang out in our trees. Jon and I recently commissioned some tree-chairs (like upright hammocks) to put in the yard – forcing me, we hope, to spend time just swinging away. Between a little blog therapy (thanks!) an upcoming vacation (Red dog: here I come!), things are already well on their way to an 8-month upswing.

Service (dis)integration...

I thought you all would like to see the complexities involved in trying to treat people who are infected with both HIV and TB at our clinic. This is, in theory, how a patient would “flow” through our care model. It was actually hysterical to make this drawing as a participatory mapping exercise: everyone in the room (providers, data monitors, managers) could not help but laugh at the absurdity. No wonder only 66% of co-infected people actually get treatment for both, and that is at the best clinic in the country! In rural clinics, I would think it is much, much worse. Still, getting it down is step one in making it better. Wish us luck!