Jo, Myanmar (Burma) - Grabbing a lift by boat - a touching and lasting memory

Our taxi to the village

So at the end of this week I will be leaving. Myanmar is a beautiful country and when I get onto that plane on Saturday evening I will be taking some wonderful memories home with me.
Here is just one of them...
We have travelled to most of the villages by boat along the branches of the Ayarawady, but the final village in the pilot programme was only accessible by car and foot. We went there on a morning after some very heavy rain and the roads were quite flooded. The car dropped us off at the end of a long lane bordered on either side by paddy fields. We set off to walk the final stretch but the lane was slippery and difficult to negotiate. The ditches at the edges of the paddy fields were flooded and suddenly there was a canoe coming towards us along the flooded ditch. A man from the village and his little boy had come to give us a lift. Such a lovely gesture! As we headed towards the village we passed fishermen up to their chests in water in the ditch.

My Doctor Livingstone moment

Just one of the many memories that I will be taking home with me.
This is Jo, signing off for the last time!

Jo, Myanmar (Burma) - Developing a new Health Education model in rural Myanmar (Burma)

Travelling by road after heavy rain

So here I am nearing the end of my mission, when I look back to the day nearly 3 months ago when I arrived, it seems like a lifetime and yet each day seems to have sped by. I have been so busy that there really hasn’t been time to count the days.


The project aims to strengthen the existing community based health services in Pyapon Township in the Ayarawady Delta following the devastation of Cyclone Nargis in 2008 and to that end Doctors of the World has developed a co-operative working relationship with the health authorities. Together we are moving towards establishing a ‘Maternal and Child Health’ programme in our target area. Doctors of the World will be supporting the training of ‘Auxiliary Midwives’ and helping to expand child development surveillance.


I have also been developing a new Health Education model, which we piloted in four villages over my final two weeks in the field. There were some concerns about the drama that I had proposed, the topic was ‘Safe Motherhood’ and the concern was that people might be too shy to get involved. Not a bit of it! There are some very talented actors in those villages and they really enjoyed taking part. The audience were hugely entertained as well and participated enthusiastically in the discussion afterwards.


I have also designed a learning game based on ‘Snakes and Ladders’, with a few adjustments in the design of the board. (I am very good at drawing snakes now!). The pilot evaluated positively and it was lovely to see the villagers being so involved in their own education.

Jo, Myanmar (Burma) - Speaking Burmese like a local - almost.

I am now in Yangon preparing to leave at the weekend. I continued my Myanmar language lessons while I was in the Delta. Although they haven’t really equipped me for long philosophical discussions,  I did learn enough to greet people and ask if they have eaten, (which is the Myanmar equivalent of an English person saying “how are you?”). I can also go shopping, ask the price of something and request a little discount, direct a taxi driver and order a cup of coffee without sugar. This is about as much as I have needed. I also think that people like it if you make an effort to speak their language, so it breaks down more barriers than just a linguistic one.

Safe Motherhood Drama. Happy outcome.

Jo, Myanmar (Burma) - Nearing the end of assignment revising a health education programme

Doctors of the World meeting with villagers

 
I am nearing the end of my mission, so I am beginning to get anxious about all the work that I still have to do. I have been working on remodeling the health education programme and we are about to start piloting the new model. It is quite exciting, but a little nerve wracking as well.
One of the main concerns since I have been here has been to evaluate the health education programme that Doctors of the World has implemented in the villages. I have observed a few of the sessions now and although the field teams do a great job, each session depends heavily on the skill of the presenter. The programme is very teacher/lecture focused.

 I feel that a different model would be more appropriate, one focusing more on the learner and learning activities that encourage enquiry and discussion. So I have been developing a package of activities for the villagers to take part in, hopefully that they will enjoy and also that they will learn from.
 I am currently piloting my new model in four of the villages. The topic I have chosen for the role play is “Safe Motherhood”.  The  package consists of a quiz, discussion topics and two role play scenarios;  a bad version (where everything goes wrong) and an ideal version, where the pregnant family does everything right and ends up with a lovely healthy baby and healthy mum. There is a section for discussion between the 2 versions.

The result is they love it! We have just come back from one village, where they had asked to have the scenario in advance so that they could prepare. They did a great job and even had a theatrical director! The audience was really engaged and the quiz section was lively and very noisy.  The consequence is we are now making a start on another topic and will probably include some board games.

In the meantime that’s it for the time being.  So from the hot, humid and sometimes wet but always mosquito-ridden Ayeyarwady Delta, I am Jo signing off for this month.

Jo, Myanmar (Burma) - Dressing like a local

I now wear a longye to work every day, it is such a sensible garment in this heat and so comfortable. I started with a nice red one that the office staff gave me and decided to build up my supply so that I could wear a fresh one each day. When Thomas was here we went to the market and I bought two. They are really pretty, you buy them just as a piece of pre-cut fabric. I think most people must have a sewing machine and run them up at home, but of course I can’t do that, so arranged with the stall holder to have them made up for me. They cost me $6,00 US for the 2!
I even cycle wearing my longye, but haven’t mastered the art of cycling in the rain with an umbrella. The roads are so pot holed that I need both hands to hang on for dear life. And when it rains here it really knows how to rain.

Jo, Myanmar (Burma) - Something going bump in the night

We spent that night in Daw Naing, the largest village in South East Pyapon. Doctors of the World has a sub-base there. It is a building where the field teams can stay when they are in the area. The sleeping room is on the first floor and was incredibly hot, I gave it a bit of a clean up before we put our mats down and hung up our mosquito nets. The washing and toilet facilities were basic. I thought longingly of my little house in Pyapon. I have no running water there, but it is immaculate.

Anyway the Project Officer and the boat man wanted to go to the tea shop and clearly didn’t want me cramping their style, so I went to bed (at 7.30 pm!) and read until I fell asleep. I obviously slept through his return because when I next awoke at midnight I could hear him snoring gently on the other side of the room. I gradually became aware that I could hear something else as well. Something animate. Something moving very close to me, it was running around the outside of my mosquito net, and then rustling in a paper bag. Then silence for a while, before it started moving around the room again. It sounded enormous, like a dog or a cat, but in the midnight silence I guess sounds might be amplified and it could have been a rat?
It was inches away from my head with only a mosquito net separating us. I tired to wake my room mate but he was fast asleep. So I stayed awake, under my mosquito net until whatever it was stopped bustling around and I was finally able to go to sleep again. This mission is toughening me up!

A beautiful baby boy

On our way home we stopped at a restaurant where we have stopped before. The lady who owns it remembered me because on an earlier visit I had opted not to have any of the meat dishes that were sitting outside in big pans, waiting for customers to make their choice. I noticed that there was no “vegetarian option” so asked for fried vegetables. This meant that she had to cook a dish especially for me and I got it really fresh. It was delicious. On this occasion when we stopped there, I didn’t even have to ask, she just got the beans out and started chopping them up.
After we had eaten she dangled her beautiful little 2 month old grandchild in front of me until I asked if I could have a cuddle, so that was lovely. They put jewellery on all the children here so it is really difficult to tell boys from girls and you really don’t know whether you are congratulating them on a beautiful girl, or a handsome boy. It didn’t matter on this occasion because Granny obligingly cleared up any confusion by lifting up the child’s shirt to clarify the situation. It was a boy baby.

Learning to speak the lingo

I have been having Myanmar language lessons from a young Myanmar teacher who has been hired by Doctors of the World to teach English to the national staff. I won’t have time to learn the alphabet so I am concentrating on pleasantries and phrases that will make basic living easier.
Last week Thomas, the Pyapon Field Co-ordinator was here so I had company for a few days. It was really nice to be able to have a conversation that wasn’t punctuated by blank stares and nervous laughter.
While Thomas was here we had a Burmese language lesson , it was Thomas’ first and my second. What a language! It is really difficult. The teacher demonstrated different vowel sounds to us and then said “can you tell they are different”? Thomas and I just looked blankly at him. They sounded exactly the same.
I asked if we could learn to say, “please don’t put sugar in it” because everything here ; tea, coffee etc is always served very sweet. Well it got so complicated and the sentence got longer and longer. We kept saying “what does that word mean”? and would get the answer “well that is just put in to make the sentence flow better” or” that it just put in for politeness”. Even if the sentence starts with “please” apparently there are other words that have to be added for extra politeness. At one point I thought it might just be easier to start taking sugar. To think, small children speak this language.
But in spite of that, I am at last beginning to be able to say some things without people looking too blankly at me. The other day, as I paid for tomatoes in the market, the stall holder said (in English) “Thank you” and I said (in Burmese) “You’re welcome” and got a round of applause. So it’s not all bad.

Jo, Myanmar (Burma) - A field trip to Phongyethung

Greetings from the Delta! Things are going fine here, I am beginning to feel like a local, as I cycle to work each day people call out greetings to me and I am learning how to reply!

Two weeks ago I had a field trip to a village called Phongyethung, the first challenge was to learn how to say it. Don’t even try, it doesn’t sound anything like the English spelling. 

This was a joint visit with another NGO and the purpose was to observe their activities. They are apparently also active in a number of our target villages and we wanted to see what they are doing so we don’t duplicate our work. I was accompanied by our Project Officer. We are beginning to communicate with each other a little better than when we started out. I don’t know whether his English is improving because he has been thrown together with me so much – poor thing, or whether I am getting used to interpreting the heavily accented English translations?  I suspect it is a combination of the two.
 

Just when I think I can understand what people are telling me something happens to completely throw me.  For instance, I was completely baffled when one of the health officers from the other NGO told me they support the latrines being built in this village by supplying “pannapye” It turns out that they supply “Pan and Pipes”. You can see how difficult this is can’t you? But I am getting the hang of it.

Jo, Myanmar (Burma) - Out and about meeting Village Health Committees & Community Health Workers

Observing a Village Health Committee

I have been out in the field on various field trips, to meet the members of the Village Health Committees and Community Health Workers and villagers in the villages where the project is focusing. Generally we have to travel by boat along branches of the Ayarawady River.

The travel by boat is wonderful, people live by the riverside in bamboo houses on stilts and you can see all of life going on as you go past. Our boat is long and very narrow with a little covered cabin in the middle, there are mats in the cabin and you take your shoes off before you go under cover, so it is clean inside. I watch the world go by as we chug along, sometimes sitting outside and then when the sun gets too hot to stay outside, I go into the little cabin and can watch life going on through one of the little cabin windows, seeing the lovely friendly people who wave from their verandas, the children swimming in the muddy water, little boys herding ducks by the water’s edge, water buffalo chewing the cud at the water’s edge and groups of people working in the paddy fields. They are planting the rice at this time of year.

Last week I went into the field for five days.  We left in one of the little boats at 07.00 I set my alarm for 06.00, so that I would have time to pack my bag and cycle to the office. The little jetty where the boats depart is right outside the office building, so it is very convenient for loading all our stuff. It really was a case of “Take up thy bed and walk” or rather “float”. We had big mats with little thin mattresses rolled up inside and a pillow each. They are kept in the store in the office building, for the field teams when they go out. So at least I didn’t have to cycle to work with my bedroll on my back.

A far off field trip – only accessible by a 10 hour boat trip 

Travelling along the Ayarawady river

The first day involved travelling to the most distant part of the project, the region called Ahmar at the tip of the Delta. It is the most distant town in our area and the journey took 10 hours. I will never again complain about a long haul flight. Cabin crew brought little tit bits and drinks around every half hour, and there were movies to keep you occupied.  This seemed interminable. No cabin crews on this trip!

My companion for the 5 days was our Project Officer, a very pleasant young Burmese Doctor, who was my guide and interpreter. On the second day three of the Doctors of the World local field teams joined us, 4 Field Nurses and 2 Community Facilitators so we were a little squashed in the accommodation that the Project Officer and I had set ourselves up in. The girls  (the 4 nurses) crowded into the room where I had set up my mosquito net. They put up 2 mosquito nets and 2 mats under each one and shared. The boys and the Project Officer, all slept in the same bed under one net.

For me it was like being in a dormitory, the girls chatted merrily away until about midnight. They are so experienced at living like this and are so cheerful and pretty.  Preparing their thanaka and applying it to their faces each morning and washing out their longyes each day. They are like a garden of flowers and always look so cool and comfortable that I decided that I would try wearing my one and only longye.  I had taken it with me, because I was told that I would need it for showering, the big water pots that are used for showering are outside in the street.

Anyway, I wore my longye to go with the Project Officer to visit the local midwife who I was keen to interview.  Well that did it!  A white woman in town and one that wears a longye! It caused quite a stir. When we got back to the house a group of women came round to ask if I would like to walk around the village with them. They linked arms with me and marched me from house to house right around the village. I got the distinct impression that I was a sort of prize that they were showing off to their friends. It was hilarious, but a somewhat uncomfortable experience.

This week on a field trip to a Health Centre, I was picked up from the house by the Doctors of the World  Willys Jeep to go overland to a meeting at a Regional Health Centre. The Project Officer and I and a driver set off from Pyapon at about 08.00 and very soon we were on the worst road that I have ever been on. It was incredibly uncomfortable, I was afraid that I would end up suffering from ‘Shaken Baby Syndrome’. When we finally arrived at our destination 2 hours later, I felt quite light headed and had pins and needles in my hands. I’m sure it was from the vibration.

Anyway during the journey we started to pick up Community Health Workers who were heading for the meeting, we picked up more and more and more until there were 13 of us in that jeep. Yes 13….one three.

The team and I packed into a jeep - who needs buses here?

This is how we managed it. There were six females in the back on a seat meant for 2, 3 of us were in the front, the Project Officer and I shared the passenger seat and the lucky driver had the seat to himself and then there were 4 people perched on the bonnet. How they managed to stay there I don’t know, I really am surprised that none of them was catapulted off. But we arrived safely although I felt as though I needed to be unfolded before I could stand straight again.

With a third of mission already underway I am sure more adventures will follow.  I will update you here on this blog.

Jo, Myanmar (Burma) - Building a sustainable healthcare system

Going over notes after a day in the field

I have now been in Myanmar (Burma) for a month and have seen and done so many things for the first time in my life, that it really feels as though I have been here for at least a year!

I arrived in Yangon, the capital, on the 30th July and had to spend the next four days waiting for my travel authority so that I could go down to the Delta region, where I am working.  After four days in Yangon I left for Pyapon, the town where I am living and working.  The drive from Pyapon alternated between no miles an hour (as the car negotiated some gigantic pot holes) and careering at breakneck speed when there were short stretches of relatively good tarmac.

My first impressions when I arrived at the office were that I was never going to get the hang of peoples’ names.  How am I ever going to learn to say Hlaing Yu Maw let alone remember it? So I started by bonding with 2 nurses called Doris and Diana and gradually the other names started to sound more familiar as I got used to them.


Making a house a home while on a healthcare mission


The expat house is old fashioned but has a certain charm, at first sight it seemed very basic compared to the lovely comfortable airy house in Yangon.  I quickly got used to no running water or reliable electricity and I am enjoying the bucket showers and living by candle light.

It is a wooden building, completely unlined, which makes it terribly noisy.  Every sound that is made outside in the street can be heard clearly from inside the house. When the dogs howl outside my bedroom window, it sounds as though they are in my bed with me.

There is also a lot of uninvited livestock trying to share it with me. I really don’t mind the little frog about the size of my thumb; it is sweet and comes into the shower with me. But the mice, the huge hairy spider and the bats will definitely remain uninvited guests.

My mission


My job title is health advisor.  The Doctors of the World programme covers 131 villages in the Pyapon Township (a township is an administrative district similar to an English county) and by the time I had been here a few days I was really beginning to see how my mission is going to pan out.

The programme was first implemented in January last year to strengthen existing (or barely existing) primary health care in this township following the devastation of Cyclone Nargis 2 years ago. The project has reached a stage where it needs to move on and become more sustainable and advice is needed about how the training and supervision can best be organized to achieve this.

All my conversations with the local people are done through an interpreter, it really isn’t very easy, because the interpreter and I hardly understand each other. The language sounds half English and half Burmese, which is a tonal language and SO different. They don’t seem to use consonants at the end of  words and so they  actually find that very difficult to do. I am beginning to get used to interpreting things like “chah” as meaning “child”. When the logistician assigned my bike to me, he told me that it was “Nuh Zeh Nah”. It took me a while to realize that my bike was “Number zero nine”!


The commute to work


I cycle to work each day.  It is the rainy season at the moment – and it really knows how to rain here!  I haven’t yet mastered the technique of riding one handed holding an umbrella. The roads are so bad, that I need both hands to cling on for dear life, so I have borrowed a poncho, and I am going to try not to worry about the torrential rain. The route is quite flat and takes about 10 minutes. The morning ride in is during the rush hour and the road is packed with bikes and rickshaws. It’s chaotic with all traffic going in different directions and none of it complying with any sort of road rule that I am familiar with. At the moment I am the only European in town, so I am very obvious as I negotiate my way through the traffic with my very white hair.  I am beginning to see people that I recognize and we wave at each other.  I’m almost a local!

Jo, Myanmar (Burma) - Leaving for my mission as a Health Advisor

I’m very excited... a new country and a new challenge.

My visa for Myanmar (Burma) has finally arrived and I leave next week for Yangon and my three month mission in the Irrawaddy Delta region.

Since the devastating Cyclone Nargis in 2008, Doctors of the World have been maintaining a programme aimed at strengthening the Community-based health services  in Pyapon Township. (A township is the equivalent of a county in England.)

Much of my role as Health Advisor will be about capacity building. The health needs of the population have increased as a result of the cyclone.  At the same time the health services have suffered a reduced capacity to meet those needs, due to the destruction of many health facilities and the deaths of many health workers.

I will be involved in monitoring the strategies used to prevent illness, as well as working on health promotion programmes, training a team of trainers, as well as reviewing and developing health service standards,  guidelines and training programmes.

My mission is specifically planned for this time of year, (monsoon season)  to ensure that the rivers are full and make it easier to travel around my area by boat.

I’m very excited, a new country and a new challenge!  I will keep in touch on this blog.

Joanna Kotcher Medical Coordinator in Ethiopia Kebri Dehar

Scottish-based Joanna Kotcher has had an extensive career.  Among her roles she has worked as a Medical Co-ordinator for Doctors of the World and other non-governmental organisations, also as a nurse, a writer and as a consultant. Originally from the USA Joanna is one of our in the field volunteers and has worked as a Medical Co-ordinator for about 13 years primarily in refugee camps and conflict situations to set up programmes and help implement changes to strategies that bring long awaited medical aid to disrupted areas.

Doctors Of the World had started work in 2007 in the Somali region of Ethioipa to provide primary health care in rural communities but was halted and was restarted in Kebri Dehar, a large town in the same region from 2008-2010. Joanna worked there from February to June 2010.

"I wanted to volunteer with Doctors of the World (DOW) as it combines work on human rights (specifically international humanitarian law and rights), medicine, and conflict. I can’t think of any other profession I would rather be in."

After arriving in Kebri Dehar , only military convoys, road work vehicles and some civil service cars were permitted to travel in the region. I was also struck by the limited amount, variety and quality of food available.

The DOW project during my mission was mainly hospital based with technical support, training, donation of drugs and supplies to surgery and maternal health. This included emergency services in obstetrics and operating theatre. Toward the end of my mission, we developed the next project plan which included time spent preparing various strategies, how to store blood donated for transfusions during power cuts, or how to organise the  pharmacy so that drugs are properly monitored. My ‘hands on’ days were spent on the hospital wards with members of our team, assisting in surgery, training staff, and seeing patients with the team. I have a specialisation in trauma (wound) care, surgery, and other conflict-related medical and psychological areas such gender based violence.

Following our return to the rural sites near town in May, we met with the elders of the community, local authorities, and village health workers that had not seen any humanitarian organisations for quite some time. Many of the village health posts had not been fully operative since 2008. The most pressing medical needs in this region were infectious diseases such as pneumonia, diarrheal diseases related to sanitation, and malaria.”

Six Months after the earthquake that shook Haiti, help is still desperatly needed.

12th July 2010

                    © Stéphanie Lelong

Six months after the earthquake, as the hurricane season begins, the timing for Haiti's reconstruction remains critical. Doctors of the World calls for the funds promised by the international community to be used to provide a truly equitable healthcare system

Our work has helped to limit the effect of the disaster on health, but the living conditions for the 1.3 million disaster victims in Port-au-Prince and the surrounding region are extremely difficult.

For many, the daily situation is not improving but getting worse as food distribution comes to an end. We still have our teams in Haiti and with the emergency phase over we continue to work to ease the desperate situation the Haitians face caused by epidemics and malnutrition. However, to date, only a few hundred million dollars of the $10 billion pledged has actually been paid by various countries and donors. It is high time that these promises were kept; things need to move faster.

The $10 billion dollars in aid pledged by the international community at a conference in New York in March would provide for and allow the implementation of a health care system which is more equitable in terms of cost and carried out in the poorest and least accessible districts. The clinics set up by us in the emergency context could then make a permanent commitment to providing a new quality of health care for the poorest Haitians.

Our actions have helped limit the effects of the disaster on health.

There has been no spread of contagious diseases. There have been few cases of malaria and typhoid diagnosed. There has been mass vaccination of children and infants. We have also tracked and managed cases of moderate or severe malnutrition. We have also made it possible for thousands of Haitians to have their first real access to care. Before the earthquake, more than 60% of the population had no access to care. Today, 5,000 free medical consultations are conducted each week by our teams in 10 clinics in tents set up in the poorest districts. Sadly, it remains difficult to refer a patient for treatment at a hospital and transfers between hospital services are very complicated.

Six months after the earthquake hit, the psychological effects are still felt, the Haitians are still suffering. People are having trouble overcoming the trauma, as Dr Emanuela explains:

"Every morning people come to see me for imaginery illnesses, there seems to be nothing wrong but if you ask questions they say they can'ty sleep, can't eat, that they are constantly reliving the 52 seconds during the earthquake."

For this reason psychological support must continue beyong the emergency phase. Mental health support must be fully integrated into the Haitian healthcare reconstruction plan.

We aren't just working in the capital Port-au-Prince; here is a recap of our international network projects across the country:

In Port au Prince

Doctors of the World is active in 10 locations in Port au Prince: St Michel, Carrefour Feuille, Cité Georges, Canapé Vert, Automeca, Delmas, Solino, Saint-Marc, Miron and the Mahotière, covering a population of about 123,000 people. The teams provide primary health care, reproductive health (antenatal, postnatal, family planning, gynaecology), detection of malnutrition, immunization and psychosocial activities. Since the beginning of the emergency, more than 71,000 primary health care consultations have been provided.

In Cité Soleil

We set up three mobile clinics in 16 displaced persons camps and we support the Choscal hospital. Since January, more than 21,000 patient consultations and 4,800 psychosocial counselling sessions have been provided and more than 18,000 people have been immunized. Meanwhile, individual and group interviews, community and prevention activities have been offered: adults have already held 75 discussion groups and 725 workshops have welcomed Cité Soleil children. 20,000 people have also participated in educational and health risk awareness activities and 90,000 condoms have been distributed.

In Sonapi

We ran a clinic in the Sonapi camp that saw 200 patients per day, and two clinics in the Croix de Bouquettes and the Lycée Jacques Premier camps. This facility closed in June.

            © Stéphanie Lelong

In Carrefour Feuille

We ran a clinic which provided nearly 300 consultations per week: healthcare and maternal-child health, health education, immunizations etc. This closed in June.

In Petit Goâve

At Hôpital Notre Dame of Petit Goâve we have been supporting maternity and paediatric units through a sexual and reproductive health programme which includes: healthcare personnel (gynaecologists, midwives, healthcare assistants) training and capacity building, providing medicines, modern medical equipment and gynaecology equipment, reconstructing buildings and assistinh in antenatal preparation for childbirth.

In addition, we have six dispensaries in the remote region of Petit Goâve to ensure the most isolated people are cared for, particularly children under five years of age and pregnant women. Our programme focussed on: family planning, antenatal and postnatal consultations, health education, family planning, training of staff etc.

In Grand and Petit Goâve, we are providing a primary healthcare and nutrition programme as well as supporting four dispensaries located in rural areas of Grand Goâve and in Petit and Grand Goâve. We also giving support for different levels of acute severe malnutrition. Between January and May, 714 children were registered at this centre. Meanwhile, advocacy and prevention are offered to communities, particularly focussing on maternal and child health.

In Grande Anse

With the influx of new comers to the area after the earthquake, Doctors of the World France strengthened its existing programme and currently offers free treatment at 12 health centres in the region. Since February, these centres have provided an average of 8,730 consultations per month; nearly three times more than in the months before the earthquake. All services provided are free to all. We had more than 2,000 consultations for children under five years old. Furthermore, in order to relieve the dispensaries and reach isolated populations, two mobile clinics visit the most remote areas. On average 630 consultations are provided per week; 16% of the patients are displaced persons. Finally, special attention is given to screening and treatment for malnutrition.

Our work would simply not be possible without your support. Thank you for helping us to react quickly in a crisis and care for the most vulnerable.

Fred, Haiti - 6 months on, the reconstruction of Haiti continues

Fred Costa arrived in Haiti to help with the clear up operation after the devastating earthquake hit the country in January.  Fred has been working as a Logistician in Haiti for the past 4 months for Doctors of the World (DOW). 

Fred is part of a team of more than 450 people working in Haiti, comprising of national and international staff.  DOW is providing health care in clinics and hospitals around the capital Port-au-Prince as well as in the towns and surrounding areas of Petit Goave and Grand Goave.

Here Fred shares his experiences:

The city of Port-au-Prince is still pretty much the same as when I got here. There is a lot of rubble.  Many buildings which were destroyed remain as they were when I arrived.  There are now thousands and thousands of makeshift shelters and tents too.

  

Pictures of Port-au-Prince.

A lot of the Haitians don’t have a house or any access to water but they always look well–presented at work - clean, tidy and shaved. They always have a smile and can have a laugh and a joke. They are always so polite and respectful too.  

 












No matter what, they always believe in better days, in a better life, in a better country, and a better tomorrow.  They believe this so that gives me the extra strength to work every day a bit better than before in order to give them the best I have.

Fred and the carpenters building a medical clinic in Miron - Port-au-Prince.

Half of my time is spent solving problems as a Logistician.  This role is largely spent building, fixing and maintaining everything so our operations can run smoothly.  

  

One of our mobile clinics in St Marc - Carrefour.

If a generator breaks down or if a clinic is at risk of being flooded I am on hand to fix these things.  The other half of my time is spent working on how to expand our programme by calculating the budget and working out what things need to be bought to continue our work efficiently.  The work is very intense.  It is fulfilling to feel that what I am doing here helps and will provide a better life for the Haitians.  I am realistic though – due to the incredible devastation caused by the earthquake, providing that better life will be difficult to achieve. 

Fred and the Logistics team.

No matter how much of a bad time they have endured, the Haitians always see a better future.  I will finish my mission here in August.  I am starting to miss this place even before I have left it.  It seems to me that life in Europe is more complicated.  People have more problems there and they are not happy.   But in Europe we have everything yet here in Haiti they don’t have anything. 

Donate now to Doctors of the World UK to help support our work. 

Sara Robbins - Bringing health care to those in desperate need on our doorstep

Sara Robbins is a 4th year medical student, Kings College London:

It’s Wednesday afternoon, and I head over to the Project:London (P:L) clinic where I volunteer as a support worker. I begin my first social consultation with Prisca*, a South African woman who has been living in the UK for five years. She begins telling me her story, explaining why she has come to the clinic, when she breaks down in tears. She is frightened. She came to London as a domestic worker with her South African employer, who abused her, took her passport, and abandoned her with nothing. After being “turned away” from an NHS Walk-in Clinic, and believing she was not allowed to register with a GP, Prisca went for years without her diabetic medication or regular checks. Over this period, her diabetes spiralled out of control, and she is now suffering from the serious sequelae of the disease.

Seeing the patients arrive at the P:L clinic has opened my eyes to the impact lack of access to health care has on vulnerable migrants, homeless people, and sex workers. In Prisca’s case, her lack of documents, poor knowledge of entitlement to care and confusion from the side of the service provider have resulted in devastating consequences to her health. From my experience at P:L, it is apparent that NHS services are becoming increasingly inflexible towards people with such diverse needs. Yet their poignant stories provide a powerful defence for their right to health, if given the opportunity to be heard.

The importance of global health is widely appreciated in medical schools across the country, and medical students are showing an ever increasing interest in the topic. However, the vast horizons of these health issues can seem overwhelming, and from my experience, many medical students feel unsure of how to help them.  There is often a preconception that issues such as problems accessing health care only occur in “developing” countries while the truth is that many people are suffering on our own doorstep. I understand it is easy to be complacent about these problems, but do not underestimate the effect you can have. At the P:L clinic, I carry out social consultations with patients before they see our doctor. I also liaise with GP practices to advocate for health care for our patients, as well as directing them to appropriate legal and social services. These opportunities provide help and advice to patients. P:L also advocates for better access to health care. So you see, you don’t have to fly half way round the globe to change lives – just hop on the Central Line to Bethnal Green, and you can make the world of difference to someone like Prisca.

P:L is an advocacy service which aims to help people access health services, while providing short term health care for their current needs.  

For more information about Project:London and how to volunteer, visit our website.

*Name changed for confidentiality reasons.
(This blog was originally published on the BMJ blog at http://blogs.bmj.com/bmj/)

Alice, Ethiopia - A positive experience

In terms of maternal health the major problems were restrictions to adequate healthcare. There was a lack of knowledge about complications and about the warning signs as well as difficulties with transportation to access the limited services. In terms of complications experienced there were a high level of problems associated with prolonged/obstructed labour often with the mothers presenting, after several days abnormal labour, at the hospital with a dead baby and a ruptured uterus. Additionally, there were high rates of maternal death from post-partum haemorrhage (as throughout the world) and again Traditional Birth Attendants (TBAs) often tried to manage these with traditional and ineffective methods and often only bringing the women to hospital when they were almost dead. Malaria is also a major health issue for the local population and is also particularly detrimental in pregnancy; during my time in this area I witnessed a maternal death from cerebral malaria. 

I had very few negative experiences luckily but many very positive ones. When I think back to my time there I instantly think of the fantastic national team (about 40 people employed by Doctors of the World from cleaners to HIV counsellors) they welcomed me into their team and gave me a truly memorable experience.  They also worked hard to ensure the work we were doing reached the right people. 

 The teaching itself was such a highlight, although challenging especially with extremely low levels of education, working with the local population was really rewarding. I particularly enjoyed making the TBAs laugh mainly with my ridiculous acting (the Somali women are generally quite reserved so it was wonderful when you see them losing their inhibitions) and getting them to participate with role plays and story telling etc..

I would say to anyone wanting to do this type of work be under no illusion that you will be saving the world, but I remain hopeful that some of the work we do can makes significant changes to peoples lives and encourages further community action. All in all I trained 130 traditional birth attendants.  I would definitely go back to Africa and I’d love to visit other African countries. 

Alice, Ethiopia - Working with Traditional Birth Attendants

 

Throughout this region most deliveries are attended at home by a Traditional Birth Attendant (TBA) and they are often the only providers of maternity care. Therefore, in the absence of other medical facilities the training of TBAs can be recognised as an important means to improve maternal health in this remote setting. In view of these factors my main assignment during this mission was to facilitate training of TBAs and monitor their activities in the region.  The aim of the course was to provide TBAs with the knowledge and skills to safely manage normal birth. The course was designed to aid the identification of high risk pregnancies and potential complications in labour. With a focus on the need for early referrals; to reduce delays in women receiving appropriate medical care and the prevention of avoidable maternal deaths. 

 

In order to reinforce the work of the TBAs within their communities it is vital to involve community elders, as they are most influential and respected members of the community. Therefore, I also undertook specific training to educate Community Elders, both from villages where Doctors of the World have trained TBAs and elders from the town itself, in issues associated with maternal mortality and how the community can work together to prevent maternal deaths.

Alice, Ethiopia - Working in one of the most dangerous places in world

I decided to sign up for a Doctors of the World mission because I particularly liked the emphasis on long-term sustainable projects, as opposed to emergency based missions.  Doctors of the World promote training local staff rather than replacing them with expatriates which definitely corresponded with my ideals. I have to admit that the fact my fiancée is French also attracted me to the organisation because I thought working for a NGO with a French connection would improve my language skills.

The Somali region is a conflict zone and there are associated risks living/working close to the Somali border so it was important to follow the security rules.  I felt really safe. I actually extended my mission in Ethiopia and I was happy I was able to do something positive in this often forgotten area.

My main tasks were focused on improving maternal child health. We were based in a main town in the Somali region, with one of the only functioning hospitals, Doctors of the World with the support of the local regional health bureau are in the process of rehabilitating the hospital. Doctors of the World has a team of national inpatriate (Ethiopian staff from other areas of the country) healthcare staff based in the hospital, including midwives, and therefore as an expatriate midwife I was not required to be based in the hospital. 

Alice Fuller, Midwife in Ethiopia

After a trip to Tanzania, Alice Fuller, a trained midwife from London, decided she wanted to use her midwifery skills abroad.  She worked with Doctors of the World in 2009 in Ethiopia.  Her main tasks were focused on improving maternal child health. Based in a main town in the Somali region, with one of the only functioning hospitals, Doctors of the World supports the local regional health bureau who are in the process of rehabilitating the hospital.

Alice trained traditional birth attendants with the knowledge and skills to safely manage normal birth. The course was designed to aid the identification of high risk pregnancies and potential complications in labour. There is a particular focus on the need for early referrals both to reduce delays in women receiving appropriate medical care and to prevent avoidable maternal deaths.

Clive, Myanmar (Burma) - Kachin bruised ribs

Clive: “I spent the end of January in Mitkinya (pronounced Michinar) in Kachin province, near the Chinese and Indian borders. The flight was 2hrs 40 minutes including a 20 minute stop in Mandalay, the scenery from the air was fantastic as the flight path followed the Irrawaddy River. I stayed with Renaud the French Coordinator for DOW, in his house (the garden included an incinerator for needles – the work in Kachin is with drug users). Transport was by bike and on the way to work we rode by the side of the Irrawaddy with mountains in the background. Mitkinya was larger and more modern than Pyapon and I liked it as a town. Each morning you could see boats coming down the river with water melons etc to sell at the market.

It was freezing at night but 25 degrees in the day.  Kachin is very Christian and there were churches on every street corner, mainly Baptist, but also some Catholic and Anglican. We went to Ubyit to see the clinic.  I also went to Moeggaung 2 hours away, accompanied by a Government Liaison Officer (as this is required for expatriates), and I visited the clinic there. I had to present the new Human Resources Policy at each site, which was translated for me and as with any new policy there were lots of questions especially on pay. At one heated moment at Moeggaung I broke the ice as the chair I was sat on (a plastic garden chair) collapsed.

The local staff were horrified I just thought it was funny. This was after an hour of holding the meeting.  My only positive was that if I had not lost weight in Myanmar it would have probably collapsed in only 30 minutes.









The picture shows Renaud, Dr Mo Thant and Min Min having a drink in the night market.

Clive, Myanmar (Burma) - The only non-Burmese in town

Clive: “I spent 4 days in the town of Pyapon (population of the township is around 300,000) in the Delta area where Doctors of the World do training and support to community health workers in remote villages. The area is restricted so special Travel Authorisation is needed from the Government; hence I was the only non-Burmese in the town. This really felt like the third world – no running water (the people just collect rain water), primitive toilets, little electricity, few cars but thousands of bikes. I got bitten by mosquitoes but luckily malaria is not too prevalent here.

The people were lovely and hospitable. The average wage is $16 per month. I had breakfast in a teashop with the DOW staff, the choice comprised of noodles, samosa, fried tofu, pork crackling, soup and on my last day fried eggs on toast.
Pyapon is about 60 miles from Yangon, but because the roads are so poor it took 3 hours. The compound is by the side of the river and almost all work is conducted by Boat, many of the villages can be 16 hours away by boat so staff sleep-over at sub bases, by the sides of the river.

I spent a fantastic day on a boat with Dr Hein Latt visiting a remote village called Hte Tan Yin. I sat in a session where a Doctors of the World nurse went through the consultation records for the last month which were completed by the Community Health Worker (a village resident who has been given 4 weeks training and receives 6 monthly refresher training sessions). His medical kit was re-stocked with drugs etc and then the Community Health Worker did a health presentation on nutrition to 25 villagers. The nurse then asked the villagers test questions giving out t-shirts and shopping bags (with printed health messages on them) as prizes for those who answered correctly. The big health problems relate to poor water and snakes.

We then went to a sub-base where DOW staff have overnight stays when out in the field and we renewed the contract with the owner (he was an old man who insisted on giving me tea and honey). They had agreed to do some work, building platforms above the ground to the toilets because the area has lots of snakes even though I did not see any. He insisted I saw the local school next door which had 60 children and they were proud because UNICEF was building a toilet for the school, it’s currently just a platform with a hole directly into the river.
On my last evening the DOW team in Pyapon took me to the best (and only) restaurant in town, they were all dressed up and I felt a bit embarrassed because I had on the same DOW t-shirt that I had worn all day. They insisted on paying for me, although they agreed to let me pay next time.