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Saturday, 11 September 2010

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.

Thursday, 9 September 2010

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!