sur terrain

I have been bothering the health team here to let me go into the field, "sur terrain". It's been a little hard for me to get motivated and really understand the health projects sitting in Yamoussoukro and Abidjan. So this week I finally got to go to Tiébissou, one of the three districts in which our current projects are based, for a training of the district health team. Our health manager and the Tiébissou district health director (or the DD, as everyone calls him) co-led the training which concerned monitoring and evaluation, why its important, and the health team's role. The district health team (made up of health clinicians and administrators) is required to do supervisory visits every month to the 16 health centers located throughout the district. This is important for collecting data from these centers (no email, or computers for that matter, in these rural health posts) and also motivating personnel. This is the DD presenting:
Here are some pictures of the district hospital, where the training took place. Probably pretty standard for a district hub in west Africa. The complex is made up of about 5-6 buildings, including an emergency care area, a maternity building...
a regular office visit/ consultation building...
even a dentist's office...
There was also a half-built surgical building, the administration office, and the DD's office and pharmacy. Most of the buildings have a sign on the outside which lists the prices for consultation.

I thought the training went pretty well on the whole. I was impressed with the DD and our health manager's presentations. They engaged the team members and got participation from everyone. As well, I was impressed with a lot of the health team.

It was at times disorganized. It started late; I helped our health manager create the pre and post tests right before the training; despite being a co-trainer, the DD was there less than half the time; and of course... everyone was constantly answering their cell phones (including our own health manager!). This is a phenomena here that drives me crazy: people always have their cell phones on and they answer them regardless of where they are. In a meeting, talking to someone, no matter. What is funny to me is that often people answer their phones just to say, "I'll call you back" and hang up. The cell phone etiquette here is out of control. I'm not sure how it is in other countries and if anyone else is suffering through the same...

I also found it interesting the amount of time we spent discussing payment. The district health team, in addition to their regular salary, get paid a per diem, meals, and a travel stipend to attend trainings. All NGOs offer this, though the exact amount varies. For this training, because no team members had to travel, they weren't offered a travel stipend, which caused consternation among the staff. I feel kind of conflicted about this myself. On the one hand, I know their government salaries aren't very much and supplementations help people make ends meet. But at the same time, it is disheartening to see this dependence and this attitude that I won't do something unless there is something in it for me. Some people get it. Some people realize that our money is better spent in direct service (medicine, building wells, etc). But some people don't. I waver between thinking these people are greedy and self-serving or just realists trying to do what they can with the hand they've been dealt. Regardless, it seems to me NGOs are complicit in this problem by the very nature of how we give aid...