My first month+ I spent most of my time cleaning and analyzing data from a baseline survey that was done in April. It was a smaller survey (2 page questionnaire carried out in just over 700 households) that set out to describe the target population and provide information on a few specific indicators: key behaviors, levels of knowledge, and coverage and utilization of water and sanitation services. Surveys like this are often part of international health projects. They are done at the beginning and end (and sometimes mid-way) and help NGOs and their donors know whether their projects were effective. An important thing I learned from doing this is that a good baseline survey does not have to be very complicated or long. Every question in this survey related directly to one of our indicators or answered a specific question we had about the target population. Although it is often tempting to ask more questions and collect more information (because it is interesting to learn more!), time and money and interviewee fatigue are good reasons to keep it simple.
So after analysis comes report writing, report reviewing, more report reviewing, and then finally a finished English draft. There is no money in our budget for translation, so I've offered to do a rough draft in French in my down time and hopefully our health manager will help me edit!
Since finishing the report I've been working on creating a monitoring and evaluation tool to hold all the information we'll be collecting for the health systems strengthening project. Basically its a massive spreadsheet where we input all data we collect from 50 health centers in 3 districts. I often dream in Excel! Luckily, a good monitoring tool for the CCM project exists already since its been implemented in other countries.
In addition to that, I am also helping the team get ready to train hundreds of community health workers: working on medication projections, revising communications materials (am I really qualified to know what will make sense to rural Ivorians?), and filling out purchase requests to buy all the materials we'll need (there must be a more efficient way than carbon copy).
Needless to say, there is a lot to do here and I'm learning a ton!
Saturday, August 22, 2009
Thursday, August 20, 2009
Tuesday, August 18, 2009
oh yeah..
I guess I should blog about what I do all day, why I am here.
Like I've said before, I am an intern for the health program of an international NGO. Our department is pretty small, we are just 6 people currently. There is the program coordinator (an expatriate also), the health manager (an Ivorian doctor who studied public health in Japan), 3 assistant health managers (also Ivorians), and then me, the stagiaire.
We currently have 2 major grants. The first grant is for a health systems strengthening project: re-equipping rural health centers, supporting them with essential medicines, training health staff and health management teams (i.e. community members who are responsible for managing the health center's finances), building pumps and water towers.
The second grant is part of a large multi-country grant for implementing community case management (CCM) for malaria, pneumonia, and diarrhea. These are the top three killers of children under 5 in developing countries (not counting neonatal deaths in the first four weeks from infection or prematurity complications). There is good research that suggests that a lot of these deaths can be avoided if care for these illnesses is made accessible at the community level. In West Africa, for example, about half the population lives in a rural area, the majority of who live further than 5km from a health post. So when a child is sick, its often not very reasonable for the mother (who is also responsible for most if not all of the household duties) to take her child to a health center. So the idea behind CCM is to train local women and men (who are often illiterate and have little education) to identify these illnesses and provide treatment (antibiotics, zinc, rehydration salts, and malaria combination therapy). If it sounds radical to you, then you aren't alone because many governments and local doctors are initially very skeptical too. It took our management staff 4+ months of meetings with the Ministry of Health and the medical community to get their support for a pilot project of CCM in Côte d’Ivoire.
Both of these projects are being implemented in central Côte d’Ivoire, in the former "confidence zone". In 2002, rebel forces from the northern part of Côte d’Ivoire launched a coup d'etat, using Bouaké (2nd largest city, located in central part of the country) as their base. Many people in the surrounding districts fled, including essentially all the government and health workers. The confidence zone was established by the UN mission to separate the government controlled south from the rebel held north. As you can imagine, basic social services in this area greatly deteriorated. So that's where we're working!
To keep this manageable (for you to read and me to write) I'm going to break this into a few posts. Here are a few links if you'd like to read more about pneumonia (short article from NYTimes) and the conflict in Côte d’Ivoire.
Like I've said before, I am an intern for the health program of an international NGO. Our department is pretty small, we are just 6 people currently. There is the program coordinator (an expatriate also), the health manager (an Ivorian doctor who studied public health in Japan), 3 assistant health managers (also Ivorians), and then me, the stagiaire.
We currently have 2 major grants. The first grant is for a health systems strengthening project: re-equipping rural health centers, supporting them with essential medicines, training health staff and health management teams (i.e. community members who are responsible for managing the health center's finances), building pumps and water towers.
The second grant is part of a large multi-country grant for implementing community case management (CCM) for malaria, pneumonia, and diarrhea. These are the top three killers of children under 5 in developing countries (not counting neonatal deaths in the first four weeks from infection or prematurity complications). There is good research that suggests that a lot of these deaths can be avoided if care for these illnesses is made accessible at the community level. In West Africa, for example, about half the population lives in a rural area, the majority of who live further than 5km from a health post. So when a child is sick, its often not very reasonable for the mother (who is also responsible for most if not all of the household duties) to take her child to a health center. So the idea behind CCM is to train local women and men (who are often illiterate and have little education) to identify these illnesses and provide treatment (antibiotics, zinc, rehydration salts, and malaria combination therapy). If it sounds radical to you, then you aren't alone because many governments and local doctors are initially very skeptical too. It took our management staff 4+ months of meetings with the Ministry of Health and the medical community to get their support for a pilot project of CCM in Côte d’Ivoire.
Both of these projects are being implemented in central Côte d’Ivoire, in the former "confidence zone". In 2002, rebel forces from the northern part of Côte d’Ivoire launched a coup d'etat, using Bouaké (2nd largest city, located in central part of the country) as their base. Many people in the surrounding districts fled, including essentially all the government and health workers. The confidence zone was established by the UN mission to separate the government controlled south from the rebel held north. As you can imagine, basic social services in this area greatly deteriorated. So that's where we're working!
To keep this manageable (for you to read and me to write) I'm going to break this into a few posts. Here are a few links if you'd like to read more about pneumonia (short article from NYTimes) and the conflict in Côte d’Ivoire.
Sunday, August 16, 2009
Sundays to relax...
..and get stuff done. Like making banana walnut muffins and cleaning all my underthings.
Tuesday, August 11, 2009
Agouti and other fun eats
Agouti is bushrat, popular meat in west Africa. I tried it once in Benin a few years ago, and today I finally succumbed to peer pressure and had some for lunch. It doesn't taste bad: it's a dark meat, not unlike wild meat you might eat elsewhere, it was braised and flakey. I guess it's just the mental block of eating something with the word "rat" in it. But I've overcome apparently. Here's a picture of what you'd see in the market. Yum...
Sunday, August 9, 2009
Futu banane
One of my colleagues recently invited me over to make futu banane, which is a popular food here. It is basically pounded banana and manioc, the starch you serve with all kinds of different sauces. First you boil bananas and manioc. Then you pound them until they get the right consistency, which is a like mashed potatoes but sticky-er. You pound the bananas and the manioc separately, with a big mortar and pestle, then you combine them and pound some more. I tried doing some pounding and it is hard work! I lasted about 30 seconds.
Here are the boiled bananas and manioc underneath:
My colleague showing me how it's done:
Instead I helped with the sauce: the sauce we made was a mix of eggplant, spinach, and lots of peppers. All these ingredients are cooked and then mixed together. Then this is folded with a meat sauce: grilled or smoked fish, beef, agouti (bush rat), escargots... They eat it all here! This is the sauce before it was combined with the smoked fish:
Here is the final product. To eat you use your hands, break off a small piece, and dip into your sauce. FYI, they also make pounded manioc and pounded yam (igname pilé) in the same way.
The whole process of making an African meal of futu banane plus a sauce takes about 2 hours. A lot of women do this twice a day! In Cote d'Ivoire, this is typically a women's job. Men and even boys don't help with the cooking.
Here are the boiled bananas and manioc underneath:
My colleague showing me how it's done:
Instead I helped with the sauce: the sauce we made was a mix of eggplant, spinach, and lots of peppers. All these ingredients are cooked and then mixed together. Then this is folded with a meat sauce: grilled or smoked fish, beef, agouti (bush rat), escargots... They eat it all here! This is the sauce before it was combined with the smoked fish:
Here is the final product. To eat you use your hands, break off a small piece, and dip into your sauce. FYI, they also make pounded manioc and pounded yam (igname pilé) in the same way. 
The whole process of making an African meal of futu banane plus a sauce takes about 2 hours. A lot of women do this twice a day! In Cote d'Ivoire, this is typically a women's job. Men and even boys don't help with the cooking.
Monday, August 3, 2009
le marriage de Bedi
(I think that has a good ring to it...)
So this Ivorian wedding started out at the mayor's office, l'hôtel de ville
Cool chairs huh?
First comes the women relatives, who were singing.
Then the bride. (Please notice the woman to the left. This was the maid of honor. She took her job very seriously and was everywhere all the time, powdering the bride and adjusting her veil. I could not stop watching this lady all night!)
Then the maids of honor...
..big train!
The mayor presided over this ceremony, sitting behind a long table in the front of the room, with two other administrators at his sides. The couple sat in chairs facing them and their witnesses sat behind them. To my surprise, the mayor spent a a lot of time talking about the roles of husbands and wives and how important it is for couples to take their problems to their elders and NOT to the courts (our gender based violence coordinator was rolling her eyes and vowing to do a sensitization with him!).
After this the party moved a reception hall where a second religious ceremony took place, and then all the eating and drinking.
The band.
It is hard to keep Ivoirians from dancing. And they make have such good rhythm, they make it look effortless... and then I try and realize it's harder than it looks. (These are my colleagues!)
The happy couple.
The first dance.
The photographers.
The cake.
So this Ivorian wedding started out at the mayor's office, l'hôtel de ville
Cool chairs huh?
First comes the women relatives, who were singing.
Then the bride. (Please notice the woman to the left. This was the maid of honor. She took her job very seriously and was everywhere all the time, powdering the bride and adjusting her veil. I could not stop watching this lady all night!)
Then the maids of honor...
..big train!The mayor presided over this ceremony, sitting behind a long table in the front of the room, with two other administrators at his sides. The couple sat in chairs facing them and their witnesses sat behind them. To my surprise, the mayor spent a a lot of time talking about the roles of husbands and wives and how important it is for couples to take their problems to their elders and NOT to the courts (our gender based violence coordinator was rolling her eyes and vowing to do a sensitization with him!).
After this the party moved a reception hall where a second religious ceremony took place, and then all the eating and drinking.
The band.
It is hard to keep Ivoirians from dancing. And they make have such good rhythm, they make it look effortless... and then I try and realize it's harder than it looks. (These are my colleagues!)
The happy couple.
The first dance.
The photographers.
The cake.
Champagne toast!
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