Community is everything

Hello all!

This weekend was a quiet one at the Omni Med house. Staff, except for our cook and guard, are off on Saturday and Sunday, so the last couple of weekends have been a great time for reading, working, taking in the sun, and reflection on my time here and what it means for my work. The electricity was out most of yesterday which turned into a fun game of "beat the clock" as I tried to get as much work done on my laptop before the battery died. Amazing for my productivity!

The next two weeks will be quite different here as six new volunteer students arrive. Two came last night. Jack and Jacob are pre-med students who will be testing a prototype for an easy to use Oral Re-hydration Solution (ORS) tool for the treatment of dehydration and diarrhea in children. They developed the tool in high school and used a 3-D printer to make 150 to test in the field with VHTs. I'm so impressed by their ingenuity (what was *I* doing in high school?) and look forward to seeing how this plays out in the field.

My big takeaway from last week was the importance of community. On three occasions so far, home visits and training have been cut short or cancelled due to village funerals or inheritance ceremonies. Everyone in the village is invited to these events and it is imperative that everyone attend as it is considered a significant personal slight if missed. VHTs are elected by their community to fill this volunteer role and their success is dependent upon trust and close relationships. To maintain these relationships, a training or visit will be postponed in order to fulfill the community obligation.

This is, of course, challenging for Omni Med staff and volunteers. Communication between VHTs and staff is not optimal, so often we do not know these events are happening until we arrive and the VHTs are absent or few in number. This means a loss of time, fuel, and energy spent preparing for training. I felt this acutely myself, when I was tasked with presenting a training on sanitation and hygiene. I spent the morning reviewing the material and writing out prompts and information on poster paper. While I certainly did not feel as prepared as I would have liked to have been, I was ready to give it a shot. Elizabeth and I drove over 1 hour to the site and were met by 5 VHTs (we were expecting 15). They let us know about the funeral and that while they wanted to participate in the training, they could only stay for 30 or 40 minutes. So I jumped in, with Elizabeth translating, and did the best I could. We were able to get through half of the material and the VHTs present had a number of questions and comments, so I think they got something from it. Afterwards, I'll admit to feeling frustrated and disappointed. This was not what I was expecting or what I am used to from training in the United States.

It was helpful to have some time to reflect on this experience both in talking with Christina and reading through a really helpful book, Helping Health Workers Learn by David Werner and Bill Bower. In it, they discuss the imperative of a community-strengthening and people-centered approach to this work. Adaptation to local customs and conditions is key, which inherently means an acceptance of a slower pace of learning and continual innovation, flexibility, and creativity on the part of  trainers/helpers. This is tough for someone coming from a culture focused on quick results and strict adherence to process and agenda.

In the pictures below, you'll see my training intro and the training location (a vacant church). 

I still haven't gotten used to being the object of so much attention in the village. Children, in particular, are incredibly curious about muzungus (white people) and will follow you and call out almost constantly. For those who know me well, you'll understand my aversion to this! The kids in the pictures below were cracking themselves up and daring each other to come close to me. They finally sobered up enough for me to take a picture but fell back into giggles when I showed them the pictures. I've never been more popular.