I feel a little bit like Carmen Sandiego these days--have the sunglasses, just need that red jacket. Greetings from Eldoret, Kenya, which, as the sign on the highway says as you enter, is home to "#1 runners in the world"! Funny thing about Eldoret, Kenya, it's like 9,000 ft above sea level! I didn't quite realize what that would mean until I tried to go running, and found myself gasping like a fish out of water after five minutes and one little hill. I even was thinking about quitting halfway (sometimes loops are a poor choice!), until this teenage guy in nice clothes--leather shoes, jacket, etc.--walking along sees me coming up beside him and decides to run the last two miles with me. I push through the side stitch, struggling not to gasp too loudly for air lest he get worried, and run the last 2 miles. We finish--he is of course not out of breath and barely sweating--we shake hands, and we go our separate ways. Not a run I'll forget soon. Beautiful landscape too--fields of corn and something that I vaguely recognize, milo perhaps--dirt roads, cows and sheep grazing. Semi-hilarious signs (totally unintentional I'm sure). Hard to beat.
I'm studying AMPATH--a medical partnership between Moi Teaching Hospital and Indiana University. If you can imagine a place where a midwestern accent seems totally out of place, this is it! And yet, the program is amazing. They were one of the first to treat HIV in Kenya and have grown into one of the largest providers in the country. Recently they started a home-based counseling and testing program, and I'm going out with a social worker next week to learn more about the community presence. They are also transitioning to primary care--so will start serving the entire catchment area, not just those with HIV. They've built income generating program, provided leadership opportunities for very talented Kenyans, and brought a lot of resources to the area. Not to mention, built a heck of an electronic medical record that they use for just about everything imaginable!!
Not a bad life here. Living in the IU dorms--get up for a breakfast of toast with Nutella every morning; have a nice cup of chai at the hospital mid-morning. If I'm lucky I can get into town for lunch or dinner--they make some mean grilled goat and beef here that one eats with ugali, a sort of white polenta-esque food that you mush into the shape of a spoon and use to scoop up the meat. Mmmmmm. Just finished up a game of soccer--again, the Kenyans that played with us smoked us completely in terms of speed and style. Karaoke is on Tuesday night; I'm very excited to see how this goes down. Given the amount of singing that I've seen on the dance floor the past two nights (my favorite so far was a club full of Kenyans singing Thriller!), I need to do a bit of practicing in front of mirror in the next two days!
The time is going quickly--hard to believe how much has happened in the last two weeks. I've yet to see a McDonald's/KFC/Starbucks/etc, so I'm kind of forgetting my cultural roots. If it weren't for the Obama quotes and pictures everywhere, I would have no grounding. Last tidbit: when obama became senator, a beer came out called Senator. Guess what it's called now :)
Sunday, August 09, 2009
Friday, July 31, 2009
Mmmbop, Mbarara
I'm writing from Mbarara, Uganda. I've found probably the only wireless internet point in the whole town--even here the internet still only creeps along. Or shall I say, at the risk of some response from my African friends, it runs on African time!
I'm on a journey to look at electronic medical records across Africa--specifically, OpenMRS, an open-source system developed by Partners in Health and AMPATH--a huge HIV program in Kenya that involves Indiana University and Moi Teaching Hospital. Health Information Technology is all the rage right now--but we've found so far that there's little data to support or refute the claims around how it improves care and efficiency in the developing world. So, that's the mission: bring some light to those issues. And hopefully, from my standpoint, bring a richer perspective to some of the key players in this field (including the large donors) around the potential for high impact investments and how to improve current funding and implementation models. And finally and most importantly, have an amazing time in the process.
We landed in Kampala on Sunday night and were shuttled to a guest house at Makerere University--essentially a house filled with beds occupied by American medical students. The next day, I visited to Mulago Hospital, which is the national referral hospital. The number of people waiting for care in this type of facility never fails to move me. Here, there are very few nurses, one person ballparked 1 nurse per 40 patients, so family members often have to perform many of the duties normally done by nurses. So they sleep outside the wards on the floors when they get kicked out of the patients' rooms at night. I had a chance to talk to a few physicians--all of whom do an amazing amount of work in extremely challenging conditions--and hope that they are able to find the support to pursue some of their very innovative ideas for how to improve Uganda's health system. I got a wish list from one doc for what he'd do with $100 million--if you all know anyone trying to figure out what to do with that kind of cash :) Top of the list was hire residents--here most medical officers (who have just done medical school) have to pay for residency.
We took to bus to Mbarara on Wednesday. The bus park was its own adventure--you tell one of the guys on the perimeter where you want to go, and then they grab you and help you run through the crowd so that you can catch the bus that's about to leave. Then you sit there on the immobile bus for a good 90 minutes while people try to sell you everything from "fresh" yogurt, watches, bibles, etch and sketch. you name it--I did most of my Xmas shopping. The bus ride itself was interesting--it's crammed full of sweaty people--and passes along a semi-paved road past miles (km, more precisely) of banana plantations, billboards, and small villages. We even saw a few impala.
Mbarara is small--maybe 40,000. It's very safe as long as you keep an eye on traffic (it comes from the left, and there are no sidewalks). People are very friendly--if you can think of ways to get out of having someone buy you a beer, please let me know (I usually have half a glass when they ask, so can't involve an excuse that includes full absention). AMAZING pineapple (50 cents for a whole one!) and bananas (75 cents for a full bunch) for breakfast, and avocado at lunch every day. I could REALLY get used to this. The shower on the other hand--sort of a "no pressure" situation. Even tepid water would be improvement. I can see why women have their hair in braids--I may have to more that way! I love the folks working at our hotel--it's a nice place--and I'm growing fond of the goats that seem to use the hotel grounds as a grazing area--I saw them chasing a cat away this morning and that just sealed it!
Took a break from the clinic this morning to go see a local elementary school play that a friend of a friend directed (I've literally met a dozen people from Boston here--so weird how small the world is). It was peter pan, with a michael jackson theme. Amazing acting, but one of the weirder things I've ever seen. Thriller Ugandan style?
Off to Lake MBuro for the weekend--minor game park near the town. This is just the beginning--the voyage continues through the end of August!
I'm on a journey to look at electronic medical records across Africa--specifically, OpenMRS, an open-source system developed by Partners in Health and AMPATH--a huge HIV program in Kenya that involves Indiana University and Moi Teaching Hospital. Health Information Technology is all the rage right now--but we've found so far that there's little data to support or refute the claims around how it improves care and efficiency in the developing world. So, that's the mission: bring some light to those issues. And hopefully, from my standpoint, bring a richer perspective to some of the key players in this field (including the large donors) around the potential for high impact investments and how to improve current funding and implementation models. And finally and most importantly, have an amazing time in the process.
We landed in Kampala on Sunday night and were shuttled to a guest house at Makerere University--essentially a house filled with beds occupied by American medical students. The next day, I visited to Mulago Hospital, which is the national referral hospital. The number of people waiting for care in this type of facility never fails to move me. Here, there are very few nurses, one person ballparked 1 nurse per 40 patients, so family members often have to perform many of the duties normally done by nurses. So they sleep outside the wards on the floors when they get kicked out of the patients' rooms at night. I had a chance to talk to a few physicians--all of whom do an amazing amount of work in extremely challenging conditions--and hope that they are able to find the support to pursue some of their very innovative ideas for how to improve Uganda's health system. I got a wish list from one doc for what he'd do with $100 million--if you all know anyone trying to figure out what to do with that kind of cash :) Top of the list was hire residents--here most medical officers (who have just done medical school) have to pay for residency.
We took to bus to Mbarara on Wednesday. The bus park was its own adventure--you tell one of the guys on the perimeter where you want to go, and then they grab you and help you run through the crowd so that you can catch the bus that's about to leave. Then you sit there on the immobile bus for a good 90 minutes while people try to sell you everything from "fresh" yogurt, watches, bibles, etch and sketch. you name it--I did most of my Xmas shopping. The bus ride itself was interesting--it's crammed full of sweaty people--and passes along a semi-paved road past miles (km, more precisely) of banana plantations, billboards, and small villages. We even saw a few impala.
Mbarara is small--maybe 40,000. It's very safe as long as you keep an eye on traffic (it comes from the left, and there are no sidewalks). People are very friendly--if you can think of ways to get out of having someone buy you a beer, please let me know (I usually have half a glass when they ask, so can't involve an excuse that includes full absention). AMAZING pineapple (50 cents for a whole one!) and bananas (75 cents for a full bunch) for breakfast, and avocado at lunch every day. I could REALLY get used to this. The shower on the other hand--sort of a "no pressure" situation. Even tepid water would be improvement. I can see why women have their hair in braids--I may have to more that way! I love the folks working at our hotel--it's a nice place--and I'm growing fond of the goats that seem to use the hotel grounds as a grazing area--I saw them chasing a cat away this morning and that just sealed it!
Took a break from the clinic this morning to go see a local elementary school play that a friend of a friend directed (I've literally met a dozen people from Boston here--so weird how small the world is). It was peter pan, with a michael jackson theme. Amazing acting, but one of the weirder things I've ever seen. Thriller Ugandan style?
Off to Lake MBuro for the weekend--minor game park near the town. This is just the beginning--the voyage continues through the end of August!
Sunday, June 07, 2009
Off to forage for more bubble tea!
We made it into China without any issue--I even got to see Confessions of a shopaholic and He's just not that into you on the plane. Thought I was going to kill myself for a few hours there.
Had some fun finding our hotel. Evidently two streets in shanghai translate into the same pinyin (western characters) so we wandered for like two hours only to be on the wrong Shanxi St. Luckily with my Chinese phrasebook, and happening upon someone who spoke english, we were able to get directions to the right one. Had a great dinner of xiao long bao, a shanghainese special dumpling filled with pork and soup. we also took a ritzy train up and down one of the main shopping streets, just because we could.
Met up with one of my bro's friends today and walked through the french concession and old Shanghai. The bund, the famous walkway on the water, is closed as they are renovating for the world expo in 2010, so unfortunately we won't get to that this trip. the city has changed a lot since 2006 when I was here last, a lot more European/American fashion, western banks have moved in, young couples are more amorous in public, and contrary to the etiquette book I read before coming, people do in fact wear flip flops these days. Some things remain amusingly different--I ordered veggie soup at lunch, which evidently had meat and duck blood, which they had neglected to mention in the description. Duck blood has a similar consistency to jello, if you ever wondered. I would take it any day over the fried whole birds, snails, and innards that we saw while walking around the market.
It's a lot of fun being back though harder without the Chinese speakers that I relied on last time. more room for adventure, I guess?
Off to forage for more bubble tea!
Note from Travis: Mangoritas on Cloud 9
We just saw the Orient Pearl Tower light up and enjoyed the view of the skyline and river (and the pollution-fog haze).
The view is even better than the underwater sightseeing tour in the Bund tunnel that took us through "Paradise and Hell" and a "Meteoral Shower".
Saturday, November 29, 2008
Love means never having to say you're sari
I have relocated. I am now staying in Uttara, a town north of the Dhaka airport, with a Bengali family (one of my professor's American friends is married to a Bengali woman, and they plus their 6-month-old son live with her mother, her brother, his wife, and some housestaff, and a lot of the sisters, aunts, cousins, and nieces and nephews live within a few houses). The house is nice--lots of light and open space, and is always bustling.
Thursday night I went to an American couple's house for Thanksgiving. It was fun--most of the guests were Bengali but had spent significant time in the US or UK. They served turkey, carrots, mashed potatoes, rolls, and even veggie spring roll-esque things. It was a really interesting group of people--many of the guests had lived in Dhaka decades ago, and it was interesting hearing their stories about how the city had changed. Several had lived through and been very actively involved in the War for Liberation (1972), which also was incredible to hear about firsthand.
Yesterday (Friday) was not black, here. I started off the day with a breakfast of curried chicken, kitera (not sure of the spelling, it's a rice and lentil dish), tortilla-like bread (roti?), and a green onion omelet, all followed by some tea. My hosts' baby turned 6 months yesterday and was going to eat his first solid food. All nearby relatives descended on the house to celebrate the occasion. They took lots of pictures, everyone fed him a spoonful of food, and stayed to eat sweets and drink tea. There were many young children in attendance, and I of course played with them as much as possible. I think that it's easier to communicate with a two year old with no common language than an adult, sometimes! It was fun, and really nice to observe/participate (I even fed the baby!) in an event so filled with love and happiness. The baby is adorable, loves being held, and warms to new people quickly. Whenever he passes by anyone in the house, their face lights up. It's impossible not to smile when you see him. That's the life, man--he gets oil massages everyday and constantly has someone petting him. I could understand him not wanting to get older!
I spent the afternoon in a very different context--I went with my hostess and her child to the American club to watch her husband play in the inter-club tennis tournament. There are several clubs here for ex-pats (proving citizenship is usually part of the process), and evidently they have competitions from time to time. The American club won the "B" level tournament, so we were happy about that. So happy, in fact, that we went to the Nordic club for the awards banquet that night. I did not think to bring any evening clothes--not that I really ever need them in the US so don't have much--but my hostess lent me a pretty black sari and even some earrings. She had to help me get dressed, saris involve lots of wrapping and folding--I'm still not sure I can recreate it and don't really understand how it stays put. It looked nice though, and until I really started rocking out on the dance floor, it was comfortable and sensible.
I had chocolate cake last night! After not having chocolate the whole time that I was here last time, I felt like this was a big accomplishment! Also an accomplishment was keeping myself to just one serving. I took a picture, lest someone be skeptical later, and I will upload soon.
Today it's back to the grind, trying to churn out some writing for early deadlines next week. The conference starts on Wednesday, so it will probably be pretty hectic until then. Amazing how fast time flies here!
Thursday night I went to an American couple's house for Thanksgiving. It was fun--most of the guests were Bengali but had spent significant time in the US or UK. They served turkey, carrots, mashed potatoes, rolls, and even veggie spring roll-esque things. It was a really interesting group of people--many of the guests had lived in Dhaka decades ago, and it was interesting hearing their stories about how the city had changed. Several had lived through and been very actively involved in the War for Liberation (1972), which also was incredible to hear about firsthand.
Yesterday (Friday) was not black, here. I started off the day with a breakfast of curried chicken, kitera (not sure of the spelling, it's a rice and lentil dish), tortilla-like bread (roti?), and a green onion omelet, all followed by some tea. My hosts' baby turned 6 months yesterday and was going to eat his first solid food. All nearby relatives descended on the house to celebrate the occasion. They took lots of pictures, everyone fed him a spoonful of food, and stayed to eat sweets and drink tea. There were many young children in attendance, and I of course played with them as much as possible. I think that it's easier to communicate with a two year old with no common language than an adult, sometimes! It was fun, and really nice to observe/participate (I even fed the baby!) in an event so filled with love and happiness. The baby is adorable, loves being held, and warms to new people quickly. Whenever he passes by anyone in the house, their face lights up. It's impossible not to smile when you see him. That's the life, man--he gets oil massages everyday and constantly has someone petting him. I could understand him not wanting to get older!
I spent the afternoon in a very different context--I went with my hostess and her child to the American club to watch her husband play in the inter-club tennis tournament. There are several clubs here for ex-pats (proving citizenship is usually part of the process), and evidently they have competitions from time to time. The American club won the "B" level tournament, so we were happy about that. So happy, in fact, that we went to the Nordic club for the awards banquet that night. I did not think to bring any evening clothes--not that I really ever need them in the US so don't have much--but my hostess lent me a pretty black sari and even some earrings. She had to help me get dressed, saris involve lots of wrapping and folding--I'm still not sure I can recreate it and don't really understand how it stays put. It looked nice though, and until I really started rocking out on the dance floor, it was comfortable and sensible.
I had chocolate cake last night! After not having chocolate the whole time that I was here last time, I felt like this was a big accomplishment! Also an accomplishment was keeping myself to just one serving. I took a picture, lest someone be skeptical later, and I will upload soon.
Today it's back to the grind, trying to churn out some writing for early deadlines next week. The conference starts on Wednesday, so it will probably be pretty hectic until then. Amazing how fast time flies here!
Thursday, November 27, 2008
Shawl we dance?
Another sunny day here in Dhaka. I'm sharing a corner office with one of my advisors from Harvard since he's out a lot, and I have to say, it's probably the nicest working space I've ever had. We're up on the 16th floor and it has a great view of the city. I find it hard to work sometimes with such a first-hand view of the going ons in the slums.
Yesterday I finally had a chance to explore on my own a little bit. I went for a walk at daybreak and walked up the main street of this neighborhood, Gulshan, which I took to work every day last year so know pretty well, relatively. There is a new citibank, which is exciting, but other than that, things look at the same. It was hot--I had to change when I got back because my shalwar (tunic-like top) was so sweaty!
I went out again this morning after breakfast without a shawl (I didn't have one that matched this particular shalwar, so decided that w/o shawl was less of a fashion faux paus than with a mismatched one), so after visiting the tourist agency (more on that when I actually book my trip!), I stopped by a market and purchased a new shawl. I put myself at the mercy of a man and his two sons, maybe 18 and 13 years old. With some gesturing and their basic english, we communicated that I needed a shawl to go with the tunic (turquoise with green and blue geometric patterns), and they brought out a full arsenal. I went with one of the lightest ones--no need for thick fabric right now--and took the blue and white checkered one that they suggested. It is a not a combination that I would have chosen, but once I was back on the streets, I felt like it did the job (I wrapped in around my head to protect me from the sun). Both of my shalwars are from Aarong, a great store with a nice selection but that probably is more popular among foreigners than locals (more expensive, but definitely more intuitive to a western newcomer and has sticker prices, so you can avoid haggling. The markets can also be pretty overwhelming since everyone tries to show you what they are offering), and this was my "authentic" shawl (cost tk 250--About $3.50. Might have been marked up, but my feeling is that if I don't know what a fair price is, and I'm in respectful position to negotiate, and it was cheap enough to assume that they were giving me a good price). It's already paid off--stopped by a store to buy a bottle of water and it was tk 5 ($0.06, but 20% reduction from the original tk 25 price!) cheaper than it was two days ago. At this rate, if there was a foreigner mark up on the shawl, it will pay for itself soon enough.
Beginning a homestay in Uttara (slightly north of Dhaka) tonight. Looking forward to being in a more home-like environment, and since most of the household is Bengali, it has great potential to be an unbeatable window into the local culture and norms. Interested to see if they use forks and knives, and what breakfast looks like.
Happy thanksgiving! I will post some pictures in the next few days. So far I have only taken pictures of others and of health facilities/personnel!
Yesterday I finally had a chance to explore on my own a little bit. I went for a walk at daybreak and walked up the main street of this neighborhood, Gulshan, which I took to work every day last year so know pretty well, relatively. There is a new citibank, which is exciting, but other than that, things look at the same. It was hot--I had to change when I got back because my shalwar (tunic-like top) was so sweaty!
I went out again this morning after breakfast without a shawl (I didn't have one that matched this particular shalwar, so decided that w/o shawl was less of a fashion faux paus than with a mismatched one), so after visiting the tourist agency (more on that when I actually book my trip!), I stopped by a market and purchased a new shawl. I put myself at the mercy of a man and his two sons, maybe 18 and 13 years old. With some gesturing and their basic english, we communicated that I needed a shawl to go with the tunic (turquoise with green and blue geometric patterns), and they brought out a full arsenal. I went with one of the lightest ones--no need for thick fabric right now--and took the blue and white checkered one that they suggested. It is a not a combination that I would have chosen, but once I was back on the streets, I felt like it did the job (I wrapped in around my head to protect me from the sun). Both of my shalwars are from Aarong, a great store with a nice selection but that probably is more popular among foreigners than locals (more expensive, but definitely more intuitive to a western newcomer and has sticker prices, so you can avoid haggling. The markets can also be pretty overwhelming since everyone tries to show you what they are offering), and this was my "authentic" shawl (cost tk 250--About $3.50. Might have been marked up, but my feeling is that if I don't know what a fair price is, and I'm in respectful position to negotiate, and it was cheap enough to assume that they were giving me a good price). It's already paid off--stopped by a store to buy a bottle of water and it was tk 5 ($0.06, but 20% reduction from the original tk 25 price!) cheaper than it was two days ago. At this rate, if there was a foreigner mark up on the shawl, it will pay for itself soon enough.
Beginning a homestay in Uttara (slightly north of Dhaka) tonight. Looking forward to being in a more home-like environment, and since most of the household is Bengali, it has great potential to be an unbeatable window into the local culture and norms. Interested to see if they use forks and knives, and what breakfast looks like.
Happy thanksgiving! I will post some pictures in the next few days. So far I have only taken pictures of others and of health facilities/personnel!
Tuesday, November 25, 2008
Round two of indhakatrination
I arrived in Dhaka around 4AM on Monday morning, after about 24 hours of relatively uneventful travel (highlights included paralyzing fear that I'd be stuck in snowy London without winter clothes, lamb cutlet brunch as one of the plane meals, and Mama Mia, possibly one of the worst movies ever made). Evidently Susan Davis, the CEO and Executive Director of BRAC-USA, was on my plane as well and staying at the BRAC Centre Inn, so I had a chance to meet her. Always ironic when you e-mail with someone who works relatively close to you (her office is in NYC) and you meet them for the first time thousands of miles away.
Today was my first day out in the field. I had a chance to return to Dhaka Medical College--the largest public hospital in Dhaka--and see the DOTS corner. One of the two women working there has worked with BRAC for 28 years, making her one of the first health workers. The clinic was quite busy; they invited me to sit in their office and ask questions, but all the while people came by with referrals for testing and/or treatment, and the women skillfully jumped between our conversation and their responsibilities. I also had a chance to see the massive paper record they keep for BRAC and the National Tuberculosis program. They are extremely diligent about data collection and recordkeeping, but I couldn't help but wonder what an electronic system would do for their ability to analyze the data and follow up on patients. As it is now, they send a patient's information form to the treatment center closest to where they live, and once the center receives it AND the patient begins treatment, they send it back. If both of those criteria are not met (or the letter gets lost in the mail either way), the patient will either not be treated or not recorded. A letter came in from a treatment center while I was sitting there: that patient has been tested on November 13 and was now on treatment. Is that indicative of how most patients behave? I am not sure.
Afterwards, I had a chance to visit a BRAC center in the southern part of town (older Dhaka). As you head south in the city, the roads become narrower and cars become less and less frequent. By the end, we were virtually the only car on the road, surrounded by colorful rickshaws and bicycles with trailers attached. This particular center was in a slum--BRAC is committed to helping the poor move out of poverty, and particularly interested in the economic development of women. There I had a chance to meet the program officers, along with the head of the microfinance program and health program. BRAC always amazes me with their ability to have very little overhead (including physical space!) for huge programs--the microfinance program alone had over 3,000 members. It forms the basis of all of their programs in the rural area, though it appeared to be less central in the urban context.
The POs took me to meet two shasthya shebikas (health volunteers--one of whom, Reina, is pictured here)) and a patient on treatment.
As soon as I got out of the car, I was surrounded by children. They are beautiful--all look curious, some a little fearful and others mischievous, but it is painful to take in the poverty that they all are growing up. Most don't wear shoes, their clothes are worn, and they are extremely thin. BRAC provides some educational opportunities in the slums, but it is obvious that more resources are desperately needed.
Last time I was here, I was overwhelmed by the poverty for most of my time here and could not move past my emotional reaction to it. This time, I find myself more analytical about it--still moved emotionally (I truly hope I never lose that sense of humanity), but perhaps with more depth. What I find myself most troubled by these days is a new issue: there is so much evidence here of ingenuity, creativity and intelligence, used to create new means of survival. Looking out of the window of the BRAC office, one sees a growing slum, surrounded by water (pictured below). One of my mentors commented that 20 years ago, there was a big lake there, with no island. People have literally built from the ground up--adding their foundation as they go. The economy that has sprung up around the slum, with everything from building materials to rowboats to shuttle people back and forth. While this is all very impressive, I can't help but wonder, what if instead of putting energy into struggling to survive on under $2 a day, we could put these minds to work on some of the most critical global priorities of our time: global warming, new cures and treatments for diseases like HIV/AIDS, or solving the financial crisis.
The fact that almost half the world lives on under $2 a day (purchasing power parity) means to me that half the world's brainpower is extremely underutilized (as in, it must first and foremost be focused on survival at all times). Maybe more, given the number of people around the world who spend their lives trying to figure out how to improve quality of life for people in resource poor settings (myself included). Moral imperative aside for a moment, this to me seems unconscionable from a perspective of a wasted resource. Not that I blame those living in poverty or those working with them--millions of lives are at stake. But sometimes I feel like we need to take a step back and say, why is the context of resource limitations and poverty a given? Why hasn't this changed after decades of advocacy? And will we ever be able to galvanize the global will to do so? I cannot come with reasons that justify the inaction. We might fail by acting, but we fail without doubt by not acting.
We should not put the moral imperative aside--I hope that future generations will look back on this time and wonder how we stood by not only during genocides, like Rwanda in the 1990s and in Sudan now, but as we watched millions struggle to combat poverty, with so many dying of hunger and conditions related to malnutrition and other poverty-related afflictions.
For all of these reasons, I feel like it's important for me to be here. So that I can write about BRAC and help build effective programs elsewhere, but primarily as a global citizen to bear witness to how others are forced to live.
I find myself constantly reminded of a very poignant quote whose origins are unclear, but are attributed to an Australian Aboriginal activist: "If you have come to help me, you are wasting your time. But if you have come because your liberation is bound up by mine, then let us work together."
I hope that my work here and elsewhere embody that philosophy.
Today was my first day out in the field. I had a chance to return to Dhaka Medical College--the largest public hospital in Dhaka--and see the DOTS corner. One of the two women working there has worked with BRAC for 28 years, making her one of the first health workers. The clinic was quite busy; they invited me to sit in their office and ask questions, but all the while people came by with referrals for testing and/or treatment, and the women skillfully jumped between our conversation and their responsibilities. I also had a chance to see the massive paper record they keep for BRAC and the National Tuberculosis program. They are extremely diligent about data collection and recordkeeping, but I couldn't help but wonder what an electronic system would do for their ability to analyze the data and follow up on patients. As it is now, they send a patient's information form to the treatment center closest to where they live, and once the center receives it AND the patient begins treatment, they send it back. If both of those criteria are not met (or the letter gets lost in the mail either way), the patient will either not be treated or not recorded. A letter came in from a treatment center while I was sitting there: that patient has been tested on November 13 and was now on treatment. Is that indicative of how most patients behave? I am not sure.
Afterwards, I had a chance to visit a BRAC center in the southern part of town (older Dhaka). As you head south in the city, the roads become narrower and cars become less and less frequent. By the end, we were virtually the only car on the road, surrounded by colorful rickshaws and bicycles with trailers attached. This particular center was in a slum--BRAC is committed to helping the poor move out of poverty, and particularly interested in the economic development of women. There I had a chance to meet the program officers, along with the head of the microfinance program and health program. BRAC always amazes me with their ability to have very little overhead (including physical space!) for huge programs--the microfinance program alone had over 3,000 members. It forms the basis of all of their programs in the rural area, though it appeared to be less central in the urban context.
The POs took me to meet two shasthya shebikas (health volunteers--one of whom, Reina, is pictured here)) and a patient on treatment.
As soon as I got out of the car, I was surrounded by children. They are beautiful--all look curious, some a little fearful and others mischievous, but it is painful to take in the poverty that they all are growing up. Most don't wear shoes, their clothes are worn, and they are extremely thin. BRAC provides some educational opportunities in the slums, but it is obvious that more resources are desperately needed.Last time I was here, I was overwhelmed by the poverty for most of my time here and could not move past my emotional reaction to it. This time, I find myself more analytical about it--still moved emotionally (I truly hope I never lose that sense of humanity), but perhaps with more depth. What I find myself most troubled by these days is a new issue: there is so much evidence here of ingenuity, creativity and intelligence, used to create new means of survival. Looking out of the window of the BRAC office, one sees a growing slum, surrounded by water (pictured below). One of my mentors commented that 20 years ago, there was a big lake there, with no island. People have literally built from the ground up--adding their foundation as they go. The economy that has sprung up around the slum, with everything from building materials to rowboats to shuttle people back and forth. While this is all very impressive, I can't help but wonder, what if instead of putting energy into struggling to survive on under $2 a day, we could put these minds to work on some of the most critical global priorities of our time: global warming, new cures and treatments for diseases like HIV/AIDS, or solving the financial crisis.
The fact that almost half the world lives on under $2 a day (purchasing power parity) means to me that half the world's brainpower is extremely underutilized (as in, it must first and foremost be focused on survival at all times). Maybe more, given the number of people around the world who spend their lives trying to figure out how to improve quality of life for people in resource poor settings (myself included). Moral imperative aside for a moment, this to me seems unconscionable from a perspective of a wasted resource. Not that I blame those living in poverty or those working with them--millions of lives are at stake. But sometimes I feel like we need to take a step back and say, why is the context of resource limitations and poverty a given? Why hasn't this changed after decades of advocacy? And will we ever be able to galvanize the global will to do so? I cannot come with reasons that justify the inaction. We might fail by acting, but we fail without doubt by not acting.We should not put the moral imperative aside--I hope that future generations will look back on this time and wonder how we stood by not only during genocides, like Rwanda in the 1990s and in Sudan now, but as we watched millions struggle to combat poverty, with so many dying of hunger and conditions related to malnutrition and other poverty-related afflictions.
For all of these reasons, I feel like it's important for me to be here. So that I can write about BRAC and help build effective programs elsewhere, but primarily as a global citizen to bear witness to how others are forced to live.
I find myself constantly reminded of a very poignant quote whose origins are unclear, but are attributed to an Australian Aboriginal activist: "If you have come to help me, you are wasting your time. But if you have come because your liberation is bound up by mine, then let us work together."
I hope that my work here and elsewhere embody that philosophy.
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