Happy Bastille Day!!!
In honor of Bastille Day, I decided to try to answer, "What am I doing here?" People ask me this a lot. Here's my answer. I'm tired, so it's long. Sorry it works out like that.
Pretty much, it's figuring out how to give people access to quality health care under the context of political instability. And then making it happen and then monitoring to see if it's working. Because there are so many rural areas with no clinics, this is usually done by way of community-based interventions. This means training people to train motivated lay-people to give simple and basic health education, diagnosis and treatment in areas where facility-based options may be a more than a week's walk away. There are several different programs each with a different structure. I work on the malaria control program (MCP) and the village health worker program (VHW) both with the Karen Department of Health and Welfare (KDHW).
MCP is one of the oldest and most established programs with about six years of really exciting data that shows that what's happening is really working. Simply put, since this program started, fewer people are dying of malaria. There are more treated nets, more education, more rapid tests for early diagnosis and more treatments being taken correctly. And because of all of these things, fewer people are dying. Awesome, huh? The VHW program is really new and a huge step in community-based interventions. It's using VHWs to branch out on a scale that has never been done before. To do this well, there's a tiered system. Level 1 focuses on gathering data about the villages, and having VHWs give information about diarrhea, dehydration, breastfeeding, proper hand washing (and installing hand washing facilities, as in a plastic bottle turned faucet), how to make ORS (oral rehydration salts) and also distributing zinc to households with children with diarrhea. These are simple, yet really important and really effective. The zinc, in addition to being really helpful to reduce the duration of diarrhea, also kind of helps builds street-cred in that he/she looks more like a medic if they have something to hand out. If data shows that the VHW was effective, and the village is ready (in terms of security, transportation, etc), then the VHW can become a Level 2 VHW, where they get training on how to educate about prevention, make diagnoses and give treatment for malaria and acute respiratory infections which are the two most common reasons for death of children under 5 (I think this is right, not 100% positive). With these VHWs, people who have never before received any health education can learn really basic skills to prevent and treat the diseases that are causing ridiculously high rates of morbidity and mortality in Eastern Burma.
Imagine there are 20 medics. Let's say each medic is generally responsible for a clinic that serves the 10 surrounding villages. That's about 120 villages who have access to health care. With the VHW program, a medic attends a training through KDHW, and then heads back to Burma and trains 20 VHWs from that area. That's 400 VHWs. At even just 3 villages per VHW, that's 1200 villages that have access to basic health care, including diagnosis and treatment for the most common illnesses. Also, with only a couple of villages per person, health education and prevention is actually feasible. Finally, the medic can now focus on the more complex cases that require more medical expertise. Cool, huh????
What do I do? As I said before, all of these programs are run by local health departments and organizations in Mae Sot that run things in Burma. For almost each program, there are bi-annual week-long meetings for supervisors and/or medics. The supervisors/medics hand over the data from the last 6 months, then talk about the good, bad and ugly from the previous 6 months, attend trainings on new and old protocol, including training-of-trainers, and finally receive more supplies (medicine, data forms, etc) to go back and distribute to the VHWs. The supervisors/medics then return to their areas, train their VHWs, send them on their way and keep tabs on them for the next 6 months.
Everything is run by the local groups. The programs are theirs, the implementation is theirs, the trainings that are held are theirs, the data collected is theirs. We serve as the 'technical assistance' for these programs. This means the we work directly with the coordinators of the programs in their office and we help get stuff done. Sometimes it's brainstorming new ideas for a new intervention or figuring out how to monitor the treatment of anti-malarial patients after an attack which has caused everyone to flee and relocate and sometimes it's double checking data and making photocopies. It changes day-to-day.
My days consist of a lot of meetings with people, with a little bit of time for me to do my part before my next meeting. Right now, I meet with my supervisors, people running similar programs within my organization, but mostly the local coordinators for the MCP and VHW programs. In the future, I'll start meeting with other people working on similar issues in other ways, outside of my organization. This week, people from my organization met with people from International Rescue Committee, Medecins San Frontier, Shokl Malaria Research Unit, Mae Tao Clinic and a ton of other groups in Mae Sot, and then even more groups through Skype conference calls. Very cool!
The founder/director came and spent the week of orientation with us. He's so cool, I didn't even realize he was the director until the second day. I thought it was just another person within the organization who happened to have the same first name. Oops. He's an ER doctor in LA who lived on a boat for a a bunch of years, who started this group over 10 years ago to 'fill the gaps' of the local health departments and organizations. (Get it?) It's definitely not about making a big name for ourselves. Most big groups, like IRC and USAID stamp their name on everything and everything they're associated with. We don't. The data, the papers, everything is owned by the local partners. In fact, we're probably one of the few NGOs in Mae Sot without a nice sponsored pick-up truck cruising around town. We keep a low profile and really exist to help the partners. There wasn't even an office until last year because most of the work is done at the local partners' offices.
As cliche as it sounds, our goal is to work ourselves out of a job. One common problem is that a big NGOs comes in, does the work for other groups (probably much quicker and more efficiently) but then something comes up, they leave, which often leaves the groups they were helping worse off than when they came and they have to either start from scratch or wait for another NGO to come and rescue them. My organization really focuses on capacity building so that we're not doing the work for them, we're helping them do the work. I know it sounds cliche, but it's a huge difference. Yesterday I spent about an hour helping the local coordinator type out a really simple email to order supplies from a pharmaceutical company in Bangkok. He had never done it before, and was nervous about typing in English and not putting in the correct information in the email. I could have had it sent in about 2 minutes, but the idea is that maybe next time an order needs to be made, he'll be able to do it in 30 minutes, then 15, then 8, then 4, then maybe 2.
This is what I do.
I help people who run programs which help the people inside the jungles of Eastern Burma live longer and healthier lives.
I like it.
Here are some articles if you're not bored of this topic yet -
Johns Hopkins Article
Malaria Control Program in Eastern Burma. (This is a program I work on!)
Access to Essential Maternal Health Interventions
More reports
Here is the outside of a restaurant with Thai, English and Burmese. The second picture is the Thai/Burma Friendship Bridge. That means - the other side is Burma. I know it looks like grass, but there's actually a river behind the grass. And if you look closely, you can see the top of an inner tube that someone used to swim across. I know it's not a great picture, but it's Burma.






