This week we commenced monitoring of the 3 clinics we trained in Grand Gedeh County last month. Oh (as in *sigh*), I wish I had good news to report. For your sake and mine. And that of WFP.
We eagerly headed out yesterday morning to the first clinic which is about an hour away. Thankfully, the roads were easily passable (it hasn't rained heavily since Saturday... is the raining season coming to a close?!). As soon as we opened up the ledgers that are used to keep track of all the benficiaries I knew we were going to be there for a while. Starting with the positive, I can say that the ledgers were set up properly and there were columns for each piece of information they were to be recording. Now, that doesn't mean each column had been filled out and it doesnt mean that what was filled out was done properly. They were not getting some information that is essential to the program (e.g. the MUAC tape measurements that are used to determine suitability for the program), coinicidentally everyone fell into the exact weight-for-height category (not possible), and no beneficiary had signed confirming that they had received their August food commodities. After a few deep breaths and about 20 minutes of chaos trying to figure out how to fill out our monitoring reports, I decided to I would just go back next week and sit with them for several hours to starighten everything out. Im a huge fan of working one-on-one with clinic staff- a lesson well learned in Zambia.
Surprisingly though, this clinic has one of the best food warehouses of all the clinics we have visited. Food is kept clean, separated properly and stored properly. Compare this to the hospital in Sinoe where bugs were crawling out of bags, the vegetable oil was leaking, and the sugar sacks had gotten wet and moldy. I'd rather be malnourished than put some of that food in my mouth. And I've put some pretty crazy food in my mouth.
When we got back to Zwedru, we visited the district hospital. I can't even begin here. So I won't. Let it suffuce to say, I will be going back here 2 times next week to help get things organized and make sure the appropriate beneficiaries are getting the appropriate food commodities. We never made it to the 3rd clinic. I won't say thats a bad thing at this point.
I have been unable to come to any final conclusions as I evaluate how the monitoring (I use "monitoring" loosely here) went. I have, however, had some thoughts about it.
Basically they go like this:
- Our trainings really sucked.
- The participants didn't listen to what we were saying at the trainings.
- The participants didn't understand my American English at the trainings and didn't ask for a"translation"
- The clinic staff are too busy to worry about this and take on yet another task.
- Our trainings sucked, no one listened or could understand, AND they are too busy to care.
Hopefully when I go back next week, Ill get a better idea of what went wrong where. I hope I can add some sort of organization and understanding. I refuse to believe its a problem that cant be fixed. Motivation, people. Motivation. A little goes a long way.
With the little time I have left, I am frantically trying to push through a "referral pathways" training for the the community health volunteers (CHVs) and the officers in charge (OICs) for all clinics in Grand Gedeh. I know what you are thinking: They barely grasped what we did at the first training and you want to do more? Yup. I'm crazy. But this one will be different. Just nod your head and agree with me.
The training will focus on how to recognize the signs and symptoms of malnutrition and what to do when you identify someone who is malnourished. The CHVs are the first line of contact for the communities so it is important for them to be able to identify the malnourished and appropriately refer them to the local health facility. Because WFP only provides food commodities to 3 health facilities in Grand Gedeh, the OICs at the local health facility then need to refer the person to one of the 3 facilities WFP provides food to. Maybe I should just insert the chart I created to demonstrate this process? Email me if you want a copy.
I won't go into it, but there are several categories of malnourishment which determines where you should ultimately be referred to and what type of food you will receive. This is where the UNICEF/WFP coordination comes in. UNICEF provides food for the severely malnourished and WFP provides for the moderately malnourished (we hope that once those in the severe category begin to get better they will be transferred to the moderate category, but this doesnt always happen- hence the training!).
Damn, I barely understood what I just wrote and I want to teach it to people?