I haven't disappeared!

I apologize for the lack of updates. I had a minor computer disaster this week. In a rush to get to a meeting, I closed my laptop quickly. And closed the screen directly onto the hard plastic top to my USB modem, which was apparently sitting on the keyboard. Screen ruined--a Rorschach inkblot or Mandlebrot fractal of pixels, and no change with rebooting the computer. Thankfully, I was able to use a projector (the computer itself works fine!) to retrieve my data, and was able to borrow a very tiny little netbook that one of my WHO colleagues had on hand, so I haven't lost much speed with work or with being connected to the outside world.

I've spent the last couple of weeks in a blurry time-warp of conferences and supervisory visits to health facilities (both City Health Center and Rural Heath Units, the more provincial equivalent), and have spent a lot of time out in the community doing rapid coverage assessments door-to-door. I am happy to report that I have built up enough of a tan (read: one large freckle per arm) that I no longer fry within seconds of stepping out into the Philippine sun, but my colleagues are still very insistent that I should carry my umbrella with me at all times. To be fair, it does keep things ever so slightly cooler to be in the semi-shade of an umbrella. There's honestly not much you can do about the combination of humidity and heat, as the Philippine summer kicks into high gear here. I don't think I have ever been as warm as I was last Monday, walking around several communities in Bulacan Province. The Village Health Worker who was showing me around kept fanning me with her notebook--I think because she could see the beads of sweat dripping nonstop from my brow!

Region III (Central Luzon) has been home to a number of STOP Team volunteers over the years, and I am essentially repeating what a team did 4 years ago--assessing health facilities using a checklist, and providing feedback and skills-building sessions in a conference after the monitoring. The coverage assessments are meant to look--quickly and unscientifically--for "missed" children, and, unfortunately, we've found quite a few. Immunization delivery in some of these contexts is downright hard. I went to a 'village' (neighborhood, really, on the outskirts of a large municipality) that was all built on stilts over a stinking, neon green river. I have no idea what was floating in the river, but it was not a particularly healthy body of water. To get to the village, the health worker and I walked a few hundred yards on a concrete dam/embankment at the edge of a large tilapia fish farm/pond, then crossed a rickety bamboo bridge which bowed and bounced with each step. We sat on bamboo benches in front of one family's home, our feet dangling five or ten feet above the surface of the water, while mothers brought their babies and immunization records to us. Imagine the difficulty of getting to a health center (where you'll likely just have to wait in line) if you lived there. And the difficulty, as a health worker, in providing outreach immunization there. I wouldn't want to carry my vaccine box across that bridge! And that's certainly not the hardest place to reach in this country. A colleague walked 3 hours or so to reach a far-flung community on another island. And to be fair, Philippines isn't even the most rugged country in the region--I met the WHO immunization coordinator from Papua New Guinea this weekend, and he said that PNG has villages that are a full 14-day's walk from a health center. Which is just mind-boggling.

Anyhow, these health facilities here are facing some real challenges, and I feel a bit at a loss, in the short time I am here, in terms of helping to provide much tangible guidance or assistance to improve practices. Sure, I can help to sort out vaccines stored in a disorganized mess in a fridge, teach a midwife to use a monitoring chart to track her progress over the year, or refresh a nurse's memory on the surveillance protocols for measles. But there are some more fundamental changes that need to happen here, and I know that many people much smarter than I have been working on these challenges for years and years. This is the fundamental issue, as I see it, with practicing global health. What my role as a foreigner, with some specialized training and experience, but without a lot of insight into the local context, can be in helping to "move the needle" on these hard problems. It's certainly given me a lot to think about these few months.

Unbelievably, I am halfway through my assignment here. Time has both flown and crept along. I have six more weeks here, and am determined to make the best of them.More soon, including more pictures. I'll be in Manila for a week or so starting on Friday, and then have a short beach trip planned over the Holy Week holiday before Easter. It will be good to be in Manila to let some of these ideas and findings percolate, and to talk through them with my STOP team members and WHO/DOH colleagues. My mind is churning. Off to bed tonight, as we have another handful of monitoring visits scheduled for tomorrow.