The moment our rooster yells outside my window, I know it is time to get up. I usually take our dog out for a walk, then there is time for a quick bucket shower and breakfast and we are out the door. Every day is spent out on the field, conducting supervision visits at one of the twelve health centers which we support within the District of Ngoma (located in the Eastern Province of Rwanda). It can take anywhere from 30 minutes to an hour to reach the majority of the health centers from our house in the small town of Kibungo.

As we make our way to work, we can see the cloud of dust as it rushes through the rolled-down windows of our car. We can see the farmers walking to their fields, the uniformed children running to school and the women fetching water. We can hear the wheels moving – the wheels of the car, the wheels of the buses and motos, the wheels of the ambulance, and the wheels of the bicycles. Driving further along past Kibungo, we can feel the windy, bumpy dirt road as we flail back and forth on the seat. (It can be quite a nice back massage at times.)  And as we peer through the window, there is endless greenery all around – it is quite scenic.

By the time we reach one of the health centers, we get a little peace of mind before it is time to get busy. We (my co-fellow, Evode, my supervisor, Philippe and I) work with an organization called The Access Project. Our overall aim is to improve the management of the health centers in our District, across domains such as Finance, Human Resources and Infrastructure. The questions that we ask everyday are big and small. Was the appropriate requisition formula used when ordering 612 bottles of Co-trimoxazole (an antiretroviral medication) from the District Pharmacy, when will the District initiate the project to install running water in all of the consultation rooms, why is there a sudden drop in family planning utilization, how can we help data managers track their annual action plans, how are the issues raised by community health workers communicated and addressed by the health center, and the list goes on.

One trend that we noticed within the first few months of our fellowship was an increase in computer viruses infecting many machines of data managers. We found that multiple computers across different health centers were experiencing similar behaviors in performance and that the only support that data managers received was their machines being reformatted. While collaborating with the District Hospital IT Manager we realized that many computer users did not understand how computer viruses spread, how to protect their computer or how to backup their work. In order to address this issue, we developed a hands-on computer basics training to share some of the fundamentals of maintaining their computers.  The neat thing that came out of this was that there were many more related topics that data managers, mutuelle (health insurance) managers, pharmacy managers and even the titulaires (health center directors) were interested in learning about – using formulas in Excel, creating email accounts, compiling PowerPoint presentations, generating tables in Word, etc.  We are hoping to use some of this renewed energy of the health center staff to develop more focused trainings, using a train-the-trainer approach which would allow the designated “IT Administrators” of each health center to start mentoring their own teams.

Even with these interventions, it’s more than the technical and tactical support that we provide to health center staff to facilitate improvement in management. It’s about building relationships with the key players connected to each health center – the staff, the partners, the funders, the District Hospital, the District Officials, the Ministry of Health, the Community Health Workers, and the patients.  Sometimes we have to zoom out and look at the bigger picture. From there, we have to connect the dots within the landscape we work in – to bridge the gaps, eliminate duplicate efforts and strengthen the links that make up this system of health center management.

We might not feel like things are moving yet but it seems that the wheels are slowly turning.

Do you remember the standardized tests you took in elementary school? Those ones testing whether you could find the verb in the sentence, calculate the area of a triangle and explain how light refracts through a prism. You would be anxious and excited by the changed schedules and rearranged desks. You would wait impatiently through the reading passages for the juice and cookie break. Everyone talked about how it was the most important test of the year. I never imagined that when I was selected as a Global Health Corps (GHC) Fellow to serve as a Pharmacy Supply Chain Analyst in Rwinkwavu, Rwanda, these tests would become a focal point of my fellowship.

In my position with Partners in Health/Inshuti Mu Buzima in Rwanda I work with district pharmacies, hospital pharmacies and health center dispensaries to improve their procurement, inventory management and distribution of medical commodities. However, on the weekends, several of my colleagues and I transform into Volunteer P6 School Teacher to help prepare young students for their exit exams from primary school. Many of the other volunteer teachers are physicians in the hospital in my village taking time after long days and nights on the ward to teach science skills. Some teachers are other staff members trained in English as a Second Language and teach things like parts of speech and sentence structure. My years of volunteer teaching and working with children seemed to fit right in. With these supplementary lessons we hoped to prepare the students for their upcoming exit exams from primary school.

The P6 level students come every Sunday for three hours to supplement their daily lessons at the local Nkondo Primary School. Many walk thirty minutes, passing many of their friends or neighbors watching a football match or playing outside, to reach the classrooms where we teach math, English and science skills. The students are enthusiastic and eager to learn, yelling “Teacher, Teacher” with their hands raised high when they know an answer. All seventy children completed their exit exams on October 25^th, 2011. They said that they felt confident in their performance and that many questions on the exam were on topics we had reviewed together. I was delighted to hear that after the New Year and the end of school holidays, the students have requested to continue their supplementary lessons on Sundays!

After seeing their improvement and learning of the program, the teachers of Nkondo School asked if they could participate in supplementary English classes as well. When Rwanda switched its national language from French to English in 2008, many of the teachers still did not know English and have been trying to learn the language on their own. I began teaching English classes on Sunday afternoons to about ten primary school teachers during their school holiday. By building the English skills of the teachers, we hope to improve the capacity of the entire education system within the Nkondo School.

As a GHC fellow, I came to Rwanda to ensure that pharmaceuticals got where they needed to go. However, my passion for teaching, could not be ignored. So, if in my time here a few kids get where they need to be, too, well, that might just make my fellowship even better.

Going into the fellowship year it seemed like everyone from last year’s fellows, to my current supervisors, to strangers I met on the street gave me the same warning: There will be a lot of bureaucracy to deal with at your placement. UMDNJ is a big institution. Things move slow and there are lots of hold ups and conflicting opinions. Get ready to be frustrated.

I currently work as a Health Literacy Consultant at UMDNJ’s University Hospital in Newark, NJ. This is indeed a much bigger place than any of the small clinics, or even city government offices I have worked at before. And yet while this advice made me a little nervous, to be honest I was really not that fussed. I can handle bureaucracy, I thought. Isn’t that the way the whole world works? I’ve been to the DMV, I’ve gone through airport security. I’ve got this. And for my first few weeks it felt like I had been right. Coming in everyone I met was very welcoming. They seemed excited to have a new fellow on board, full of energy and ready to push the project forward.

That was the first few weeks. After that things began to, well, slow down. I would send an email to thirty people and not get a single reply. I would send a second email. A third. I would call and set up meetings only to have them cancelled last minute. I would hold an education session and have one person show up. Our monthly committee meetings, that have an invite list of over twenty people, would draw in only six or so. (This is including the five people on our immediate team who had to come, and the one poor sucker I had talked to and guilted into it on my way there.) Now I understand that at a hospital like UH people are busy. They all wear too many hats. Everyone either cares too much about too many things, or has burned out already and doesn’t care about anything besides getting home in time to watch the Yankees playoff game. But still, this seemed crazy! Weren’t these people who were now ignoring me the same folks who were just itching to push Health Literacy forward just a few weeks, days, even hours ago?

It was hard for a while not to feel burned out myself. Sitting at my desk, having seven projects going, all waiting on other people’s responses and approvals, I would read through the entire New York Times (the online version, with extra articles and features) and wonder, am I making a difference here? But this winter when it came time for me to update GHC on the work I had done in my first two quarters I had a mini revelation. No, no angels showed up bring good news of great joy in my newly (and finally) acquired, but as yet unfurnished office. But a little voice spoke to me out of the borrowed laptop I was using until the computer that had been ordered for me showed up five weeks later. And that voice said, Claire look at these goals! Sure, some were a little overly optimistic. (“Girl, you wanted to open a Health Resource Center in two months! Pssh, you were dreamin’!”) But there were also a good number of them that I had accomplished, or at least made solid progress on. Not only that, but since August we had also gained quite a few new projects and contacts. I had found my allies and won some battles, and while day to day sometimes it felt like trying to take the Chinatown Bus from New York to Boston on a Friday at rush hour, in the end the work we had set out to do WAS getting done. And most importantly the patients we were trying to help, so often forgotten about or given up on a big, overcrowded hospital like UH, were seeing some of the benefits.

So what advice do I have for others who often feel at their jobs that they are only a little, bitty fish in a big algae-filled pond? I have three things: Make friends, because you never know who holds the final word. Stay positive. And I mean hop around the conference table, whistle-while-you-work, “How many cups of coffee has she had today?”, positive. Positivity is not only contagious, but acting positive will actually make you feel more positive as well. And finally take a step back (and listen the voice speaking to you out of your computer) every once in a while. You may just find, not that you’ve gone insane (which could be the more obvious answer here), but that you have accomplished way more than you thought.

That’s all for now. Reporting from her dorm room in Newark, Claire Perkins (aka the little fish) out.

With the rising increase in global health and development jobs and the pressing need to make an impact, we find ourselves more and more in new environments/cultures significantly different and outside of our comfort zones. Adjusting to this new ‘home’ usually doesn’t come easy for most of us, as we all have different thresholds for adapting.

There is no doubt that working internationally or even nationally comes with its own challenges for various reasons such as the nature of the job itself, the type of organization we work for, the political and economic climate of the country we are working in, the culture and language of the local community and the urgency to make quick, tangible and meaningful contributions, amidst other reasons. These challenges can often lead to frustrating moments, such that if they are not astutely handled can easily erode one’s sense of judgement, passion and might even have long term detrimental effects on one’s life and career.

I had my fair share of challenges, which led to a period of frustration, and the desire to put a kibosh on it inspired me to develop the FOCUS model, a simple tool that has helped me regain my strength and passion during those low moments. Just to give you a brief background about myself, I am a Global Health Corps fellow from Nigeria working in the United States, and currently serving as a Health Literacy Consultant at the hospital of the University of Medicine and Dentistry of New Jersey. I use my skills to implement various health literacy projects within the hospital, with the overall aim of improving the quality of health care services that are being delivered by the hospital to its low literate patient population.

I was really excited to start working, but in retrospect I would say that I never really envisaged the challenges that lay ahead of me. The American culture was very new to me, different from the Nigerian culture, where I had grown up and the European culture, where I had been privileged to visit couple of times and had studied for my master’s degree. To put it straight, I was completely new to a different environment, a different country and culture with so much diversity. Coupled with it was that I was going to work in a new organization and yes, I was also starting a new life again!

I experienced those frustrating moments of trying to find a balance between having to be part of a new identity and still having to hold on to my original identity. I also was trying to adjust and at the same time understand a different work culture. The desire to be useful and quickly make tangible contributions to the achievement of the goals and objectives of the projects we were working on which yielded no quick result as at that time also exacerbated the frustration.

It was then I developed the FOCUS model, which consists of five basic step-by-step processes that I followed and it can be used by anybody working in the field of international health or development. It goes thus;

Firstly;
F – Find someone you can talk to in your moments of frustration. I will tell you this, a problem shared is half solved. I didn’t realize how much I had harbored inside of me until I began to talk about them. Graciously, I was able to leverage on my awesome friends within the GHC community who helped me tremendously and are always people I can call on during moments of despair.

Secondly;
O – Organize your thought system. I don’t know if you are familiar with this quote but it goes this way, ‘‘Watch your thoughts, they become words. Watch your words, they become actions. Watch your actions, they become habits. Watch your habits, they become your character. Watch your character, it becomes your destiny.’’ Understanding how true this quote is, every morning, I began to feed my mind with positive thoughts of things that I wanted and was looking forward to. Consequently, I began to notice a change and instead of reacting negatively to what was going on around me, I began to respond confidently because my mind got used to being expectant for the good things that came with each new day.

Thirdly;
C – Check for bright spots. This I had not realized I had been practicing until much emphasis was placed on it during the Quarter 1 retreat. As humans, it’s always very easy to concentrate on the things that are not working in our lives. Truly, I was guilty of this and needed to change, so I began to write down things that I was most grateful for in life. This also helped to positively change my perspective and I began to appreciate better the things happening around me and my family that I had truly missed.

Fourthly;
U – Understand your own limitations. I realized that there was a limit to what my abilities could do. In as much as I wanted things to rapidly change for the better, I couldn’t solve everything. The greatest lesson I learnt from here is to always do my best and leave the rest.

Lastly;
S – Savor each moment and Shape up. Life is a journey and every situation is a passing phase to a new level. I made up my mind to learn from every mistake, understanding that whatever I was going through would only make me become stronger and a better person, because after the test, usually comes the testimony!

This is a simple model that I have developed and wanted to share with you all. The essence of this model is to make us remain focused in the midst of the challenges that come with making significant impact in the global health and international development fields. Depending on your circumstances, using the FOCUS model might not be able to change everything, but it’s definitely going to be a step in the right direction to appreciating every challenging moment you find yourself in. However, this would also require you to be open as possible and be ready to make amends where necessary. Most importantly, it’s not even that we are not aware of these basic processes; it’s just that we ignore them and often feel that they are too simple to help us. We end up seeking for the complicated solutions, which necessarily don’t come easily to us on a platter of gold. The FOCUS model has helped me and I hope it will be of great help to you.

I wish you all the best as we continue to brave all the obstacles in order to achieve social justice and global health equity!

Here I was several thousand miles from Zimbabwe trying to tackle the insurmountable role of assisting homeless youths get access to health services. My first day at ‘The Cov’(Covenant House) my whole perspective of homelessness was trashed. Coming from a country where homelessness was also rife and you could tell a homeless individual from a mile away, I found myself struggling with the picture before me. The youths I was to deal with were well dressed, with some ‘cool’ hairstyles and were far from the picture I grew up knowing of homeless people wearing tattered clothing and smelling badly. I was confronted by a set of people who knew what was trendy and were quite self assertive and proud. They did not in the least look as desperate as their situation was. A few had cell phones, someone came in with a laptop, and for the most part these youths had gone through to high school and were just shy of GEDs and diplomas. To make things more complicated for my poor brain, some on occasion would go visit their families and relatives and spend the weekend and be part of ‘family reunion’ events and then they returned to ‘The Cov.” I couldn’t understand how this batch of people could be termed ‘homeless.’ However as my stay has progressed I have begun to appreciate several dynamics at play.

Homelessness is a difficult thing to define as it’s a dynamic process and has a high turnover rate. For the most part most agencies define it in terms of the number of people who experience homelessness over a period of time, not the number of “homeless people.” In 2007 the National Law Center on Homelessness and Poverty estimated that approximately 3.5 million people and 1.35 million of these being children, were likely to experience homelessness in a given year. There are a cocktail of reasons why these youths end up homeless and I won’t try to explain them in this blog. However the thing I have found challenging is the fact that it is so hard to assist these young people to get their lives on track. They have been through so much mental, physical and emotional trauma that they struggle to appreciate help when it is right before their eyes. Some, mostly males are preoccupied with the ‘tougher than life’ mindset which plays a significant role in hindering their progress. There is such a great need to empower these young people to overcome the past that haunts them and try to make them see the future that lies ahead. A considerable number of the youths have psychological and behavioral issues that also need to be concurrently dealt with.

Research has also shown a considerable link between foster care and homelessness. My organization in 2000 noted that 40% of homeless youths were former foster care clients. So one sees that some of these youths have been through programs meant to help them become better people and yet they find themselves in these difficult circumstances. One is tempted to question the effectiveness of the foster care system in this regard, but much success has come out of foster care programs nationwide.

As my partner and I navigate our journey in helping these youths, I find myself with more questions on how best to assist these youths. But one thing remains certain, we should never give up helping these young people no matter how insuperable the task. They do have the potential to be world changers and our role in addition helping them access healthcare, we play a part in being role models and mentors to some extent. I believe as we play our part, they get an opportunity to achieve what they see as possible and yet seems  so far.