A couple of weeks ago I had the privilege of attending the Economist’s Healthcare in Africa Conference whose theme this year was, “The Future of Healthcare in Africa.”

I was excited to hear the highbrow policy discussions from the mouths of the big decision makers from various sectors working on the continent. However, as the sessions began, I couldn’t help but hear Gregg Gonsalves’ words ringing through my head from his article, Rage Against the Machine (the article articulately questions the effect that bureaucratic meetings, conference, and paper pushing actually have on the causes they’re intended to impact).

I truly did enjoy hearing where the Ministers of Health of Zambia and South Africa were targeting their efforts to improve health in their countries, and the debates about task shifting and the role of the private sector in healthcare were incredibly interesting (especially as a youngin’ who finagled my way into the conference as a volunteer so I wouldn’t need to pay the huge registration fee that I couldn’t afford – secret of how to get into big conferences officially shared with the rest of you). But it was hard for me to answer the question, “what did all of these high power players listening to each other give speeches and then networking afterwards over a glass of wine actually accomplish?”

During Gregg’s article he imagines “Zackie Achmat‘s voice in my head calling me an ultra-leftist for refusing to deal with institutions to affect change.” I just so happened to call Zackie during a break to schedule dinner with him, and when I told him I was at the The Westin for the conference, the only response I got from him was a sarcastic, “oh how bougie!”

There’s a strong disconnect between the policy makers and the people they’re supposed to be helping (a notion that is getting huge press with all the reactions to the Kony2012 campaign – my favorite of which, by the way, written by Teju Cole). Things are changing though. The government of Rwanda, for example, has done an extraordinary job making it a priority to react (and react surprisingly quickly) to the voices of its poorest people (for example the high priority National Multi-sectoral Strategy to Eliminate Malnutrition in Rwanda that President Kagame mandated after his visit to a health center in 2009).

We need to make sure that policies keep up to speed with the needs on the ground, and that whenever the wallets sit around a table, the “beneficiaries” voices are sitting right there next to ‘em.

“…actually King Faisal hospital is really disorganized, Why would you put the pediatrics on the third floor in the wards with unsafe balconies on both sides? We are forced to keep the children in the rooms like prisoners and we are ever running after them. Yet the administration is on the ground floor and many attempts made to change the space it occupies for pediatric service have failed…” says to my biggest surprise, Dr. Christine Mutaganzwa, a friend of mine and a young GP doctor at the country’s most prestigious hospital during a conversation we were having while visiting friends.

King Faisal Hospital is the country’s best hospital. It is designed around an internal courtyard with balconies on both side around the courtyard and with gorgeous views of the country landscape, yet the structure of the building is so bad that the staff of the hospital can tell you millions of stories of how this challenges their work and affects their performance on a daily basis.

These are people who have to deal with high levels of stress every day and would greatly appreciate if these obstacles were not in their day to day work life.

The project to design King Faisal cost millions of dollars–many organization were involved and a lot of time and resources were put in.

Now it raises a question, if the staff have so many complaints about the hospital, how about patients? There is no doubt that the stories from the few privileged patients to be treated at this state of the art hospital will be a thousand time more humbling than the staff.

Another question then arises from the above, if the country’s best resourced hospital can be so unpleasant to be in, what  about the rural district hospitals and health centers that the government provides very limited budgets, which are awarded through public tenders and contracts awarded to money-hungry contractors? What stories would the staffs working in these facilities tell us, if we took time and heard them?

Jennifer Gottesfeld, a Global Health Corps fellow who is working with clinics in Malawi , tells how people are cramped in narrow corridors like sardines. Most of these clinics are put up by non- profits that are so focused on health services delivery, that they forget how incredibly impactful a certain organization of the space can be to help greatly improve the efficiency of these organizations while helping their cause of prevention and fighting diseases.

Do we just let the idea behind these facilities stay as a favor done to the population or look for clever but simpler ways of tackling some of the issues that will improve the experience of the people using these facilities on a daily basis?

Watching patients at the GICUMBI District hospital in the northern province of Rwanda sitting by the water tank, 5o meters from the ward they were in, I wished the whole hospital was a digital model on my computer, so then it would be easy to rotate the building around and make them enjoy the morning sun from their beds, making the windows bigger. I believe being an architect that is the contribution I can bring to patients’ well-being. If we could think and care about such things before these structures are put up, we could definitely make health care facilities much more efficient, healing and safe for the users.

It’s always been my pleasure to be part of the GHC movement! Today, at the very last day of the GHC 2012-2013 fellow class recruitment period, I would like to take a little time to remember and share thoughts about my journey.
On November 22, 2011, I was confirmed part of the GHC recruitment ambassadors for Rwanda. The team was assigned to raise awareness about GHC fellowship opportunities around the country and recruit the 2012-2013 GHC class of fellows on the Rwanda side. Many communication means were to be used. Here, I am going to share the course of my recruitment journey: means, successes, challenges, pieces of advice for the future recruiters and express my gratitude to people as usual.

The course

On November 28, 2011 in Ngoma District of the Eastern province of Rwanda we had a team briefing meeting that was led by Shema-the GHC East Africa Program Manager. He helped us understand what the task looks like, available means for the team and what GHC expect from us. The whole team brainstormed about the target populations and the approaches to be used. Some of our targets were universities (from the national university of Rwanda, to Kigali health institute, to Kigali Institute of Education, and many more), youth groups and institutions such as AERG (Association des Eleves et Etudiants Rescapes du Genocide), organizations such as Generation Rwanda, Rwanda Business Development center and finally individual contacts of ours.

After the team meeting, we went on doing individual and collective tasks for the common goal.
I personally divided my work into 4 main approaches and strategies:
1. Phone SMSs and calls: I had a template SMS in my phone that I could send to whoever, in my contacts and those I meet from time to time. I should also send the SMS to people who were referred by others to me.  As by now I have sent 233 SMSs. I also received phone calls and called back those who could miss call me for more information and help with their application processes.

2. Flyers and word of mouth: I printed 400 flyers with the summarized GHC recruitment message. I distributed these flyers in many venues around the country: from street sidewalks, to university settings such as KHI and KIST, to Kirehe-my work place, to Rwanda Business Development Center in Kigali, to partner organizations and youth groups such AERG, and finally to GHC fellows while at the mid-year retreat in Kibuye to list a few.

A copy of the flyer posted at Kigali Health Institute

A Saturday dedicated to GHC recruitment: January 14, 2012
I woke-up and attended a meeting of Rwanda Business Development Center alumni before noon. At the occasion I requested time to spread the word about GHC among a selection of emerging leaders and entrepreneurs. The audience appreciated it and promised to spread the word. I especially remember a head of dentistry department at KHI, current student of BDC, who directly promised to help me get time to talk with students at KHI about GHC. He definitely kept the promise!

Pitching GHC fellowship opportunity at Rwanda BDC, Kigali
In the afternoon, I went to KHI and KIST and distributed flyers to a big number of students. I also talked with small student groups for three hours in total.

Pitching GHC fellowship at Kigali Health Institute, Kigali

3. E-mails and Facebook posts: I also shared a number of e-mails, posts and chatting with my contacts and referred ones.

4. Information session: On Friday February 10, 2012 from 5:30pm to 7pm, I facilitated an information session at KHI. 103 students attended. I used the GHC information session slides show, the flyers and the GHC website. After my presentation students asked questions and generated ideas. It was a sweet experience to return to my school and former work place with such good news.

The audience at KHI for the GHC information session

Some challenges and pieces of advice

1. Time: It was not easy to get time to go to Kigali from Kirehe in the east of Rwanda (3 hours on a bus) since work was also busy at FACE AIDS. I propose that raising awareness about GHC should be a continuous thing and separate from recruitment. For instance negotiating some information sessions before recruitment period instead of having everything packed in that short time period. The same thing should be applied for flyers and other promotional items. There we should have people waiting for the applications to open instead of us waiting for applicants. My thoughts!
2. Recordkeeping: my recordkeeping has been poor. We were required to record and upload contacts of people we communicate with. However, it is not easy to record every number to which you send an SMS or call as it was required. The same challenge happened to me with uploading all the e-mails to our Google document since the internet is most of the time not good enough to easily access the document.
3. New concepts: words like fellowship, health equity, and global movement are new for Rwandans. It was not easy to talk about recruitment without first giving enough explanations about those vocabularies. However, since people are not really familiar with them it was not easy to get them understand everything by the suddenly provided meanings. I remember someone asking me the difference between a fellowship and an internship and a job. I replied that the fellowship is in between an internship and a job since it is paid (which is not always the case with internships) and its aim is to build professional experience which is most of the time required for usual jobs. Also fellowships do not usually last longer as jobs should do.

Soon the next step ahead will start with interviews and I hope it will also be successful. I have applied for it and I believe my active involvement will, together with others, help select candidates who deserve it to be part of the GHC 2012-2013 class.

Without the support of many folks, this blog was definitely not doing to be written. I would like to express my gratitude to GHC staff for giving me the chance to be part of the recruitment team and for facilitating the exercise. My thanks go to all recruiters for doing a great job and sharing insights throughout the journey. I also would like to thank all GHC fellows for spreading the word and advising me and other recruiters. Finally, I owe a debt of gratitude to God who enables me to meet the right people, do what I believe in and feel satisfied with my contribution to the community,

In conclusion, I would like to acknowledge that I learned much from the exercise and would like to recommend it to future fellows. GHC is really training young leaders of today and tomorrow. God bless you all!

We had spent close to 5 hours on the road, but it was a safe journey. Having travelled the night before, we were able to get our breakfast in time and head to our first site for support supervision. A quarter to 9:00 am and we had successfully made it to the first site far in the eastern part of Uganda.

Though they were expecting us (following earlier communication), we had to observe protocol. We asked for directions to the Medical Superintendent   but unfortunately, she was not in her office. We went ahead and started our day’s work. This was the second time I was involved in this kind of exercise. I had obtained more confidence, especially because I had taught a number of sessions in the data management and monitoring and evaluation courses at my work place, and so I had a good idea of the people I was going to support.

As one of our strategies to develop capacity in systems strengthening, a number of health facility staff were trained in the areas of data management and M&E. We were to follow up on them over the project period to ensure that the skills transfered into practice at their respective sites.

All was well until one of my teammates met the Medical Superintendant (MS); she came back in a hurry and reported that she urgently wanted to meet us within 15 minutes. I quickly went through my checklist and went to meet the MS. We waited patiently and read clearly the instructions on the door as they read, “Knock and wait and be brief while inside for other people might be waiting”

As we waited we wondered what this short meeting was intended for, they warmly welcomed us and asked for the rest of our team members. To their surprise, we had travelled as a team of two young women.

MS: Is this all?

Me: Yes

MS: You look very young…

Me: Looks are very deceptive. I am …………….M&E Officer, Global Health Corps Fellow IDI Training Department and this is my colleague ………………. In charge of Data

All of this happened in front of all the hospital department heads and all the staff we had come to support. This was a semi-interview in disguise. A number of questions were shot at us. Fortunately or unfortunately I was the team leader and hence had to respond to most, if not all, the questions. Questions ranged from the lingering questions from the previous support supervision to technical questions in M&E.

All this went on well, however the support supervision turned tough, for the seat of a team leader had never been as technical as it was!!!!

Are you ready for it? If not, think otherwise for a lot might be expected from you!

Finally we have all marked the end of our first quarter; it was a transitional quarter for all. Looking round the clock a number of new things have occurred, experience accompanied with some challenges.

Having been at IDI before the fellowship year, I thought I knew it all, but I was proved wrong. We know all projects are unique just from the project name and so is the IDI training department unique from the rest of the IDI departments. Before I overcame my jet lag I was welcomed by a phone call inviting me to serve as a facilitator in one of the courses I found ongoing. Little did I know it was the beginning of  long days for 3 consecutive months.

I have come to learn that we normally fail to reach our potential because of lack of opportunity to do so, but we can make it. As gold is tested by fire, one must first go through trials in order to give him or herself a pat on the back. Now we can proudly give ourselves a pat on the back for we definitely made it. When I first started, I was asked to serve as the acting data manager and the head of the M&E team from the first day of arrival. Now it all feels like a heavy weight was lifted from me, and it’s time to catch up with all the rest. I am now called proudly by my name and not “M&E” any more.

I’m so thankful for the team we found on the ground and the great partnership with my co fellow Faith. The work of covering  for our immediate supervisor, who has been a way on a long leave, is over, and now it’s time to sit and ponder the best we can do to leave an impact at IDI. Or will they say that during the time that the head of the M&E team was not around the fellow did a great job? The latter has been said, but what more will be said? It’s time for critical thinking and searching for the bright spots to improve health equity.