Mozambique: Week 3

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Well, another week bites the dust. Actually, I suppose Wednesday was that mark, but since I’m American I mark weeks by weekends. It’s been an eventful week and lots of data collected. The hard part, of course, is always analyzing it. It’s fine recording a conversation, but then trying to transcribe and translate it is no fun. On Monday we went to Nhamaxaxa for the first time to speak with the activists. There is no health worker there, so there is not one central person. I find this odd since the grant they got for the community was to train people and buy supplies, which they did – people came to CoH for training and such, but none was allocated for in depth training for a CHW. This is unlike Mukambe feha, where there is a CHW (Benedito) and 20 activists, but they don’t have any other support in the way of fancy t-shirts or training at CoH. To be fair, one got money for HIV and the other Malaria, but the projects, activities, and money are all muddled anyway.

On Tuesday I had meetings scheduled with Isva and Paulo to get the initial drawings for “Maria Visita ao Hospital” and the translations of the books into Xitswa (sheets-waa) along with the transcript. Isva was sick, so we postponed that, but Paulo was great and had stuff when we met at UniSaF later in the day. We sat and talked over things and I let him know that I was looking for other people to join the group and help out. He suggested his English class and we took a look at my poster that I made the night before and printed out. (Complete with crappy Portuguese mistakes) I finished up with him and ran to the post office, where I had to argue with the people behind the counter (the same two guys as last week) because they wanted to charge me 135 meticais to send a letter to the US. It was 92 meticais last week for the same size and weight letter. I swear, anything to make a friggin buck. I wouldn’t’ be surprised if that letter never made it to its destination. :/

Shortly thereafter I met with Shaun Bisset, a former Peace Corps Volunteer who stayed in Mozambique and is now principal of a local prep school and the owner/founder of One World Academy, a private elementary school aimed at the average Mozambican instead of the elite or expat crowd. His school is great and has wonderful potential, and after being in education here in Mozambique for 10 years he knows what is needed and how to get it done. I’m posting his website on facebook when it is up and running (it’s under revision), but for now, you should definitely google his name of One World Academy Mozambique. (There is another Indian organization by that name that is not his) Anyway, over food at the local pastelaria he offered to let me speak to his English class, the same one that Paulo is in! It’s English II for teachers and I thought, “If they speak as well as Paulo this is excellent!”

Also, the power went out after I got home. It was kinda fantastic actually. The club/shack down the road that was blasting thumping music shut off and the full moon was out so it was great. I went for a night time walk on the beach in full moonlight and no light pollution from the houses or anything. (Though the moon was super bright and big). Also, everyone started singing to pass the time. When I passed the lot next to the hospital where the expectant mothers wait until it is time to have their babies, an older woman was singing something around a fire. The thumping club scene turned into a sing along. Generally, it was just nice to be forced to stop working and enjoy something for a bit.

On Wednesday, I was to meet with Shaun’s class at 9:40 and left CoH at like 8:20, thinking I would make a quick stop at the hospital to show my face to Mr. Jack, a contact that Dhairya had given me the day before regarding talking to nurses. This guy in the head of clinical services apparently, though when I went to ask for him everyone was very confused. I’m just going to tell myself that my pronunciation is so spot on that everyone can’t possibly believe I am saying the correct thing… yeah… I showed the guy I was talking to my notebook with the name (Jack Flor) and he was like “Oh yeah! Jackie Flore!” and pointed to a door not 10 feet away. Knock. No answer. Call. Total misunderstanding cause I can’t understand crap spoken over my phone. I’m trying to shout into my phone that Dhairya was there the day before and that I am there to speak to him about nurses, but no luck. Then someone indicated that they could help and took the phone from me. Thank gawd for Virgilio. That only solved the probem of finding Mr. Jack though… then I had to explain myself and my project (which I’m getting pretty good at since I’ve done it so many times in Portuguese now) and he called in someone else and said one sentence, basically that I was here from the US to talk about malaria with nurses. Meh, not exactly it, but it got me the in I needed. Mauricio (I couldn’t make out if he was the DON/manager, or charge nurse) introduced me to a few nurses and we said we would talk later. Fine.

Not much of the rest of that day. I walked back from Maxixe instead of taking a chapa and was drenched by the time I got home, but didn’t do anything else the rest of the day anyway. (Except work) I was all excited about working in a group on this project, not just because of the help, but because it gets more people involved with the whole process, which is the idea to begin with. I want to get the students out into the community and if possible, the community in to meet with the students. I am supposing that it will be very difficult to get anyone from Mukambe feha here for any training, but it would be nice. (As I’m writing this, I’m brainstorming ideas for a traveling trainer program where they would go up one night and spend a week traveling the area and training the people either centrally, or from house to house if the distance is long. Provide them a bike and a tent to travel to each location with, or have a central location and have people come up for the training. Hmmmm…)

Thursday was another day of meetings. Wednesday I got a text in the afternoon from Mauricio at Chicuque that said Thursday at 9 would be better, so I was up and ready to speak bright and early. I put my scrubs on (who knew I would be wearing Tulane green in Mozambique…) and walked toward the hospital. I stopped at the little yellow shipping container-turned-general-store-hut and met Rita, a very pleasant local who asked if I was Cuban (clearly not) and then when she figured out I was American she asked if I was from CoH. I said yes, and she asked if I was Cuomba (Dhairya). No, I replied – and then she named me Rungo, which is kind of hilarious since it is Miguel’s last name. We had a chuckle and I got bread, then I walked to the hospital. The bread was actually a test of sorts, since I had asked Maria and Pastor Marcia what the price was before I went. It is 2 meticais, but I wanted to see if she would up charge me since I am a mulungo. Nope, she was fair, so I wouldn’t mind going back in the future.

The nurses’ focus group was actually the easiest so far. It was a bit weird at first since I had to explain everything and why I wanted to talk about their experiences (and not how to treat malaria), but I’m pretty sure it was the most successful one. My scrubs and being a nurse probably gained me a good bit of access with them, then of course I admitted that I had never had a patient with malaria and didn’t know anyone who had ever had it (which is now a lie, since Elfie tested positive on Monday – oh yeah, that happened too…). There were two adult medicine nurses and two peds nurses and they all volunteered good information and fed off of each other, which I what the group format is supposed to be like. Unfortunately, the group aspect is kind of lost on people here. In fact, the conversational model is lost altogether and most “business” is conducted in very terse terms. They were laughing and joking by the end of it though, so that’s good. I want to talk with them again if possible.

I also got to meet with Isva to get the initial sketches for the Maria comic. They look great and I want to pass them by others to see what they think as well. I may want to make two versions, one with actual sketches, and the other with more symbolic language. We’ll see. That took a while since it’s Mozambique, and then I went shopping for groceries, to the bank, and then chapa home. That took all afternoon. Ugh. Mozambique time. Just worked til late that night and bucket bathed before hitting the sack.

Today – Friday – was another big day! So many big days all in one week, wow. I was up early to prep for Mukambe feha and “class”/project meeting tonight. I spent the morning explaining things to Manuel and Maria over breakfast, then packed stuff into the car when it arrived at 9. So funny – the driver wanted to wash all the windows before we took off even though there was basically a dust storm today all over. Also, Maria came with so I sat in the back on the way there, which turned out to be a great deal more comfortable than the seat. I was very surprised, especially going down the dirt road at 70 miles an hour and hitting ruts and such. No, I wasn’t amused at the speed or the dirt road if you must ask.

When we arrived the medical team was giving a presentation and the older, heavy set woman talking was very good. She has very good presentation skills, and I didn’t’ even know what she was talking about! (later, I found out is was about using condoms and getting tested and such) We got a small break and pulled the activists aside for more information and activities. I made it very clear to everyone on the CoH team that I needed 2 hours for all my activities. I was on time with everything, and still got pushed for time at the end – which I find amusing since nothing is ever on time here. -_- Anyhoo – what did we do? I gave and overview of what we talked about last time and how it related to the materials that I had created up to that point. I passed around the booklets so that people could see them and asked for feedback. I didn’t get much – they said they liked them both – but it was a start. After that I told the men that they had 30 minutes to do what they needed and then we would talk together as a group again. The women were a little more talkative (as a group) than the men, but apparently I offended someone through something lost in translation at one point and had to do a little backpedaling and explaining. Basically, she told a story about how she went to the hospital because she thought she had malaria, but it wasn’t. I wanted to know how she felt about that experience and if it made her not want to go back because she had wasted her time. (I didn’t say that exactly, but generally hinted at how she felt). She replied that the information was for me only and not for everyone to know (despite having said it in front of the group in Xitswa, but maybe she was referring to even just the fact that she went in the first place). I had to have Benedito explain that I wasn’t asking what was wrong with her, that it was not important. I wanted her to explain if she was angry or frustrated that she had gone a long way to the hospital for not the reason she thought she went. No, she wasn’t phased. (good to hear)

A few more questions, but by and large they just didn’t get the process very well. I don’t know if it is an access problem, or a format problem. I have been told that it is a format problem, that they are just not used to giving their opinion on anything and are only used to being handed something. I just find that so odd, but I guess that’s my upbringing talking.

The next exercise was actually kind of fun to watch – they broke into four groups and each took a booklet of pre printed posters in languages from all over. The point was that even I couldn’t read the languages and so I was stuck with only pictures to make the story, but that everything was about malaria and all said the same sorts of things, which was important. I wanted them to take sticky notes and put an S or an N for “sim” (yes) or não (no) for things they liked and things they did not like with an arrow label. They were to look at different posters and tell me what aspects of the posters they liked and which they did not. Again, I think something may have been lost in translation for some of the groups, but overall I think it was successful since it got people working together to look at the pictures and talk about them. That’s all I really wanted them to do – look at examples of other things that had already been done and see how they could be different. It also let them get a chance to do something more than just talk about problems. I was really trying to get them to feel like they were a part of the project, and I think by the end they had gotten into it a bit, at least the women had. (Which is good since they are typically overshadowed by the men)

Finally, I gave them each a pen and a single sheet of paper with clear instructions to do whatever they wanted with the paper. Ha. They could draw one symbol, tell me one story, draw one thing, tear it up and make something with it, fold it over and make a book, or just do whatever they wanted with it, as long as they came back in one month with one thing about malaria on it. Two of the older women declined the paper, which I was a little sad about since I was really trying to get them to participate, but that’s ok. After that, the CoH team doled out money for the month, which came with great enthusiasm, and then we left.

After many stops along the way to do all sorts of things, I finally made it to the padaria to grab bread before “class” at 5. I was hoping, but not expecting., there to be a decent turn out. I got 5 out of 15, which I’ll gladly take. We talked about the background of my project, what the purpose(s) is/are, and how I’m going about it. Then I showed them what I had already done and we talked about it for a bit. These guys are in English II for teachers and speak very good English, so having a conversation was pretty easy. I’m glad they showed up and hope that the project itself keeps them interested and that they want to partake in the process as a whole. Getting to this point – having a group of people to work with – was my entire first mission on getting here. I mean, yes, talking to people and making things, but getting the people connected is the next step. I think some of the students want to go to the communities and/or translate for me or do other things – which is good. I introduced them to SMART goals (Specific Measureable Attainable Realistic and Timely) and had them write out a smart goal for the first week that would move the project forward for next week. One will talk to his family who are all nurses and come back and report on what he found out, another will think about how to incorporate the idea of mosquitoes going traveling between villages into the Maria comic, another will continue to transcribe/translate the Men’s Mukambe feha focus group, one will brainstorm questions related to the process of going to the hospital, and another will start to develop a game for kids with his two children. I told them they don’t have to have anything solved, that the questions are where we want to start and that next week we will think about the overall problem of malaria in a wider context.

Things are looking up! Only, I should really think about “lesson” plans so I keep myself straight and on topic when we meet. These biweekly meetings will be helpful to keep me on task actually. Hopefully, if things go well, some can present the results with me at the end of the summer. That would be awesome actually. We’ll see, I have to get to next week first.

*Yawn* finishing this up – Saturday has been a bust pretty much. Didn’t do anything but write and sleep and eat carbs until 4:30 or 5:00 and then we decided to walk to the teacher’s school funded in part by Mozambique Development In Motion (MDIM) down the road. They are a group of Methodists from Texas who are investing in the area in various ways, including the CoH and the hospital. The campus is really, really nice actually. Very well maintained and everyone greets you in English. (Not that that is a requirement of any sort, but they are obviously eager and/or willing to put into practice what they are studying which is cool.) They also have a library that is open to the public and I’d like to check that out at some point. I know what to do with my books I’m reading when I leave now.

After that we ventured into Maxixe via chapa – only it went through Expanso instead of straight to Maxixe (the long, bumpy, very circuitous route through a rural neighborhood down a bad road). Explored a bit, and then went to Taurus, the grocery store, for supplies. The girl at the cheese counter started flirting with me and I made a quick escape… or so I thought… I was in one of the aisles looking at sweet chili sauce and she came up and stood by me looking at them and making small talk. Then she was like “oh, you have an empregada (woman who does housework and such)here in Maxixe?” Me: ”yes.” Her: “Do you have a girl here?” Me: “no” Her: “You should have a girl here” Me: “In the US” Her: “But not here, right? You should have a girl. Someone to laugh with, joke, show you Maxixe. Have you been to Tofu yet?” Me:”No, I’m only here to work. I am here for very little time. I live with other people” Her: “yes, but a nice girl, a simple girl, you should have one” Me: “We will see, I come here often” … It continued (with me beet red) until Dhairya showed up an was like “I thought you were outside, I was out there waiting…” and I saw my chance and RAN. I thought this was only supposed to happen to white women when they traveled.



Chapa home and more carbs in my face. I’m going to become a potato by the end of this. Off to write lesson plans and such.

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Photos

Nhamaxaxa Main Road
This road actually goes straight to Chicuque in the other direction. It is just a short chapa ride from the CoH to Nhamaxaxa

Nhamaxaxa group
Everyone talking at the beginning of the meting before we split into two groups.

Nhamaxaxa Focus Group 2
While I'm not officially doing focus groups since that would require research status and would have to be much more controlled and structured, I am talking to a lot of people.

Nhamaxaxa T Shirts
The Imagine No Malaria program through CoH got a grant to support training for the activists and t shirts so that the community can identify them. Pretty nifty. (but do they wear them at other times other than this??)

Josh talking in Nhamaxaxa
Today was brought to you by Penn's Master of Public Health program. ;)

Josh talking again
I'm saying something important, trust me.

Nhamaxaxa Roadside
The road. yay.

Mukambe Feha Health Fair
This is the health team giving a presentation on condom usage to the whole group. It was very windy and looked like it was going to rain heavily this day, so not as many people showed up.

Health Team
This lady is an awesome presenter - and I didn't even know what she was talking about until afterwards when Benedito explained it to me!

Josh Listening
I'm paying much attention to the presentation. I swear.

Women's Focus Group
I was able to snag Benedito to translate for me (into Xitswa) when I did the women's focus group. They speak Portuguese, but Xitswa is the mother tongue of the area.

Explaining the exercise
So, Benedito had to leave and then a local who spoke (some) English was going to help me translate into Xitswa....
The road to where is paved with good intentions???

Posters 1
They are really getting into it talking about the designs and I thought they were doing a great job.

Posters 2
There were four groups - two for the men and two for the women, and each had a group leader, but the others were supposed to talk too.

Posters 3
Again, really getting into it discussing the images and such, but in Xitswa...

Posters
I'm explaining that even I can't understand what the poster says because it is in Arabic, but that it doesn't matter because we are only looking at the pictures today and discussing what we like best.
Then they started asking a question about one of the pictures and they had "n" (não, for no - we don't like this picture) by all the mosquitoes...
I only realized after the fact that the instructions had gotten lost in translation and they all thought it was a kind of test where they had to find the right answers. :(((((

Mukambe Feha Team
Most everyone from Mukambe Feha - though some had left already

Paulo
This is Paulo, who is a great guy from the local university here in Maxixe. He speaks 6 languages and is a sophomore, but he took part in the innovation conference we put on at UniSaF last week. He speaks great English and is helping with translation stuff.