Tuesday/Wednesday catch-up

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So, now that I got the excursion to Livingstone all told, time to dive into the events of the past week.

The work week for us started on Tuesday, since we didn't get back from Livingstone until very late Monday. My day's task seemed pretty simple: get the RUTF from Chipata clinic that we ordered last Wednesday. We were instructed by the district health management team (DHMT) that Chipata was to put in our order for us, and we would be picking up our supply from them. A couple weeks previously, we had ordered 20 boxes in anticipation of needing that many for the month. We got 10 at that time. I called in the morning, strongly emphasizing that we really did need 20 boxes this time. The woman at Chipata clinic said she would be going in the late morning to pick everything up.

I should have known better.

I have learned not to trust anybody to do anything for me here when they aren't working directly with me. While this may seem cynical and jaded to those of you who haven't been here, those of you who have will know exactly what I'm talking about. I called the woman at Chipata at about 10, which is late morning in my book, and she told me she was leaving "soon". I hadn't heard anything by a little before noon, so I called again, and she told me she was leaving "just now". I urged her to hurry, knowing from past experience that DHMT shuts down for lunch at 12:30 and doesn't reopen until 2. I called again at 1, already knowing what I would hear, and she said she had arrived at DHMT but that they were at lunch. Shocking. By this time, she was starting to get really annoyed at my incessant phone calls, so I figured that something might finally get done.

I called again at 2:30, and she said that the RUTF was ready to be picked up. This was a slightly different message than I'd been planning to hear, since in theory she was supposed to be bringing the RUTF back to her clinic for us to pick up, but I knew there was no way she was back there. I was informed that contrary to the arrangement, we would have to come to the source and get it ourselves. Great. "Where should we go to get it?", I asked. This was apparently a very challenging question. She was very able to tell me where she was, DHMT, which I already knew, but which I also knew wasn't where the RUTF is kept. At this time, I still wasn't entirely sure that we weren't going to get it at Chipata clinic. Eventually, after eating through about 10,000 Kwacha of talk time, when she realized I wouldn't give up by just having her confuse me, she finally admitted that she didn't actually know where to get the RUTF, a fact that I found incredible since she was supposedly picking it up for her own clinic as well. She promised to ask, and to call back.

Finally, at 3, I got my answer: I had to go to Chilenje clinic, on the opposite side of Lusaka, with a Bwafwano truck, and pick it up today. I felt like I'd almost hit the lottery: finally, after an entire day of harassment, I got a straight answer. Then reality sunk in: Bwafwano had one truck available, with a couple of errands to run before everything closes down at 4. This was going to be tight. I jumped in anyway.

The truck arrived at Chilenje clinic at 3:55, and I've never been happier to witness so many transgressions of traffic law in one ride. I hustled into the pharmacy there, and was relieved that the staff hadn't knocked off early for the day. "I need 25 boxes of RUTF," I said (I had spent my morning making a spreadsheet that would predict our RUF needs for every site and for our monthly orders, and determined that 20 would actually leave us a bit short). A look passed between the two staff members there that didn't hold a lot of promise. I decided to justify myself. "I'm from Bwafwano, and I was told by C----- from Chipata clinic that I had to come here to pick up our order."

They looked at each other again. "You were told to come here to get it?" one said.

"Exactly," I replied.

"We don't have 25 boxes of RUTF."

I began to recognize their glance to each other as one of confusion, since it now matched my own expression. "You don't?"

"Actually, we don't have any boxes right now. Sometimes if there's extra, they put some in our storage, but we don't have any now, and we never have as many as 25 boxes."

I wanted to call up C----- from Chipata clinic immediately and start giving her a brutally honest assessment of her capacity to perform simple tasks, her honesty, and an overall assessment of her character. I repressed the urge. "So .... what am I supposed to do then?" I asked instead.

The man behind the desk checked his watch. "Well, since it's now 4, you'll have to go to DHMT tomorrow, talk to Mr. K-----, and have him tell you where to go."

I wanted to scream. I knew Mr. K----- from Becca and my efforts to get the initial shipment of RUTF, and if we hadn't been specifically instructed to work through Chipata clinic, I would have done exactly what the man had just suggested to me. The difference is, though, that I would have done it a week ago, when we initially put in our order, rather than the morning of a double-clinic day when we were completely out of it.

So there I was on Wednesday morning, doing exactly what I would have been doing the PREVIOUS Wednesday, if not for baffling roadblocks put in place by DHMT, and the frustrating (in)action of the lady from Chipata clinic. Thankfully, Mr. K----- at DHMT is a very bright and reasonable person. He was one of the most helpful people in the office for getting the RUTF initially, he approved the disbursement of contraceptives to Bwafwano after one meeting with Rebecca and Amanda, and after hearing about the hassles I'd dealt with the day before, he agreed that the current arrangement was rather foolish. So, the one highlight of the whole fiasco is that I basically got approval to do exactly what I'd wanted to do in the first place, which is to get our RUTF directly from DHMT.

The rest of the day was fairly routine, I suppose. I went and picked up the RUTF from the storeroom at Valid. The clinic at Bwafwano ran late, because I had been doing all this other stuff before I could head there. By the time we got to Mungule, most of the patients had given up on us because we were so late. I felt bad, because the home-based care workers at Mungule tend to be pretty active and helpful, and we've been late there on several occasions in the last month, but they accepted my apology and my reason for being late. They agreed to deliver the RUTF to those people who had already left. My lunch there included fish, head and all, again. I didn't even wince at eating the head, this time.

Well, there's half of my week down. I'll tackle the rest of the week tomorrow, most likely.

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