Today I went into the field. I visited a health center in Karonga and spoke with local health workers there about the rapidsms malnutrition survellance system. It was incredible and really made me connect with the work I was doing. This was necessary because I was becoming bogged down in beaurocratic hastles and was losing hope. But, thanks to the field visit I have renewed vigor.
The health center was fantastic. While I was there, about 10 women came in for vaccinations and blood pressure readings. Twomothers brought in their children, and there was one sick girl hanging out who looked like she had a very very very bad cold and drippy eye. I think she probably could have used some chicken soup from Katz's deli - and maybe vitamin A. Vitamin A is very big here. All the health workers I have spoken with have expressed distress at the lack of vitamin A (why vitamin a I asked - eyesight?) - yes but really vitamin A is good for the immune system. One of the best things I have had in Malawi are the carrots. I dont like carrots, but I love Malawi carrots - they are incredibly sweet. So I asked Edwin, my escort and the local instructor at the university - why Edwin dont people eat more carrots? Ahh, Edwin said, people dont like vegetables. Well what do people like (I asked) - Meat! Well there you have it.
The surprising fact about Malawi is that it is a fertile area. There are fruits and vegetables being sold everywhere on the roads. I have yet to come across someone who has looked under fed. So I think the issue has more to do with educating people on what a balance diet consists of, and with making sure that everyone in a family is fed a balanced diet. I can also see the case where some girls in a large family, are perhaps thought of last, after the boys, interms of nutrition and health.
In addressing health education, I have a tech idea - but first I need my wolfram alpha API!
Back to the health center. It was on a campus with a girls school, a hospital and a church, and was very peaceful. The landscape of the north of Malawi is a bit different from the south. No Baobab trees, lots of tall grasses and the occasional lone large mountain rising up out of the landscape. I did not take pictures. People are not into pictures here (except children). At the Health center we met with about 5 health workers - they seemed young - maybe in their 20s. Some were very happy to talk to me and some I think were a bit skeptical and hostile. My main concern was in the usability of the system. I was planning a few changes such as linking a health worker's id with a report and expanding the id numbers for children.
The health workers like the idea of adding a health worker id. They thought that would encourage better measurement taking - because you could identify the health worker. People were not so keen on changing the id system, so I am going to go back to the system and create unique keys made up of health worker ids + clinic ids , as well as children ids + clinic ids.
I think this may be specific to malawi so I will not push this to the child health app that I am working on.
There were also issues with stunting and wasting cut offs. Right now we are using WHO stunting and wasting cut offs - as expressed by weight for height - but apparently Malawi has other metrics. So, children will go to the hospital for wasting/stunting because of rapidsms diagnosis, but then are sent away because their measuments are fine for Malawi. We need to rationalize these systems.
Another issue I found was with parent participation. The survellance system takes 70 children, randomly, and takes their measurements every month. I dont think I will blog about the randomization process used but I was sad to hear it did not involve geomancy ala Eglash. One of the problems with the survellance system is that parents have no incentive to bring their children into the clinic for this trial. I can understand that - when I was at university we always paid people to participate in trials. One woman, a health worker, suggested that we educate the parents about the rapidsms system. I think that is a great idea. Another woman, a health worker, suggested that we turn it into a game, the child with the best attendance wins a prize (a candy or extra sms credits).
I really liked this game idea. I was trying to think of a way to make the rapidsms interaction more fun and less burdensome - ie to turn it into a game. But I really had no ideas. This game idea is great. I am thinking that we can also expand it to HSAs, you know the health worker with the most texts but the least errors - gets extra sms credits.
The health workers were very interested to see how they fit in with the rest of the country, and I think this is very important to develop a larger sense of mission and connect with other people doing similar work around malawi (and perhaps bitch about crazy americans and their rapidsms system - I dont know)
The other complaint was that the toll free phone numbers did not work. I am going to put Stanley on this case. When I got here, I knew Zain had a problem with their toll free number. (There are 2 cell providers in Malawi Zain and TMN) Stanley said he would take care of Zain, perhaps when he returns from vacation we can go to Zain together.
On the way back we stopped at a massive open air market selling all types of food, clothing, etc. Me, Edwin and the driver stopped to take a look around and Edwin bought me some roasted corn. He said he once tried american corn and it tasted bad. I said he should read the omnivores dilema. Well I ate the corn - it was delicious -it sort of tasted like popcorn. It has been a few hours and I dont feel sick, so I think I'll be okay!
We also stopped to visit Edwin's sister who just moved near Karunga. She works for AdMark - we met her friend who is the granddaughter (but not real granddaughter) of the other UNICEF driver Lindsay! crazy
Finally, we also stopped to get some tangerines - 12 for 150k ($1!) yumm. Edwin said, you see, fruits are much cheaper here. Yes, I said. Perhaps we have malnutrition in the US. My husband is vitamin D deficient because he does not get outside enough.
We had fantastic discussions about developing systems for sending farmers text messages for the price of commodities at the local market, and for developing intelligent measurement devices - I would like to investigate this more back in the US.
I am not going to engage the internet vs sms debate. SMS is in Africa NOW so lets develop for it, we can always adapt systems and front ends for technology that comes in the future. Why develop something for future infrastructure that no one can use. Its like the market - it doesn't matter if your right - it matters if you match the market.
I am learning a lot about how I want to manage future projects - and people I want to work with. I am feeling better about the project. I'll feel EVEN better when some of the stakeholders start responding to my emails.
Time for dinner - I am going to live it up and get some food at Don Brioni.