Office Space

Since coming back from Safari, I’ve been hard at work trying to wade through the mess that is healthcare data in Malawi. There are so many gaps and inconsistencies with healthcare indicator reporting it can be frustrating if one were to arrive with inaccurate expectations. Luckily, I was told before I came that it would be a shit show. Based on that and the chuckles I received when people knowledgeable of the project stateside heard what I was going to attempt, I set the bar nice and low. No, better yet, I arrived with no expectations. It’s slow going: getting a simple list of CEmONC (Comprehensive Emergency Obstetric and Newborn Care) facilities is not at all straightforward. Many things require speaking to someone in person, which slows things down quite a bit – not having immediate access to information electronically.

This is not the first time I’ve been thrown into the middle of a foreign project and been asked to do something nobody in their right mind would attempt. Of course, many would say I’m not in my right mind. So when the project was laid out before me, I immediately tried to grasp the big picture: the players involved, what positions and authority they hold, and how they are all connected. After many questions and piecing together the connections between my organization, MaiKhanda, and the Ministry of Health, Reproductive Health Unit, and Health Management Information Systems, to name a few, I found a potential shortcut. I figured traveling to many different facilities all over the country trying to dig up years old log books and sort through poorly recorded handwritten entries would be, well, more for seeing the country rather than obtaining any complete data. I learned that the government does track many health indicators throughout the country, including those we are interested in. So it was a matter of schmoozing the right person, right? I sent out some emails and received some polite replies or none at all, which was great but no guarantees or deadlines. I didn’t have time to wait and hope for something to pop up. So I asked for a ride to one of the government offices to start tracking, kind of like tracking a cheetah or a tiger, only an excel file instead. I bounced around and finally found someone who knew something about what I was looking for. I bugged the crap out of him until he broke down and gave me names and cell phone numbers, realizing he was better off just getting rid of me. I’m exaggerating of course, or am I? Really though, I could see the official didn’t want to deal with me and would do anything to be rid of me so I made it clear I wasn’t leaving without what I needed. A little nuisance can go a long way.

Before I knew it, I was off to capital hill. We drove up a large hill, which had impressively large government buildings and wound our way to an older building, which housed the Ministry of Health. I started searching for the contact I was given and spoke to a couple people before finding someone with some authority and knowledge of what I was looking for. We went back and forth several times and after some clarifications I saw a light bulb go off in his head. He took me to a couple offices and before I knew it, I was sitting in the waiting room of the director for Health Management Information Systems in Malawi. It was intimidating, the formality of it all, having to be very careful of my etiquette, and being sure to respect local culture. I was let into the director’s office and took a seat. He had heard of my inquisitions and was aware that I had received polite email responses and let me know it. He didn’t seem too pleased with my eagerness and I was starting to sweat, sensing I may be leaving with nothing having rubbed him the wrong way. In the Malawian culture everyone is extraordinarily polite and so emails and phone calls will be returned, however, in their politeness, many promises are made without much thought to their content. My mind was reeling at this point wondering how I was going to turn this around. He was clearly skeptical – here I was, an obvious foreigner, stranger, someone nobody knew and now waltzing in breaking proper customs and making my way straight into the director’s office without so much as an appointment! I can’t say I was surprised by his reaction. In a last ditch effort to turn the conversation around, I did what I do best, I name-dropped. I have to say this was one of the starkest examples of what making a connection to someone, no matter how small, can do. I mentioned the name of the research fellow I am staying with. It was a moment to remember as I watched the flicker in his eyes at the recognition of the name and I could feel the tension in the room lift. All of a sudden he was smiling and in a matter of minutes, joking with me. He knew my host well and they had corresponded on many occasions in reference to healthcare work in Malawi. At that point he was happy to see to it I was provided whatever I needed and I was sent over to the statisticians office where I was provided with several humongous excel files, which have been the subject of my fancy recently. That was my adventure to capital hill last week and now it seems that I may be on the fast track to finishing up the project. I may still make a few visits to hospitals randomly selected around the country just for purposes of auditing/quality checking, but I should be saved a fair amount of legwork.

Last week was also a stressful one in the office, not for me but for the permanent staff, because the program donor was in town from the UK as well as several colleagues from IHI in Cambridge, North Carolina, and South Africa. I was able to meet the director of the entire IHI international program, which was a great opportunity and someone I’m sure I will be working more with in the future. It happened to also be one of the driver’s birthdays so a group of us took him out to dinner. He was one of those guys you start talking to and then easily goes on for hours. He was barely in his forties and had quite a story. He was currently making one of the most amazing recoveries from a severe spinal cord injury I’d ever heard of. He was on duty driving back from a site visit about a month ago when he was struck by a drunk driver. He was left completely paralyzed from the neck down; the site of injury was C3/C4 for the medical nerds (you know I had to ask!). At dinner I watched him very slowly stand up and inch his way, without any assistance, from the car, to and from the bathroom, and back to the car. He still has a long road ahead of him but he is regaining much of his mobility and hopes to return to work soon. I went on to discover he had fought in the Rhodesian war and when one of the group quipped, “Well, at least you haven’t stepped on a landmine”, he answered, “No, I’ve done that too”. Unbelievable.