The Difference Between What Works and What Doesn’t

25 07 2011

By Joy Liu

Somehow our weeks here in Muhuru Bay are always more filled than I expect. In the past week, our childhood vaccination study has progressed from surveying to data entry and analysis. In addition, we held a focus group for community health workers, visited nearby dispensaries and clinics, and participated in a mobile clinic outreach program. In the process, my understanding of the healthcare system here and the numerous factors that make it functional has deepened. The reoccurring theme that my thoughts constantly returned to this week was the difference between what works and what doesn’t.

Since starting the project, our group has been so focused on finding the gaps and shortcomings that I was surprised to find fully functional dispensaries in our visit to nearby health centers. Some mothers we surveyed mentioned three dispensaries nearby that they visited for vaccinations. In an attempt to get a better sense of what services the mothers received, I paid a visit to the dispensaries. The differences were drastic. The first, a newly opened clinic, lacked patients and personnel. The doctor arrived at the clinic two hours later than his scheduled time, presumably because he had been notified that the clinic had foreign visitors. The second was also a dispensary, but it was the polar opposite of the first. There were at least twenty or thirty patients when we arrived. The head nurse gave us a tour of the facility. Every door that he opened had a staff worker or patients inside. I felt like an intruder, which in retrospect reveals so much about the facility. I’ve never even had the opportunity of feeling like an intruder at any other clinic here because there are never enough patients and staff to fill up all the rooms. The dispensary said they rarely had a shortage of drugs, and the pharmacy did indeed look well-stocked. Although they lacked electricity, they bought a gas-powered refrigeration system to store vaccines. Despite taking everything that’s said with a grain of salt now, I left wondering how different the services can be when the two dispensaries (plus the one we are working with, Tagache) are a mere 15 or 20 minutes away from each other. What makes one successful and another a failure?

This theme came up again and again throughout the week. In our focus group for community health workers, it was apparent that some programs (like indoor residual spraying) I saw each day while others languished. Some outreach attempts reach their target audience (Katy Falleta and I had fun deworming children) while others never get off the ground at all (we only went on the mobile clinic on our third attempt). While I realize that there is a host of complex factors, my curiosity prompted me to seek some answers or ideas. I have been having informal conversations with some of the staff at WISER-people who are knowledgeable about the community but also know me well enough to tell me what’s on their mind. The responses have been jogging my mind, considering everything from income level and the ability to go to private clinics to the strictness of the community especially from local chiefs and elders.

Ultimately, the goal is to erase the difference in between, to turn what does not work into something that is fully functional. The differences are present, whether in policy or management or community attitude or economic status. They are differences I welcome. I love that there is a standard to measure against not 20 minutes away. I love that I personally witnessed the contrast. In looking for the shortcomings and what is lacking, it’s sometimes easy to forget what has already been achieved. This week provided me an opportunity both to appreciate what has worked and to question what hasn’t.

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