What I Do - Special Edition for Consulting Peeps

Now in my very first blog post I had mentioned what I was meant to do during my volunteer stint in Kenya. I just wanted to give an update on what I have done during these past 3-4 months. My consulting peeps might find this post a bit more interesting just because I jazzed it up with some consultant terms (sorry, I couldn't find a way to add "ping" in here). Just to recap, I am working with Voluntary Services Overseas (VSO) which has a business partnership with my company, Accenture. VSO placed me in Embu, Kenya where I work with AIDS, Population and Health Integrated Assistance Program (APHIA II) Eastern (A2E) which is a 5 year project funded by the US Agency for International Development (USAID). The project is managed by JHPIEGO, an affiliate of John Hopkins University and implemented by a consortium of 6 strategic partners that work closely with the Ministry of Health (MOH).Whew....ok. So I am based in APHIA's office in Embu (the very unsuspecting and small headquarters of the Eastern Province) where I work with the Monitoring and Evaluation (M&E) team. Essentially we collect health data (e.g. HIV/AIDs, TB, ARV, mortality rates, etc.) from the health facilities, dispensaries and district hospitals, etc. on a monthly basis, aggregate and analyze it, and send it to the national level for policy making and such. We also ensure the APHIA programs (HIV counseling and testing, outreaches to orphans, etc.) implemented in the communities are achieving its goals based on the data analysis. One of my tasks was to analyze how these health facilities were reporting their data to A2E ("as-is" data process flow) since reporting rates are rather low for some locations. From that, we identified key issues as to why reporting rates were so low (e.g. personnel not trained sufficiently, no computers available, extremely long distances or harsh terrains to traverse to send data, etc.) to make a "to-be" data process flow. Needless to say, it has been very interesting since the issues I see here are not even issues we consider in the U.S. For example, one of the biggest issues with receiving timely data submissions is because health facilities may be at least 3 hours from the nearest town and there is no transportation (or roads at that).You may recall from one of my previous blog posts where we visit Chalbi desert. The facility we visited there has no transportation to the nearest town and there are no official roads to that town AND there is no internet access and spotty cell phone connection. Thus, receiving data is no easy task from an area like this. Moreover, data records are not electronic; everything is still pen and paper! So you can imagine the risks of human errors, loss of data, etc. associated with the integrity of the data. Many health workers entrust their data to friends passing by their town to submit to their data since they don't know when they next vehicle will pass by the town (I've included a pic of the main means of transportation in Northern Kenya). So the more technical solutions I'm used to with consulting are a bit "out the window" but my knowledge of impact/needs assessments, stakeholder management, and training development have definitely been useful! Another issue that has been brought to my attention is with resource management/staff development at these facilities. There is a significant training need (not to mention staffing need) but you can imagine the obstacles with training staff when they're in remote locations and online training is not an option. Moreover, because some of these places are rather remote, staff can easily lose motivation when they lack the resources and management supervision they need. Thus, I could quickly see how one issue can lead to many other issues making them all interelated. So a great deal of my efforts have been in data gathering, observation, analysis, and proposing an action plan. At the same time, it can be rather overwhelming when you see so many issues that need to be tackled; but strategy comes into play here when you can see how targeting and addressing one issue can consequentially resolve other issues. I sometimes compare it to gears where when you set one in motion will ultimately cause the others to begin functioning.

In addition, my Excel and PowerPoint knowledge (thanks PPT Master, Nick) have been put to good use as of I've created many presentations for management and an Excel reporting tool to capture data submission by health facility and region and easily highlight those facilities/areas that are under-reporting (yay for conditional formatting!) and track trends over the quarters and the year. I've also been able to help capacity-build the M&E team by imparting some Excel and PPT skills to them.

Being fabulous on the coast!

Its official. I am now having the best time I've had in Kenya. My dear friend Haley and her friend Jeanie are (as we speak) visiting me in Kenya. We just left Lamu island which is now in my "top 5" fav places to go. there are no cars on the island and only donkeys. Once you get off the plane you literally take a boat (luggage and all) to get to the island. Its kind of a celebrity hide out too. Princess Caroline of Monoco and Mick Jagger apparently have some houses there. We spent 5 fabulous nights at this quasi remote island and got to catch some of the cultural festival. From this trip:

1. I am now extremely "mocha" (bordering espresso color). Christmas gift to myself = wicked tan for the holidays.
2. I realized I can eat fish everyday.
3. I can dodge donkey poo at night.
4. I am very ok with waking up and going directly to the pool every morning.

Anyways, we are now in Malindi and head to Mombasa tomorrow. Pics are soon to come! Sadly this trip ends for me since i return to Embu Sunday. FYI I will be back in the US on the 20th. Can't wait to see you all soon!

Hot off the press!

News Flash!!! ~Elisa is coming back to America in late December! ~ The plan is to spend Christmas with my sis in NYC, swing by OK to get my stuff, and make it to Houston before New Years! Now, you may be wondering..."WHY?! Huh?!" And it may take too long to blog about it now but to appease those curious minds, I'll just say for now its for numerous reasons both personal and professional alike. Not only is it a good stopping point for me here, but also I am rather ready to be go home. I will email my 2nd, and well, final (lol) newsletter soon. I haven't written/blogged as much since I've been busy finishing things up here and going to Nairobi almost every weekend to visit my other vol friends. (See pic for some of the fun I've had with other vols in Nairobi). When I visit Nai, I stay with 2 other girls there in an area called South B. But we fondly call it South Beach Sorority. :) It is literally my 2nd home now since I have a cot there too. :) I cook lovely things for them on the weekend in return for their company and shacking me up. I realized how MUCH I miss cooking. So I must say the last few weeks have been great! Plus, my dearest friend Haley will be visiting me in T-minus 3 days and we're going to Lamu (islands in Kenya) together for a week! There will be a cultural festival during the weekend. Woot woot! To be honest, I can't even wrap my head around the fact that its almost Christmas here. The weather is so warm I just keep thinking I'm in some sort of eternal summer "twilight zone." Its nice because its not unbearablly hot but at the same time, I wouldn't mind some "Christmas-y" weather. Plus, I will have a wicked tan for Christmas I guess. Anyhoo, just wanted to let ya'll know that I'll be seeing ya'll soon! :) Yippee! Will update you more soon!

Kenyanized

Today I have been given an official Kenyan name - Kwageria. It is from the Meru tribe and it means "one who brings others happiness." Mission accomplished. I can now go home. :)

It's one big Obama Partay!

Note that in Kenya I usually introduce myself as such: "Hi! My name is Elisa and yes, I will vote for Obama. " Seriously, I can almost guarantee you that after asking my name, Kenyans will ask me something about Obama. I also tag on "And yes, I too am his cousin" since most people here also claim to be his cousin. :) His grandmother lives in Kogelo in western Kenya and her house has been on high security because of all the publicity! It is an Obama madhouse here with Obama shirts, songs, etc. Poeple have been partying since the previous night already celebrating his impending victory! I would compare the whole election coverage here to the World Cup times 100. Given that he is part Kenyan, the news can be quite biased when they have stories on the presidential election. The Obama "phenomena" is so big that some students said they'd refuse to go to school if Obama wasn't elected president!
Just some FYI about the Kenyan roots of Obama per a NY Times column online: "As for Africa, Mr. Obama’s Kenyan father was of the Luo tribe, a minority that has long suffered brutal discrimination in both Kenya and in Uganda (where it is known as the Acholi). The bitter joke in East Africa is that a Luo has more of a chance of becoming president in the United States than in Kenya." -By NICHOLAS D. KRISTOF

Funny story - My colleagues have proposed that we take a trip to Kisumu to set me up with some Luo man so I can conceive the next American president and they can continue the Kenyan legacy. Hmmmm....tempting but I'll pass.

So get this.... tomorrow is a public holiday in Kenya per President Kibaki due to Obama's win! Wow! Being an American in another country has really opened my eyes on how influential American politics truly is. However, I hope some Kenyans aren't disappointed if there is no significant change in Kenya with Obama as president since some people have really high hopes. However, only time will tell. And with that I will leave you with two very interesting articles on:

The worldwide perception with having a Black president - Rebranding the U.S. With Obama
The tricky voting system of the US - How Much Is Your Vote Worth?
How Kenyans are naming their kids Obama and Michelle - Name Craze

I got tested!

Sorry if this post is a bit TMI (too much info) or too personal for some peeps. I just thought it was a neat experience, some good info to share and something to encourage others to do.

I got HIV tested today and (yay!) I'm negative. I got tested even though I practice abstinence just because:

1. The guy doing the testing looked really, really bored since no one was there
2. I was curious to see how HIV testing and counseling is done
3. I was curious to learn more about HIV and AIDS
   

So this traveling clinic set up a tent (no, really an actual camping tent) on the 2nd floor balcony for these tests. Initially I thought people just wanted to camp there (I'm now used to having anything happen!). I think I cut out a lot of the material to be discussed since I plan on abstaining until marriage so we didn't really get into the whole "previous experience" topics. But I did learn that:

1. If 2 parents are positive, it doesn't necessarily mean the child will be positive too. Children can only get it upon birth or if the mother passes it through breast feeding the baby.
   
2. HIV positive couples are still encouraged to use condoms to prevent re-infection since they can have different strands.
3. Sexually active people are encouraged to get tested again after 3 months from their last intercourse.
   

So the experience went like this: I first signed a consent form to be tested. Then, he pricked my finger to get a blood sample. He actually had to squeeze what I felt was quite a bit of blood from my finger (that, and I'm also a baby with needles). While waiting for the results, we talked about ways of prevention. I also learned how to use a male and female condom. Now that was interesting! (And yes, we got to use the little private part wooden models). Just from my work though, I have seen that in Kenya, males are far less inclined to get tested (about half the number of women who get tested). Many reasons contribute to this: fear of knowing the results, women have "more of an opportunity" since they can be tested while attending antenatal care when pregnant or go during the day since they're usually home-bound taking care of the family, cultural/tribal attitudes towards it, etc. Plus, more women also attend HIV/AIDs related outreaches and other health education seminars. Unfortunately, there are still some very bad cases of stigma in the remote areas we visited in Eastern North Kenya. People still talk to HIV/AIDS patients through handkerchiefs since they're afraid of contracting it through the air. People are also outcasted in some areas if they are known to have HIV/AIDS. Misconceptions are also common. Some refuse ARV treatment since patients hear that the treatment can kill you; whereas in fact, the deaths are often because the patients can't afford good food (if any food at all) to sustain them through the physically taxing treatment phase. Or because of poor nutrition, they die due to other illnesses in their weakened state. So many of these issues we hear on TV or in the papers in the States take on a different light when you see it for yourself in person. No longer is it a distant problem that can be easily forgotten by a mere click of the remote or flip of the page but rather someone you're staring at right in front of you. And although beforehand I'd think the (easy) answer would be to say "Well, go educate those people on the truth about HIV/AIDS" but now I clearly see that its not so easy especially when you have to travel endless hours to some places in the desert and the harshest terrains, there are no roads to these places, you're trying to create behavioral change in people ingrained with hundreds of years of a certain belief and culture, language barriers, lack of food and water to sustain them through treatment, etc., etc., etc. So the problem becomes rather complicated. Historically speaking though, Kenya has done a really good job in reducing the HIV/AIDS rate since the early 90's when about 13%-14% of the population was infected. By early 2000, the rate had dropped almost in half to around 7% since the government initiated a national plan to address the rising issue. However, since the post-election violence, the rate has started climbed again so the need for HIV/AIDS prevention is more important than ever to reduce the rate before it regresses back to its initial state. But basically the whole purpose of this post is to encourage others to get tested and to hopefully open our eyes to this very real and serious issue not just in Kenya but in the world.

My 2nd Home in Embu!

As of October 1st, I have found a 2nd home in Embu, the Child Welfare Society. I have spent every free moment there where I have been peed on, thrown up on, bit, hugged, slobbered on, but ultimately loved by the most precious children you've ever met! This Child Welfare Society is a Catholic orphanage run by Italian nuns. A vol recommended that I visit it just to see if I can volunteer there occasionally, and so far its been the best recommendation yet. I spend my time with the toddlers (4 years-old and younger) feeding them and playing with them during and after lunch. I occasionally help out in the kitchen. Its a wonderfully run orphanage since they also have a salon and dress making school for the older children to train in a skill. The children are so happy there and its the most amazing family I've seen yet. The older kids care for the younger ones and the sisters and other workers there are just absolute outpourings of love, joy, and patience for these kids. It is a beautiful example of communal living. These kids and the staff are each other's sisters, brothers, mothers, friend...everything! And you can see the kids really love each other and are truly happy! The first day I went, I got to be with the older kids (around 7 year olds) for lunch and watched the kids serve each other and pray before they eat. I almost cried as I was watched them and served them food. I surely hope Heaven will be full of this- each of us serving one another with the most sincere and genuine love!
I have taken almost 500 pictures since I've been there and am making a small "movie" with the pics I've taken (will post when done). I've gotten to really know each of the toddlers I work with and they each have VERY distinct personalities (which you will see in the movie I'm working on). I am particularly smitten by one boy, Francis, who is by far the BIGGEST "Mama's boy" I've ever met. He clings to me (and almost any familiar female adult). He wraps his tiny arms around my legs, and for the rest of day I walk with a new appendage on my leg. If you are upset with him for any reason, he bursts in to tears terrified that he's disappointed you. But his eyes are the most innocent, "puppy dog" eyes you will ever see. I have seriously considered adopting him (but maybe I should get married first before adopting :)). I have included a movie clip of these kiddos as they pray before the meal. Warning: this could make you a little teary-eyed. I have taken more photos and videos that are posted here.

Elisa, Boys Scouts, Wrestling, and Kenya

So get this.... one of my routines in the week now is watching WWE Smack Down with my twenty-something year-old Boy Scout friends who work at the guest house I'm staying at. Seriously though, I just got done watching Kane, Cena, Kofi and Batista have a throw down while finishing my meal and chatting with Willis and Peter who are Scouts and absolutely in LOVE with WWE. Sadly, I had to break the news to Willis that WWE is not real (like Santa isn't real). He was in denial at first but finally realized that maybe the long-haired, speedo-wearing muscle men really didn't act like that in real life. I was pinching myself thinking "OMG am I really in Kenya right now watching WWE with 25-year old Kenyan Boy Scouts....someone please wake me up!" Not that its a bad thing. I actually really like it. In fact, I take comfort in it since ....ok..fine.. I used to watch WWF with my dad when I was younger and I LOVED it too. I can bond with the guys as we wince or yell "Ohhhh," "Ouch!" or "BAM!" at the stunts (and terrible acting). Ha! And you thought I'd be in some hut eating dirt....

My Close Encounter with Turning African

Funny story:
While strolling in Embu with my friend Anne, I walked past some kids on the street. As usual my "whiteness" attracts attention, especially from little curious children. Of course there was hollering of "How aarreee youuuuu?" followed by pointing, staring, and chattering in Kiswahili. Anne quickly translated to me that they said "Look at the mzungu (foreigner)! Look! Look! Wait! Don't look at her too long! She may turn African like us!"
Whew....that was close....after a few more seconds...who knows??!

Thank YOU! Yes, you!

I am overwhelmed by the encouraging responses from my first email update! Seriously, it brought tears to my eyes. Everyone who emailed me back encouraged and lifted my spirits. Thank you (Asante in Kiswahili)!!!!! You make my days so much better and keep this little tug boat keep on tuggin'!

Super Somali September Birthday weekend

In case you wanted to know what I did on my birthday, I went with my friend Nimo to visit her friend Hafsa in Nairobi. They are both Somali so I got a taste of Somali culture and what they do for Ramadan. Click here for the pics: Birthday weekend

Idioms, phrases and slang, oh my!

Though I'm not completely fluent in Kiswahili yet, I've managed to catch at least the Kenyan English lingos and other idiom:

1. Water the Nation - an euphemism....er...for... releasing...umm... ok its basically just peeing outside since you can't find a toilet anywhere when you're traveling to these remotes places. We "watered the nation" many times during our trip to Northeaster Kenya. I suspect they should be drought-free for a while at least.
2. Water the Desert - See above; this happened once we got into Chalbi desert.
3. Looking smart - to look good, stylish, dapper, etc.; I didn't know if I should've been offended when I was told I looked smart because I assumed I looked dumb the other days but I finally got it.
   
4. Take - By this I mean I use "take" instead of "have"; I now "take" lunch and I don't "have" lunch
5. Kenyan Water - Tusker Beer
   
6. Chips - Fries
7. Roasted potatoes - Bigger fries
8. Good day - Have a good day
9. Now - Later
10. 1:30 PM - Tomorrow
11. Top-up - To refill credit on your phone
    

So I forgot to mention

...One thing I forgot to mention about our trip in Moyale…so while in Moyale, Ethiopia (during the 2 week project trip), our driver notices this same boy at a local restaurant all the time when he makes his trips to Moyale. He finally asks the local people the story behind him and finds out his dad died in the tribal battle and his mother died of an illness. The boy, Getu, of about 10 years had been living on the streets for who knows how long. And like that, our driver, Kenyua, decides to “adopt” Getu and take him back to live with him. None of us knew he had done so and thought the boy was just accompanying a man hitching a ride with us (it’s pretty common to here to give people lifts since transport is hard to come by). Finally, Kenyua tells us he decided the kid needed a better chance at life than what was offered and knew he had the capacity to help (along with the assistance of the NGO he worked for). And like that, he took on the responsibility of another life. I was floored…like mouth-gaping, wide-eyed, “are-you-serious” floored. I know I sometimes feel good about spending time with the local kids or teaching them some basic math or English skills but I was completely and utterly humbled at this act of kindness. I don’t know if I would have had the guts to do that. I was completely excited, though, that this had happened and wanted to get involved. So when everyone went to dinner that night, I spent some time with Getu trying to talk to him (he speaks Ethiopian, barely any Swahili, and some very broken English). Needless to say, it was an interesting endeavor, but I did come to find out this boy is really, really clever. First of all, I offered him some chocolate wafers and asked simple questions like his name, age, etc. When the whole verbal communication thing wasn’t working so hot, I turned to writing and drawing pictures (and yes, using my very animated face and gestures). We wrote our names, drew pictures (well, he just copied what I drew) and tired some simple math and English. Considering he hadn’t had consistent education, his basic education skills were fairly decent. We then proceeded to watch WWE on tv (don’t ask me why they show wrestling here) but the reception was bad. Being the little engineer that he was, he got up on a chair to re-connect the wire, re-position the antennas, and to clean the tv to better the reception. Once he found out the remote wasn’t working, he decided to rotate the batteries in the remote. I was surprised at his ambition and knowledge. More so, I was encouraged at what seemed like a precocious mind. I then showed him my digital camera and he went nuts. He wanted to take pictures of everything and everyone. So we had a photo shoot outside (note the Marsabit pics in the links below). I told Kenyua later that day I would love to mentor Getu on the weekends if it was possible. Unfortunately, I have been traveling during the weekends these past weeks and haven’t see Getu yet but hope to do so soon. Anyways, I thought that was an amazing story and just wanted to share. I definitely know I be less skeptical of random acts of kindness. Who would have ever thought that our driver would just up and adopt a kid without even thinking twice? I am humbled and hope I have a heart to do something similar.

Home sick.....home ill.....home everything!

So I'm gonna be honest, these past weeks have been tough! This is rather atypical of me since I usually love traveling, meeting new people, exploring, etc etc. This time around, its a bit different. Maybe its because of my small town, my all-in-one bathroom/toilet/shower, abandonment of my vegetarian ways, lack of football/basketball. Well, really its just the isolation and loneliness. I am staying at a guest house (actually its a Boy Scouts Guest House created by Dutch scouts...don't ask me how/why...I just live there). The monotony of life is setting in: wake up, breakfast, walk to work at 7, walk back at 5:15, jump rope and do push-ups, eat dinner, play scrabble, watch tv, repeat. I've sought advice from other vols and it seems the 1st month is always really tough and critical to get through. Basically you just have to go day by day and things usually end up getting better. I hope this is true! I am fortunate enough though to have met a girl staying here at Scouts who is on rotation at the hospital. We at least can have dinner together and play scrabble. Also, my colleague at work, Cate, has been a great person I can confide and share my feelings with. I've really learned to take joy in the small things of life. It may be just taking a walk, a smile, saying hi to a person, etc. It also makes me realize how my life in the US was so full of distractions. It was so easy not to face challenges or do things you didn't want to because there were alternatives (like my sports, numerous restaurants, a car to drive places, cultural events in Houston, etc.). Since I don't have those things here, its kind of a rude awakening. It has been a long time since I've actually just been alone....really alone...and just really see yourself. Its both interesting and difficult to see who I am ...alone...out of context...out of my comfort zone. I hope this slump turns for the better as time goes on. At least that's what most people say.

Over the hills, and through...who knows where!

Hello! Well I've made it back alive from my almost 2 week trip in northern Kenya with my project team, APHIA II and the Kenyan Ministry of Health (MOH). This past week has been in-your-face,-up-close-and-personal training. We went through what was the roughest parts of Kenya (basically off-roading since roads are not quite developed yet in most places). We literally got lost in the desert for an hour or so (no joke, we're talking no land marks, just dry, parched, cracked land speckled with camels and ostriches). I was slightly scared but realized that a nearby nomad may consider me to be about 10 camels worth as a bride and I could live happily in the desert forever. Right. I gave the driver a 'if-you-don't-get-us-out-of-here-soon-I'm-gonna-go-ballistic-on-you" look. We made it out eventually.

Anyways, I've lost many precious brain cells jolting in our SUV for a week. Moreover, I think my head is more loosely connected to my body. Awesome. Basically the purpose of the trip was to see the issues these district hospitals, dispensaries and health centers were facing. Apparently, the data quality my team has been receiving hasn't been great or consistent. Plus, much of the northeastern part is disregarded in terms of government aid since not many people are there and its not really a thriving area (e.g. it isn't a profitable place for the government to invest at this point). I could see why since about 3 hours out of luscious green Embu, we hit dry. flat, rocky no-man's land. Kenya is a land of contrast to say the least! Pics from our trip are located here:

• Isiolo
• Laisamis
• Sololo
• Kalacha and Chalbi Desert
• Marsapit
• Garbatulla
• Moyale
  

Jambo from Embu!

Hi! Jambo!
Just wanted to let everyone know I made it safely to Embu now. I am in the APHIA II office (my project) and there are quite a few people in my office. Just trying to wrap my head around everythings I've seen, everyone I've met, and well just everything! Its crazy how similar things are to the consulting world I was in but just at a different level. I will details more soon! Miss you all!

Gimme the 5 W's!!

Who? Elisa (aka. E-Chen, Elsie, E, Mei Mei, etc.)

What? Going to volunteer in Embu, Kenya through a great business partnership between a non-profit, Voluntary Services Overseas (VSO) and my work, Accenture. I will be working with a Non-Govermental Organization (NGO) called Family Health International and with the Kenyan Ministry of Health (MoH) as a Health Information Systems and Data Advisor.

What??!!?? Yes, my work and passion has found a somewhat happy medium!! I can now apply my work experience towards something I find worthwhile. So more details about my volunteer role:

The MoH has a lot of good health data captured at a local level (e.g. health centres, dispensaries, hospitals); but, most of the data is lost because it does not flow efficiently from the local level, to the district level, to the provincial medical office and onwards to the various technical leaders at the national level where it is needed for influencing policy and strategy.

So my job is to analyse the system and help work out an appropriate and sustainable system and mechanism to ensure that all the data that is captured at the provincial medical office and available to the various technical leaders.

When? I leave for Embu August 21st, 2008.

Why? Surprise surprise...... for those of you who know me well, you know that I have had the "travel bug" since college and have a love for culture, people, and international development. Since I've found out about this program/partnership at my work, it has been one of my goals to volunteer with VSO (so don't think this is due to any quarter-life crisis).