Earthquake?!

So I don't usually like to take time at work to write a blog - mostly at home and then post it the next day.

BUT

There was an earthquake today!! Actually there was an earthquake in Martinique region (http://earthquake.usgs.gov/eqcenter/recenteqsww/Quakes/us2007kha5.php) at around 3pm. I guess we felt the after shock or some tremors about 10-15 minutes later. The whole building shook! I didn't know what was going on. Obviously the logical option is just to follow everyone as they ran out the building. By the time we got outside, the powerlines were shaking a little bit, but they stopped. We stayed outside for about another 10 minutes and I gave hugs to shaky co-workers.

I remember being pushed on the stairs by someone and thinking that she did not learn in kindergarten about walking out in an orderly fashion. Someone dropped a poster and I thought, well that's a hazard waiting to happen and picked it up - it turns out it was from my office, Maria just ran with it!

Later outside, the girl who pushed me accused me of trying to make her fall because she tripped on the poster that I had picked up. Funny world.

Moral of the story: I'm okay. Kindergarten taught me well. Little shook up, but it makes for a good story!! And now I know what to do if it happens again.

Probably on the list of things you shouldn't tell your mother, but I'll probably call her when I get home in case there is something on the news. According to the Richter scale, an earthquake of 7.4 is a "major earthquake. Can cause serious damage over larger areas." I'll let you know if I hear of anything else in Guyana.

I’m working, really I am!!

What do I do? It’s an easier question to answer than “What are you going to be doing in Guyana?” At least now I’m here and doing it!!

I work for the Canadian Society for International Health (CSIH) on their Public Health Strengthening in Guyana (PHSG) project. I work at Main and Newmarket in Georgetown, Guyana at what is commonly referred to as the “CIDA Building” because of the number of Canadian International Development Agency-funded projects inside. Officially I am a shared intern between CSIH and the Guyanese Ministry of Health, but they don’t have any space for me so I will be staying in the CSIH office until I leave in March.

The PHSG project has been in existence for about four years. The project has four official focuses: HIV/STIs, TB, home based care and a health information system. The project has worked with the Ministry of Health, the Georgetown Public Hospital Corporation and associated clinics (Genito Urinary Medicine Clinic, TB Chest Clinic, and Dorothy Bailey for mother/child care), the University of Guyana and with various hospitals and clinics in other Health regions. The scope of the project ranges from lab equipment and training, clinic refurbishing and organization, manuals and guidelines for treatment and diagnosis, and training and hiring of staff ranging from administration, field outreach workers, lab techs… I could go on. Everyday I learn something new that the project has done, every little bit helps! The one part of the project that I should know more about is the health information system. Officially I am a Health Information System Trainer intern, but I haven’t actually done any training (shh…) I have received an introduction to the system and witnessed training at the clinics, but most of my knowledge of the system is from my own exploring and creating imaginary patients. A health information system (HIS) is a complex database that records everything – demographics, medical history, immunizations, allergies, contacts, encounters (doctor’s visits), signs/symptoms, orders investigations from labs and forwards prescriptions to pharmacies… and that’s just a snapshot. If your doctor or nurse has asked you about it, it is in the system. It’s beautifully organized so it’s not surprising that I love it.

Unfortunately, though the system is on version 1.1 (0.1, 0.2, 0.3…) and has been around for a few years, it is still not used consistently. In theory, the system should be used in real time and paper should only be used as backup when there are blackouts or computer problems. It is still instinct for health care workers (HCWs) to reach for the paper. Some do both. Everyone has their reasons for why they don’t use the system and I have my own ideas, but that could take an entire entry itself.

When I first started, there was a team of students (by students, I am referring to the fact that they will be recent graduates of the pharmacy program and Dr Plummer taught them at UG) that visited the clinics, trained staff and answered any questions. They finished the end of October and essentially, HCWs have stopped using the system. I should clarify that there are those users that are firm believers in the system, use it and use it well, but they are the minority. I went to the clinics a couple of times with the team, but most of my time has been at the office.

The project is coming to an end this year having accomplished the goals set out initially. There are certain items that were promised to the MoH connected to the HIS… which is a bit of an introduction into what I have been working on.

Like any computer software/system, there are manuals. Installation manual, system administrator manual, clinical coordinator manual, user manual – if you have a question, it will be answered in a manual. I have been working on and off on the clinical coordinator manual. It is interesting situation to be in because the first draft of the manual was part of my introduction to the system and with a better idea of the responsibilities of the clinical coordinator manual, I have determined where there are holes in the manual that if I were the clinical coordinator manual, I would have questions about. It’s a long process and I’ve reached a point where I need help because I don’t know enough about the system. Still waiting…

Another product that MoH wants is a paper version of the system to be used during black outs and where there is no computer access. I reduced one big form into separate forms and created flowcharts on how to use which form and where. As part of condensing the system to paper forms, I am currently supervising the aforementioned students (hired back for another month) to pilot the paper form and test its efficiency compared to the current paper forms.

One of the great things about the HIS is that once it is used on a regular basis, and used well, then it will be able to generate reports on the raw data. There are certain reports programmed currently, but one of the complaints along the lines is that it doesn’t generate the reports that they need. The problem is that they haven’t told one person. And the other problems are that they are complicated reports to program, or are essentially useless – producing reports to use paper, but have no real value. I am trying to talk to everyone who creates reports about what they want from the system to see what is doable. So far I have talked to one clinic director who fortunately is a huge fan of the system and happy with what is produces.

The office is slowly, but surely, condensing in size. Currently there are three people in an office that from my understanding had held up to eight. At the end of this week we are moving into a smaller office and next week there will only be two people in the office. Wallis leaves just as the HIS programmer comes from Canada comes, but after he leaves, it will just be me in the office! The office is currently three areas – the main office with about 6 desk spaces, the project manager’s office and a store room. I have been going through boxes in the store room to determine their contents and the next step is to figure out where it all goes! It’s handy that most of the material can be divided into the four components of the project, but less handy that the boxes that the material is currently stored in do not reflect these topics. It’s going to be an interesting time organizing everything in the office this week.

See? I’m keeping busy! That’s just a snapshot. I’m hoping that when the project ends that MoH will still keep me busy and not forget about me.

How to eat a mango

I am currently living in a country where you know that the mangoes are fresh- when they fall off the tree. Maria had 3-4 mango trees in her yard, and they all produce a fruit with a slightly different flavour. One is just sweet enough, one requires a little salt, and the other two are juicy and sweet, though taste slightly different. My previous experience of eating mango has been to peel the skin off and slice it, hoping that is ripe enough and sweet.

Here when you pick it off the ground, you know it’s perfectly ripened. And you can cut it, but there is another option….

Step 1: Hold the mango. Take a bite from the end opposite the stem and remove. You’ve created a hole at the bottom of the mango.

Step 2: Squeeze and catch the juice and fruit flesh before it drips down your hands.

Step 3: Get a paper towel because you can’t catch it all.

Step 4: The seed will loosen as you eat more mango, remove and clean off the seed. Continue to squeeze the mango skin.

It sounds odd. It is actually kind of odd. But think about it the next time you grab a mango…

Mmmmmmmmmmm…………

Happy Diwali!

Background (compliments of Wikipedia)

Diwali,or Deepawali, (also called Tihar and Swanti in Nepal) (Markiscarali) is a major Indian and Nepalese festive holiday, and a significant festival in Hinduism and some of the other faiths which originated in India - Jainism and Sikhism. Today it is celebrated by Hindus, Jains and Sikhs across the globe as the "Festival of Light," where the lights or lamps signify victory of good over the evil within every human being. The Sanskrit word Deepavali means an array of lights that stands for victory of brightness over darkness. The festival marks the victory of good over evil, and uplifting of spiritual darkness. Symbolically it marks the homecoming of goodwill and faith after an absence, as suggested by the story of Ramayana. On the day of Diwali, many wear new clothes, share sweets and snacks.

See http://en.wikipedia.org/wiki/Diwali for more details relating to the stories.

Part 1: Thursday night

On Thursday night, I went with Mrs Boodie (my landlady) and her friend Desiree to the sea wall for the Diwali motorcade. We took a taxi as close as we could, but there was a traffic jam of people trying to get to the sea wall. We walked there and then along the wall looking for a place to sit that wasn’t too crowded. As it got closer to 8pm, our quiet little place became just as crowded as the rest of the wall. Vendors sat up in front of the wall and walked along the wall selling almost everything you could think of: cotton candy, honey roasted peanuts, regular peanuts, sugar cane and every kind of beverage you could imagine, plus light-up necklaces for the kids and squibs (aka firecrackers) which are illegal in Guyana. Mrs Boodie made sure I was well fed with cotton candy, honey roasted peanuts and regular peanuts. Best honey roasted peanuts I’ve ever had.

The motorcade itself was probably about eight floats in total. All the vehicles were covered in Christmas lights. Some were over the top, others were tastefully done. The common theme usually included a central focus around who I believe to be the goddess Lakshmi sitting on a water lily. Most floats had musical instruments, especially drums. The Ministry of Health sponsored a float that had a red ribbon in lights, always a reminder. The motorcade was quite the event with hundreds of people in attendance, sitting and standing on the sea wall. We left right after the vehicles drove by, but the rest of the crowd showed no signs of leaving.

Part 2: Friday night

Maria picked me up around 6pm with her two daughters, Megan and Geneva, and their cousin Marie. She greeted me with a cup and told me to drink. I trust her, but it’s still makes someone a little nervous to drink something they can’t see and don’t recognize the smell of – but my special surprise was freshly squeezed mango juice! Delicious!!

We did a bit of a driving tour to see the diyas lit up. Some houses use Christmas/fairy lights. Some go all out while others only have a few. Our first stop was at Maria’s friend Indarie whose house was aglow with Christmas lights and diyas sprinkled the balcony and her front yard. She greeted me with open arms and a hug even before who she knew who I was which was wonderful. She has two of Maria’s puppies who were very happy to see their mom and smell their siblings. Indarie took great pleasure in sharing with me some of the traditional foods made for the special day including sweetmeats, channa, mithai, and other things that I can’t remember the name of but were sweet and tasted good. She sent us home with care packages.

Our next stop was at Nalina and Noel’s. Nalina went to school with Maria for pharmacy. They decorated their house with diyas, but had to put them in paper bags because the wind would blow them out otherwise. Noel loves birds and showed us his rare purple parrot, some finches, budgies and a toucan!! Nalina also cooked up a feast and shared with us pholouri, vermillia, curry, sweet rice and ghugara. She sent me home with my very own package.

The most beautiful sight was quite unexpected. When I came to Guyana, I was surprised, but have become accustomed to the squatters areas and their shacks. Poorly built. Old tin. Aging wood. A place that I can’t imagine anyone living, let alone families. Almost every house as we drove along had diyas lining the path and up the stairs to the house, being tended with care. Here, on the darkest of nights, is where I saw the brightest lights.

Sea Wall

For those of you currently not living in Georgetown, the city is built below sea level. Approximately 7.5 feet below sea level. Why don’t I need scuba gear to get around you might ask? Because when the Dutch built Georgetown (formerly known as Stabroek), they built the sea wall, or maybe the French or the English. Somebody built the sea wall! It also helps protect against coastal erosion and protect the city from shrinking. The sea wall itself is 240 miles long, extending along most of the central and eastern coast of Guyana. I guestimate the width to be atleast 4 feet. and equally as high. The ground around it has been built up as well, helping make it higher.

I’d driven by it before, but Maria took me with her daughter Geneva to stand on it last week. I love the ocean. There is nothing like the ocean breeze. The water isn’t the clear blue that you might expect and it’s a rocky shoreline, not a sandy beach. The water is brown because the rivers run into it. The rivers are brown because the leaves fall in the river and soak the water like tea leaves.

Groceries

As much as I love trying new foods, there is a lot to be said for what is familiar. There is a lot that becomes familiar because it is what is available. I thought I’d share some prices with you (in Canadian dollars and they’re rounded, Guyanese would be a little overwhelming) of some things that I picked up. Most of these are from Nigel’s. It’s one of my favourite places to go. It’s like the Zehr’s among No Frills and bulk food places. It’s small. It’s fresh fruit/veggie section is one side of an aisle – most of it is imported and anything that is local is a few days old (better to buy it at the market). There is a lot of chicken, fish and beef to choose from, but I’ve only bought the chicken so far. Not having an oven cuts down on how to cook things. The Bounty sticker on chicken is a mark of quality. The beef is apparently good but tough so it needs to be cooked accordingly. I’m spoiled rotten for fish and didn’t buy it in Canada so I haven’t bought it here. Dad – I want speckled trout when I come home.

Kraft Dinner $1

Raisin Bran $5/ 20 oz box

Ocean Spray Cranberry Juice $6

Can of baked beans $2

1 Royal Gala apple $1.25

1lb fresh garlic $0.50

Can of Del Monte Veggies $1.25

Can of Del Monte Fruit Salad $2

Chicken breast $6/kg

Parmalat Milk 1L tetrapack $2

Loaf of whole wheat bread $1

Banana pop $0.80/L (like a carbonated banana freezie – I’m in love)

Yoplait yogurt $1.50/170g

Saran wrap $5

Anchor Cheese $12/kg (imported from New Zealand, there’s only one kind of cheese at the store – I bought $1’s worth)

Don’t worry Mom, this is only part of what I ate. If there’s anything you’re interested in knowing the price of, let me know! I might have bought it… or there might be a reason why I didn’t buy it.

Now I know I splurge on things that I like to eat or I know that I will react better with. Got to keep your mind and your body happy. But I do have to draw the line sometimes. On that note, I am asking everyone out to go out. Buy a tub of Ben and Jerry’s icecream. Go home. And eat it with a spoon straight from the tub. It’s your special treat to me – splurge the $6 for a tub and enjoy every bite because I can’t rationalize spending $23 for it. I want it. But not that badly. Yet.

National Park

This past Saturday, I spent the day with Maria and her family. I went to Georgetown Club with her and watched her daughter’s squash lesson in the morning. It’s so great – there are squash courts in the back and they offer free lessons on Saturday mornings. We were greeted at the gate by Maria’s herd of dogs and puppies, and I mean herd! I think she has about 10 in total. I helped Maria make a lovely lunch of chicken (with jerk and special sauce), macaroni, twice cooked potatoes, fried plantain and veggies. We watched Madagascar as a breeze blew through the house and I admired the pawpaw, passionfruit and mango trees in her yard. Just before we called it a day, her daughter suggested a walk in the National Park.

I had driven by it before, going here and there, but I had never been to it. It’s not like a National Park in Canada with forest for miles and wildlife, but more of a regular park meets a sports field. There is a outdoor stage area, several sports fields, a track around a field that is a mile long, trees and ponds. When we got there, there was a rugby game just finishing up on one field and a football (or soccer!) game on another. It gets dark here at 6pm and we left for our walk at 5:30pm. As we were turning a corner, Maria and her daughter were talking about manatees. Oh yeah, manatees. No seriously. Manatees. They live in the ponds in the park. And people feed manatees like we feed ducks. It was almost dark when we got to the pond, but we were able to see a manatee feeding on some grass at the edge of the pond. I saw his back and his cute little nose. I saw a MANATEE! Actually, I saw four other little bumps that were also manatees. I can’t wait to go back and see them during the day. And feed them!