I am sitting in the Outpatient Clinic at the New Amsterdam Hospital. This is my second visit to this hospital - the first being October 2, 2007; my second day in Guyana. It seems quite fitting that I should return here as I officially will soon be starting my new role as HIS consultant with the Health Sector Development Unit and the first module to develop under my new title is the Outpatient Module.
It is not quite as overwhelming as my first visit. I am used to the open air concept, understanding that the flow of air helps the air from getting too hot and stale, and is more cost efficient than air conditioning. Though I am still not used to the near freezing temperatures of administrative offices which make me feel like I've stepped out of wood heated house into a cold November morning with frost on the ground. I don't know much about electricity costs, but if they all turned the temperature up a few degrees, I am positive there would be somewhere else that could use the money. The waiting areas still get to me, outpatient less so than emergency where they wait outside on benches covered by a roof. Waiting to be seen or hear word of a loved ones condition. It is very advanced compared to some countries because all services are free. I guess waiting is the price they pay.
I am the only white girl for miles so my position sitting on a bench is drawing some attention. I guess they are more used to me at Georgetown Public Hospital Compound or perhaps I just notice their stares less because I am going somewhere, doing something, not sitting and observing.
I am here to learn about the paper system with the purpose of analyzing it to design the electronic module. The task feels a bit more overwhelming as I sit here staring at the forms I collected, questions I developed and thinking about the system I just learned. I feel like if all the log books in this country were stacked one on top of the other, the pile would reach the moon. Maybe even back. The same with all the charts/cards in filing cabinets...
The module won't be as straightforward as I thought. The forms offer little to no information. all information is in the brain of each clinic doctor or hopefully on some hidden list somewhere... Means more meetings... More traveling by car and boat (hopefully no more 6am departure times)... This certainly has been a crash course in hospital and clinic activities.
Mothers and children have a special place in my heart. I can only imagine the joy of having a new baby or the distress at having a sick child. Perhaps this is why two images from today are stuck in my mind....
The woman holding her sick child, limp in her arms, standing outside the emergency wing, surrounded by family and curious observers, wanting to know when she will be seen, the pleading look in her eyes that I could do nothing about....
The woman, glowing, holding her new baby in her arms, leading the parade of proud family and friends out of the hospital, leading them and taking her baby home...
Thursday, May 22, 2008
Monday, May 19, 2008
Adventures in Guyana... with a friend!!
Yesterday was, without a doubt, the best Sunday I have ever had in Guyana. I love this country, the food and of course, the people, but there is nothing quite like meeting up with a friend from home and sharing a little bit of this country!
He is here through his university to work with the Red Cross and run workshops on various health-related topics. Georgetown is the first stop in his adventure before he travels to Lethem. We started the day with a trip to Oasis for some email checking, pastry tasting (cheese rolls, cheese straws, pine tarts...) and some much needed coffee.
We then called Andre, one of my trusty taxi drivers, to take us on a tour of the big GT. We had walked over to the world's tallest wooden structure (St George's Cathedral) and had Andre drive us south of the city to the Demerara Harbour bridge - the world's longest floating bridge! Yes, we drove across it just to get to the other side and turned around!!
Andre drove us through big residential areas, the equivalent of the GT ghetto, by the cemetery and the prison, and for all the photo opportunities at old government buildings. Final stop on the tour being the zoo with lots of birds, cats and creatures... and a close-up of a manatee! No trip is complete without some fried chicken (yesteday's selection: fried chicken sandwich from Church's). We finished the day with a trip to the sea wall, enjoying the ocean breeze without the brown water and seeing the bustle of activity with families out to enjoy vendors and activities.
Perfect day :)
He is here through his university to work with the Red Cross and run workshops on various health-related topics. Georgetown is the first stop in his adventure before he travels to Lethem. We started the day with a trip to Oasis for some email checking, pastry tasting (cheese rolls, cheese straws, pine tarts...) and some much needed coffee.
We then called Andre, one of my trusty taxi drivers, to take us on a tour of the big GT. We had walked over to the world's tallest wooden structure (St George's Cathedral) and had Andre drive us south of the city to the Demerara Harbour bridge - the world's longest floating bridge! Yes, we drove across it just to get to the other side and turned around!!
Andre drove us through big residential areas, the equivalent of the GT ghetto, by the cemetery and the prison, and for all the photo opportunities at old government buildings. Final stop on the tour being the zoo with lots of birds, cats and creatures... and a close-up of a manatee! No trip is complete without some fried chicken (yesteday's selection: fried chicken sandwich from Church's). We finished the day with a trip to the sea wall, enjoying the ocean breeze without the brown water and seeing the bustle of activity with families out to enjoy vendors and activities.
Perfect day :)
Thursday, May 8, 2008
Sending a Package
There is nothing like having a mother's day present examined for illicit materials that will make you feel guilty for having done nothing and increase your frustrations with the system.
I will not mention the courier because it is not entirely their fault, but it was a bit ridiculous. After careful inspection of the contents: a beaded chain and a homemade cross-stitch picture (which is NOT a placemat and no I don't know it's value - my mother will think it's priceless, tell your customs officer that!), I was faced with the following frustrations:
1) Not being allowed to write the to/from addresses out on the packing slip - and then having to spell most of the words out letter by letter anyway... several times... B-A-N-C-.... F-A-R-A-...
2) Almost not accepting the copy of my passport that everybody else accepts as identification - more specifically that the last person at the courier accepted as id without question.
3) Signing my life away stating without a doubt that there were no narcotics or banned material in my package and guaranteeing the contents BUT then not being allowed to seal the envelope.
4) Feeling like that annoying customer when they go and find the operations manager.
5) Having the manager inspect my package again. And indicate that the package will probably be opened again by customs in Guyana and maybe other countries...
6) Having my package held for a day in Georgetown - obviously because I'm a suspicious individual.
7) Having my package held in the States for a day too.
8) Planning a package to be home before Mother's Day but arrives late.
*sigh*
I will not mention the courier because it is not entirely their fault, but it was a bit ridiculous. After careful inspection of the contents: a beaded chain and a homemade cross-stitch picture (which is NOT a placemat and no I don't know it's value - my mother will think it's priceless, tell your customs officer that!), I was faced with the following frustrations:
1) Not being allowed to write the to/from addresses out on the packing slip - and then having to spell most of the words out letter by letter anyway... several times... B-A-N-C-.... F-A-R-A-...
2) Almost not accepting the copy of my passport that everybody else accepts as identification - more specifically that the last person at the courier accepted as id without question.
3) Signing my life away stating without a doubt that there were no narcotics or banned material in my package and guaranteeing the contents BUT then not being allowed to seal the envelope.
4) Feeling like that annoying customer when they go and find the operations manager.
5) Having the manager inspect my package again. And indicate that the package will probably be opened again by customs in Guyana and maybe other countries...
6) Having my package held for a day in Georgetown - obviously because I'm a suspicious individual.
7) Having my package held in the States for a day too.
8) Planning a package to be home before Mother's Day but arrives late.
*sigh*
Friday, May 2, 2008
Stop and smell the....
...stagnant water outside the Georgetown Public Hospital, more specifically the creation of perfect mosquito breeding ground outside the Malaria Clinic.
...ocean breeze while walking along the sea wall or sitting in the National Park after a good walk.
...fresh homemade roti and squash curry.
...warm unfamiliar floral breeze walking by Promenade Gardens.
...burning of cane fields.
...dead cat in bin two days before garbage day.
...molasses and alcohol in the air outside the El dorado rum building.
...ripe fruit in the market.
...too ripe fruit in my kitchen when I take home more than I can eat!
...ocean breeze while walking along the sea wall or sitting in the National Park after a good walk.
...fresh homemade roti and squash curry.
...warm unfamiliar floral breeze walking by Promenade Gardens.
...burning of cane fields.
...dead cat in bin two days before garbage day.
...molasses and alcohol in the air outside the El dorado rum building.
...ripe fruit in the market.
...too ripe fruit in my kitchen when I take home more than I can eat!
Wednesday, April 30, 2008
Recipe to enjoy: Bake and Saltfish
The first time I had Bake and Saltfish was at the El Dorado Inn where I stayed during my first ten days in Guyana. The bake had been freshly made that morning and the fish was just perfect - served with a glass of cherry juice and fresh fruit, it was a great way to start the day! I have had it again since then, but probably one of the most memorable times was sharing it with my family during Boxing Day brunch at Mrs Boodie's! I haven't tried this receipe, but it looks pretty easy and the ingredients look right. Mom?
Saltfish, once a staple in the West Indian diet, is salted, dried codfish, imported from Canada (traditionally Newfoundland), historically as standard food for slaves. My understanding is that Newfoundland Screech (aka Jamaican rum) was acquired through this kind of transaction. A conversation with the Minister of Health assured me that those the saltfish is not necessarily cod anymore or from Canada - Canadian cod makes the best saltfish!!
You can eat the two separately or put the saltfish in the bake like a sandwich. Enjoy for breakfast or brunch - or anytime of day!!
Fried bake (serves 8)
Ingredients:
4 cups flour
1½ teaspoon salt
4 teaspoons baking powder
about 2 cups water
1 cup oil for deep frying
Instructions
Sift flour, salt, and baking powder. Add enough water to make a soft dough. Knead for about ten minutes then let rest for half an hour or more
Cut in pieces and roll each piece five to six inches in diameter and ¼ inch thick. Fry in hot oil, turn once, and fry until brown. Drain on kitchen paper.
Saltfish (serves six)
Ingredients:
½ pound saltfish
1 tablespoon olive oil
½ pound tomatoes, chopped
a few drops of lime juice
½ cup sliced onion
about 1 teaspoon minced garlic
2 tablespoons chopped chive
1 teaspoon thyme
½ teaspoon chopped hot pepper
pieces of avocado (optional)
coriander/cilantro/chadon beni (pronounced “shadow benny”) to taste (optional)
Instructions
Break fish in pieces and boil for ten to 15 minutes. Drain. This is to remove the salt: skip this step and you mash up (screw up) the whole dish. Remove skin and bones from fish and break into pieces.
Fry fish in hot oil for about four to five minutes. Add tomatoes, lime juice, onion, garlic, chive, thyme, hot pepper, and optional ingredients; cook for ten minutes.
Serve warm with bake or white rice. To eat the saltfish with the bake, open the bake as you would pita bread, fill it with saltfish, and enjoy.
Alternative method:
Don’t fry the fish, since it is cooked when it is boiled. Do not cook the vegetables with the cod-fish. The result looks similar to bruschetta, for lack of a better description. It can be served chilled with bake.
Saltfish, once a staple in the West Indian diet, is salted, dried codfish, imported from Canada (traditionally Newfoundland), historically as standard food for slaves. My understanding is that Newfoundland Screech (aka Jamaican rum) was acquired through this kind of transaction. A conversation with the Minister of Health assured me that those the saltfish is not necessarily cod anymore or from Canada - Canadian cod makes the best saltfish!!
You can eat the two separately or put the saltfish in the bake like a sandwich. Enjoy for breakfast or brunch - or anytime of day!!
Fried bake (serves 8)
Ingredients:
4 cups flour
1½ teaspoon salt
4 teaspoons baking powder
about 2 cups water
1 cup oil for deep frying
Instructions
Sift flour, salt, and baking powder. Add enough water to make a soft dough. Knead for about ten minutes then let rest for half an hour or more
Cut in pieces and roll each piece five to six inches in diameter and ¼ inch thick. Fry in hot oil, turn once, and fry until brown. Drain on kitchen paper.
Saltfish (serves six)
Ingredients:
½ pound saltfish
1 tablespoon olive oil
½ pound tomatoes, chopped
a few drops of lime juice
½ cup sliced onion
about 1 teaspoon minced garlic
2 tablespoons chopped chive
1 teaspoon thyme
½ teaspoon chopped hot pepper
pieces of avocado (optional)
coriander/cilantro/chadon beni (pronounced “shadow benny”) to taste (optional)
Instructions
Break fish in pieces and boil for ten to 15 minutes. Drain. This is to remove the salt: skip this step and you mash up (screw up) the whole dish. Remove skin and bones from fish and break into pieces.
Fry fish in hot oil for about four to five minutes. Add tomatoes, lime juice, onion, garlic, chive, thyme, hot pepper, and optional ingredients; cook for ten minutes.
Serve warm with bake or white rice. To eat the saltfish with the bake, open the bake as you would pita bread, fill it with saltfish, and enjoy.
Alternative method:
Don’t fry the fish, since it is cooked when it is boiled. Do not cook the vegetables with the cod-fish. The result looks similar to bruschetta, for lack of a better description. It can be served chilled with bake.
Tuesday, April 22, 2008
My Little Corner of the Chest Clinic
I have moved from my spacious Newmarket and Main office with a large corner desk and a view of palm trees and a garbage dump to a little computer desk in the corner of the boardroom at the Chest Clinic! Thankfully the room is air conditioned and after a bit, I found someone to help me get the internet connection working. I have a cupboard that I can lock and I moved some boxes around so the corner is a little less claustrophobic surrounded by electronic and condom boxes...
I took a bit of a break for awhile, but I have been back at work for over two weeks. It was a little disheartening to find that the use of the system definitely relaxed while I wasn't here supervising. Also nobody was entirely honest about their use of the system - forgetting that I would notice the gaps of information in the computer and the effect that one person not using the system has on the whole process! Even if I weren't so involved with every chart that goes through my hands, with a click of a button and my handy dandy administrative report, I can see that they too took a bit of a holiday!
All joking aside, it was a bit frustrating discovering that yet again two steps forward means one and a half steps backward. On the plus side, a HIS specialist came to visit and he thought they were using the system (well they probably were that day) which inspired his recommendation to keep working on the system and push forward faster with the rollout to the rest of the country. The lack of usage and some small details inspired me to write a letter that prompted a little action and a lot of laughs - with such confessions as "I have a confession to make. I am only one person. I am not magic. I can only be in one place at a time. I can only see so much clinic activity in my time here. More than ever, I need your continued help and support to make this system work for you. It's not for me, it's for you and the patients you see" and instructions like "take the pen away from the doctor" (reaction - we can't do that! my response - pretend you're me and if they say anything, send them to me).
I am continuing to work on modules for the system - currently the focus is TB. Because of my time at the Chest Clinic and the fact that they are essentially in full time, they are using TB as an example that the system can work (I am so proud of my people!). They want to make sure that the system can produce the required reports for tuberculosis and that the data from the system is of the quality required. It's a bit of a task with some inconsistent use of the system and the amount of back data that needs to be entered, but I'll keep working away at the planning document and hopefully keep encouraging system use and maybe someone else will take charge of the back entry of quality data and we will prove that the system can work. Still. Again. :)
I took a bit of a break for awhile, but I have been back at work for over two weeks. It was a little disheartening to find that the use of the system definitely relaxed while I wasn't here supervising. Also nobody was entirely honest about their use of the system - forgetting that I would notice the gaps of information in the computer and the effect that one person not using the system has on the whole process! Even if I weren't so involved with every chart that goes through my hands, with a click of a button and my handy dandy administrative report, I can see that they too took a bit of a holiday!
All joking aside, it was a bit frustrating discovering that yet again two steps forward means one and a half steps backward. On the plus side, a HIS specialist came to visit and he thought they were using the system (well they probably were that day) which inspired his recommendation to keep working on the system and push forward faster with the rollout to the rest of the country. The lack of usage and some small details inspired me to write a letter that prompted a little action and a lot of laughs - with such confessions as "I have a confession to make. I am only one person. I am not magic. I can only be in one place at a time. I can only see so much clinic activity in my time here. More than ever, I need your continued help and support to make this system work for you. It's not for me, it's for you and the patients you see" and instructions like "take the pen away from the doctor" (reaction - we can't do that! my response - pretend you're me and if they say anything, send them to me).
I am continuing to work on modules for the system - currently the focus is TB. Because of my time at the Chest Clinic and the fact that they are essentially in full time, they are using TB as an example that the system can work (I am so proud of my people!). They want to make sure that the system can produce the required reports for tuberculosis and that the data from the system is of the quality required. It's a bit of a task with some inconsistent use of the system and the amount of back data that needs to be entered, but I'll keep working away at the planning document and hopefully keep encouraging system use and maybe someone else will take charge of the back entry of quality data and we will prove that the system can work. Still. Again. :)
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