I was all by myself

Through Wednesday, I was with Janine, the outgoing Healthcare program manager. Janine has been doing an excellent job of showing me the ropes, making introductions and helping with the transition. She negotiated our transportation, made plans with Nelly and chose the places to eat lunch. It has been something of a humbling experience; not knowing even how or where to relieve oneself.

But by Thursday, Janine figured there was at least greater than a 50% chance of my being able to return alive. And so she announced to me that she would not be coming with me. A transient pang of fear shot through me; I would not know what to do! I had become lazy, relying on the experience of another to figure things out. Being able to rely on others for this sort of information has been a singular experience for me. My previous work in Mexico afforded me no guide but Reality the Merciless.

On Thursday, I was thrust out of the nest, and I had to flap my wings or splatter (i.e. get so lost that sympathetic Kurians, seeing a crazy white man wandering about, would lead me back to where the other muzugus were staying). I would have to again rely on my wits to survive, which, I found, had dulled considerably since their last use.

Another unique feature of my situation was the continuing issue with language. I have said that “I don't speak Spanish.” But that was hyperbole. I meant that “I only speak a little Spanish, maybe a few hundred words.” But it's literally true that, “I don't speak Swahili.” I can't even say “I don't speak Swahili” in Swahili! This added to the trepidation with which I would go out that first day.

I was supposed to meet Nelly at the “stores of Taragwiti,” a village to the north of the district about four kilometers away. Ibraim, my boda driver, arrived on time (a “boda” is a motorcycle taxi, usually in various levels of disrepair). I hopped on, told him where to go in English (a language which he, Thank God, is fluent in), and we headed off. I had been to Taragwiti once, so had a rough idea where to go; fortunately, so did Ibraim.

We drive through the city (if it can be thus termed) of Isibania, and drove a good distance. Then we arrived at Taragwiti. But Ibraim didn't stop. He kept driving. A momentary panic was stilled by my ever-sharpening wits which reminding me, “You don't have any flipping idea where the stores of Taragwiti are, do you? Trust him.” My wits were nearly outmatched by my yellow belly which cried, “OMG OMG WHERE AM I?!/??[sic] OMG.”

It turned out my wits were right this time (they usually are). We arrived and Nelly was there to greet me. I would find out later that Ibraim lived very near the shops. I met Steven, one of the seven Field Officers (FO) who report directly to Nelly [According to the present organization, each FO has 6-10 Healthcare Representatives (HRs) reporting to them, and each HR has 9 other Nuru members they are responsible for].

I worked with Nelly as I had the days before on a malnutrition screening. I asked questions in English and she translated into Swahili (which, I am discovering, is a sandbox with many nuggets of English left behind by mischievous creatures like myself). After the first interview, I had an idea. She seemed to be tracking, so I gave the clipboard to her. And without skipping a beat, she continued the survey while I helped Steven do the weighing of the children. I had modified the form I had printed for myself and had my own private (so I thought) system of adding additional notes. She had been paying enough attention to me the previous days to figure it out without instruction. Amazing! The day proceeded like this and we got a great amount of data with the muzungu middle man cut out.

Sitting there with nothing to do but listen to the Swahili, I began to realize the power of the Nuru model for disease surveillance and, God willing, disease intelligence. Instead of simply collecting data and responding in a slow, top-down fashion, intelligence is information that can be acted upon, and that right quick! Imagine being able to have weekly Malaria reports, identifying hotspots. It would be possible to pick up outbreaks of diarrhea or epidemics of tuberculosis. And then have the manpower to do something about it! And the best part was that she was taking the first step right in front of my eyes!

After a few more minor adventures (scheming with Nelly, a debate with laborers working on the health center, a popped tire and a tipped boda) and a dozen more kids, I was back at home. Home sweet home. And I was greeted by Janine, who seemed not even a bit surprised that I had managed to return alive.