Work...

So today was the first day of real work.
So what was everything up till now?
Prep...

Regardless of what good works you plan and intend on doing, you can never be sure of the how your plans fit into the situation on the ground.
It was not in my plans to be doing prep work for this long in Salone, but alas, some things are out of my hands. I have spent the last two weeks getting the appropriate clearances for the research component of the project, learning about locally-produced RUTF (ready-to-use therapeutic food, commercially known as Plumpy'nut) and how it is used in community-based management of malnutrition (CMAM - a UNICEF/WHO term... it is alternatively known as community-based therapy (CBT)), and preparing my room in Masiaka. I've called the carpenter over to fix the gaping hole in the roof of my room, to make me a shelf, to make a door for the makeshift shower facility. The carpenter calls me "OOOHHHH~ my sweet sweet darlin" every time he comes over, and I just laugh it off like its the funniest thing in the world. I've also hired people to actually make the shower facility and a mechanic to set up the generator. Busy busy busy... but not really because things here take time to get done.

So work.
Today is day 1 of "Active Case Finding" - which means going door to door to get the mid-upper-arm circumference (MUAC, a user-friendly indicator of malnutrition) of all children under 5 years of age. I have working with me 2 nurses (Andrew and James, both N.O.W. staff), Amadu (N.O.W. staff) and two community health volunteers who work w/o pay at the Masiaka health clinic. We 6 have split up into pairs to cover the Masiaka town area. We are going door to door getting the MUAC of all children under 5 (the population most vulnerable to malnutrition). The MUAC strip is color-coded (thus user-friendly because it doesn't require lots of skill to use it effectively - so it can be extremely useful in areas with high rates of malnutrition, and low numbers of skilled staff where screening [screening defined as measuring weight and length/height of child] every child is not necessarily the most cost-effective method). All children with a MUAC in the red or yellow-colored areas have been given referral slips (neon green post-its) and have been told to come to the Masiaka clinic next Monday, June 22, at 9AM in the morning.


[Picture: Nurse Andrew training community health volunteer Isatu]

So - I have allotted in my project budget enough money to treat about 70 children with RUTF. Also, I initially projected my target population to by one chiefdom (like a county) in on district (think "state" - one of 13 in Sierra Leone) - but when I realized that was too large a population, we downsized to one catchment area (the group of villages whose people the Masiaka clinic serves) which includes about 30 villages. Today, we worked in just 1 of the 30 and have found already about 70 children with dangerous MUACs. Granted, not every one of those referred children will be severely, or even moderately malnourished, and not all will come to the Masiaka clinic to be screened - but we are finding too many potentially malnourished children... too fast. We will probably have to downsize again to just the Masiaka area and not all of the catchment area.

I thought I did a good bit of field work last year but going door to door, walking mile after mile, hour after hour under the scorching sun makes me realize again how hard this kind of work is. The sun helps give life, but today it was the subject of my contempt. I think again and again how difficult it is to maintain motivation for this kind of work - how do these people here do it?

As for me, the heat has stolen my appetite, the sun burns my back and drains sweat from my body like a soaked rag - no matter how much lukewarm, plastic-tasting water I drink, my thirst cannot be quenched. Under the wretched sun, every step forward is an effort and my smile reflex is no more. This kind of work environment just wrings out the motivation.

[Picture: picture perfect? but you wouldn't want to be under these skies.]

Its not like any one of us has an air-conditioned house to go back to.

But at least now, we have a generator that gives us 3 hours of electricity at night and we've got a shower facility we can take showers in as opposed to in the outhouse. I've got a firm mattress to sleep on and a good mosquito net over me - and for that I am thankful. Praise God.

During my time last year and this year, I never once cried despite the situations I observed - starving children, those deathly ill, extreme poverty. But today, just as we were wrapping up our door to door case-finding, the sun still beating down on us, I felt a rush of some emotion from the pit of my stomach to just below my throat.. and it came up to my eyes which filled with water. Maybe it was because I was just so tired - maybe it was because I was thankful to the staff who remain motivated to continue this truly long and hard work.