In Which It’s The First Day Of Work...But There’s Little Work To Do
on Zoe Page (Sierra Leone), 05/Oct/2010 06:31, 34 days ago
It is my first day of work in over 2 months. Maria walks me in and even dawdling we get there at 8.45am. I have been told, by the District Medical Office (=community) to report to the Medical Superintendant (=hospital). But the latter is nowhere to be seen, so they send us to the former, who is also nowhere to be seen, though a minion sends us back to where we were before. It’s like a reverseCaucasian Chalk Circle– no one wants to claim ownership of me, and they both keep pushing me back in the other’s direction. Eventually Dr S arrives, acknowledges us, and promptly vanishes again. Someone comes to tell me there will be a meeting at 10am. This is promising. We sit in the open air Under 5s area and watchas labourers remove the wooden benches one by one, until the only ones left are the ones the mothers and babies are sitting on at the front, and the one Maria and I are on at the back, looking now as if we’re somewhat out to sea.The room where the monthly meeting is held used to be the Paeds ward, but is now home to all those many benches that were removed from the Under 5s area. They are lined up like a classroom, and there’s even a desk at the front facing them, sort of like a head table, or seating for a panel. Guess where they put yours truly. I stare out into a sea of some 80+ faces, many clad in bubblegum pink dresses with a thin lace trim, the uniform for the Maternal and Child Health Aides (sort of unqualified midwifery assistants, I guess, only with a broader remit, and, most of the time, working without the supervision of a qualified nurse). They’re the only ones in uniform, and elsewhere it’s bizarre company name overload, with a Ford polo shirt, a T-mobile t-shirt, an Ernst and Young cap and anEvening Standard backpack among others.The meeting begins with prayers: first Muslim (because there are more of them present) and then Christian, which is the Lord’s Prayer today (and maybe every day?) I have to introduce myself and get a round of applause. We get a stern lecture to turn off our phones during which the DMO’s own phone rings. Luckily he sees the funny side, as we sure as heck do.We have‘a minute’s silence’ for a colleague who has passed away, except it’s not a minute, and the loud prayer that is said is far from silent. Then we find out that the meeting will be a short one today as her funeral is this afternoon at 2pm...implying that normally this would be at least a 4 hour meeting. Goody.The first presenter has not appeared, so in a blatant ad lib, they tell me to stand up and talk about my rose. My what? Your rose. Huh? Your rose, your duties. Oh...my role. I waffle a little about health managers in the UK and get another hand as I sit down. The main theme for the meeting this month is data management. They are moving to a system which NHS peeps will recognise as being very similar to Payment by Results, except here they’re going to call it ‘Performance Based Financing’ which is suitably different so no one can say they’ve pinched our idea. Various speakers drone on about how important it is that their activity data is complete and correct, and then comes the fun bit: they explain how the tariff will work.For every delivery they do (I don’t like to ask if it needs to be a live birth) they will get $3.50. This will be broken down into 60% for getting the kid out, 10% for it taking place on a delivery bed, and 30% for something I don’t catch. They will get $2 for every child who is immunised but again, it breaks down into chunks against things like do they receive the right jab at the right time. It also seems that from their potential income, there will be deductions if they don’t deliver in other, non-clinical areas, like cleanliness, submitting their HMIS by 5th of every month, and minuting meetings. I wonder if this is something I can get involved in.Throughout this and future agenda items (and by the by, there’s no paperwork, just an agenda written up on a flip chart) whenever people get rowdy, the chairman calls out “Hello!” (in a Duh! sort of way) and they all shout back “Hi!” and settle down.We talk about Lassa, Malaria and nutrition, and then the meeting is over. I am collected and walked to a classroom, so I can meet the MCHAs in training, who all call out‘Good Morning’ with gusto as I enter, and shake my hand. I write my name on a very dusty chalk board, and then we leave. It is...random, but I suppose (?) what I get for answering ‘yes’ to the question of whether or not I have ever taught. Then we go back to Dr S’s air conditioned office where he works and I sit still for as long as I can before surreptitiously picking up my Emily Barr. The matron, a friend of Theresa’s, appears, and though my Krio is patchy, I seem to hear Dr S tell her I am to work for her, except not today as she is off to the funeral... It’s all a bit odd, and they clearly have nothing for me to do today, nor anywhere for me to do it, so I ask for something to read and say I’ll be back in the morning.With the‘National Health Sector Strategic Plan 2010-2015’ under my arm I detour to Maria’s, then hit Choitram’s. You know how many Hollywood peeps do Asian advertising campaigns for things they’d never touch in the USA/UK? Well today I get my first example of it, as I buy a Mischa Barton mirror. No, really. It’s a piece of plastic tat, but there she is on the front of it, tossing her hair and smiling, in case you didn’t know what to do in front of a mirror.My afternoon of reading the NHSSP on the balcony is interrupted by people painting my house. I do not understand the priorities here. I have no furniture, but they think painting my white railings white will cheer me up? Yesterday Dr S very kindly loaned me a CD/tape player to be going on with. Even if I did have CDs or tapes with me, I don’t think it would really make up for a lack of drawer space. At 6pm the carpenter and his motley crew arrive and start hammering very loudly even though, as far as they know, I am hard at work on my computer. They have mesh for the back balcony door and my kitchen so I ‘can open the window whenI cook’. Ha, chance would be a fine thing. Today I had a peanut butter sandwich for breakfast, a handful of popcorn for lunch, and a peanut butter sandwich for tea, followed by a Royalty Bar which was essentially some Indian knock off of a Mars Bar, confusingly adorned with Union Jacks.The power goes off so I finish my book by the light of a rather outstanding torch from a Blackpool pound shop, and lie on my bed, watching the spectacular lightning that’s crazy bright even through 4 layers of stuff (tinted window, mossie mesh, flimsy curtains, mossie net). No one told me it rained this much in Africa. Hmpf.