Friday, April 23, 2010

April is a month of workshops... three to be exact.

The first was to discuss my Close of Service (COS). Although it seems like it crept up out of the depths of the Sigatoka dunes, I suppose I'm not surprised to find myself here, at the end of my 27 month contract. The workshop covered the piles of paperwork that will need to be filled out before I leave. Besides the number of trees that were slaughtered in order for me to spend countless hours providing detailed information about the last two years of my life, we were also inundated with information regarding reintegration- jobs, life, family, friends... everything. So what's my decision? I've been getting this question a lot. I dont know what it is quite yet, but I assume the answer will present itself in whatever fashion it feels suited. Even though the unknown is exhilarating, I have to say, these are the moments that I silently wish the options weren't so endless. But, alas, I remind myself of the people that fought for my options and I thank my lucky stars that I have another blank canvas waiting for me to paint on.

The second workshop was an HIV and Non Formal Education (NFE) training which I had a hand in developing. The office was lucky enough to receive a large grant from PEPFAR to carry out this training for Nurses, Peer Educator, and other Volunteers. We created resources to allow the various groups entry points and identify innovative ways to work together in their respective communities. Through NFE techniques we were able to equip 26 people with new ideas and allow them to draft an action plan to execute in the coming months. The program worked out quite nicely and I'm really looking forward to the feedback on the activities carried out in the coming months.

It's Saturday now, which happens to be my roommate's birthday. With two workshops complete, I'm waiting for the final one to come. Beginning on Monday we (the HUB Centre in Lautoka) will be hosting people from the three different STI/HIV clinics to come together to discuss ways to standardize their practices, both clinically and educationally. This forum will be the culmination of 7 months worth of work, and the closer it gets the less excited I am.

Before I go any further, I would like to defend myself by saying... the program was developed based on 'need'. But, in development even when the 'need' is there it doesn't mean that people will take to it easily. For instance, I 'need' to start wearing sunscreen more. If I dont, I put myself at higher risk of getting skin cancer, but I dont because I forget or dont want to. That might not be the best example, but it gets my point across. In this case, I developed a program to bring people from the three HUB Centres because they 'need' to try to start standardizing their practices. As it stands the three clinics hardly communicate and have different forms for the same thing... which puts them at risk of constantly re-inventing the wheel and makes it difficult for them to learn from each other. By bringing them together, I thought this might allow them a better starting point to begin moving forward and addressing the various shortcomings that each clinic faces.

Unfortunately, despite my efforts people lack enthusiasm. The program begins in two days and I'm afraid that I'm falling victim to the worst part of development- pushing my agenda and potentially wasting funds. Wish me luck. Hopefully good things will come out of this forum.

Friday, January 29, 2010

Sharks and the law

My dear friend Alex is on an adventure to experience the beautiful world that we live in. To introduce the new decade she proudly exclaimed to the universe ‘I rocked the last one, but watch this world, I’m going rock this one even HARDER!’ So it’s 2010 and her stories have only gotten better since she left. Her exciting adventures are being posted at Alexodyssey.com and she’s made a link to this blog.

Alex, how can a measly work blog be of any interest after reading your ridiculous entries, huh? Puh-lease, and look what you’ve done, people are starting to read this again, after almost 2 years! I guess this means I can no longer put off adding my next entry.

***

There is no excuse for my absence, but to say ‘It was the holidays’ (you can imagine a shrug if you like).

A lot has happened since Civil Servants day; World AIDS day, Christmukkah celebrations with volunteers, gallivanting around the islands, etc.

Let me first say that I left the last decade scuba diving with sharks- big ones. And no, there was no cage. We saw black AND white tip sharks, bull sharks, reef sharks, and more. Some of them were over 3 meters long. So this is how it went down; you get your gear on, you jump in, you swim 30 meters to a shelf, you sit on the shelf and you watch/take pictures of big and small sea life. Oh and was it ever beautiful. I have to say that sharks are one of the most graceful creatures to watch. Many of them were mangled, huge gashes on their fins, and one had a hook line slowly trailing behind him. As gentle as the sea can seem, it’s clear that it is that much more terrifying.

After saying goodbye to the sharks AND 2009, I made my way back to Lautoka. Straight to the bed where I would rest for two days in the attempt to recover from the festivities that, of course, followed the shark dive and the end of a decade.

Let’s move on to more recent events. Work.

Usually during these months people take their time trying to recover from the holidays- ‘Fiji Time’ at its worst. But, this year has been a bit different. The government is instating a few new decrees that will affect our work and our clients- 1. 2009 Crimes Decree and 2. HIV Prevention and Treatment Decree.
The 2009 Crimes Decree for Fiji will be enforced beginning 1 February 2010- Monday. There are a few relevant clauses, but the one we have been focusing on is Section 231; a law stating that any form of prostitution, loitering, and use of such services can be arrested on probable cause. Well, you might ask, ‘hasn’t prostitution always been illegal?’ Valid Question.

Women exchanging sex for profit has been illegal for many years. That seems clear. Unfortunately, or maybe fortunately, depending on whether you ask a cop or a prostitute, most of the Commercial Sex Workers (CSWs) are transgender (M to F). So with their mini skirts and frustratingly beautiful calves, the strut their stuff up and down Narara Parade without legal consequence. But with the new Decree the law applies to both men AND women.

This past week a meeting was held to discuss the new law and also provide education to nearly 50 CSWs in the Western and Northern divisions in Fiji. A legal aid personnel came to explain the terms and ramifications of this new Decree in relation to their chosen profession.

As you might imagine, the CSWs were terrified and upset. They asked so many questions, which also lead to horrific stories of being beaten and assaulted by cops only to be left for dead in a near by ditch. The questions were so keenly articulated that sometimes I wasn’t sure who was the lawyer and who was the prostitute. Especially since the lawyer repeatedly stated to a mostly Fijian crowd that ‘US Fijians, we’re Christian and when we see YOU, well, uhh… we think bad things, you know?’ No Ma'am, I don’t know. Please explain.

She also recommended that they bring in someone from the police force to talk to them. GREAT idea, now that CSWs can be arrested without a warrant, we should bring in a person who can label and target them.

***

Following this two day workshop Kelera, the HIV Project Assistant in the West, and I were asked to attend a meeting to revise the HIV Prevention and Treatment Decree. This is probably one of the most exciting meetings I’ve had the pleasure to sit in on. A group of the most educated people sitting around revising THE National Decree regarding HIV. Once it’s revised it will be given to Cabinet and then signed by the President of the Republic of Fiji.

Despite the excitement and novelty of participating in the forming and revision of a national policy, I have decided to stay on the ground level and leave policy making to those who have chosen a profession in the field. It’s not for me.

Thursday, December 3, 2009

working in Fiji

There are many ways to describe my volunteer experience... now I can use the all encompassing words: 'civil servant.' I never thought of myself and my volunteer position as this until a celebration was held in honor of the work I'm involved with.

I received a call early in the morning insisting that I wear a specific shirt from one of the programs we had run out of the HUB Center (the reproductive health clinic where I am based). I followed my instructions and went to work sporting a bright blue shirt tagged with the Ministry of Health logo.

It was CIVIL SERVANT's DAY! People were huffing and puffing with excitement; there was a band, booths were set up for each sector, everyone was all dressed up. And as people queued up for the parade I realized that- sure, I don't mind being described as 'not deficient in common courtesy' (dictionary.com's definition for 'civil') and 'a person employed by the government' (dictionary.com's definition for 'servant'). In fact, when I write my description of service, I might just begin with 'In Fiji, I was a civil servant.'


Proudly marching through the streets of Lautoka

Wednesday, August 5, 2009

door to door

MDA (mass drug administration) is an easy enough concept to grasp- reach out to the community by going door to door and locating yourself in a central location, outside a the normal clinical setting, where people can reach the needed 'drug.' These programs are often difficult to carry out, but in a country of under a million, it's totally feasible.

For this program we were trying to eliminate Lymphatic Filariasis. The MDA was successfully eradicated the worm in Tonga, but has yet to be successful in Fiji. So this year, again, we packed our bags with mild de-worming drugs and went door to door passing out the tablets provided by WHO.

Lymphatic Filariasis (more commonly known as Elephantitis) is caused by a filarial worm carried by mosquitoes. The worm, Wuchereria bancrofti and Brugia malayi, lodges itself into the lymphatic system - which is why it generally presents inflammation in the genital area. The growth that people are most familiar with takes years to manifest, which is why it is important to continue taking de-worming drugs annually until the worm is fully eradicated, and also why we went door to door passing out these drugs.

People were generally receptive and took the tablets. Those who were not, were shown pictures of people living in Fiji who were unfortunate enough to be affected. This method was quite useful.



Staff Nurse Kesa- who took my on as her volunteer for the program.

Nurses and volunteers getting ready to leave

breaking barriers, not rules

Recently, we developed a program that addresses gender and health issues at the local correctional facility- Natabua Prison.

Together with a counselling organization in town, we came up with this program which we called The Peer Support Network for Health and Well-being in Natabua Prison. We chose 2 people from each living block amounting to about 14 people in total. Over a two week period the training covered communication skills and reproductive health and other general health information.

The program finished after four sessions. Unfortunately the project was by design sustainable, but in practice, well, not. At this medium security prison the inmates generally stay for 10-18 months. In other words, those who were trained to be 'peer educators' to their fellow inmates will be leaving in the near future.

Although the program will slowly fall apart, I did see an advertisement in the paper printed by Natabua prison looking for a health educator. They DO see the need! If nothing else, the prison was able to see the importance of these topics being addressed within their facility.




The 'gang'


Working on communication skills- Ratu from Pacific Counseling and Social Services.


The face of HIV

It's all about ambassadors these days.

A new NGO has come to Fiji- Pacific Islands AIDS Foundation (PIAF). Their regional office is strategically placed in Lauotka. Their function is to raise awareness in the community by sharing their stories as people living with HIV. Their program has been the most effective one I've seen for HIV education in rural areas.

Essentially what they do is start off with an interactive training. A man named Temo, who is both a trained peer-educator as well as a ex-Red Cross trainer, gets up and involves all participants in a game to better understand the spread of HIV. He walks the participants through the steps of transmission, emphasizing the importance of testing and safe sex.

After the training, everyone settles down and listens to stories to "put a face to HIV." When the stories begin the crowd falls silent as the heart wrenching tales resonate through the room. Never have you seen such intent listeners as the audience faces turn to sorrow. The room is silent, the people leaning slightly forward hanging on to every word as these AIDS ambassadors talk about going through watching children die to the difficulties in confronting their families.

These outreach programs range from going to villages to army barracks to fire stations. The 'face of HIV' is changing peoples perception and truly educating people on the gravity of the virus.

The change in perception is evident. I remember going to the army barracks and having someone ask something along the lines of- "well, why doesn't the government just give all the infected people injections so that they cant transmit it anymore." After the program, the same man came up and profusely apologized, saying that he had never met anyone with HIV and had no idea that they were 'normal' people. It's incredible to see the transformation.

Outside of these programs, the AIDS ambassadors are involved in many activities relating to HIV education. Below I have added photos from a outreach program at a rugby match (this is just to show their involvement outside their own programs), a school program and the military barracks visit.





A booth at the rugby game- passing out educational materials.



Explaining how the questionnaires work


Outreach team. Also photographed are Champions (professional athletes from Fiji who volunteer to promote HIV education)



The program at the military Barracks

A program at a secondary school in Ba.
Disclaimer- not all of the people photographed are AIDS ambassadors. The ambassadors I have added are only the ones who have come out publicly in the media.

Sunday, May 31, 2009

The new year

The 21 of May 2009, represents my one year mark as a volunteer in Fiji. A time like this is often overlooked in the midst of projects and daily obligations. But, much like New Years, I see this day as something to celebrate- a day to reflect on the past year, and how I can improve in the year to come.

So many thoughts come to mind on how to celebrate the amazing exposure my work and situation have offered. But perhaps the best way to do this is to recap some incredible, noteworthy, moments;

· The pleasure of living three months in a village with Viliame, Tavenisa, and Lo.

· My site- working in a reproductive health clinic in Lautoka (the best place to live in Fiji- but then again, I’m biased)

· Living with and getting to know my amazingly accommodating roommate Nagisa- a very close friendship that will surely continue beyond this experience

· Carrying out a nightclub condom distribution program in the major clubs in Suva (the largest city in the South Pacific)

· Working on a large scale donation to provide medical equipment to the hospitals and health centers in the western division

· Having the opportunity to travel for two weeks on a government boat around the Yasawa islands, stopping at every health center, nursing station, and village, to provide rural, outpatient services.

There are so many other noteworthy experiences, but the chronological list I have provided stands out as having been unique to my volunteer experience. Not included are the moments that have taken my breath away- a sunset here, a shared meal there… the small pleasures afforded on a daily basis that have made me so fond of this country and my particular circumstance.

There, of course, has been the odd occasion where I have been robbed, forced to move houses, or been treated with disrespect because of my age. And, to overlook these things would be foolish and give a misleading perception of my situation- but, these experiences are what have made the last year “real,” has given me perspective, and have served as lessons that I may not have learned otherwise.

So the year is over and a new one will start. The new class of volunteers has arrived- launching a journey that they will make their own. As for me, I will be celebrating both their entrance into the country, and the beginning of my second year.

A family visit

My mother, brother, grandfather and uncle Bobs came to visit. While they were here, we were able to snorkel, scuba dive, travel to far off (well sort of) islands, go white water rafting, and visit the Fiji Museum.

BULA! from Fiji.

At 91, he is the oldest person to tackle the rapids of the Upper Navua river... and here's what he has to show for it, complete with a satisfied grin :o)

Tuesday, March 24, 2009

Out at sea

Carlito (I am now on nick name basis with Carlos Castaneda by merely reading his book) wrote that "in fact, the reality of the world we know is so taken for granted... that our reality is merely one of many descriptions." In that case, I concede to the fact that my relationship with the English language and therefore my descriptions, often prevent me from portraying my true reality.. whatever that is... And since I am giving you insight into my reality I have chosen to add a few photos (along with short descriptions) and simply state that... I traveled with work for two weeks on a boat through the most beautiful islands of Fiji- the Yasawas, there was a dental, school and outpatient team, we visited two villages a day, there was a lot of fishing....


Despite quoting Carlito, no drugs were involved - though I will say that there were many times when my reality did feel like a dream. I have decided that there are two kinds of people- those who can tell grand stories about their experiences and those who can't. I'm the latter. Here are some photos...




My living situation for 2 weeks


Where we slept


Where we ate






Afternoon refreshments- yummm, coconuts. Everyone likes the water, but few like the flesh, which works out well because the flesh is my favorite part.






The medical boat. The engine hasn't worked in over a year. Quite decorative... not?



Inside a very well stocked nursing station


Unloading on Yasawa-i-rara (the top most inhabited island)- also called 8 month island. They say that if you get the sand from here in your hair, it'll take 8 months to get out. I don't know about all that, but I will say that walking on it was like walking on an inch or so of powdery snow.



Swimming in the open sea



delivering a much needed water tank to a health center. Water supply is scarce on most of the islands- and hygeine is the biggest public health issue in the villages and schools.


Out-patient mobile pharmacy


Pap smear team- Auntie Vani is wearing a head lamp upon my suggestion, unfortunately that meant that she no longer needed me to hold the flashlight during pap smears... I lost my job to better technology.







School team.



Dental education

Toilets by class



MMR and TT vaccinations


Class 1 teacher leading students to the community health school team




Looking out to Waya island- you don't see that everyday

Farewel Viwa


Girls collecting sea weed. You know... typical after school duties.



The ladies- the head sister and two dental therapists



Last night, the i-tatau, departing ceremony



Baby powder and a garland- in true fiji fashion.

The old capital

Before Suva became the capital of Fiji, it was a little town called Levuka, on an island in Lomaiviti (translation, inside Fiji-- look at a map and you'll see why the translation is relevant) called Ovalau. Oh and is it ever beautiful.

I didn't take any pictures of the town itself, but it's quite unique as far as South Pacific towns go. When you get off the boat you are overwhelmed by the smell of Tuna- as the Sunbell factory sits just beside the wharf.

After you get over the strong scent, you begin to enter the city. When I had cowboy boots I never wore them- but you need a pair for Levuka. Due to colonization, the buildings and town structure make it feel as you have walked on the set of an old Western movie-- except there were no pubs with swinging doors... unfortunately.

Anyway, what was I doing there? I was on vacation. On a whim another volunteer and I decided we would take advantage of the long weekend of March 6-9. Carron, the volunteer stationed there, is always complaining of her isolation on "the rock".... so we went. And what a treat is was. Below are some photos.


Putu- this is what I was looking at when I called you on your birthday

Mission steps - 199 steps to the top

the view at from the top

on our way for a swim

on the road to Carron's house

Tuesday, February 24, 2009

Back at the hospital


Lautoka Hospital from the back


After taking a few months off from observations at the hospital, I have managed to weasel my way back in. This time in obstetrics and gynecology, where I have observed three natural births in the first day. I'm becoming more and more fascinated by the medical field- particularly the practical/clinical portions.

The medical students have changed since last year. There is a new batch of sixth year students, who Im just starting to meet. They will be doing their attachment at Lautoka Hospital for the next year before, most of them, return back to their respective countries.

Fiji School of Medicine is the only internationally recognized medical school in the South Pacific. This means that each incoming class will include students from all over the pacific like; Samoa, Tonga, Solomon Islands, etc. Many of them are sponsored by bond programs provided by international organizations. They literally get paid to become doctors for their own countries. That's pretty neat, if you ask me.

Chompers

The fluoride varnish project is starting to get off the ground. We have found out that we can expand the number of kids that we had originally allotted and cast out a larger net. We are now looking at a total of three schools, which will drastically improve the legitimacy of the research we are able to get out of the project. The research will be crucial to presenting the idea of switching over from gel to varnish, to the Ministry of Health.

I have been working with the dental outreach team who is very excited about changing over to varnish. They too think it will be much more effective. The gel they are using now contains only 0.4% fluoride, less than most fluoridated toothpastes.

I was invited to see the how they are currently applying the fluoride gel. Below are the photos from the visit.



Waiting for recess to finish

Kids lining up

Getting ready to receive fluoride on their toothbrushes

Kids who didn't bring toothbrushes applied fluoride with their forefingers