Sylvia's Journal

There was something in the Ethiopian food we ate yesterday that made Liz very sick and sidelined her for the day. I was reminded of my bout with food poisoning some 25 years ago in Coney Island. I thought I was going to die then. She did too but didn’t; instead she spent the day in her room letting her body get rid of the toxins. Hopefully she will be well enough to join us tomorrow on our venture out of Addis. I experienced some intestinal rumblings myself but nothing serious enough to intervene with the plans for the day.

In the morning we visited NASTAD, a group with a mandate that overlaps slightly with ours. We met with the country director and a consultant who man the small country office in Addis. Each new visit puts into place another small part of the giant Ethiopian HIV/AIDS puzzle.

After that we visited a health center with a nurse as the medical director. I learned that doctors don’t want the job. Of the health centers in Addis most are led by nurses who have the difficult task of keeping doctors in line, a huge headache. The doctors, from the descriptions we got, appear to be a bit of an undisciplined bunch, coming and going as they please, not required to punch their time cards (unlike most everyone else in the system) and letting the nurse-in-charge deal with the messiness of managing money, people, supplies, data and drugs. I commented that I did not see any grey hairs yet and was told she was only one month on the job.

Asked for examples of the challenges that she was up against she told the story about the new PMTCT center that was opened with much fanfare over a year ago but not in use because the septic system was not installed. It had been forgotten in the planning and no one noticed it when the construction company handed over the keys. Since then the health center has been asking the authorities for a septic system but it has not even gone out for bid yet. The new building will be old before it is even in use; just one more example that underperformance in health centers isn’t just a matter of missing technical skills.

One more meeting in the afternoon completed our investigations for the day. Our design is shaping up as we test ideas with various stakeholders, each pointing out things we missed or that need refinement. In the process we are also trying to pin down how much everything might cost so we can stay within budget limits.

Late in the afternoon I participated in a phone call that was a technological feat: a team meeting by phone with people in Chicago, Cambridge (US), Addis and Islamabad to prepare for a leadership program launch in two districts in Northern Pakistan next week.

The program for tomorrow is still unclear; some of the people we had planned to visit in health zones some 200 km from Addis are not available. They are being trained in something, a national pastime – the BPR is sometimes referred to as ‘Business People Removed’ (for training). We will remain in suspense where exactly we will travel tomorrow and how and where we will meet with our man from USAID. All we know is that we will leave at 7 AM and that our path will cross someplace. We cannot communicate directly with him because his cell phone fell into the water and damaged his simcard. I trust that all will be revealed in time.