(Summer ’15) Julia Heyman, ’16 & Cathy Yu, ’17
Julia Heyman (’16, Civil and Environmental Engineering) Cathy Yu (’17, Biological Engineering)
This summer, Julia and Cathy will travel to Togo to work on expanding Hope Through Health’s current data management skills by training staff skills in Microsoft Office. In order to improve the clinic’s monitoring and evaluation techniques, they plan on capacity building through expansion of data analysis skills. To ensure the clinic’s growth, they will develop a sustainable training program for future staff which can be continued in their stead as Hope Through Health undergoes a major expansion program over the next ten years. Additionally, Julia and Cathy will train the clinic’s new IT hire in Commcare, a mobile health platform which involves transitioning from paper-based to computer-based patient records.
By: Cathy Yu
After seven weeks of lessons, Julia and I proudly handed out certificates to the clinic staff at AED who attended the computer literacy trainings. On this last day, we also celebrated with some Pringles and chocolate to give our friends a taste of some American flavors, and a post-training evaluation because there was still some business left to do. And then we said our final goodbyes to the clinic staff who we had been seeing on a daily basis for the past month. The next morning, we would be leaving Kara and by nighttime, saying goodbye to Togo altogether.
Thinking back to my impressions and expectations of this trip, I realized that before coming I really did not understand what our project would be. I knew it would be computer literacy, but it was difficult to get a sense of the true levels the clinic staff in terms of comfort with computers. We knew they worked with Excel spreadsheets and sometimes had trouble with which cells they should be writing in, and which cells they shouldn’t be writing in. Some of the clinic staff didn’t have any experience with computers, and others just wanted to learn a bit more about some Excel functions such as entering formulas. Lesson planning for this felt pretty straightforward; we planned to include some review of network connections and Word, but generally it would be a basic training. We even planned for more advanced lessons, in case the basics were too simple. Overall, we were expecting very paced lessons in which we would show the staff how to do something once, they would practice once or twice, and then we would move on to a new topic.
And even when I told others about the project, I would often see faces betraying slight confusion at the necessity of such a simple project involving so much travel and planning. One person asked me why we couldn’t just record a video tutorial or slideshow demonstrating the functions and features of Excel or Word, and then they could just try it out for themselves and learn that way. After all, don’t most of us do that? At the time, I answered that there was more immediate response and feedback that could be given when you’re present at the lesson and giving it. We would also have the flexibility to adjust the lesson pace or teaching methods after observing their progress. And given that there were staff members who had never used a computer before, sending a video couldn’t have been the solution.
But only after beginning our lessons did we realize how we needed to adjust our approach. When we arrived, many of the clinic staff did use computers daily for their jobs; for most though, it wasn’t integrated use of multiple programs, but rather they were just given instructions on how to fill out a specific spreadsheet to collect patient information. And during our trainings, we found that some who had been working with spreadsheets for a while didn’t know what a cell was. No one really felt comfortable enough with the computers to “explore” for themselves, try clicking on different buttons to see what happens and if something undesirable occurs, either closing out of the program or undoing the action. Consequently, in our lessons we needed to explain every step explicitly. For example, our explanation of how to copy and paste text included directions to click and hold the click before dragging to highlight whatever was to be copied, and then right clicking with the cursor over the highlighted text to copy.
We also often needed to emphasize that you needed to copy something before you could paste it elsewhere, and when pasting you first have to click where you wanted to paste before right clicking to find the option to paste. A lot of our explanation reiterated the fact that even if you knew what you wanted to do, you must tell the computer what you want to do, this idea of transferring what was in their minds to direct the computer.
To us, clicking to select an option is such a basic concept that it doesn’t require thought. However, Julia and I found that often times we would need to break down an action into these most basic steps in order to more effectively teach. A lot of repetition and practice in the order of steps taken to copy and paste a block of test was necessary. It’s important to mention though, that this step-by-step guided teaching wasn’t needed for all the groups, just a few of the individuals in the lowest level groups. We hadn’t expected this to be the case, but I guess it’s not all that surprising. Coming into the trainings, I was still in the mindset of someone who grew up exposed to computers, and other technology with our smart phones and tablets. Whenever we get a cool new gadget, the first thing we want to do is explore all its features and test all the limits of its functionality.
It’s definitely not the same with many of the clinic staff, who often needed confirmation that the next click should be a left click, hesitant because of a fear they might make something undesirable and uncorrectable happen. And changing that was part of our goal this summer: we couldn’t possibly teach them how to do everything correctly in Word and Excel, but by increasing their exposure and comfort level with the laptops, we hoped to increase their confidence in their abilities to undo any mistakes made while exploring the endless functions and features of their computers. That would increase their willingness for exploration, a process from which they could learn more than we could teach them in seven weeks. Realizing this, I was able to view the trainings from a different perspective, and learned to adjust the way we presented information.
Given how foundational the computer literacy training was, one might think why was it worth the staff’s time if they already knew enough to complete their jobs? Well, there is an obvious efficiency advantage to using computers over the previous paper system that the clinic was using; if done well, the data entry into spreadsheets allows the patient information to be much more easily organized, accessed, and ultimately analyzed for monthly reports on the progress of the clinic. But only if the data is entered well, meaning that the jobs should be less of a mechanical input of data, but rather involve understanding the significance of accuracy and completeness of the data as well. This value placed on the quality of the data entered was another result we hoped would come from increased comfort with using computers. And it is inevitable with the clinic’s plans for expansion that computers will be playing a larger role in the staff’s jobs. As long as Kossi continues the trainings on a regular basis to maintain the exposure to new skills, our project plays a role in this expansion in the long run.
After spending seven weeks living in Togo and working so closely with the clinic staff at AED, I’ve learned a lot. I’ve learn so much about Togolese culture, traditions and foods, and so much about our partner as well. Before traveling, I knew the numbers that represented what the clinic did from reports that are sent out, and from how often they are repeated by GlobeMed members whenever we summarize the work that we’ve done with AED. The clinic offers HIV care and other medical services to over 1,700 patients and that number continues to grow. Yet, for me, understanding the real impact of these numbers came when I met AED patients who spoke about their experiences at the clinic. Many patients said that AED provided them not only life-changing but life-saving medication that gave them back their health and energy to take of kids, or continue attending university as one patient told us; all were grateful for the services AED provided them and their families. When asked what about AED could be changed, one patient said he wished more people could be helped by AED. In the end, that is the goal: AED has impacted so many lives and has the potential to help so many more people.
The patient stories really made all the numbers more significant to me. I feel even more of a connection with the clinic because I got to know the staff members who make the patient care possible. I know Farilatou, who was one of the most dedicated students we had, is a CHW who also runs an internet café on the side; Emmanuel, who manages the Monitoring and Evaluation, has an adorable 2-year old son who dresses in collared shirts and jeans; and that Kossi, the IT guy, actually studied finance at university and really likes singing children’s cartoon theme songs. So having left Togo, I won’t really be missing the heat or the mosquitoes or flies (or any of the bugs), but I will be missing the people. But I leave with good memories of the seven weeks: hiking with Toussaint and Kossi, trying Pringles and chocolate with them, how Kossi fell asleep on the bench with a CHW phone on his face, how Koffi copied and pasted his name all over his Word document once he learned how to because he was so excited about the option, and many more. The enthusiasm of the clinic staff was very motivating, and they made our experience so enjoyable. There were some unexpected challenges that came with our project, but I’ve definitely learned from it all, and in the end, everything contributed to a successful project!
Before We Leave
By: Cathy Yu
As we wrap up the trainings this week with a post-training evaluation to gauge how the clinic staff felt they’ve improved through the lessons, we’ve started reflecting more on the project on a larger scale and its effectiveness (Julia’s last blog post summarizes these thoughts). For this past week of lessons, we’ve covered the basics of Google Drive, which many of the staff members mentioned in the pre-training evaluation that they were curious to learn about. We were a bit nervous about the week at first because our translator had told us he would be in Lome for the week, leaving us no way to communicate efficiently with the staff during the lessons. But fortunately, it was an opportunity for Kossi, the new IT hire who is present for every group anyways, to take over the lesson on Google Drive. Ultimately he would be the one to continue the trainings after we’ve left, so this was his chance to practice. With our occasional interjection of reminders, Kossi’s lessons went very smoothly. He even joked that Toussaint, our translator, didn’t have to come back because he wasn’t needed anymore.
Outside of work, we’ve had a healthy mix of cultural adventures and just relaxing. It’s difficult to plan anything after work because the workday ends around 5:30pm, our dinner is prepared by 7:30pm, and generally we go to bed by 9 or 10pm. During the weekdays after work, Julia, Alicia, and I have been playing our adapted three-person version of bridge. The classic card game has kept us amused and well-occupied in most gaps of time that aren’t quite long enough to do much else. Over the weekend though, we have been venturing out more, the majority of the time to the market for pagne shopping!
Sold as raw fabric in square meter units called “pagnes,” the colorful cloth is extremely versatile — apart from the tailored shirts, pants, dresses, and skirts that you see people wearing around, the pagne can also just be a wrapped around the waist with a corner tucked in for a simpler skirt. At the market, we’ve seen women vendors do this, and tie up the change and money they make in the corner of the pagne that’s tucked in, like a convenient purse, easily accessed when change needs to be made and securely on them at all times. The raw fabric is also used for mothers to strap their babies to their backs so that their hands are free, and this is done just by crossing the ends of the cloth once in the front and tucking the ends into the rest. Many Togolese make an entire outfit of the same pattern, or mix and match the different colors and prints. Julia and I were very excited about the pagne and the opportunity to make some clothes from it.
At the large market, vendors showed off their collection of colorful cloth in ordered racks. As we passed by the stalls, they beckoned towards us and gestured to enter. Many held out a pagne taken off the rack, personally hand-picked as something we might be lured in by. The vendors praised their assortment by repeating “joli pagne” (French for “pretty pagne”) as we walked by. Their strategies didn’t always work. Some of the more interesting designs I’ve seen include pagne decorated with giant dancing shrimp, movie popcorn boxes, playing cards, and one whose center design is a hand placing a wedding band on another finger, none of which I could imagine as a shirt. However, there was such variety in the designs that Julia and I didn’t have trouble finding our favorites: there are flowery pagne, ones with geometric shapes, ones with animals (mostly birds), and batiks, which are my favorite. Because of all the joli pagne though, the difficult part was deciding which ones to buy! The cloth ranged from 1000 CFA (about $2) for one pagne to almost $10 per pagne for the very nice ones. Ultimately, we made our selection, choosing the cloth that costs between $4 and $5 for one pagne. The next day, we dropped our cloth off at the tailor’s and awaited the transformation of the cloth to our skirts and shirts! (We also bought a lot of cloth to be tailored for our pagne campaigns!)
Almost a fifth of the Togolese population is Muslim, including the family with whom we eat our meals during the week. And this month in the Islamic calendar is Ramadan, a period of fasting from dawn until sunset, charity, prayer, and reflection. This Friday marked the end of Ramadan, celebrated with a feast to break the fast. (Thursday night, Tanira called her friend to come do her henna for Eid, and Julia and I joined in the fun and got designs on our hands.) Friday morning, Tanira bought a live chicken, as well has half a goat for the feast that day. We didn’t have work Friday so we were able to watch Tanira prepare the chicken.
She first slit the neck and bled the chicken out. After the chicken was dead, the process of removing the feathers involved submerging it in boiling water to more easily pluck the feathers. I didn’t try it, but I was amazed at how Tanira could stand touching the hot water! And when all the feathers were in the bowl of water and we had a thoroughly plucked chicken, Tanira continued on with removing the organs and finally cutting it up to cook. A few hours later, there was a delicious meal of couscous and pasta topped with a spicy tomato sauce, and a piece of chicken or goat for each plate. I wish I had taken a picture, but I was too ready to dig in and eat!
By coincidence this year, Eid lined up with the beginning of Evala, which is a coming of age ceremony for Kaybe boys (an ethnic group in northern Togo), and also a week-long festival that attracts people from all over the country. The two celebrations in sequence raised the spirit and energy of everyone around town even more! For the week of Evala, there’s a huge fair at the Congressional Palace that’s alive and bustling at night with food and music. Even the president flies in for a few of the days to watch the wrestling matches that go on. This weekend, our last weekend, we hope to be able to watch some of Evala, maybe climb another mountain, maybe travel out to see a village outside the city, but definitely have a few final adventures before we leave!
The Last 10%
By: Julia Heyman
The GlobeMed National Office asked us to share a story about displaying vulnerability to foster grassroots change. I decided to focus on writing about GlobeMed at MIT’s difficult process of critiquing our projects, and the challenge of self-sufficiency.
In the research laboratory I work in at MIT, something my boss commonly says to me when discussing our project is that the first 90% of a project is easy and can be completed quickly, while the last 10% is trying and can take a long time to finesse. Since I came to Togo, I’ve thought about this statement a decent amount. It feels like GlobeMed at MIT has put in a lot of the front-end work, implementing a variety of technical focused projects at our partner clinic. We have worked on a breadth of projects including computer literacy, GIS mapping, building a database, and a mobile health platform (CommCare). No doubt, the clinic has built their computer skills – before our first trip, there were only a few computers at the clinic. Now, almost all the clinic staff owns a computer, the staff have incorporated computers into their job to increase their efficiency, and the community health worker platform has completely transitioned to working on phones.
The question that still remains is how are we doing on that last 10%? It’s difficult to know how to measure success—the clinic staff all have some knowledge of computers, yet some of the databases are filled out incorrectly or not at all; CommCare is being used at most home visits, but sometimes the forms aren’t synced to the server for months, and then maybe the data isn’t being used. The thing is we haven’t really figured out the last 10%, we haven’t created a system where these projects are set up when we aren’t here. And it’s difficult to be critical—to have these hard discussions about projects we are really excited about but aren’t sticking. I’ve feared that we will get stuck in this zone where every 6 months we come back to the clinic and we teach a few more lessons on computer literacy, or sync all the phones and try to solve all the current CommCare form issues.
So we started talking, changing our approach to focus on the evaluation of our work. The previous GROW trip focused mainly on observing the clinic to analyze their transition to a computer-based system, and watch the expansion of CommCare. We have put in a lot of time and resources into building the technical capacity, but we saw the need to focus on filling in the holes that still remain in the foundation. For starters, our current trip is a seven-week long computer literacy/data management training class, longer than any of our previous computer literacy trainings classes by four weeks with the hope that the added length will contribute to an increased absorption of the knowledge. But as we teach, we openly acknowledge that this is just a start for improving the data management at the clinic.
So we teamed up with the clinic’s new IT hire, Kossi, who will continue the computer literacy trainings once we leave. Over the past few weeks as we have taught, the staff have been improving—making fewer mistakes during data input and honing their Excel skills. But this time, we hope as Kossi takes over, that the staff will continue to build new skills and increase their comfort with computers. And as we near the end of our trip, we have had lots of conversations about the future of data management at the clinic, and recognize that as the clinic expands and builds there will have to be future improvements to the data management that will involve more than just a computer literacy training.
Similarly, with CommCare, we connected with Kossi to transfer over our knowledge and skills to him so he can take over management of the whole application. We practice syncing the phones with him, and as problems have come up with the forms, we fix them together. One morning I came to work and Kossi walked up to me smiling and holding a computer and said “I found the problem!” We had been dealing with a formatting issue for the past week in CommCare that prevented one of the forms from loading, and none of us could figure out why. I was ecstatic—we had been stumped by this problem for days and he figured it out all on his own! I want Kossi to know more about CommCare than I did, to be self sufficient to the point where he didn’t need my advice.
Our approach is training people to train others. This wasn’t the first time we have had worked like this either—when we initially worked on computer literacy a few years back, we focused on training Emmanuel, director of monitoring and evaluation, in Excel and he is now a wiz in creating databases and sheets for others to fill out. This time, we are focusing on working with Kossi to create a plan together for how he can train and troubleshoot issues that arise himself. And even during our trainings we focus on helping the staff help other staff. When one member of a class picks up on an idea quickly, we have them teach the others until everyone in the group understands rather than us doing the talking. Not only do staff get the chance to practice teaching their skills, they often can connect with their peers better than us.
We also focus on having staff narrate what they are doing on the computer during the lesson so that they have to take ownership of what they do in order for them to think about “the how” and “the why” of an activity, but also to ensure they can explain an idea to others. Additionally, as many of the staff narrate what they are working through, they end up catching their mistakes and correcting themselves. This is crucial because we hope to have them understand the logic of what they’re doing, rather than going through the motions. When we had a lesson on saving files, we had staff say what folder they were saving the file in, and what they were naming the file. During the activity, many of the staff mixed up folders and files while speaking, so we then focused on clarifying that up with a comparison to a physical file and folder on their desk. Some of the staff are getting really good—they could teach the lessons themselves.
Self-sufficiency goes hand in hand with the last 10%, even if it takes 90% of the time. We’re making progress, but we still have a long way to go. We opened up this difficult idea of being critical of our work and ourselves to figure out what’s not sticking and why. We tried to embrace the idea of “grassroots” more and started small with just teaming up with someone who can make the projects more self-sufficient. But what does it really mean to be self-sufficient—does it indicate that we aren’t “needed” anymore? What we realized by focusing on the last 10% was that we needed a synergy between all the ideas of self-sufficiency: being needed, and finishing a project.
By setting themselves up to continue their own education, and improve CommCare, it’s opening up the opportunity for the staff to continue education and take new directions themselves. We want to establish ourselves as a resource so that we can continue working together on the common goal of building the depth of the projects we are working on, with the overarching goal of increasing the technical capacity of the clinic. We’re working on coming to a full circle with our technical projects, but we are also aware that our projects are essentially a Band-Aid for the overall data system currently. Some of the current issues with data management at the clinic involve the system itself, so our computer literacy trainings and the effort of continuous education will hopefully build the strong foundation that is needed to tackle these higher-level problems in the future. When we have the man-power, time, and resources to approach the next generation technical projects at the clinic, we’ll be thankful for the critical evaluation and time we put in to ensure a strong foundation.
By: Cathy Yu
It’s been three weeks since Julia and I arrived in Togo, and food cravings haven’t hit us yet. I remember hearing many horror stories before departing for Togo about travels to foreign countries, during which one is tortured by the lack of a favorite flavor or taste. Personally, though, there’s still a lot of familiarity in what we eat, despite it being different from what’s at home. And even the completely foreign tastes have been fun to try!
For breakfast here, we usually rotate through a selection of fried eggs, cornflakes (mixed with cold water, milk powder, and sugar) and sometimes sliced avocado with onions and bread. Interestingly, it was during breakfast one day that Julia and I had a great revelation. One of the first mornings we were in Togo, we got a cup of hot water and a tea bag, with milk powder and sugar to customize our morning. As we were waiting for the water to cool a bit, we noticed how the water had a familiar scent. It turns out that people often boil water with lemongrass, which is the flavor of FrootLoops (another fun fact: all the colors have the same flavor). So naturally we just associate our morning tea with warm FrootLoops.
What we’ve eaten for lunch and dinner have generally been the same: a starch with a spicy sauce. It has become a small game between Julia and me to guess what the starch of the meal will be. So far, we’ve had corn paste, rice, mashed rice, sourdough paste, spaghetti, and always popular fufu, each with its own unique texture. Corn paste is grainy, mashed rice is essentially rice stuck together, sourdough paste is a bit gelatinous, spaghetti is spaghetti, and fufu is smooth (a little reminiscent of mashed potatoes, but a little less soft). Fufu is my favorite, for both the soft, smooth texture, as well as the subtle taste. But sadly, the paste made of mashed boiled yams has the most difficult and strenuous preparation process of them all, involving continuous full-body pounding of the yams for a good bit of time. But I guess ultimately the hard work put in makes the fufu taste all the better.
As little as I know about the various pastes and starches in the Togolese diet, I know even less about the accompanying sauces, apart from some basic observations and opinions of mine formed through the 20-ish meals I’ve eaten of the sauces. Most of the sauces contain lots of tomato paste and oil and onions, and often with a certain dried fish we always see sold at the market. Sometimes it’s a sesame and tomato sauce, sometimes there’s a green vegetable (like spinach but not spinach) in the sauce, sometimes beans and cabbage. But the sauces are always spicy, to varying degrees. And it’s a mix-and-match situation with the starches and sauces; some go well with others, but there is definitely not a one-to-one correlation between the two.
One of the more interesting sauces we’ve tried had mashed baobab leaves among other ingredients. The leaves give the sauce a slimy and goopy consistency so that when eating it, one needed quick flicks of the wrist to break the singular thread of slow-dripping sauce that would drag along from the plate to one’s mouth for the inexperienced. We were definitely not well-practiced in this delicate process. Consequently the viscous sauce coated our hands and parts of the table at the end of our meal. Tanira, who cooked this meal for us, laughed when we said we wanted to try it. Having already correctly predicted that it would not make it into our list of favorites, she had offered us the safer option of spicy tomato sauce with onions, which we declined.
I’ve said that fufu is my favorite, but it is still greatly dependent on its sauce pairing. One of my favorite complete dishes here is the Togolese salad. A variation on what we’re used in America, the Togolese salad contains the usual lettuce, onions, carrots and beets, mixed into spaghetti with mayonnaise and oil as dressing. The final product is absolutely delicious! We also have had more familiar dishes such as spaghetti and tomato sauce, and chili; there hasn’t yet been a dish that has (undesirably) surprised our taste buds.
On the second weekend we were here, we made spring rolls with Vietamese rice paper. Seemingly a strange choice for our time here in Togo, the spring rolls meant we could fill up on vegetables, which are often a little absent from our meals during the week. With the exception of the Togolese salad, what we normally eat is mainly starches with less vegetables and meat than our diet in America. So we took the opportunity over the weekend to eat lots of veggies. And with the convenience of the imported goods store, we had a very successful meal!
Another important aspect to mention is the Togolese snacks available, important because for both Julia and I, snacking is a big part of our lives. Some of the snacks Alicia has introduced us to include various fried doughs that differ by how fried they are, fried banana chips that taste more like the salted potato chips than the sweetened banana chips I’m used to, and couscous and yogurt on the side of the street, all of which I’m a fan of. Essentially, the taste of fried anything makes a good snack. Fried cheese is another example; apparently deep-frying it is the only correct way to prepare the large blocks of cheese. After frying, the cheese reminds me of tofu: a brown outer appearance with an airy inside. It doesn’t taste like any of the cheese I’ve eaten before, and sometimes I wonder if it’s really not tofu.
What I was most excited about food-wise was the promise of delicious fruit here! And I haven’t been disappointed. Currently, we are in mango season (that conveniently extends to the end of our stay in Togo) so we’ve been able to indulge ourselves. Mangoes are everywhere in the market, and one can even make requests of the vendors to choose one that’s either ready to be eaten today or tomorrow. Pineapples are also readily available, in season all year-round. And while I haven’t eaten an apple here in Togo, I’m not complaining when there are mangoes and pineapples!
By: Julia Heyman
Getting to Togo was easy, getting into Togo was a different story. We’re walking off the plane and its 3:45 am. Someone quickly takes my temperature, and it’s normal….good, no ebola. Everyone was always asking me if I was scared to go to Togo because of ebola, but I always said no—Togo has never had any cases of ebola! We keep walking and someone asks for my “immunization card” which would prove I had received the yellow fever vaccine.
Immunization card…hmm that rang a bell. I remember sitting in the doctor’s office and she handed me an immunization card and strictly said “Put this in your passport and never take it out so that you can travel to Togo.” Good thing I took it out two mornings ago when I was packing because why would I need to carry a random piece of paper? The guy asks me again for my immunization card, and I start sweating, I’m nervous…what do I do? Will I get in the country? Are they going to quarantine me?
I try to calmly say that I don’t have it, and he just gives me a weird look, and says he will administer it to me. Not exactly how I planned my start to my trip– going into a room with someone whom I can barely communicate with due to my lack of French and get a vaccine, one that I already got two weeks ago. I ask him if I can get a picture of it and I start frantically texting my roommates asking for them to send me a picture. By now, I am dripping sweat, a feeling I would soon learn to “love.” They send me the picture in a text…wouldn’t load…they send me the picture in an email…wouldn’t load again…they send me a snapchat. It loads and I screenshot quickly! Who knew snapchat was so powerful?
Eight hours later we’re in Kara, and getting the big tour! We are staying in a two room house and it’s a nice mint green color. We are about a five minute walk from the clinic and all around us as we walk there are houses similar to our own. Goats, pigs, and chickens wander around everywhere. Women walk by and have beautiful cloth on called pagne, and carry big bowls on their heads with babies tied to their back. It truly is an art—the way Togolese women can move so gracefully while carrying so much. All the younger children point at us, staring because we are white, and yell in unison “Bye bye” as we walk by. I assume this is the only English they know asevery time we see them we get the same chorus of voices.
We have had some friendly visits in our house and bathroom. And by friendly, I mean frightening insects and animals that make Cathy and I scream and run as if we were five. First we had a lizard in our bathroom and eventually got over it thinking ‘Well as long as we don’t have a lizard in our house.’ Then we got a lizard in our house. Along with the lizards, we got called on by some frogs, assortment of spiders and other insects, and even had a beetle in our bed, under our sheets, which we eventually braved up and killed. We’re getting braver…some gecko eggs were on our wall–these big white eggs that we originally thought were spider sacs, and we managed to get them down and out of the house! The one thing I learned about insects…don’t use the Internet to try and identify the animal/insect you are dealing with. Terrible, frightening webpages come up… I swear I convinced myself that we had a special kind of tarantula in the house (which we obviously didn’t!) because apparently that is a common spider in Togo.
I can ride a moto…with no hands! (sorry Mom!) The main mode of transportation here is motorcycles so while were on our journey of exploring Kara we take our moto rides around the city and it’s surprisingly easy—you just have to sit except for the occasional bump. The hardest part of the moto is when the driver asks me questions in French and I have no clue what he is saying, but I guess it usually is along the lines of ‘where are we going? Is this the correct turn?’ The funniest part is when I just say “No François” in my terrible French accent; he just speaks louder and slower as if this time I will get him. Thank goodness for Alicia, the MIT alum here who is fluent and constantly helps us get around.
The first week of working in the clinic mainly involved shadowing staff to observe their computer usage and data flows. In addition, we planned basic computer literacy outlines for the upcoming weeks. What was interesting as we shadowed was that many staff just didn’t use their computers at all. The computer would idly sit right in front of them as they wrote information on paper, which I hoped would eventually be inputted into the computer but was unsure of. I wasn’t entirely sure of the cause for the lack of computer usage but I could tell our work was cut out for us.
After some more conversations and shadowing, one problem became apparent. The data flows currently at the clinic did not make a computer-based system easily attainable. Different departments, organizations, and the government required different data—one required this book to be filled out, another a different database, another with a set of different indicators. Combining the confusing data collection system that was in place with a lack of confident computer users results in a system that is slightly resisting increased computer usage. I know I couldn’t change what data needed to be collected, but I do have the tools to educate the staff about the basic computer skills and hopefully inspire them to manage their data in a more organized and efficient way.
We started with the basics—using a mouse, right and left clicks, saving files. I’ve never thought about explaining how to use a mousepad to anyone. Using a mouse on a computer felt autonomous to me, like breathing—there was never any thinking about it. I just move my mouse, click this and that, etc, but for the first time I had to break it down, into such simple thoughts that our translator would also be able to easily interpret what I was saying into French. It’s crazy how the simplest things are the hardest to explain-this job has forced me to really think. It has made me want to really understand what the staff is thinking, and be able to see the perspective from their shoes.
It’s hard to walk into a system with cracks and broken bits and not be able to fix them. Sometimes it may be a lack of skills or for reasons that are completely out of your control, but its tough. Linearly speaking, the problem we have been focusing on can be broken down to: the clinic is having trouble keeping track of and managing their data in a paper-based system, so the proposed solution has been: transfer the clinic to a computer-based system which allows for increased efficiency, standardization, and an assortment of improvements. But it’s never that simple. I do believe that moving in the direction of a computer-based system is the correct direction but it takes time. We’re putting in all of our time and we’re learning, with the hopes that as we work and put energy into improving the staff’s skills, we reach the activation energy that is required to make a computer and this transition seem a little less scary. I’m excited for the next five weeks to see what happens and what we will learn.
And so it begins!
By: Cathy Yu
At 9 am Saturday morning, Julia and I met at South Station for the bus ride to New York. After a five-hour bus ride and two-hour commute from the bus stop in New to the airport, we were on our flight heading towards Morocco, on our way to Togo!
During this first flight, my screen for personal in-flight entertainment wasn’t working. It seemed like my seat was the only one: the children around me were watching cartoons, while adults were watching movies. When I stopped a flight attendant to ask, he just said, “We can only fix it when we land,” with an apologetic face. Oh well. This gave me a lot of time to think about the upcoming adventure Julia and I were about to have (as well as sleep).
Both of us have been in GlobeMed since our freshmen years. For Julia, her involvement has been over three years, and for me, two years. Over these two years, I’ve repeatedly heard about the amazing progress our partner AED has been able to make, and how we’re working with the clinic there to build their technological capacity to completely allow a transition to a computer-based system. But I’ve come to realize how significant the partnership is: as college students, we are able to contribute directly to the progress and development of this HIV clinic, and positively affect the patient outcomes. The very real impact that GlobeMed students have made by working with this organization is incredible and since joining, I have been continuously inspired by the motivation and initiative of the members to develop these projects and execute them. And this time I’m part of GROW!
As I awoke from a nap, I noticed on the screen of another passenger that we had 3 hours left in the flight. We were 3 hours closer to Togo! It would be my first time in Togo, and my first time living in an entirely foreign culture, but I was excited. I was excited to practice my French a bit. I was excited to try the Togolese cuisine, and live immersed in a new culture. But most exciting will be the opportunity to contribute firsthand to continuing the work that GlobeMed does with AED. This trip is also Julia’s first GROW trip, and this time we would be the ones interacting directly with the AED staff and bringing back stories to MIT. With that thought, I dozed off again for the remaining few hours to the sounds of a humming engine, crying infant, and toddler in the seat in front of me trying to get the attention of his dad watching soccer.
When we arrived in Casablanca for our 16-hour layover, we were directed to a Moroccan hotel (courtesy of the airline) called Relax Hotel. The name was definitely fitting; we finally had the opportunity to sleep comfortably in beds as opposed to in a sitting position as we had been for the past day. The prospect of exploring the city tempted us, but ultimately sleep won. We slept for about 7 hours, and spent the remainder of the few hours at the hotel eating dinner and relaxing outside.
The final leg of our journey to Togo was the 4-hour flight from Casablanca to Lome, the capital of Togo. The in-flight entertainment was a screen every few rows that projected French movies. Neither Julia nor I even attempted to understand the movies (we both don’t speak French), so while Julia read on her phone, I tried to sleep again. But having just slept for much of the flight to Morocco as well as in the Moroccan hotel, I was having trouble falling asleep. So I thought a little bit more about our project.
Our 7-week-long project this summer is not a completely new project: computer literacy has been the topic of previous GROW trips during IAP of both 2013 and 2014. A computer literacy manual that explains the uses of Word, Excel, and PowerPoint was even created by GlobeMed members at MIT, and brought to the clinic in the 2014 trip. But in the subsequent GROW trips, we found that many of the staff were still having problems with using computers because they are still unfamiliar with them and don’t feel comfortable enough with them to explore individually. The database students had created previously and Excel forms staff are supposed to fill out with patient information were done inconsistently and incompletely often, with the staff still preferring hand-written forms. And the manual was rarely if ever consulted when issues arose. It seemed as if the clinic staff slowly lost all that they were taught those two GROW trips.
That would be my biggest anxiety about this trip: not that I would not like the food, or I would find the heat unbearable, but that after we finish the trainings and return to MIT, the clinic staff will return to how they were using the computers before, and nothing would come from the 7 weeks of hard work that we and the clinic staff put in. Sustainability is always kept in mind for these projects because we have to leave eventually, but we want the knowledge and change to remain. Julia and I are returning with a similar project because rather than starting a new project, we hope to work on maintaining, troubleshooting and expanding on what data management progress the clinic has already made. This time, a few things are different, and hopefully the differences will ensure the transfer of knowledge and skills to the staff will last.
First, we are not restricted as much by time. Although we will generally be covering the same material as before, our timeline allows us to provide the trainings for 7 weeks, much longer than the two weeks of lessons over IAP, when GROW members had at most four weeks in Togo. As with any learning, the more time spent the better the mastery. We hope that this continuous exposure to computers for 7 weeks will increase their comfort levels with them, and maybe even encourage their own exploration of what else they can accomplish with their laptops.
And secondly, rather than having the training for only a small group of people, we expanded the lessons to include most of the clinic staff. They are divided into five groups by comfort level with computers, and each will have two lessons of 1.5 hours each week. We hope that by offering the trainings for everyone, the overall comfort level of the staff with computers will increase. And finally, this time the clinic has hired an IT person who will be managing CommCare and helping to resolve any technical issues (like problems with Wifi and network connections) staff might have once we leave. I’m optimistic that with these changes we will have a successful GROW trip.
When the plane landed, it was around 3 am local time, about two days after we left South Station in Boston. We had finally made it to Togo!