More Photos

Clouds over our hotel

Craft store in Windhoek

The lodge Lisa is staying at

Ah Africa...

5/15/2006

Ah Africa…this is the phrase that was repeated several times at dinner last night…mostly in response to the dire and complex condition most countries here find themselves in…my dinner companions consisted of Drs. Hudson and Mutebe from Uganda representing the WHO, Dr. Oke from Nigeria who is the head of WHO Namibia’s HIV/AIDS initiative, and Iggy (Zimbabwe) and Alexinah (Namibia) from ITECH Namibia…I am always in awe over how passionately many of my African friends speak of politics and wish I felt more informed to be able to really understand the complexity of things here… Ah Africa…how does she manage to replace colonialism with local dictators through "free and fair" elections…Ah Africa, how is it that things have gotten to the place that they are…even though her capacity and resources are enormous…Ah Africa, how can such a beautiful and culturally rich place exist alongside such rampant poverty, illness, and war…Ah Africa…

I arrived in Okahandja yesterday evening and am enjoying the break from the city feel of Windhoek. We are in a lodge just outside of town (a small town) and I would not be shocked one bit if a giraffe was hanging outside my back window in the morning. It is really peaceful here, and aside from the large quantities of birds, it is fairly quiet. A few of us went on a long walk along one of the side roads and enjoyed another beautiful African sunset… there are few things that can compare with the orange and red backlit scrub trees of the African bush.

Over the weekend I was able to explore a great deal of Windhoek and managed to walk around the entire downtown area of the city. My colleagues recommended going to the Namibian Craft Centre which has several local artisans and their reps who sell traditional Namibian items (and a few not so traditional). I was impressed with the variety and quality of crafts and managed to purchase quite a few souvenirs. Sunday I also did a lot of walking. Not far from my hotel was a large Dutch Reform Church and since it was very difficult logistally to go to my church, I walked up the hill and listened outside to the hymns, read for a while, and then followed a group of German tourists around to the Parliament buildings.

There is also the national museum of Namibia which I went and walked through…it is small, but very interesting. Namibia is still a very young country and is working to overcome the effects of apartheid. The museum focused on the struggle of Namibians to gain their independence starting with colonialism and then from South Africa…there was a lot of memorabilia from the independence movement of the 70’s and 80’s and documents and images from the first free elections held here. Part of the museum was also dedicated to the rock art which is found all over the country. The San/Himba people (Bushmen) make up a large part of the population here and so you can find all sorts of things relating to their history (including ample copies of "The Gods Must be Crazy" in several languages).

Around lunchtime I made my way to the Grand Canyon Spur, (one of the few restaurants open), which is about the South African equivalent of a Chile’s…only more meat and less variety. When I was in South Africa, we ate there a lot and each franchise has a different US State or landmark…hence, I think I’ve been to the Utah Spur, the Indiana Spur, and now the Grand Canyon! I sat near the kid’s play room and there were kids running everywhere who had all come out for Mother’s day. At one point I was watching the kid’s room monitors trying to keep kids from severely injuring one another on the trampoline, with a really terrible Musak version of "The Rose" playing in the background and the group of servers started in on an African drum accompanied version of their happy birthday song and I couldn’t help but wonder, "am I really in Africa, and how exactly did this become part of my job?" It really was funny…and an odd juxtaposition to the rest of what I am doing here.

Our meetings went well today. For the first two days, we will be debating policy issued related to the implementation of IMAI, e.g. what type of policy changes need to be made to allow nurses to prescribe HIV drugs and what qualifications/training must those nurses have. There are a lot of divided opinions from stake holders and many of the workgroups worked well after we were officially done for the day. The logistics of rolling out such a huge and complex program is a bit overwhelming, but when we look at the current state of the health care system, there is no question that it is needed. Tomorrow the workgroups will present their recommendations and we will try to come to consensus as a group so we can move forward. It should be an interesting debate. The last three days will be dedicated to making adaptations to the generic curriculum modules to localise them to the Namibian context. Then my real work begins...yikes!

We had a brai (BBQ) for dinner tonight…did I mention that eating meat in Namibia is an artform? The lodge set up the tables outside, which at lunch was very nice, but tonight it was a bit cold and I couldn’t help but laugh at many of the group members who had wrapped themselves in blankets to sit outside and eat their dinner. We have a fun group here and when it comes to work, they are serious and passionate about improving the conditions here, but they also know how to relax and enjoy themselves and laugh a lot. And maybe that is what I appreciate most about Africa…that no matter how serious or how bad things are there is always room for laughter and joy. Ah Africa …

Keep well,

Lisa

Map of Namibia

First Leg - Windhoek/Second Leg - Okahandja

Acronym Soup

5/12/2006

Dear all,

I hope this finds you all doing well and having an excellent Friday!Today was a good day in Namibia! Today has been one of those days that I am reminded of how much I enjoy my job and how blessed I am to be in a position that allows me to meet good people from all over the world dedicated to changing people’s lives. How lucky can I be?!?

Quite a few of you have asked me what it is I am doing in Namibia…and aside from living on Luna bars and Satsumas and watching a lot of soccer in the evenings, I’ve been assigned to come to Namibia to work on the adaptation of a WHO (World Health Organization) curriculum called IMAI—Integrated Management of Adult and Adolescent Illness. This curriculum is a generic tool developed by the WHO to assist resource poor settings in managing chronic and acute illnesses such as TB, Malaria, and HIV/AIDS (and its associated problems). It is written at a very simple level and gives very basic guidelines to be able recognize and treat the majority of illnesses that plague resource poor settings.

Many countries, like Namibia, have shortages of trained health care workers, especially doctors and nurse practitioners are essentially unknown. Consequently, there is a need to be able to transfer some of the tasks normally performed by a doctor to other healthcare workers such as nurses, pharmacists, etc… Many places have clinics in smaller, rural areas, that have no full time doctor. Nurses are running the clinics with huge patient loads, but don’t have adequate training or authority to treat many of the people and cases that come in the door. Others may have a doctor, but one that is not trained to manage more chronic illness such as HIV. Namibia is working to adapt the IMAI curriculum to their local context to train and empower nurses especially, to be able to assist with the patient burden the country is experiencing. This not only will help with patient care, but will allow individuals to be treated without having the burden of travelling long distances at a great expense.

Of course there are numerous barriers to this being able to more forward including policy issues, training and capacity deficits, etc…and this is what the meeting I will be attending next week will be dealing with. My job will then be to take all the information we gather and work we do to start the adaptation and then create the Namibian IMAI training. I’m really excited about the project and looking forward to next week.

Today the WHO delegation arrived so we were able to meet. Liz Stevens, the I-TECH Namibia country director, and I met with CDC Namibia, WHO Namibia, and WHO IMAI delegates to discuss next week’s meetings, go over the agenda, and determine if anything else needs to be done in the planning. Several workgroups have already been meeting to discuss some of the policy issues. While we were meeting, we all took a quick field trip to meet with the permanent Secretary of the Ministry of Health and Social Services to have an audience with him and meet him. He gave his blessing to the project (which has been a problem in the past) and everyone left very happy and confident that this project will now really start to move forward.I’ve been trying to get back my “African ears” to be able to understand everyone’s accent and the quiet way many people talk. I’ve even picked back up my continual “hmmm’s” of assent as people are talking…kind of the southern African equivalent of nodding your head or saying uh-huh. I’ve also realized that I’m starting to speak much slower and clearly so people can understand my accent…so all in all things are good and I’m enjoying myself.

Tomorrow I have some free time to explore the city and do some souvenir shopping. I’ve been told there is a history tour of one of the townships which I’m currently on a quest to find information about…me and the ladies at the hotel desk have diligently been trying to figure out how to find out more information. They’ve been very helpful so hopefully tomorrow will turn out to be a good day. The Windhoek film festival also starts today so I may try and see some of the films it has to offer tomorrow as well.

Thanks to everyone who’ve been emailing, sending good thought my way, etc….I appreciate it. Keep me posted on how things are going on the other side of the world.

Keep well,

Lisa

Photos from Windhoek

Gazebo at the Office

View from the office

Harold & Rosemary

View from the Hotel

Farming Elephants

5/10/2006

Greetings from Namibia!

I've managed to survive my first day in the local office--jetlag andall--and must admit that I'm really enjoying being here. The I-TECHoffice is located in a nice house in one of Windhoek's residentialareas, which is a lot like where I worked in Zambia, so I'm feeling abit nostalgic. My temporary office is in the equivalent of the diningroom and looks out onto the backyard/patio which has a nice thatchedgazebo sitting area and a pool. Everyone told me before I came that ithas been very cold here and I should come prepared...but it feels anawful lot like Seattle right now, only dryer, so its actually reallypleasant. Perhaps it wasn't necessary to bring my wool coatafterall...but just in case, I have it and won't be cold :)

Today has been very low-key since the group from WHO that I was supposedto meet with today will not actually be arriving until tomorrow to meeton Friday. So, instead I've spent my day meeting the office staff andsitting in on another technical workgroup meeting of physicians who arelooking at one of our curricula on HIV/AIDS medications. We met outunder the backyard gazebo and went through some of the trainingmaterials and I found myself fascinated by the characters in the groupand the amount of knowledge and passion they have for fighting thisdisease. All have been involved on some level in developing andmodifying treatment guidelines for the country and are considered theleading local authorities.

At one point in the discussion, Dr. Ishmael F (whose last name Icouldn't quite understand) was asked about his elephants...this ofcourse immediately caught my attention, as this is typically not a pointof conversation in most of my meetings...and it turns out the Dr.Ishmael has a cattle farm which a group of abnormally large elephantshave taken a fancy to...and since Namibia has had a lot of rain thisyear, the normal feeding grounds for this particular group of elephants,had been flooded out, so they discovered the lush feeding grounds of theDr's farm and decided to push down the fence and help themselves, muchto the dismay of the cattle and the doctor. He has repaired the fencemultiple times and tried several things to keep the elephants fromcoming back with no luck...he thinks he might be stuck with them for theseason...So, the moral of the story is, if you're going to own a cattlefarm in Namibia, be prepared to share your fields with gangs of hungyelephants.

I've also been reminded today of some of my favorite things and phrasesfrom southern Africa--first, the fabulous soft drinks Grapetizer andAppletizer...delicious! Basically like sparkling apple cider and grapejuice, but so much better...Everyday/meeting also includes a morning andafternoon tea break, complete with snacks--I should have remembered tobring my hot cocoa...always a treat! One of my favorite phrases alsocame up today--"Are we together?"--basically asking if we're all inagreement--but I just like the phrase.

Anyhow, I'm doing my best to combat the desire to go to sleep at 3:30 inthe afternoon and wake up at 2:00 in the morning, but the jetlag willwear off soon, I'm sure...just in time for me to come home mostlikely...but all is well adn I'm sure that things will become a bit moreintense as we head into next week's meetings, but for now I'm enjoyingmyself.

Cheers,

Lisa

Safe and Sound

5/9/2006

Hope this finds you all well.

Just wanted to let you all know that I have arrived safe and well in Namibia after many, many, many hours on a plane and minimal sleep. But, aside from the trouble of getting here, I can definitely say it is good to be back in Africa! I’ve missed it here and as the sun is going down, I’m reminded of how beautiful the sunset can be!

My flights were actually pretty good, and considering the distance that I travelled, didn’t take terribly long. From Atlanta to Johannesburg, I sat next to a very chipper man named Wally who is a 69 year old minister for the Church of the Nazarene and one of the heads of the Association of Evangelical Ministers in South Africa. During our 18 hours of being seat neighbours, Wally told me all about the things and people I should look for while here in Namibia and also all sorts of interesting things about his ministry, his family, and life in general in Southern Africa. I helped him to work the in-seat entertainment options and smiled when he would whistle hymns without thinking about it…all in all a pleasant journey.

Harold, the driver, picked me up at the airport, which is about 40 km outside of Windhoek. We are situated in the middle of a desert and there is next to nothing but scrub bush between the airport and the city…that and a couple of baboons on the side of the road (did I mention that I have missed Africa?). My hotel is in downtown Windhoek and is actually located in the middle of a shopping mall…so if I get bored, I can go wander around the shops a bit. I’ll start work in the morning, meeting with people in the office here and at some point the WHO delegation is supposed to arrive. In the meantime, I’m hanging out in my hotel, trying to stay awake until normal sleeping hours, and flipping between the soccer channel in English and the cycling channel in Italian…life is good :)!Hope you are all well! I’ll keep you posted as things continue.

Keep well,

Lisa