Sunday, July 26, 2009
Friday, July 24, 2009
Em pinis. I officially closed the fourth and final day of the Autonomous Bougainville Government's first Health Summit today at 4pm. I think I'll have myself a beer.
This project really has been a lesson in how to go about doing this sort of thing. The Health Summit was conceived in response to signs that we have serious problems with the health sector here: drug supply shortages; high maternal mortality rate; deteriorating infrastructure; and only six practicing doctors. I initiated the project as a result of a discussion with a senior ABG official here, who shared the same concerns. From that point on it was a careful balancing act, with me pushing the project along while trying to ensure that the Division of Health took responsibility for it.
Although it tested my patience on many occasions, this project has taught me that one has to be very considered when choosing the moments to step in and the times to step out. It was hard to stay on the sideline at times, but I learnt from doing so that they will go beyond my expectations when left to manage the work themselves, and must make some mistakes in order to learn. I know it sounds quite patronising, but this is a funny game.
At the end of the day it is all about nurturing and respecting relationships, as without them no project will succeed. I've definitely had my fair share of tongue biting moments, but I think I have learned a lot about being patient and maintaining an optimistic outlook…and in the long run this will probably be the most important lesson I will have learnt from my time here in Bougainville.
I hope the seeds sown during the Summit will bear fruit.
Wednesday, July 22, 2009
And Day Three concluded with a presentation by Rayleen Sole on drug supply in Bougainville. As I have raised already, drug supply is a serious issue here. Finally, we have had the opportunity to discuss it together.
Rayleen did a great job and seems to have it covered. Seems to be a mix of classic supply chain problems and poor stock management skills within health facilities. Regrettably, there is also evidence of theft for private sale (a problem across PNG).
It doesn't help that ABG has cut the drug supply budget by 92% over three years, so I relished the opportunity to raise this at the forum. The CEO of Health's response was that he doesn't know why the budget is so low; apparently they bid for 1.5 million kina and what they got was 40,000 kina. Now, I know for a fact that the budget process is a mess, and to an extent political interference is to blame. However, I do feel that the Division of Health should make more of an effort to advocate for itself, and should be using the Minister of Health as a lever. The current state of play is not good enough.
It is good to have these issues out in the open and my colleagues within the sector seem to be very happy with how this is all going. The key issues are clear and I look forward to debating the priorities with my fellow Health Summit participants on Friday.
Ka kite ano.
Ok, straight into it on Day Two with group work on challenges we face in preventing and treating common illnesses in Bougainville. This morning began with four discussion groups on malaria, pneumonia, tuberculosis and diarrhoea. Again, great engagement from participants on the issues and good ideas on the way forward.
I'd like to share an example that is a classic for development practitioners. Malaria is the leading cause of morbidity and the second most common cause of mortality here. So, many suffer and we need to focus on preventative measures.
There are several measures that can be taken to reduce the risk of malaria. Firstly, the local environment. Water is a breeding ground for mosquitoes, and they like long grass, so build homes a fair distance from fresh water and clear the bush from around your house. Secondly, the type of mosquito infected with malaria bites at night, so put mosquito netting on your doors and windows and put treated mosquito nets around your bed (chemically treated nets kill mosquitoes). Thirdly, stay indoors at night as much as is reasonable. Fourthly, take a preventative medicine such as doxycyclene so your immune system is able to defend you, should you get bitten.
Governments and their development partners (the latest jargon which tries to capture donors, NGOs, churches, community group etc) like to target funds on distributing mosquito nets. A good idea, as you can't really buy them here and not everyone could if they were available. However, the trick is getting them to use them. The group discussion on malaria raised the following:
- People are using their mosquito nets for shredding of cocoa seedlings
- People are using their mosquito nets for fishing
- People simply aren't using them
Simply providing the solution is not enough. As participants noted, the community has to have some ownership over the solution. This means that you need to help them see the value in having mosquito nets, and communities must desire to have them for the purpose they were designed for. Now, I can't really say that this is why we are having the problem, but that's the impression I'm getting here at the Summit, which means more time needs to be spent with the communities to get them to the point where they are identifying and asking for the solutions, instead of having them randomly handed out by Santa Claus. The lessons continue…
Well we finally got there! Day One of the Autonomous Bougainville Government's Health Summit was conducted on Monday 20 July 2009, almost nine months after we first began planning for it.
The Division of Health has done a great job of organising the venue, I was very impressed. Name tags, seating numbers and stationary folders, a media and secretariat desk, microphones and overhead projector for presentations were all sorted. The participants seemed to be either very excited or very serious, such were the expectations amongst those gathered here. I was just stoked that the day had finally come!
Day One's presentations went very well, and there was good debate amongst the participants about the issues raised. Highlight was probably the domestic violence agenda, which got added at the last minute. Fellow VSA volunteer Lesley Young and Helen Harkena, the head of her host organisation, presented on the topic and fielded the many questions. The debate was very emotive, with one participant breaking down in tears as she recounted the stories of patients she has treated. All that resulted in a commitment by the CEO of Health to place domestic violence on the health agenda. Good stuff.
Only quibble is the lack of staff in attendance from Port Moresby, however I gather this is due to the staff taking too long to send out the invitations…ah well. I reminded them again and again about that but in the end I had to step back and let them learn it for themselves. More on that later.
All in all a great start to the Summit!
Thursday, July 16, 2009
My German friend Dete has just walked in with a WWII photography book covering the Solomon Islands and Bougainville. This has caused a lot of interest as the executive manager from the Torokina district, 3 hours south by boat, is grappling with the growing black market for WWII weapons.
Torokina was the launching site for the campaign to capture Bougainville (1 November 1943), which followed the hard won success in Guadalcanal. Although this took place 60 years ago, local communities are still dealing with the consequences: namely, the volume of live, dangerous rounds and explosives easily found around Torokina.
Many of these arms were dug up and put to use as part of the war with Papua New Guinea, and unfortunately, despite the signing of the peace agreement and the push for disarmament, many locals in Torokina are profiteering from a black trade in WWII weapons and munitions (e.g. mortar shells, machine gun belts, grenades). The consequence for Bougainville is the arming of trouble makers in the south, which is contributing to ongoing insecurity in the region.
To help with the issue Bougainville has sought assistance from the American Embassy in PNG, which recently visited to see the munitions for themselves. Hopefully they will be keen to lend a hand in solving an unintended consequence of their presence here over 60 years ago…
Monday, July 13, 2009
So we have internet access now! Wow. It is running via a satellite dish on the top of our new building, which is coming along nicely (although at least 3 months behind schedule).
In other news:
- The date for the Health Summit has finally been set, 20th of July. It's been a lesson in sitting back and letting them work it out for themselves
- The review of Bougainville's development priorities is slowly lumbering forward. Recently visited the Carteret Islands, a group of five coral atolls just past the horizon line. Was amazing and promise will put in some blog entries soon
- Will be launching the ABG Corporate Plan this month (I hope), almost exactly 12 months after we first began working on it!
- I've been preparing advice for the Minister of Finance on financial (mis)management within Government…has been interesting
- I am juggling about seven different projects at the moment, but am finally getting on top of things
- Next holiday is scheduled for September. Will be running around in the Highlands and some of the coastal areas (Madang, Rabaul)
- I have two currently homeless VSA volunteers moving in for a week or two, and possibly a permanent flatmate from late August onwards
- I thought it would be cool to hold a concert in August with me mate Francis. Time will tell whether that was a good idea
Ka kite ano.