Friday, January 9, 2009

Holiday Greetings


A belated Holiday greeting to everyone. We have had a pleasant Christmas break thus far. People have included us in numerous celebrations and we have had lots of time to play games with the kids. A Nigerian work colleague of Char’s from Winnipeg came to Jos to visit family last week and graciously carried along our new laptop for us. It is nice to have one again. (He also brought along a care package from Char’s family with chocolate, jolly ranchers, and the newly released Prince Caspian DVD- what a treat!) There are even plans for an internet cafĂ© offering wireless access to be developed right next to our house in the next few months, so we are keeping our fingers crossed. Family Christmas gifts enabled us to have some extra meals out, an overnight stay at the Miango Rest Home, and a new table tennis setup for the children, which is a big hit with their friends here as well. Thanks!

On January 2-3 our Mennonite Central Committee had a team meeting here at the guest house in Vom. (We had originally planned to have a retreat in Abuja, the capital, but due to the crisis some felt that we should not be away from our homes for that long.) All the families of the national (Nigerian) staff as well as our family and the Hartman-Souders met. It was nice for us to get to know the families a bit and it now feels like we are really part of a team. Our team benefits greatly from having the long term national staff. Just briefly, Athanasius is involved in programs serving the deaf community, Gopar does peace work, and Matthew runs the office as well as being involved in programs like the EPRT (see below), and the Hartman-Souders are the country representatives (overall MCC Nigeria program planning and connecting with partners). The MCC Nigeria program/staff is fairly small and its major mode of operation is to work through local partners. The balance then comes in being more than just an external funder- We can see that MCC works very hard at the relationship to these organizations. MCC currently has multiple partners with HIV/AIDS programs and has asked me to use a portion of my time to add a public health perspective to our connection with these organizations.

Char and I look forward (with a bit of anxiety) to starting our health work assignment this week at Vom Christian Hospital (on whose extensive compound we live, a 35 minute drive from Jos where the kids go to school). My position particularly is vaguely defined now, which is fine at this point. Clarity would be nice, but I am often tempted to try to impose clarity when it isn’t really there. I remember a communications professor at seminary once saying that it is a gift to be able to wait for clarity- So that is what I will strive for.

My goal is to connect with people in a meaningful way as I work at public health (which is the basis for our family’s being here with MCC, reflecting the “transformative” aspect of MCC’s mission). There are pre-existing givens and needs of the hospital that I will try to meet as much as possible, while also hoping to utilize basic public health precepts in shaping my work (e.g. looking at what information is available on illness and death in the region and what are the existing public health efforts to address them; what has program evaluation shown; what issues have the attention of the community, its leaders, and potential funders; what evidence based interventions are there for these issues). One of the expatriate physicians will be leaving in 6 months, and it is likely that I will try to fill in for some of the administrative/program planning HIV/AIDS clinic (PEPFAR funded) work that she currently does. They are also hoping to tie in to more home-based care and perhaps work with the existing extensive church networks in some way. Their Tuberculosis clinic also is in need of strengthening.

Hopefully that work will still allow for me to spend some time looking at some other public health issues- things like basic sanitation (e.g. latrine use, water quality, and other environmental health issues which are readily apparent) or malaria prevention. Injury impacts people heavily (particularly traffic related- the risk of driving here feels about ten-fold greater than in North America- it would be interesting to see the stats), and the recent hundreds of deaths in the Jos crisis of late November is a reminder that violence in its many forms takes a heavy toll. (Mennonite Central Committee was instrumental in the formation of an Emergency Preparedness and Response Team for the Plateau State a few years ago. This diverse, government connected network has played an important role in the response to the recent crisis and has likely helped to prevent other violence in the past. Peace work is a major focus of MCC and is considered a unique lens we have to offer in our service here.) Polio survivors are often seen on the streets, although it is further north in Nigeria where they are still experiencing outbreaks. Tobacco use seems very low, although I am told substance abuse is common and increasing. (The Vom Christian Hospital has actually formed a partnership with the Jos University Teaching Hospital in the last year to run a couple of wards for inpatient substance abuse rehab here- an important service as well as generating much needed income for the hospital.)

A 2000 WHO report ranked the Nigerian health care system 187 out of 191 countries. Nationally, the fertility, infant and maternal mortality rates are very high, with immunization rates and life expectancy very low.

On the positive side, I see amazing examples of community networks and support systems for community capacity. I have read that historically, the western medical model brought by missionaries was not always readily accepted/utilized by local cultures. Although western influences are readily seen today, particularly in urban settings, I have to think that such considerations will still guide my involvement in community health. The balance and tension are always challenging between sharing knowledge and listening, taking direction from communities and also being rigorous in the application of established public health principles. I look forward to learning a lot.

So the New Year has started and we hope to settle into some new routines. The Jos crisis still hangs heavily over life for everyone here. Military checkpoints and curfews will likely be maintained for months yet. Figuring out how to get the children to and from school when they start back the 14th is another major decision. We will likely rely on drivers, but due to the high risk of travel here, we are quite anxious about how this will work out. The 3 ½ months we have been here in some ways seems so short, in others so long. Living day by day is always a good idea- I’m not sure if that’s harder or easier to do here.

Thanks for your thoughts and prayers.