After a somewhat frustrating day spent partially with me deciding what I needed more, a big cup of coffee or a nice glass of wine (I know...two things with totally opposite effects...I'm not sure which effect I desired more), I am happy to be back at Alice's house and relaxing on my bed. It wasn't a bad day in any way, but for some reason by the end I was more than ready to be done. It's funny. After yesterday, I was excited about being here, excited about working with TERREWODE, excited to tackle anything. I still felt that way this morning on our drive in. And then somewhere in the middle of the day, I had apparently lost that drive. Anyways, I guess I'll start with yesterday.

I'll spare you the details and go with what was interesting. It's pretty bad that I have to go back and look at my notes to even remember yesterday and what I did. Yesterday I started out working a little on the monitoring and evaluation system for TERREWODE to use. I then worked on redoing a grant that had been previously submitted to the Birthing Project USA. The grant returned with some support, but not all that TERREWODE had asked for. The committee said that they should work on strengthening the proposal and resubmit it to try and get more Safe Birth Kits. It was interesting coming in on someone else's work and project idea and trying to adapt it and strengthen the proposal. I worked on that again a lot today, and it definitely didn't get any easier. I think it would have been easier to start from scratch, which, if you look at the changes that were tracked in Word, that's probably pretty much what I did. 

At one point, two people from a small organization came in to have a meeting with Alice. Their organization was called Mama Alive Initiatives. They wanted to partner with TERREWODE as they were working on things such as Mama Bags (bags filled with supplies for pregnant women who were near their due dates in case they went into labor and couldn't reach a medical center). They also talked about some of their other programs like bicycle ambulances (a bike with a cot on wheels attached to it). They sounded good and probably could work if adapted but if you really looked at their stated goal (to encourage women to use health facilities when giving birth) and their bag program (give women the supplies necessary in case they went into labor and birthed at home), they didn't add up. If you want to encourage a woman to get to a health facility and receive care from doctors or midwives there, why would you give her everything she needs so that she doesn't have to come to a health facility? Why not wait and give her the supply bag when she arrives at a hospital to give birth, since often times in less developed countries a patient is required to supply her own supplies for procedures and hospital stays. I think I go in circles on this. You want her to be prepared. Often times these are rural women who have trouble accessing a health facility. Yet you also want to encourage her to use trained health personnel at a clinic so that you can work towards cutting down maternal and infant morbidity and mortality. so you don't want to provide her with the means to try and birth alone. After they left, Alice and I discussed their ideas and I brought up this dilemma that I was running through in my head. She said exactly...if you give a woman a bag of supplies like that, she will not go when it's time. TERREWODE instead wants to do something similar with the Safe Birth Kits (and maybe partner with this other organization and use the bag idea as well) but to do it at the facility level rather than the individual level. All in all it was an interesting meeting to sit in on and listen to. They discussed a lot of things I spent my last year discussing in classes. And we came to just as many firm conclusions yesterday as I feel we did in classes all year. Close to none. 

Later in the day we had a staff meeting to review the past several days of having the women from the Fistula Foundation around. Alice recapped their time together and it sounded like it went really well. I missed most of it since I wasn't here yet. She then did introductions of the staff to me (a little late but it's ok) and then told them about me. It was here that I learned that the visitors from the Fistula Foundation had suggested to Alice that she utilize me in resource mobilization. So she told the staff that I would be doing resource mobilization for them. And then we launched into a brainstorming discussion on that. I figured, well, ok, yea, I can do that. Thanks for the heads up. And at the same time was thinking...is this going to fit into my internship requirements? But no worries because at the end of the meeting Alice tells the staff that I have already created for them a newsletter, that I have several grant applications to do, and then I will be updating training manuals, creating a monitoring and evaluation system, ...as she proceeded to list the things I was originally going to do. So, looks like I will have plenty to refer to for my internship requirements.

We always talk in class about small time non-profits and how difficult it is to manage on such little funding that is available at times. You don't really need class to tell you that. It's a tough sector to be in. Grants and donations. It's all they rely on. It's amazing how they can keep plugging away even when their grant proposals are not accepted. TERREWODE has so many needs with little funding to cover them. Their longest standing funder the African Medical Research Foundation recently and suddenly pulled out funding from the Teso region for all treatment of fistula. Reminded me of what happened that led to the birth of Chariots for Hope. I don't know how you work day to day knowing that you don't have funding for what you are doing or for what you need to do to make your programs succeed. Thankfully they did get a second year of funding from the Fistula Foundation, but now that AMREF has pulled out, they only have enough to do half the number of surgeries they were hoping to do. We wrote to see if the Fistula Foundation would consider granting TERREWODE more funds, so we will just have to wait and see. Surgeries for these women have been suspended for several months but they are scheduled to resume starting Monday. On top of the lack of funds, TERREWODE's office was broken into last week and their laptops were stolen. Many businesses employ night watchmen but TERREWODE had not yet. It was something they hadn't gotten to because of operating on such a low budget. They just have so many needs. Their car keeps breaking down (and no wonder given the state of the roads) and they keep pouring money into it. What they need is a new vehicle but that's a little difficult when there are no funds to be had. They are also really wanting to get several motorbikes and bicycles to give in the rural villages where they work where transportation for women in labor to a health facility is lacking. These are small ways in which they could use help. If anyone has ideas for mobilizing resources for small one-time project-oriented donations, let me know! Because apparently resource mobilization is now my job.

Today (Wednesday) Alice and I went to Mulago Hospital to visit with Dr. Justus to discuss the work plan for the next several months. He is a gyn/obs who does many of the fistula surgeries in the region. On top of his work at Mulago Hospital in Kampala and his work teaching students. It was an interesting meeting to be a part of. You could tell he and Alice were both passionate about the work but that they were also both coming from different positions with different priorities. Dr. Justus referred to himself as "like an American" who wants to do things the quickest and easiest way. He was complaining about all the big meetings where the money from the Gates Foundation or wherever never actually gets to the women that it is supposed to help. Instead it gets to the point of the meeting where people sit around and talk for hours and hours developing "the system." Unfortunately, the system is necessary and will one day be helpful but that doesn't make it any less frustrating now. Justus was suggesting TERREWODE and his team of surgeons use the village health teams and locate volunteers from each district within them to help in patient identification. He said all they do is call up the district leaders, ask for the village health teams, and from there, identify their advocates. They will then spend a week and visit the advocates in all 10 districts and give them a quick training on fistula. Then he said they just do a huge radio message calling all patients and referring them to the identified advocates. And voula. You're done with the patient identification. Alice, on the other hand, said it's not that simple. That they will do radio messages but there are those women who will need persuading to come. Fistula is such a personal problem with so much stigma and discrimination attached. It's an embarrassing condition for many and some women need to be encouraged to come and seek treatment.  She also thinks it's necessary to go to each district and meet with the leaders and then identify volunteers from there rather than just using the village health teams. She doesn't trust them as they are first and foremost representatives of the government. From her experience, she has found that recruiting volunteers from other groups typically works better. And she thinks they need to go and do a more in depth training. Not just of what fistula is but how to approach a woman who has it. Again, different motives and priorities. Dr. Justus has a huge heart for this and his goal is to fix as many women as possible. Alice's goal is to not only fix the women but to help them reintegrate into society. It's a more relational approach and it takes more time. I think it was an issue of quantity over quality. Dr. Justus sees it as the more patients you get to the better. Alice agrees with that but thinks about quality as well...she doesn't want to leave anyone out. It's a complicated thing that's for sure but I think together, they make a great team. Dr. Justus had some really valuable contributions to the work plan and I think they finally agreed on a timeline that would be most effective. (During this time and other meetings I have been in, I have been reminded of my time in Kenya. They will be explaining something and then stop and say, are we together? Um, well, No...no I have no idea what you're saying. Or they stop themselves mid sentence and say, "and from there we will do what?" And they pause. And it's just silent. I still can't determine whether or not that pause is meant to provide a moment for you to chime in and guess what they're going to say next or if its purpose is for you to sit quietly and allow the suspense and excitement to build…Jessica? Ashley? Crystal? Any thoughts on this?...random but remember asking mama faith to say "can I get a what what"? Ha.). 

We then went into town for lunch. We went to a little café in the middle of the city. I think the girl at the buffet line was surprised when I asked if she had matoke. I saw that another man had gotten it but I didn't see it in the line and so I asked about it. She probably found it weird that a mzungu would ask for matoke (bananas that have been wrapped in banana leaves and cooked for like 4 hours on a charcoal stove...you then eat it with g-nut sauce...which is like runny peanut butter in a way) when there was so much other, "more desirable" food like beef and fried chicken. 

Then we headed back to the office and I continued to work on the Birthing Project grant for Safe Birth Kits but like I said, it's hard to do someone else's especially when you start to realize the activities mentioned in one place don't match the activities you're budgeting for nor the activities you're monitoring in the monitoring and evaluation plan. We then had a work plan collaboration meeting. But at this point it was about 7 pm and looking around at the few staff, I saw that NO ONE was involved or checked in but Alice who just kept going. Everyone else looked like their heads were going to explode. I know mine was. I was starting to feel slightly sick. We finally left the office around 7:45 to go home and arrived around 9:30...on the way home I was just sitting and thinking about how overly stimulating the environment is here. Maybe it's just because it's foreign to me and I'm not used to it. Perhaps a US city would be just as much so to someone from here. Part way home I was finding myself stifling laughter just thinking about how ridiculous some things are here.  The roads...who can blame the driver when the vehicle needs to go into the shop when the roads offer a better adventure than the rides we pay for at an amusement park? I can't even believe sometimes when the driver turns down a narrow road that barely fits the vehicle with walls on either side and the road itself with huge rocks and bumps and holes...no matter how many times it happens (multiple times every single day that I've ever been in Africa), it still surprises me. And cracks me up. And the rest of the rules to driving around here...don't even get me started on the use of roundabouts (which, by the way, do seem to work here despite the fact that nothing in the realm of their traffic patterns should logically work). 

We then passed a lady who was walking on the other side of the street going the other direction. So we slow down and stop, yell to her, she looks at us, then we keep going. It was a friend and I thought we had offered a ride but she had refused. However, much to my surprise, 20 minutes later after we had dropped Martha off at home and were going back the other direction, we slow down and stopped and here this lady was just waiting for us on the side of the road. So we stop and pick her up. Her name was Janet and she is one of the founding members of TERREWODE. So it was nice to meet her. I found it all slightly funny though... approximately 3 minutes into driving, the car starts making funky noises (probably because we had just driven it in and out of 31 ditches). So, we stop and pull over on the side of a super narrow highway. And Mwanda (the driver) gets out and starts checking out the car...as cars and trucks are flying by at who knows what speed. I really thought I was going to see Mwanda get hit head on right before my eyes. I think I was a little nervous the whole time he was outside the car. But not him. He just kept walking around as cars we're within 6 inches of him flying by. Ay. So then we probably sit there for 20 minutes trying to fix the car and call a mechanic to see if it's ok to drive a little further. At first you know I think why not. It'll be fine but then I couldn't help but think about it being a major problem and the car blowing up (irrational? probably). To calm my nerves I started to pray and moments later the noises stopped (Maybe the kinks just worked themselves out...or maybe not). So we drive maybe another 300 yards and then we pull over. And Janet gets out. At her house. A good 45 minutes after we had first seen her and approximately half a mile down the road (somehow I think she could've gotten there much faster if she had continued her walk in the first place). I just found myself laughing about it all. And thinking about the reasons I do really enjoy it in Africa. So all in all, the long, once annoying car ride after a long day at work ended up being just what I needed at the end of the day to settle my mind and pray and find encouragement. Not a glass of wine nor a cup of coffee.