Decisions, Decisions...

It seems that I’ve arrived in the midst of an intense period of decision making for the VHW program. Before I arrived, the VHW coordinators were busy researching for Level 2 of the VHW program, which was originally going to be both ARI (Acute Respiratory Infection) and malaria interventions. But after looking at the data returned to KDHW, it seems that after 6 months, the VHWs are not ready to move on to Level 2. It was disheartening to translate many supervisor forms this week that read something like, “The villagers aren’t following the VHW’s advice because they don’t respect him/her.” Although each VHW was technically chosen by his or her entire village, the VHWs are also villagers with more time on their hands to do such a job, which generally means they are younger than the mothers who they attempt to educate. It seems that VHWs are visiting much older mothers who are saying, “What do you know about children’s health? I know more than you do about children!”

Therefore, the upcoming training needs to address our questions about how the program is progressing (or not progressing), as well as address some of these social issues. Earlier this week, we thought focus groups might be the answer—VHW supervisors could go to a certain number of villages and conduct small discussions with villagers about what they truly thought of the program, and what needed to be changed. But we aren’t sure if the supervisor would be able to elicit honest responses, as he/she does hold a position of power. Now we’re juggling with the idea of doing a modified outcomes test, where the supervisor visits a certain number of houses in each village and asks the mother if she knows how to prevent and treat diarrhea, if she knows how to make ORS, and how often the VHW has visited her. We know that we will debrief with the supervisors and review Level 1 diarrhea interventions with them during the training, so we can plan for those parts in the meantime. But a final decision about how best to do assessment will need to be made this week that involves both GHAP “field” (in Mae Sot) and GHAP “core” (the big shots, based in the US).

This week I also began to understand the challenges of “capacity building.” While working with Hei Ku Wah on debriefing questions for the supervisors, I struggled with my level of participation. Obviously, things might have gone a lot faster if I had typed the list on my computer and written down all of the ideas that I had discussed with other GHAP staff. But it is not always about getting the job done quickly—Hei Ku Wah is a slower typer, but will get faster with more practice. And she’ll also get more practice with planning trainings if she comes up with her own ideas and we discuss them, rather than me just feeding her ideas that I have already discussed with GHAP. There is a very thin line, and it’s hard to know when to cross it. It will definitely be a challenging aspect of this type of work.

In terms of other decisions, I have decided to study Thai! There are many languages spoken in Mae Sot (Thai, Burmese, Karen, even Mandarin), but Thai seems to be the most useful for my purposes. I started lessons this week with a Thai tutor. The various tones are hard to pronounce, but I am getting better as I practice! I do know my numbers pretty well now, so I can officially bargain in the market (well, slowly).

Finally, another new intern, Johanna, and I decided to move into a two bedroom house in town. It’s a beautiful wooden house, but unfurnished, so has posed some challenges as we learned how to hook up a gas stove, search for a cheap refrigerator, and buy mattresses and house supplies with our limited Thai skills. After our first heavy rain in the house, we also noticed that both the basement and kitchen flood, so it looks like we’ll need some buckets too! I’ve been going to pick-up ultimate on Saturdays, where I recruited a third roommate Sam (yes, things might get confusing), who will be sleeping in our living room or basement, depending on if it’s flooded or not. He’s only in town for three months, so it looks like we might have a revolving-third-roommate this year. Should make things interesting!