Now more than 5 months after arriving, I was ecstatic to learn this week that I will now be considered an “official” American here in Mozambique.
The ways people are hired and contracted through the US Government are incredibly complex and have included countless forms and paperwork, getting both a full medical and security clearance, taking a course (in Atlanta) on “Preparing to Work Overseas” (mostly security related), and countless emails, phone calls, etc almost on a daily basis. This has meant that while the paperwork was being processed, I was still under a temporary contract and not able to settle in here more fully.
My final clearance came through this week which means I should be transitioning over from my temporary contract to the direct CDC contract in the next couple of weeks.
Now as an “official” American in the eyes of the CDC and US Embassy here, I can finally...move into more permanent housing...all my things (which are still in storage in Malawi) can be shipped to Mozambique...I can purchase a car...and I can get a visa that no longer requires me to go to the border each month.
Needless to say this is some of the best news I've had and am happy that the end is in sight!
Sunday, January 27, 2008
Sunday, January 20, 2008
lessons for 2008
The end of 2007 was filled with friends visiting for Christmas, sun and sand-filled days at the beach near Tofo, several hours north of Maputo, and a string of parties and year end parties.
At the same time, in December, living, working, and playing in Mozambique felt like more “work” than it every has before. Continued problems with my contract (still on temporary contract), negotiating a morass of bureaucracy at work, related to borrowing a friend's car to travel of the holidays, etc have been slowly cracking away my eggshell of happiness here. Things which seem like they should be relatively simple and straightforward to take care of end up taking a lot of time and energy to address.
For example, when we were up near Tofo for Christmas, my friend Roger and I went into town on day to restock on food. This was intended to be a short, simple, and fun excursion.
We managed to sort out some things, finding a nice variety of fresh fruits and vegetables in the market. Fuel on the other hand was another matter. The town of Inhambane (the provincial capital) had run out of fuel due to the influx of tourists over the holidays. Roger and I drove to Tofo (half hour away) but they too were running out. I had less than quarter of a tank left so worried we would get stuck with no petrol (no AAA here so something generally to be avoided!) After trips to several ATMs (all the cash in Inhambane had run out as well), we did manage to fill up the tank and arrive safely back, but the day during our holiday left me feeling like i needed another vacation!
At the same time, we did some diving while in Tofo. Christmas morning was a particularly good dive. Diving in the ocean (as opposed to fresh water) one quickly notices the strong effect of the ebb and flow of the currents, which were particularly strong that morning. Every couple seconds, the tides would pull you 4-6 feet forward, 4-6 back. The immediate reaction is to fight the tides, to swim against the tides, we were often in small caves or underwater crevices with fragile coral as well as potentially dangerous marine life (e.g. scorpionfish) on both sides. One quickly finds however that the tides are much stronger than any of my kicking and that fighting the currents only made me tiring.
At the same time, at one point, I began to resist the fighting, just breathe and let myself go through the ebb and flow, giving a quick kick when the current was pushing my forward. When I did this, I realized I could stay in control, I would not bump into the coral or anything else, and I could swim through it all.
This lesson seems important for my life above water as well. Life in Mozambique continues to pose daily challenges but I'm trying to not fight it, take a deep breath, and perhaps give a good kick i feel the current is moving in my direction.
And both under and above the water, if I do learn to “go with the flow” as it were, the life will bring me some beautiful experiences and moments. One of the highlights from the diving was getting to snorkel on Christmas morning with two different whale sharks, a somewhat rare but beautiful graceful and awe-inspiring animals I've ever seen.
Saturday, January 19, 2008
bringing in 2008, baixa style
Maputo literally closes down and goes to sleep over the holidays. The majority of expats and even Mozambicans often return home, visit families, or go otherwise on holiday during a 2-4 week period over the holidays, leaving Maputo literally a ghost town. Not only is the office empty, but many restaurants, theaters, clubs, (much of the social life of Maputo) disappears.
Given this, it seemed like I might be in for a quiet New Years. In all honesty, New Year's has never been one of my favorite holidays but I was determined to do something that would at least keep me up past 10! But friend Claire, literally one of the few friends still in Maputo, made a plan to enjoy New Year's together.
After making a stop at a warm and lively party at one of my colleague's house from Ministry of Health, Claire and I headed down to the Baixa, the old part of town down by the sea. Each year, the Cordoso Hotel, perched upon a cliff overlooking the Baixa, holds a fireworks display at midnight. Tickets for the big event at the hotel are quite expensive so the masses instead turn out on the streets in the Baixa just underneath the hotel.
Claire and I arrived about 11:40 and the scene was already wildly animated and frenetic. Cars lined both sides of the road and were wedged into the median strip. So many small fireworks were already being set up by spectators, we were not sure if midnight had already arrived or not. We had seen fireworks for sale all day on New Years along side of the road and let's just say that there are many fewer restrictions and safety precautions with fireworks in Mozambique than one would find in the US.
We climbed up on top of the roofrack of the Landrover that my friend had lent to me while he's back in the States, opened up a bottle of champagne, and took in all the energy. Around us hundreds if not thousands of Maputanese joined in the celebration. Many were Maputo's large Indian/south-east Asian community. Entire families were there, young children, teenagers, adults, grandparents, in a range of traditional dress from countries of origin that included the very conservative (hajib) to more provocative. Music was pumping out of the cars, people were dancing, and midnight buffets were being set up on the trunks of many cars. By midnight, the sky was alive with lights, sound and color in every direction. On one hand it was beautiful and energetic and so alive, while at the same time, when i closed my eyes, I could for the first time imagine what it must have been like to be in Maputo during the civil war, with the whizzing, screaming, and exploding bursts of sound coming from every direction.
Safety precautions around fireworks were minimal to non-existent. Young kids were setting off large fireworks in the middle of the street with lit cigarettes and lighters with cars driving by (or at times cars driving over lit fireworks.) We could see fireworks being set from the balconies of apartments up the hill. We were waiting for a firework to go off in someone's hand or for an explosion to go off in one of the nearby crowds. My friend Claire is a nurse who has worked in Africa for many years and in many intense situations (including Sudan, Burundi, and Congo) and so was half-prepared to respond to any health emergencies that happened (we had the ice coolers and towels from the champagne bottle.)
The fireworks on the street continued on well past the official show was finished. The families in the cars next to us offered us fried pastries and warm wishes at midnight. By 1, we started to head home, but the party would clearly continue for hours. Families were still sitting around tables outside celebrating, kids dancing, and couple lingered around together. Clearly 2008 was off to a good start in Mozambique.
Given this, it seemed like I might be in for a quiet New Years. In all honesty, New Year's has never been one of my favorite holidays but I was determined to do something that would at least keep me up past 10! But friend Claire, literally one of the few friends still in Maputo, made a plan to enjoy New Year's together.
After making a stop at a warm and lively party at one of my colleague's house from Ministry of Health, Claire and I headed down to the Baixa, the old part of town down by the sea. Each year, the Cordoso Hotel, perched upon a cliff overlooking the Baixa, holds a fireworks display at midnight. Tickets for the big event at the hotel are quite expensive so the masses instead turn out on the streets in the Baixa just underneath the hotel.
Claire and I arrived about 11:40 and the scene was already wildly animated and frenetic. Cars lined both sides of the road and were wedged into the median strip. So many small fireworks were already being set up by spectators, we were not sure if midnight had already arrived or not. We had seen fireworks for sale all day on New Years along side of the road and let's just say that there are many fewer restrictions and safety precautions with fireworks in Mozambique than one would find in the US.
We climbed up on top of the roofrack of the Landrover that my friend had lent to me while he's back in the States, opened up a bottle of champagne, and took in all the energy. Around us hundreds if not thousands of Maputanese joined in the celebration. Many were Maputo's large Indian/south-east Asian community. Entire families were there, young children, teenagers, adults, grandparents, in a range of traditional dress from countries of origin that included the very conservative (hajib) to more provocative. Music was pumping out of the cars, people were dancing, and midnight buffets were being set up on the trunks of many cars. By midnight, the sky was alive with lights, sound and color in every direction. On one hand it was beautiful and energetic and so alive, while at the same time, when i closed my eyes, I could for the first time imagine what it must have been like to be in Maputo during the civil war, with the whizzing, screaming, and exploding bursts of sound coming from every direction.
Safety precautions around fireworks were minimal to non-existent. Young kids were setting off large fireworks in the middle of the street with lit cigarettes and lighters with cars driving by (or at times cars driving over lit fireworks.) We could see fireworks being set from the balconies of apartments up the hill. We were waiting for a firework to go off in someone's hand or for an explosion to go off in one of the nearby crowds. My friend Claire is a nurse who has worked in Africa for many years and in many intense situations (including Sudan, Burundi, and Congo) and so was half-prepared to respond to any health emergencies that happened (we had the ice coolers and towels from the champagne bottle.)
The fireworks on the street continued on well past the official show was finished. The families in the cars next to us offered us fried pastries and warm wishes at midnight. By 1, we started to head home, but the party would clearly continue for hours. Families were still sitting around tables outside celebrating, kids dancing, and couple lingered around together. Clearly 2008 was off to a good start in Mozambique.
Standard Setting in Nairobi, December 07
After a nice albeit brief personal and work visit in the States, I landed back in Africa for a meeting in Nairobi on Standards in Health Information sponsored by WHO and including a number of countries in Africa. I was joined by a number of colleagues from Mozambique, including the Ministry of Health, a public hospital in Maputo that is one of the first to implement an integrated electronic information system, and staff and students from one of the major universities in Mozambique who are working with the Ministry of Health on information systems.
Information systems in health care is an area where I have been increasingly working, first in Malawi, and now in Mozambique, as local governments and implementing organizations try to set up systems where patient information can be better documented thereby improving the quality of care as well as setting up systems to monitor what is happening at the local, regional, and national level (e.g. how many patients are accessing ARV therapy.)
The challenges to doing this--and especially doing this well--in Africa are great. Health care workers are in dire numbers (Malawi had about 1 doctor for every 100,000 persons and Mozambique has equally staggering rates, compared to about 1 doctor for every 300 patients in America.) Much of clinical care rests on health care workers who are less trained, in fewer numbers, and with fewer resources (e.g. anything from dependable electricity and running water to drugs). And many of the typical tools for such systems (sophisticated IT systems, communications infrastructure) are non-existant or non-reliable in Africa. Many computers hit the "computer graveyard" within their first year of deployment, "dying" from lack of virus protection, misuse, and the elements (dust, heat, moisture).
In these crowds, I am always humbled by the expertise and knowledge of those around me.
Though I do not necessarily speak the same language of software, hardware, communications standards, etc, there are clearly many lessons that are learned.
That as much as we can, we should not be trying to reinvent the wheel every time.
That we should continue to find ways to foster collaboration and communication as collaboration results in a better, more applicable, more scalable product (i sat and watched a group of developers try and debug a system for a while, each offering ideas, input, and other constructive criticism on how to make it better).
That sometimes working 80% is good enough to get going and start trying it rather than waiting until things are perfect.
And finally when something is working, trying to standardize and share those products, ideas, etc, can ultimately help us all move forward.
Information systems in health care is an area where I have been increasingly working, first in Malawi, and now in Mozambique, as local governments and implementing organizations try to set up systems where patient information can be better documented thereby improving the quality of care as well as setting up systems to monitor what is happening at the local, regional, and national level (e.g. how many patients are accessing ARV therapy.)
The challenges to doing this--and especially doing this well--in Africa are great. Health care workers are in dire numbers (Malawi had about 1 doctor for every 100,000 persons and Mozambique has equally staggering rates, compared to about 1 doctor for every 300 patients in America.) Much of clinical care rests on health care workers who are less trained, in fewer numbers, and with fewer resources (e.g. anything from dependable electricity and running water to drugs). And many of the typical tools for such systems (sophisticated IT systems, communications infrastructure) are non-existant or non-reliable in Africa. Many computers hit the "computer graveyard" within their first year of deployment, "dying" from lack of virus protection, misuse, and the elements (dust, heat, moisture).
Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems. 
Perhaps the most noteworthy piece is the role of collaboration across developers.
Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems.
Perhaps the most noteworthy piece is the role of collaboration across developers. Whereas software and systems development is often a competitive process with developers fighting for dollars and recognition, the meetings was full of ideas and learning being shared across individuals and teams, projects and countries. Though the needs remain extraordinary, there are small glimmers of initial success of appropriate and feasible information systems being developed and implemented, all with the aim of improving health information for persons in Africa and other less resourced countries. Most importantly, a community is starting to grow that is actively dialoguing and sharing what's working and what's not is being shared.
Perhaps the most noteworthy piece is the role of collaboration across developers.Despite these challenges, there is some amazing work going on to build these systems. Teams across Africa, with support from the US and Europe, are building the foundation of systems.
Perhaps the most noteworthy piece is the role of collaboration across developers. Whereas software and systems development is often a competitive process with developers fighting for dollars and recognition, the meetings was full of ideas and learning being shared across individuals and teams, projects and countries. Though the needs remain extraordinary, there are small glimmers of initial success of appropriate and feasible information systems being developed and implemented, all with the aim of improving health information for persons in Africa and other less resourced countries. Most importantly, a community is starting to grow that is actively dialoguing and sharing what's working and what's not is being shared.
In these crowds, I am always humbled by the expertise and knowledge of those around me.
Though I do not necessarily speak the same language of software, hardware, communications standards, etc, there are clearly many lessons that are learned.
That as much as we can, we should not be trying to reinvent the wheel every time.
That we should continue to find ways to foster collaboration and communication as collaboration results in a better, more applicable, more scalable product (i sat and watched a group of developers try and debug a system for a while, each offering ideas, input, and other constructive criticism on how to make it better).
That sometimes working 80% is good enough to get going and start trying it rather than waiting until things are perfect.
And finally when something is working, trying to standardize and share those products, ideas, etc, can ultimately help us all move forward.
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