The Workplace-- Three Months In

Three Months In:  The Workplace

Everyone who writes or comments about their Peace Corps experience reveals unexpected personal growth.  Most volunteers confess that they gain far more than they give.  Three months into my service, and I am feeling much the same. 

Each day I sit with my Mozambican colleagues in the hospital observing their work and the daily activities.  I sit in the corner of the office, sweating in a pleather chair, a voyeur, hovering over the counseling sessions offered to patients who have just received their positive HIV test results.  Most of the people seem non-pulsed.   Different reactions attributed to cultural differences? Denial?  Maybe they are all too familiar with this epidemic? Others laugh nervously throughout the session.  

Hospital workers walk in and out of the office, dropping off files, greeting their office-mates while cell phones ring with tones of merry music or recordings of children,  all at peak volume.   The counselors answer these calls in the midst of the counseling sessions.  Loud and long conversations ensue.  I cringe internally, my American sense of propriety, confidentiality and privacy shattered.

Other times, I sort through files, desperately trying to interpret indecipherable notes, trying to track adherence, CD4 counts or other necessary and measureable variables.  I pore though stacks of cumbersome registry books, feeling like a character straight out of a Dickens novel.   A patient’s age is noted on the outside of the folder, when their file is opened, and never updated.  So much for reliable data.   Clinical workers make notations, request lab tests, but there are no dates noted, so it is impossible to determine if there has been follow through or updates.  The files and folders are dirty and tattered.  In an attempt to organize the papers, I use one of the two staplers available in the hospital.  After every fourth staple, I need to adjust the stapler.

Other days I accompany the volunteers, the Buscars, into the community as they search for patients who have abandoned treatment.  Their mission is to encourage the patient to return, seek counseling, and pick up a new supply of medicine. We speak to the village elder for assistance to locate the patients.  As we walk winding dirt paths throughout the barrios, without abandon we ask for directions and more information about the patient.  While we do not divulge the status of the person this practice is so common that everyone is aware of what it means when a Buscar visits.

More often than not we do not find the person.  Either the address is incomplete or false.  When we do find the person, we learn about their obstacles to treatment; the medicine is making them ill and they do not have the food, or the money for the food, to counteract the side effects.  Or, they do not have the transport, or the money for the transport, to get to the hospital.  We have nothing to offer them, no food, no transportation, no money, no solutions; simply encouragement and education as to why they should continue treatment.

For me, the experience is like stepping into a scene from National Geographic.  I take in this new world; the mud houses, the hordes of children playing in the yards, women sitting on straw mats, plaiting one another’s hair.  I note everything that I can, the physical and social. 

But my presence often disrupts the process.  Almost everyone asks my Mozambican colleagues if I have come to give money.  After watching countless movies and novellas about the lives of white people, and particularly Americans, they think that I am the person of their dreams, stepping into their mud homes to suddenly and magically transform their lives.

Sometimes we offer workshops about family planning or domestic violence to the women.  The men are never invited. I make the suggestion along with an explanation of the importance of including men.  I am quickly rebuffed.

Back at the office I make simple recommendations.  Why not put messages on the Dry Erase White Board, our singular and coveted resource, in the hallway?  We could promote the importance of adherence to the HIV medicines, our biggest challenge in Nicoadala District Hospital.  Each day there are crowds of people waiting for service.  This could be a passive form of education, to replace the daily workshops that are no longer occurring.  It would be easy and without cost. 

The counselor, who is a government worker and supervises this office, tells me this is impossible.  Firstly, she would like to keep the board for the staff, all five of us. Odd, I think, I’ve been here for three months and I’ve never seen this board put to use, for anyone.  In her defense, there were no dry erase markers.  She had taken them home for her own use.  Secondly, she tells me this is not necessary as it is her job to make daily announcements and offer workshops on this and other health issues.  As politely as I can, I point out that, in fact, she is not making any announcements or offering workshops.   She shrugs and tells me it is for the local volunteers to do so. 

But most of the volunteer Peer Educators have stopped their activities, dismayed and discouraged that their small stipends have not been paid in months.  Last week I had written up a proposal, in the SMART format, to meet with the remaining volunteers to reignite the program.  This was to be the focus of my volunteer role and the area of my greatest excitement and interest.   I was told the situation is too delicate and that we must leave it.

So, what is it exactly that I am offering my organization, ICAP, or the people in the office?  Surely, I am gaining knowledge as to the workings of the hospital, the medical aspects of HIV, forming relationships with colleagues, and taking field trips that fuel personal short stories and essays.  I am practicing patience beyond what I thought imaginable; sitting for days at a time, witnessing and accepting very different standards of care, assuming a loosely defined role that is neither worker, intern, consultant or advisor.  I am learning about Excel and monitoring and evaluation by doing work that my colleagues should be doing, work that is most likely not to be sustained when I leave.   My language skills are improving slowly but surely. 

This is the Peace Corps approach; building relationships and slowly becoming a part of the community to then be able to facilitate change.  And facilitating that change isn’t about what I will do, but how I will help those I work with to identify what those changes should be and how to make them. 

Each day I review my day with the following questions: 

Was I helpful?

Was my work useful?

What was the impact?

Is it sustainable?

Normally, I can only answer yes to two or three of the questions.  I take that as a small success and put the day into perspective.

Yes, I am certainly gaining more than I am giving.  But for my host organization, what is in it for them?  Am I meeting Peace Corps objectives and goals?  Is this experience enough to keep me here for two years?  It all continues to unfold. Three months into service and my questions abound.