Thursday, December 22, 2011

Data Management: 102

In global health and development, the best laid-out plans rarely go as planned. Take the evaluation project that I’m managing, for example. It seemed so simple to me: spend a week or so collecting hard copies of client data from almost 50 sites across Malawi, spend two weeks entering the data into an electronic database, spend a month cleaning and analyzing the data, and then write up the results in time for the Christmas holiday. In a past update, I described that the process was more complex, though hopeful that it would be completed during a two-week leave I took in November. I’d envisioned that upon my return, our team of three would have completed data entry and we would start the process of data cleaning and the “fun” stuff: analyzing the data and seeing program results. What I came back to nearly gave me a heart attack; our team had actually backtracked due to “technical difficulties.”

My initial response was disbelief, and then frustration (especially since I had to relay the lack of progress to my boss, my bosses boss, and a director at headquarters). But after two days of meetings, phone calls, and sifting through piles of data, I realized that all the frustration in the world wouldn't solve the problem; I had to develop a plan.

Lesson One: communication is key. I am more convinced than ever that in life – professional or personal – communication is a major proponent of success. In my current position, this is no different. There are so many people involved in the evaluation: community health workers, who are intimately familiar with the data they collect; in-country management staff, who oversee the community health workers and manage national-level data; headquarters staff, the “top dogs” who make international decisions that affect the entire organization (and who also set the deadlines that affect our work at the country level). There has also been a lot of fluidity: management staff who spend alternating weeks in the field, and community health workers, who are often meeting with clients; the resignation of a colleague who was co-managing this project; the brief leave of the sole data entry officer. With these circumstances, it’s no wonder that communication is crucial.

Lesson Two: development is the way forward for health. The transition from paper to computer records has been a topic of debate in the context of the developing world. The challenges against it are numerous – inconsistent power, high costs, belief in the lack of technical capacity – but the challenges that arise from not implementing such a change are numerous as well. Since the beginning of October, we launched our attempts to collect data, thinking the process would be quick: contact managers to make photocopies of logbooks with hundreds of clients’ information, and send those copies to our head office in Lilongwe. But between slow transport, illegibility of the copies, and lost data, a simple process has become challenging. I've spent hours on the phone, speaking with community health workers in my sad attempt at the local language of Chichewa. I’ve requested that sites resend data when its quality seemed compromised. I even made a six-hour trip to three sites just recently since we couldn't get in touch with them by phone, hand-copying client information to ensure data accuracy. I kept thinking that if we used computer databases and invested in training personnel here, an expensive investment but with many returns, we could have avoided several of these challenges.

The Verdict: Overall, I am proud to say that by the end of this year, we would have collected all necessary data (albeit a month behind schedule). I continue to learn a lot through this data management process. I can’t say that I see a future in this – nor would I have expected I’d end up here post-Master degree – but it is a learning experience that a classroom couldn't teach me. While I continue to learn about then non-profit world and working with colleagues from very different backgrounds, I’m also learning about myself: about the way I directly and indirectly communicate, about the way I handle stressful situations, about the role of leadership when there are still people above you. I’m learning that I am a creative problem-solver – that there is no such thing as “no” in my rulebook – but that I also need to be creative in the way I interact in places where that same mode of thought is not a norm. And perhaps most importantly, I’m learning to accept that while plans are important, flexibility and adaptability in a global setting are just as necessary. An unexpected lesson from a data management assignment, but an eye-opening one nonetheless.

Tuesday, December 13, 2011

Oh Nigeria, I Think I'm in Love...

In loving memory of Grandpa and Grandma Adewusi... 

Grandpa, Grandma, and the grandchildren
(That's me, back row, in the blue dress and jheri curl)

Oil. Power. Population. Corruption. Do a Google search and you'll probably find these terms used synonymously with the country of - I'm sure you guessed it - Nigeria. 

Beauty. Culture. Community. Promise.  After my recent visit (the reason for my extended silence), I really believe that these words describe this nation.

After a challenging start to my time in Malawi, I was excited about making this trip to Nigeria. I was sad that the occasion was my grandmother's funeral (or "the celebration of her life," as the event was viewed), but I was happy that for the first time in more than 3 months, I would be with family. In true Diva-style, I began my trip with a 15-hour layover in Nairobi (code for: 2.5 hour bus ride to city center, 1 hour visit with a friend, 3 hour dinner with another friend and her adorable toddler, 3 hour visit to boogie down at a local joint, more time than is worth counting on public transport, and, oh yes, a 2 hour nap at the airport).

Adorable. So worth the 15-hour layover.
My friend and I in Nairobi.
Reminiscing, as I visit the apartment I stayed in last summer.

After a short stay in Lagos - Nigeria's former capital, and upon my parents arrival, we traveled to Ibadan - another south-west city known for its massive size (one of the largest cities in Africa) and "town-like" feel. I spent quality time with an entertaining cousin and enjoyed some of my favorite things: shopping for fabric and designing new clothes (though bartering at the market is an art I've yet to cultivate), suya - delectable meat slices covered in chilli and other spices roasted right in front of you, and, of course, all the fried plantain I could eat!

Traffic in Ibadan. (This is a good day...)
Stands off the side of the road where we bought fresh fruit.
Development at its finest.
Ankara! Time to design some new clothes.
Preparing the suya.

A few days later, we made the trip to Ede, a town in Osun State and former home to both my grandparents and my mother. We spent most of our time preparing for the event, but had a little time for family fun too! 

The road leading into Ede.
Possibly the best fruit ever. 
Ede town.
Organizing the personalized souvenir flashlights that were
given to guests at the reception. 
Bush meat. (aka: "birthday meat" for me, two years in a row).
Enjoying a glass of palm wine with my mama!

The trip was bittersweet. My grandmother's funeral was beautiful, and a perfect representation of what she would want her last party to look like. The 2-day event started with the transport of her body from Ibadan, followed by a procession from the outskirts of Ede to the house. A hired group of performers carried the coffin, dancing to the tunes of a small band, while we followed behind in parade-like fashion. As a siren blared in front of us, alerting the town of the event, community members offered their condolences. 

Preparing for the event at the house. A cow is being cooked (left)
while the yard is being cleaned.
Preparing the front of the house for the wake. 
The performers sing and dance, followed by the body and family. 

Upon arriving at my grandparent's property, I was greeted by an exciting aroma and most welcome distraction - the smell of fried dough, puffpuff  and buns, possibly my favorite snacks on the face of the planet. My mom and aunt arranged for the special preparation of these yummy snacks in mass numbers in honor of my birthday, which coincided with the first day of the celebration of the life of Grandma. 

Mixing the dough...
Frying the dough...
Me following the chef, ready to eat the dough...

Yum! A hundred buns just for me!
After eating far too many donuts and an outfit change, it was time for the wake, held at the home. It was the last viewing of my grandmother, a true woman of faith often remembered (and misrepresented) for her theatrical nature and beautiful voice. What a lot of people don't realize is that my grandmother was an exceptional woman, well-known in her earlier years for her work in nursing and midwifery, and that she took a lot of hits for those around her. 

My dear Grandma.
May her soul rest in peace.
The next day hosted a two-hour church funeral service, followed by a three-hour reception of music, dancing, and traditional Yoruba food for hundreds of family members and guests. The local king, who belongs to one of three families including my own eligible for the crown, attended the event as well, dancing and "spraying" (tossing money over someone who's dancing) my family. I had a lot of fun attempting to shake my hips, Naija-style.

The dancers dance with the coffin on the way to the church.
The grandchildren now after an afternoon of dancing.
We've come a long way...
The afterparty.

The last few days of my trip involved another trip to Ibadan, where I enjoyed more suya and saw the University of Ibadan Medical School, one of the best on the African continent.

Ibadan Medical School. 
Suya stand: where good things come from!
Quadruple yum!!!!!

My stay ended in Lagos, where one cousin took me to Victoria Island for a day of fun. I watched a newly-released film (something I can't do in Lilongwe, since there's no movie theatre^), road an okada (motor bike), and was so surprised to see development on the island: required helmets for the okada passengers, people actually waiting in line at proper bus stops...These things may seem trivial, but anyone who's traveled to the African continent can attest that they are positive signs.

The Galleria. Am I still in Nigeria?
The okada drivers and passengers are wearing helmets!
(For some reason, they didn't give me one when I rode...)
My cuz and me on the bus back to mainland.
Notice: people are waiting patiently in line to board the bus.

Though I was sad to leave, I ended my trip in true Diva fashion, amusing myself during a missed connection in Nairobi. 

Me at a hotel in Nairobi, compliments of Kenya Air.
Well, I tried...
I think I improved by the end of the night.

And so I returned to Malawi, missing the vibrancy of Nigerian life and confident that I want to test it out for a year or so, should the opportunity arise. Of course it was only fitting that in my first week back in Malawi, I would meet a Nigerian at the vegetable market who would invite me to a soiree with at least 200 Nigerians present (who knew Malawi had so many??). 

Don't be tardy for the

I really miss my beautiful grandmother and her voice, my insightful grandfather (whose "life celebration" was exactly 1-year earlier) and his stories, and being back in Nigeria makes me feel connected to them. I loved interacting with almost all of my family for the first time in ages and seeing that we can all relate to one another despite differences in age, upbringing, and geographic location. I loved experiencing the richness of Yoruba culture - the Ankara fabrics and bold fashions, the music and dancing whether at church or hanging out in the kitchen, the religious conviction whether through the five-times-a-day Islamic prayers blaring over megaphones or nightly family prayer sessions, preceded by the phrase "Oluwaseun" ("We thank God") at least 20 times in a day. I loved talking and listening to intelligent conversations on Nigeria - on politics, challenges, and the way forward. I loved looking at the success that some people have been able to achieve through hard work and opportunity, in spite of other challenges: my uncle's architecture business and my adopted grandfather's international school (soon to be expanding to the university level). In spite of its blemishes, I really love Nigeria. 

^I stand corrected. There is, in fact, a movie theatre in Blantyre, Malawi that is operational as of June 2012. It's actually nicer than the theatre in my hometown...

Thursday, November 17, 2011

Data Management: 101

Over the last two weeks, as part of a program evaluation, I've been doing  something that sounds relatively simple: data entry. Our individual client records are kept in hard copy form only, and so in order to meaningfully look at how our program has impacted HIV transmission in Malawi, the first step has been to put the data into an electronic version. The steps involved seemed simple enough: 1) collect almost client registers from 50 sites throughout the country, 2) randomly sample tens of clients from each site's register, 3) enter the data into the electronic database. The reality is that I now have a much deeper appreciation for this part of data management!

Counting then number of clients seen at each site

Step 1: collecting the documentation of the data. Because the client registers are used on a daily basis, it's impossible to remove them from individual sites for a prolonged period of time. We asked locally-based staff to make photocopies and send them to our headquarters, which proved more challenging than I anticipated. We then dealt with the additional complication of illegible copies, not knowing which pages correspond with one another, and the list goes on! We started our project two weeks ahead of schedule, and it seems we're now falling two weeks behind....

Step 2: random sampling. Well, this is a fairly complex process that computers have made super easy. Statistical calculations help to determine how many samples you need based on total clients and the level of "power" that you want. Software also helps to generate random numbers, which were necessary for the sampling. I won't bore you with details but this was the easiest part of the process!

Step 3: enter the data. Now the fun begins! It seems straightforward: identify all 100 or so clients required for each site's sample (using the random numbers) and plug their data into the database. But when you're entering 30 pieces of information for hundreds of clients, it starts to become tedious! Then there's the challenge of reading our data recorders' handwriting, understanding conflicting information that's documented, and - of course - making sense of the non-English comments that sometimes appear alongside a client. The other day, I spent more than an hour on the phone struggling to communicate with health workers at a few sites to get clarification on some of their data!

So after two weeks of data entry, my hands are hurting, I have a crick on one side of my neck, and I can say with full certainty that I won't be sad when when this part of the process is over. When I was working on Masters thesis, I thought that the quantitative data analysis component was so difficult, trying to piece together two years and seven quantitative classes worth of information as I analyzed Demographic and Health Services data. But today, after two weeks (and counting) of attempting to enter data to the highest quality in hopes of improving our impact, I have a much deeper appreciation for data entry. I have enjoyed mentoring our assistant data entry clerk and being able to take ownership of this project from the very early stages, but I'm confident that data entry isn't where I see myself in the future. The next time I read an article with the latest statistics on HIV or the hot health topic of the minute, and the next time I perform any type of statistical analysis, I will have a much greater appreciation for the work that went into just compiling meaningful data!

Monday, November 7, 2011

Clothes, my Old (and Now Renewed) Obsession, and the Malawian Textile Industry

In hard times, when "looking within" just isn't working, it's easy to look around you for little things that make you happy. While food (via cooking and self-taught nutrition lessons) has captivated my attention lately, I was recently reminded of one of my first loves: shopping!

Many of the Malawians I've spoken to buy clothing at a second-hand market, where they have every item (in every brand) that you can imagine. And so after weeks of trying to convince someone to take me, I decided to dive in head first, and explore the second-hand market. This past Saturday, my friend Eric and I walked through our favorite vegetable market across a tiny bridge to get the infamous "kawunjika" of Lilongwe. I watched groups of women sifting through piles of clothes, trying to grab the latest fashion before then next woman would. I tried on countless pairs of really skinny jeans and after negotiating down from an initial price of 1500 Malawian kwacha, I settled on a slightly looser pair at Mk500 (just over US$3). I left three hours later feeling very accomplished, and very tired...

As I reflected on my exhaustion, and how I wouldn't have the energy to regularly haggle at the kawunjika, I remembered a very different form of shopping I was recently introduced to.  

From time to time, a saleswoman comes by the office selling something: jewelry, homemade spicy mango something-or-other, office supplies...Two weeks ago, a woman came by selling just what I needed: brand new clothes.

To my surprise, I learned that Malawi has a textile industry. Companies particularly in South Africa and Canada contract with a factory in Blantyre and have their clothing mass produced. I was surprised to learn this, given the hundreds of clothes "Made in Mexico" or "Made in Tawain" or "Made in [insert non-African country]" I've purchased over the years. Malawi's textile industry, I discovered upon inquiry, exists, but is not on the mass scale that other countries have been able to capitalize on.

Could it be, as Sema-Banda wrote a few years ago, that the dwindling cotton industry is the root of low textile export? Or is the "Made in Malawi" brand so little known because exports have been stunted due to competition from the second-hand market? I bought a brand new "Made in Malawi" blouse at Mk1000 (US$6), though I'm told I could negotiate down to Mk300 or less (<US$3) for the same shirt in the market.

Or maybe, as Pereira eloquently blogged about, it's much more complicated than that. There's a history of the textile industry here that must be considered from the 1994 structural adjustment policies (SAPs) that introduced a liberal trade policy, to Malawi's importing of fabric (despite being a cotton producer), to two key elements "private investment and the political will to entice that investment."

My recent shopping adventures have stimulated my curiosity on Malawi's textile industry while reminding me of Dr. Edozie's undergraduate course where we read and discussed "T-Shirt Travels," a story on how the clothes we give away "to charity" in the U.S. actually have significant impacts on developing country's economies. I won't bore you with jargon, but needless to say, I've discovered two exciting forms of shopping that I just wouldn't be able to do in the U.S. My pocketbook needs to take a break but I'm sure I'll have plenty of updates (and several new clothing items) over the coming weeks.

A small-scale version of market shopping: piles of clothes are
left for the buyer to sort through and select. 

The shirt I bought.

Good Times, Good Peoples at Lake Malawi: Salima Style

This past weekend was my third trip to Lake Malawi. Rather than heading south to Mangochi or Cape Maclear again, I and 13 of my friends traveled to Salima. Just an hour and a half away from Lilongwe, Salima is a beautiful, Michigan-esque lakeside town; there were so many trees and such beautiful vegetation that I envisioned the natural beauty of my home state, with a twist of course.

We stayed at a lodge called Safari Beach, which I settled on after contacting at least 15 different venues. The place was beautiful and quaint, as we stayed in two-story family-style bungalows, complete with two balconies overlooking the lake. The food was delicious (which, of course, was essential), and they even had a Saturday night lakeside barbecue with an awesome DJ, just what we needed for a late-night dance party.

What was my favorite part of the weekend? Well, besides the amazing company, the time at the beach, and a late night swimming fest, I really enjoyed the "safari" element of the lodge. There were colorful lizards, no-tailed squirrels, and these cute little rabbit-looking rodents, but the highlights of all the animals were the baboons. They hopped on our decks and thatched roofs, walked in the pathways, drank from the pools, and a big papa even tried to steal my french fries! (Definitely much cuter from a distance).

All-in-all, another fabulous weekend by the lake! I think for the next adventure I'll have to travel north...

Our cute bungalows

The view from my deck

Adorable...when they're little...and at a distance...

Breakfast time!

Lakeside; seems there's a fish market over there

Conference center at the lodge (the baboons loved jumping
on the roof)

The view!

Fun on the beach

Friends hanging out

Went kayaking (and didn't fall in!)

Beautiful landscaping at Safari Beach Lodge

Welcome back dinner (there was no power...)