flickr stream
 |  |  |  |  |
Posts Tagged ‘stopstockouts’
Live from Livingstone
Ciao!!!
so on Wednesday afternoon Casco came home together with Banza to pick me up, then we all traveled to Livingstone, the Zambian ex capitol city, founded by the famous British explorer Dr. David Livingstone, located in the very south of Zambia, at the border with Zimbabwe.
We started our trip at 3pm to arrive in Livingstone 9 hours and 500Km later, very tired after the long travel (and the last 50Km in an out road that felt like 200 ), but very happy and excited for what we were up to do at destination. We settled in a ‘classic lodge’, a very nice resort and finally went to sleep, to gather the energies for all the activities we had to perform during the following day.
On Thursday we got up early and we swiftly headed towards the Mosi Oa Tunya building situated along the Mosi Oa Tunya Road… well in Livingstone Mosi Oa Tunya is the word, it means the ‘vapor that thunders’, and is the name the locals use to refer to the world famous Victoria Falls, which can be found some 10km out of the town!
Arrived at the Mosi Oa Tunya building we met with Lloyd, the coordinator of NZP+ there in Livingstone. The NZP+ team welcomed us warmly and we started the first activity of the day: a focus group about the medicines stockout situation in the Livingstone area. During the meeting various experiences were shared both from patients and health workers and the panorama that was illustrated was quite critical: the District Distribution Centers seemed to have all the medicines that were needed, but in the end the local clinics were receiving just a very little subset of them, not even those medicines that they requested, but just a random sample of them.
For example a local clinic needs 10 kits of ORS(for Diarrhea) and 20 kits of Coartem (for Malaria); it requests them to the District Distribution Center to receive them on the following month (the deliveries are monthly based). On the following month the truck arrives, they open the crates and usually what they find out quite far from what they actually need: ONE kit of ORS, NO Coartem at all plus a random set of NOT requested medicines.
This is a huge problem as you can imagine, and after the long discussion in the focus group it seems to be caused by four layers of challenges:
1) Infrastructural: the road connecting the District Distribution Center with the local clinics is not adequate. It is narrow, the tarmac coverage is patchwork like and it doesn’t reach all the local areas, so the (few) trucks are having big difficulties to reach the end destinations.
2) Economical: the clinics and pharmacies have very little personnel, one person for example is running the whole distribution at district level! So she has to receive the requests, check the inventory, prepare the crates and load them on the truck. On the clinic side the doctors and nurses are few and they struggle to diagnose the disease that is affecting any given patient because of the lack of reagents that the clinic lab should use to perform the needed tests… so they end up diagnosing the patient just looking at him, maybe checking its temperature with the palm of their hand hoping to diagnose the right disease… it is a trial and error process.
3) Technological: there are NO controls over the distribution flow of medicines, meaning there is no way to rationally check if the requested medicines have been actually sent or received. Due to this lack of controls a plethora of crimes are perpetuated both at the Central Distribution level, where pharmacists steal the public medicines to later sell them at high price in private clinics and pharmacies, and at the Local clinics level, where underpaid health workers just sell the public medicines to pump up their spectral salary. A computerized system could easily put a patch on this issue, the issue is the money… it seems there are no funds to have such system in place (the HIV/AIDS medicines distributions system is fully computerized, everything is trackable and surprisingly enough there are NO stockouts of HIV/AIDS medicines countrywide… it is funded by external NGOs not by the government…)
4) Cultural: the Zambian population grew up with such system in place so they just consider it the rule… they are not educated to be aware of their rights as Zambian citizens so they don’t recognize when their rights are being violated, thus they don’t protest, thus nothing changes. This issue can be fixed just trough the education of the new generations and sensitizing the older generations on the ground about their rights.
After the focus group we started with a series of interviews featuring a government pharmacist, a nurse from a local clinic and a patient suffering from malaria. The results were key and they will be all part of the final documentary we’re going to produce by the end of this first stage of the project.
On the following day we went to a very famous local radio station ‘The Mosi Oa Tunya Radio’ to broadcast a one hour program about the medicine stockouts theme. It was quite successful and the use of radio has been selected as the medium of choice also for the future activities of the campaign.
In the afternoon we all moved out of town to visit the Victoria Falls… one million words cannot describe them… I will just say INCREDIBLE
obviously I squeezed out of my camera’s batteries all the possible juice eheh
Now I’m back in Lusaka, there are just two days left to work here before I come back to NYC so lot of stuff to do!!
CIAO
StopStockouts Zambia Debrief
So yesterday I finally had a meeting with both Casco(NZP+) and Banza (representing TALC) in order to evaluate the results of the Pill Check Week event and to plan the next steps of the StopStockouts campaign here in Zambia.
Up to now the results of the Pill Check ‘Week’ here in Zambia have been not completely satisfactory as during a period of two weeks and a half we have received a total of 50~ stockouts reports while in Kenya, for example, the team received more than 300 messages!
after a long discussion with Casco and Banza we came to the conclusion that the pill check here in Zambia didn’t work out as expected for a multitude of factors such as:
a) The health workers strike which completely destabilized the health care system settings for a long time
b) In Zambia the interviews had to be taken by volunteers not belonging to any professions, just common citizens while in Kenya the interviews were carried on by people belonging to the medical professional branch.
c) The volunteers were left with little technical, economical and conceptual support as Casco and Banza, the two responsible for the project, left for South Africa for two weeks during the most delicate moment of the campaign, that of the interviews.
Given this scenario we decided to extend the Pill Check event for the next two weeks, this time giving proper technical, economical and theoretical support to the volunteers, especially those outside Lusaka which suffered most the lack of direct contact with our central team. We hope that, following this strategy, we will be able to receive the critical amount of information that will give substantial results to be then disclosed to the media in order to sensitize the population, but more importantly, put pressure on the government to face this challenge and find a solution.
This were the contents of the first half of the meeting, during the second part we discussed a plan for the upcoming trip to Livingstone, a city very close to the Victoria falls in the extreme south of the Country. We agreed that we’re going to travel on Wednesday July 22nd, stay in Livingstone for 3 days and come back during the weekend. We are going to interview many people there including patients who suffered essential medicine stockouts, nurses and doctors, who are in a very crucial positions as, having direct access to the medicines stocks can determine whether to be part of the problem or to help to solve it.
During the very final part of the meeting I showed them the rough draft edit of the first interview I’ve performed, with the help of Dando, in the Chasanga compound in north of Lusaka one week ago. They were very satisfied by it and enthusiastic about it, they want to use it for the next advocacy events too! We discussed the best strategy to publish it in an online environment and I suggested to differentiate in two formats, a short and a full version. In the short version the user will be able to pick a single interview and watch/download it. The full version will provide the user the whole mini-documentary with all the interviews and extra materials included. The casual blogger may be interested in a single interview, while a news portal may embed the whole documentary.
Capocola’s Curse
Ciao! for the last 5 days I haven’t been able to connect to the Internet so here it is a cumulative update 
About the StopStockouts campaign: finally this week the health strike has ended so we’ve finally been able to receive data about stockouts from the volunteers spread all around the country.
In the mean time I’ve kept myself busy preparing for the interviews that will be included in the stopstockouts.org website, together with the map which visualizes the stockouts data. As Casco is out of the country until Saturday I’ve worked with Dando to come up with a simple yet effective strategy to collect the information we wanted from the persons we were going to interview. Friday, the day of the first interview, arrived and we departed early from Lusaka towards ‘Ten Miles’, an outpost, surprisingly, located ten miles north from the city center! Once arrived there we called the person we had to interview who informed us that the community center she was located in was VERY NEAR ten miles… well that ‘very near’ probably was related to the size of the earth as after some good 30 minutes of driving in the bush we found out that the community center was still 25 miles ahead of us… the fuel was little, the temperature was high, and the nearest fuel station was back in Lusaka so, despite the suggestion from Dando to go on and risk, I kindly declined and decided to go back to Lusaka as I opted to be at home in the night rather wandering around in the bush to find a plant able to distill fuel.
Once in Lusaka we I suggested to rehearse the possible interview so that on the next occasion we would have been much more prepared for it, Dando accepted and everything went fine. On Sunday we had scheduled the second interview, this time was really just out of the perimeter of the center of Lusaka. We reached the location where we met Phelloner, a woman who recently suffered Malaria, victim of a medicine stockout. We followed her to her place and met her husband, then, after introducing them to the stopstockouts project we went on doing the interview. She proved to be a perfect candidate as she explained her situation very clearly though emotionally, providing also a broader view on the issue at national level. The first rough edit of Phelloner’s interview is ready and it lasts almost five minutes. Many more interviews are going to follow as soon as Casco comes back from South Africa, next Saturday. We’re going to move from Lusaka to the rural areas in the sound provinces to collect some experiences of people from around there.
On Saturday I took all my A/V equipment to the church Casco’s family uses to go to as the pastor Moyo asked me to prepare a dvd video of the performance of the group “Redeeming Love”. We prepared a simple set in one of the classrooms and the sun was our friend as it provided a very warm light for our footage. The dvd is now ready and the group really liked it, they’ve been watching it continuosly for hours! I even memorized the songs! I’ve received some proposals from other groups to document their performances during a one day event, one group composed by 6 people, one composed by 24 people and a Theater company doing acting and dancing performances called COPATHAZ… I just hope I have time to meet everyone needs!
Why the title? Capocola means Cop and the curse is that every time they see me driving alone they seem to feel the irresistible need to stop me for any reason, officially ask for a huge sum of money and then settle for 50p the equivalent of 10$… sadly corruption is the rule here.
There’s always something to do
Ciao! so in the past few days the combination of wordpress+my internet connection was not the happiest one but finally today I got connected!
lot’s of things happening, very briefly:
the StopStockouts campaign is going on well, most of the regional teams are up to speed and they’ve received lots of data about lack of essential medicines (Kenya in particular, good for Mike!!!)
In Zambia we’re a bit back compared to the other countries because of the health workers strike which has been going on for one month now. The government has menaced the health workers to go back to work if they don’t want to be fired, so most of them are starting to work this week putting a patch on this very dangerous and sad situation. In few days the health centers should be back to normal so our volunteers can proceed with the interviews. Up to now we’ve a total of 23 volunteers working on this project all around Zambia, from the capitol Lusaka to the far provinces of Mansa in the North and Livingstone in the South.
Casco has gone to a two weeks workshop in South Africa and left me to coordinate and push forward the project in its most crucial moment. He left me his car which I’ve enjoyed driving for one day, before it completely FAILED on me on the second day: the battery was drained, the starting engine was leaking oil and finally the electric circuits controlling the engine rate went crazy so the car was almost driving itself! Accelerating and decelerating on its own! So now it is being repaired, in the mean while I’m working with Dando planning the structure and the strategies for the documentaries we’ve to produce to illustrate the stockout situation here in Zambia. We’ve prepared a set of ten questions which will allow us to retrieve this sensitive and personal information in a smooth way. We’ve agreed with Casco we’re going to take two interviews in the Lusaka area while he’s abroad and when he will be back we move to the rural areas to interview some people there to have a broader view on the problem, not only in a urban area as Lusaka but also in a very different part of the country, where even the basic services like electricity and clean water are missing.
So, I’m keeping busy! 
note:
as I’ve not been able to post every day because of the interweb+wp problem I would like to ask Bruce and Steve if there’s a way to speed up the wp amin interface, make it more lightweight to load. Looking at it seems pretty lean but you never know what’s happening under the hood of a cms.
CIAO
Oribuangi
Ciao!
On Saturday I joined Casco at the MeTA (Medicines Transparency Alliance) workshop hosted at the FRINGILLA lodge 50kms north of Lusaka.
Casco picked me up from Matero (a neighborhood of Lusaka) where I was attending a funeral of a young man who died of Tubercolosis because of the health strike still going on in much of the country.
After some 40 minutes of driving on the main road connecting Lusaka to the northern provinces (quite a thrilling experience no lights, two lanes, HUGE trucks going in the opposite direction) we arrived at the lodge where I could finally eat and rest, preparing for the talk I had to give the following day. The problem is that I ate TOO MUCH, TOO LATE and happily drinking a FREEZED can of Coke; it didn’t take much that I discovered that combination was not the smartest one… the following hours were characterized by abdominal pain, no sleep and frequent visits to the restroom
Casco arrived at 8am and, after I notified him I had food poisoned myself, we agreed to meet at noon in the conference room, so I could recover a bit and, at least, join the workshop in its last session. I woke up at 11 to find myself in a very beautiful surrounding, with bungalows, springs and trees all around in a very sunny and crisp day. Fortified by such vision I dressed up and reached the conference room. Casco had just started presenting the StopStockouts campaign and, as soon as he finished the introduction, handed the presentation to me, so I could practically show how the system was implemented and to answer the more technical questions. The presentation went well, the MeTA people were very interested to the project and the technology behind it, as they also work on the issue of medicine transparent distribution and accessibility, which could benefit from the use of mobile technologies to track medicine and check their status.
After the workshop we passed the following day just enjoying the place and having fun with Casco family.
We then returned in Lusaka. Now we’re a bit stuck with the campaign, at least here in Zambia, as the health strike is far to be solved. In the mean time I’ve helped the Malawi team to setup FrontlineSMS and to sync with the other teams in the other countries. Hopefully we’re going to start to collect data by next week. It is possible that in the next few days we’re going to meet with the Ministry of Health, to inform him about the upcoming data collection event; Casco told me the minister is supporting the project so he may have some suggestion to give us.
About the title; Oribuangi means how are you in the Zambian slang, you have to respond Bueno! that is sooo italian eheheh
A striking situation
Ciao!
so yesterday we held a workshop here at Civic Center in Lusaka, in order to orient the local volunteers on the StopStockouts campaign. We went over the fundamental concept of Essential Medicines and how it is currently implemented here in Zambia. We digged deep into the guts of the problem together with the help of some medical staff which, surprisingly, was present at the meeting. I knew we had the support of the Minister of Health but I wasn’t expecting to see actual medical staff attending our lil’ workshop. It turns out that the NATIONWIDE strike is only partially settled and almost all the public hospitals and clinics are still unoperative. They have been basically closed for three weeks now, the workers ask for an adequate salary and a TRANSPARENT AND MORE ORGANIZED distributions of the medical equipment (included medicines). The government is doing the worst thing, it just keeps silent, doesn’t say yes, it doesn’t say no, it just waits… in the meantime the main population just suffer or die.
This was the main reason the medical staff was at our workshop, they had nothing else to do than wait! During the workshop we discussed in detail the action we’re going to put in place and everyone present in the end agreed to be part of it! we have more than ten people, just on Lusaka, helping us, sending us data from various clinics.
The ugly side is that we need to wait, as long as this strike is in place and the government doesn’t find a solution all the hospitals will be closed, clinics as well, thus there will be no point for us to initiate the data collection next week. Hopefully the situation is going to be resolved by the end of next week, so not only we will be able to go on with the project but, more importantly, the people will start again to receive medical treatments!
Ragù!
Ciao! so the past few days have been quite hectic because the day for the Pill Check is approaching fast, but Mike is a good partner and we’re sure everything will work fine (if someone finally gives us access to the sql and ftp on the server…).
Yesterday there was another massive blackout caused by a fire in the transformation plant, authorities are investigating in the meantime the population is just left without electricity… this has good and bad sides:
the good side is that thanks to the darkness and the complete lack of energy yesterday nught we had to prepare dinner THE OLD SCHOOL WAY meaning outside, with charcoal and a special pot, under the stars! There was such a magical atmosphere and we had lot of fun telling stories waiting for the food to cook while enjoining the warmth of the fire and the sound of the sparks.
the bad side, I couldn’t play Fallout 3!!! eheh I’ve brought here a copy of one of the games I wanted to play last year (but that thanks to thesis I never played eheh)… now I’m totally in it, it is great eheh
The main entry yesterday was PASTA (in my honor) with a local salsa called Mis mit (which I pronounce Will Smith). I was so surprised by it as it looks, smells and taste exactly as the italian infamous RAGU’! my favourite dish of all times prepared my my grandma Carmela.
After dinner I introduced the family to the wonders of 80’s videogames playing Super Mario on my NintendoDS, it was amazing to see how they approached a totally new medium and they picked it so fast! Audrey, Casco’s wife, after only 10 minutes was already speeding through the levels and having lot of fun!
I’m very happy about how’s going, I’m taking lots of photos but cannot post them as my Interweb speed here is pre 9600baud in upload…
CIAO
Finally
That certain individual has been out maneuvered! The site is off MAMP and online! A very confusing conversation with Claudio has been clarified! The method in which we will get text information visualized on the website has been finalized!
OK, so the website (www.stopstockouts.org) is definitely not finished (yellow title backgrounds) but it is at a point where the stopstockouts community can actually make sense of it, representatives from five countries can upload content easily, and users understand it well enough to offer suggestions on how to make it better.
So the point of the SMS campaign is to make the public, local media, and the government aware that people are walking miles to the chemist (pharmacy) or clinic only to discover that the medicine they need is out of stock. This is usually do to a range of problems that often point to an incompetent arm of government. We will hold a one week campaign where people text in their stock-outs to our phone which is picked up by FrontlineSMS which sends the information to a PHP mapping program (ushahidi). Claudio and I were going back and forth today while my coworkers were also going back and forth about 1. which medications to include, 2. whether the associated illness should be included, 3. whether individual clinics would show up on the map and 4. how exactly to boil this data down into something textable.
Claudio and I finally ended up on the same page and developed as simple a system as we could:
Each of the five countries get a code: 1-5.
One hundred areas in each country get a code: 1-100.
Ten essential medicines get a code: 1-10.
The stock-out victim will get a list of the codes and if Kenya=1, Nairobi=26, and Amoxicillin=4, they will text “1,26,4″ to the stock-outs hotline. FrontlineSMS will send these numbers to a PHP script which will look them up in the SQL database I am currently building to get the right latitude/longitude for each area and POST the data to ushahidi. Bam!
Frontline is still a concern of mine since I won’t be getting the right cable until the first day of the campaign but Claudio will be a Frontline expert by then so he can guide me through the installation process.
