Monday, July 21, 2008

Oh, Ye of Little Faith

After a lovely drive through the hills we arrive at Abbottabad about one o’clock. The first road signs I see make it obvious that I have been misspelling it. I thought it was a local name and it is just a Pustoon/Pashtun version of an English name.

I am placed in the Royal Suite (royal because it has air con) in Jan’s Continental Guest House. Only Emel and I will stay here as it is deemed too expensive by others who will stay together or with friends. Emel has brought his three lovely children who are on summer break. We look over the front lobby of the guest house which will serve as our meeting room. It has a wall we can use for projecting the slides and is currently full of overstuffed sofas chairs. It seems to function as the dining room part of the time but it will do. He assures me it is much cleaner than other places he scouted. And it certainly has wonderful gardens full of pomegranate and apple trees.

I return to my room to collate the clinical material, simplify the flow charts and begin to develop the counseling sessions. I sort out what needs to be photocopied and what needs to be printed the next morning. I hope we will have a computer and printer but if we don’t it will be taken to a copy shop. Either way I need to be organized. Power seems to cut out frequently here too, so I continue with putting the info on flip charts.

At 10 pm, I finally hear from the project staff. They confirm that they have brought the pretest, handouts, timetable, certificates and all the case studies I have sent ahead for them to copy. All of it is stored somewhere for now so I won’t be able to check it till tomorrow. As it is late, we agree to meet at 7:30 am the next morning.

I assume they have prepared the room but I am getting anxious about organizing the material according to when they will be needed. I wonder if they removed the answers from the pretest before copying it for the participants and I fret about when we are going to have time to put the role plays on cards. Pre-workshop jitters, I assure myself. There are a lot of ways for this to unravel but I seem to be the only one worried so I go to sleep.

When I go down next morning for breakfast at 7 am, the workshop room is shrouded in darkness, still jammed with overstuffed chairs while three inert forms, bundled in capacious white wraps, lie asleep on the floor between the sofas I notice more white wrapped bodies in the spacious hallways upstairs. There is a biblical quality to the scene of a fancy hotel with people asleep all over the floor.

Now I am convinced we won’t be ready for the workshop. Of course it’s not the end of the world to be delayed a day. But at 7:30 on the dot, the place is swarming with project and hotel staff. Sofas and chairs are pushed back. Tables removed. Banners are erected outside and inside. A printer and computer are set up. A tidy pile of what needs to be photocopied today is sent off with the driver when the shops open at 8:30am. Role plays are glued onto cardboard and the backup generator put in place. The answers, it is true, have been printed on the pre test and have to be manually removed but that is easy work with many hands. That is the thing. It is all easy when there are many hands. I hardly know what to do with all the help I have now.

The workshop opens right on the dot. Usually when the syndromic approach is presented to physicians in the developing world there has been considerable opposition and resistance. What doctors want and do not have is laboratories to improve their clinical management. The syndromic approach which is strongly supported by the World Health Organization, has been around for a while now and has proven itself effective in not only the management of STI but in decreasing the spread of HIV. It is not without challenges but it helps practitioners to provide early, effective treatment even in rural areas where there are no doctors. These physicians from North West Frontier Province would also like laboratories but they seem much more aware of the drastic lack of access to health services within their own rural and urban areas and most of them immediately realize the necessity for using it here. So we are off and running.

Photos: Jan Continental GuestHouse, Abbottabad; Flow Charts; Infection Control Demo



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