Friday, July 25, 2008

Trip up the Mountain


One evening as it is cooling down, a group of us from the STI workshop for physicians take a trip up the mountain, heading for a dry river bed where locals picnic.

The road clings to the side of the mountain. We stop in the sun to top up our water supply with clean, clear, cold artesian water pouring out of plastic pipes along the road. Young boys sell fresh bright yellow plums, roasted corn and small black mountain figs. The figs look like plums as they are fresh. Everyone knows what they are called in Pashtoo, Urdu and Farsi but not in English.

When I inquire if they are figs, I am met with bewilderment.

Finally, I ask, “Are they are used to break the fast in Arab countries?”

“That’s it," the kids reply gleefully.

“Ah, then they are figs!”

Our second workshop in STIs has gone much smoother than the first even though there are more non-English speakers, because we have made a concerted effort to translate everything into Pushtoo. We noticed in the first workshop that although everyone understood some English, many did not have a great deal of facility in English and some points were not being sorted out until they were in small groups speaking Pushtoo.

Many of the Afghan physicians attending the workshops are not fluent in English so they sit at the back with a colleague beside them translating. Amazingly to me, they follow closely and are active in the discussions which are mainly in Pushtoo. The wonderful thing about participatory training is that so much of the learning takes part in small groups and discussion.

Since everyone speaks Pushtoo fluently, I assumed all the translating was being done in Pushtoo. But then when I asked for some of the written feedback at the end of each day which was not in English to be translated, I was told it was Urdu. I t seems that a number of the educated Pushtoo-speakers, such as doctors, do not write Pushtoo,. They write and speak Urdu. So unbeknownst to me, the workshop has been moving along in three languages, Pushtoo, Urdu and English. Make that four, it seems the Afghan physicians are using Farsi some of the time especially for the more complex concepts.

With all these languages being used, the draft flow charts needed to be available so everyone had a copy of them. I was concentrating on having everyone memorize the flow charts and not planning to print them until after the workshops. But with all these language challenges, the core material needed to be more accessible so I sat down with my marker pens and drew up the flowcharts

.

At the base of the mountain, the area of the dry river bed is huge and given the number and height of the mountains that surround it, one can imagine how quickly it would fill up in a downpour. But right now there are small trickles only and trucks, buses and taxis have wound there way down. Kids are dangling their feet in the small streams. Colourful carts move about selling gum, sweets, roast corn and chips. The woman are dressed in colourful, holiday attire, which seems out of keeping with the flat gray stone and gravel-covered dry stream bed. But there is generally a festive atmosphere. Our large van crunches slowly down the slope, and it is a slope and not a road, so we too can be part of it. But even with care it is clear this is not the best vehicle for such a spot and we carefully maneuver with some difficulty up the slope.

Down in the dry river bed there are a whole slew of beehives and some beekeepers, in their net and gloves moving supers around. I can’t quite make out what they are doing from up on the road but it seems a strange place for so many hives as it is a long way from any flowers. Later, higher up the mountain in Nathiangali I find young fellows selling their mountain honey. They have collected in buckets a number of actual bee hives wrapped around branches in a teardrop formation. They pour the honey into a plastic kilogram jar for me for 200 R (about $3.50). It is exquisitely flavoured with a light, clear consistency. There seem to be a lot of flowers similar to our jewelweed, with its long pouch full of nectrar growing on the mountain sides. I think I might have acquired some jewelweed honey.

Shortly after we have made our way out of the dry gravel river bed, it starts to rain. Not just rain, but it pours. It comes down in sheets so thick you can’t see across the road. It is monsoon season, which I had no idea reached this far inland, having only experienced it in South East Asia. There is a rapid exodus of the formerly dry river bed as bikes, carts, buses and trucks lurch up the slope. I catch this fellow in his cart with his feet drawn up as he cowers under the small shade of his cart waiting out the rain.

The most surprising aspect for me at the STI workshops has been the response of participants to the gender training. There was initially resistance as in why are we talking about gender. In the clinical sessions we had delineated the biological issues which make women more vulnerable to STIs - the increased area of genital mucosa, cervical ectropy in young women, the lowered immunity to infection in pregnancy, the high rate of assymptomatic STI disease in women and the exposure before during and after pregnancy as well as during breast feeding of the infant.

Gender issues everywhere are of concern. Women experience higher levels of poverty, illiteracy and violence but more especially in this area of rigorous purdah there are added burdens of poor access to health care, lack of mobility and shame. It would seem that without a framework for analyzing issues such as gender, the current situation becomes the norm even for a group of reasonably enlightened physicians.

At the end of the workshop, one of the doctors, who had recited a number of moving Pushtoo poems for us as energizers during the workshop, confided to me that he had three sons and one daughter who at 15 was the eldest. His daughter was brilliant at school but recently had complained to her parents that she felt they favoured the boys and neglected her. He said that since learning about gender at our workshop, he understood her concerns and had to agreed he had favoured his sons. He was going to start to listen more carefully to and support his daughter more actively.

When I shared this story with my fellow trainer Emel, he replied that he had always thought he treated men and women equally but after his first basic gender training he realized he was running the health programs of his organization differently, taking extra care to reach women.

That is the ultimate test of any training workshop, that we transform the way we see the world and are motivated to make personal changes. I feel as if I had my hands briefly on the golden ring.

Photos: boy on edge of mountain road; mountain figs, dry river bed picnics; beehives in river bed; Mountain honey; monsoon rain on cart

Labels:

7 Comments:

Blogger TBTAM said...

Great photos! Thanks!

9:47 AM  
Blogger Desmond said...

Whew....so many country hopping. I salutr your ability to adapt to rhe changin environment - how do u adapt to the differenr diet change in each country

6:52 AM  
Anonymous Anonymous said...

TBTAM Nice to see you here just when I think nobody is around.

desmond- The food is the perk! Right now Pakistan is a sultry as Sarawak is most of the time but just as easy to adapt to. You have been doing some in-country hopping yourself. Thanks for keeping in touch. Makes the world seem more connected.

--travelingdoc Can't seem to get into my own blog

6:04 AM  
Anonymous Geoffrey W. Rutledge, MD, PhD said...

Hi, I think your blog is terrific, and I would like to feature you on Wellsphere (http://www.wellsphere.com). Would you drop me an email?
Good health!
Geoff
--
Geoffrey W. Rutledge, MD, PhD
http://medblog.wellsphere.com

2:06 PM  
Blogger Dr.Rutledge said...

I think your blog is great, and I would like to feature you on the new
Wellsphere. We feature only the best health bloggers on our WellPages,
which are special pages that our Health Knowledge Engine crafts to give
our users answers to their health questions. We would feature you on all
the pages on topics that our knowledge engine finds are related to your
blog postings. Because we have over 2 million visitors each month (and we
are growing rapidly), you would benefit from an expanded audience for
your writings. If you would like us to feature you, send me an email to
Dr.Rutledge@wellsphere.com

Cheers, Geoff

2:09 PM  
Blogger Dr.Rutledge said...

I think your blog is great, and I would like to feature you on the new Wellsphere. We feature only the best health bloggers on our WellPages, which are special pages that our Health Knowledge Engine crafts to give our users answers to their health questions. We would feature you on all the pages on topics that our knowledge engine finds are related to your blog postings. Because we have over 2 million visitors each month (and we are growing rapidly), you would benefit from an expanded audience for your writings. If you would like us to feature you, send me an email to Dr.Rutledge@wellsphere.com

Cheers, Geoff

3:02 AM  
Blogger chanpheng said...

You've covered a lot of ground since you left Laos. I'm very impressed with your work, and the way you seem to click with many groups of people.

1:52 AM  

Post a Comment

<< Home

Add this blog to my Technorati Favorites!