Tag Archives: health meeting


*August 15, 2011

Sareeta Apa and I had the first part of the day off. It was spent beautifully. We followed our old routine and took a rickshaw ride around Gaibandha. It was an adventure, at the surface, to shop for fruit, but our true unspoken motive was to take in the hidden parts of this bustling little town. We visited the train station, walked rock paths lined with old trees, next to quiet green ponds.

Beautiful scenery

Beautiful scenery

We even visited a small Hindu village inside Gaibandha, which boasted architecture starkly different from the colonial-style buildings we kept spotting. In the center of the village, we entered a Hindu temple where a group of men, sitting on pillows, were debating in a circle. Sareeta Apa asked if it was okay if we could go in, and they smiled welcomingly. What a serene place – so much of what we saw was handmade. We hesitatingly exited the temple to finally head back to the field office for our meeting later in the afternoon.

Poking around in hidden Hindu temples

Back at the field office, the director of community-based programming started the meeting off with an overview of what monitoring would entail at the field level and the expected outcomes. As he talked, I noticed there was a lot of nodding (my translator was studying for exams today!) among the five field officers and paramedics, four of which had been at our first meeting in Gaibandha in July.

As we talked, some voiced concern that monitoring and focusing on quality might make Friendship compromise on the quantity, or vast access, of health services the organization offers. As in, giving more time to each patient might mean more patients turned away. This is a significant concern and one that cannot be dismissed without discussion, but if Friendship operates with the goal of improving community health, there are things we can do through monitoring to maximize our potential without having to compromise on the number of patients we see. The good part of the meeting is that it allowed us to lay down some additional concrete benefits of starting a monitoring culture within Friendship, per request of the meeting attendees.

i)  Creating a monitoring network within Friendship, where different tiers of field workers monitor and provide feedback to each other allows us to learn from each other, improve our services, and recognize/celebrate good performance.  One of the most eye-catching results from the situational analysis showed a lack of feedback loops, or unidirectional feedback. A network allows us to have “loops of feedback” that gives as much information back into the loop as it takes.

ii)  We can present these tools not only as accountability mechanisms for the quality of our services in addition to the quantity, but also to prove our liability to donors and interested parties alike. And honestly, no matter where you are, quality cost$ le$$ (don’t let the dollar signs fool you – costs include time, precious human capital, suffering, and losses to the organization when patients aren’t treated to the best of our capacity).

iii)  Monitoring and supervision allows us to create a paper-base, built-in documentation within our health system, which Friendship can use as a basis for future evaluations and impact assessments of our satellite clinic services.

What I particularly liked about the meeting was that we received a lot of questions and concerns from the field staff, which indicates that they’re actively thinking about all of this. A weakness of the meeting was that as we talked about our monitoring tools, the actual tools sat in the middle of the table, mostly untouched. I had envisioned a meeting where we would get feedback from the group for each of the tools, but alas, we spent most of the meeting actually convincing the field staff that monitoring is a good, worthwhile, and valuable thing. I would have liked to be a bit farther at this point, but at the same time, to have the director give the meeting, voicing some of the very points he had contested weeks ago, was a small victory for me. We attained ownership today, which I hope will be the foundation for Friendship to build upon the outcome of my internship and my time here.

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Filed under Field, Supervision and Monitoring Tools

Char Visits

**Retroactive posts because of low internet again, 2 more to come tomorrow!

*August 14, 2011

Today marked our first day of validation among the chars. We are very lucky that the director of community health services from the Head Office is accompanying us these next few days as well. He brings a wealth of experience and knowledge, about Friendship and about our health services on the field, that neither Sareeta Apa nor I possibly match. His ownership is a pivotal part of this project – without him, we don’t have leverage or the investment needed to finalize and distribute the tools, and advocate for monitoring and evaluation culture, in general.

We were also accompanied by my translator today, a kind-faced young fellow who ended up not only translating for me, but also eagerly took on the role of cultural ambassador, pointing to fish farms and different crops, to villages “where victims of river erosion live,” to bridges destroyed by floods and newly rebuilt. As we drove down to the riverside and hunkered down on the boat (it would take us 3.5 hours on the water each way today, excluding FCM pick-up time from different islands), he leaned over to tell me this was his first time on a boat like this. I smiled, asking: “Why? You live so close to water!” His answer, delivered with a nervous smile: “I’m so, so afraid of the water!” A part of me felt for him, especially when his mother called to ask if he was wearing a life jacket. In that instant, I realized a newfound appreciation for how far I’ve come with my own parents. They still worry, but I also think I’ve set the bar high enough that I can picture my dad being a bit disappointed if I didn’t take on some of the adventures that have come my way. My translator rose above, though, even coming with us to the roof of the boat from time to time.

A gray sky, with periodic bouts of rain, accompanied us on our long journey through the river. We visited two chars today, Mollarchar and Shonnashir Char, where satellite clinics were taking place. Both are stable chars that have had a lifetime of 15 to 20 years.

Because I had a translator, we were able to effectively delegate validation of the tools as the satellite clinic took place. The health meetings (uthan boitak) were delegated to me. On our first char, the FCM had just given birth, so instead the assistant health manager gave the meeting on fever and diarrhea. I pulled out the tool, made up of about fifteen benchmarks, and listened to my translator as he transliterated the lesson. I observed the audience, participation level, and the relationship between the manager and the attendees. One by one, I could see the components of the checklist coming to life! It was an amazing feeling and happy warmth rushed through my body.

The same happened on the second char, where this time the FCM gave the uthan boitak to some attendees. The tool also incorporates a check-in with one of the meeting attendees, a short interview to assess quality conducted on a private basis away from the satellite clinic. On both chars, my translator helped me to ask questions to women beneficiaries regarding the topics discussed, such as if the beneficiary is planning to, or has already used advice that she’s learned at the health meetings, and if she feels comfortable asking questions during the meeting. This went smoothly, as well, with one of the women even saying that because of the health meetings, she now knows how to make oral saline solution at home for her children whenever they have diarrhea. Perfect. That’s what we want!

I noticed some points of dissonance with the checklists, though – for example, the culture of taking attendance had disappeared somewhat from the meetings and needs to be brought back so we can track community involvement.

Once we were back in Gaibandha later on, a check-in with my supervisors revealed that there’d been frustrations about the distance traveled versus the actual amount of time spent at the clinics validating (about an hour each). I didn’t have any control over this and though I agreed, the selfish part of me enjoyed each of the seven hours I got to gaze at the gurgling water of the river, the numerous chars new and old, green and amber.

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Filed under FCMs, Field, Satellite clinic, Supervision and Monitoring Tools, Travel