I have now been at my permanent site for nearly three and a half weeks, and I suppose that I should talk a little about what I’m supposed to be doing for the next 23 months, although even after 10 weeks of training and three weeks at work, that is not entirely clear.
I’m working at a small clinic (the literal Turkmen is “House of Health“) with six doctors and six nurses, but the clinic is located on the grounds of a county hospital, since my village is the county center. The clinic doctors are all family doctors and nurses who make house visits to their patients and would be considered general practitioners in the US. Each doctor and nurse pair is responsible for about 1,000 patients, and each pair is assigned to a different district of the town (doctors and nurses here are all employees of the government). At the large county hospital, neighboring the clinic, there are obstetricians, two blood labs, surgeons, dentists, internists and other specialists. These doctors do not do house visits.
In Peace Corps around the world, each volunteer is assigned a host country national counterpart, whose role in the community is relatively close to the role of the volunteer. The counterpart is the official link of the volunteer with the community and the government, but there is no requirement that the volunteer work exclusively with the official counterpart. The counterpart situation in Turkmenistan is unique for several reasons. First of all, there are no health educators in Turkmenistan, so my counterpart is a family nurse, and the only existing health education in my town is a few health posters from the government plus any information which may be passed along during patient visits. Secondly, some volunteers are paired with someone who has no interest in working with them, simply because the director of the hospital desired a volunteer. This is not the case for everyone, and many many volunteers are paired with enthusiastic counterparts, but others must work hard to find someone interested in collaboration. Fortunately for me, everyone in my clinic has been very friendly, so even if my role is unclear, I am making connections and am optimistic about building a working relationship with some of the people at my clinic.
According to the official Peace Corps training, health volunteers are supposed to do a “needs assessment” of the community in conjunction with the doctors, and we should “community integrate.” The purpose of the needs assessment is twofold; it should help decide what health programs would be relevant and possible, and it should give health workers a new tool by which they can look at their community to establish effective programs in the future. “Community integrating” means making friends, work connections, learning appropriate local culture and establishing myself as a trustworthy and helpful person. Most volunteers spend at least the first three months improving language and getting to know people at work, or so I have gathered.
To approach my needs assessment, I decided that I would try to go on house visits with every single doctor in the clinic. My plan was simply to talk about what diseases we might see on house visits and good ideas for educating about any preventable disease I saw. So I explained to everyone at the clinic that I needed to learn about the town and its diseases, and that I wanted to do this by joining them on house visits.
The idea that my job could be to observe and listen, at least at first, is pretty novel and has gotten varied receptions. When I have gone on house visits with my official counterpart, or even when she is seeing patients in the clinic, she sometimes asks me to teach about the disease immediately. For instance, we saw an older women who was crippled by a fairly recent disease (in the past five years, I think), and she wanted to know what exercises she might do. A similar question came up with a man with polio arthritis. Because there is no health education, and because many teachers do no write lesson plans, the notion that I am not ready to effectively educate yet may not be fully comprehensible. The vaccination nurse with whom I once went on house visits, thought I wanted to learn house to give injections so I could make some money on the side. Almost all medications, including vitamins, are given by injection. But, I think I have had some small victories that come on house visits. There seems to be a lot of kidney disease here, and I talk about reducing sodium in the diet to patients. Right now, I don’t have a lot of credibility, but I want to co-write a kidney disease lesson plan with a doctor. I also did have one point of credibility when I saw a patient for a house visit a second week in the row, and I talked about ways she might reduce her baby’s scalp rash (with ideas from Where There is No Doctor). At any rate, the brief talk was rewarding because she seemed genuinely interested, and I think she listened because it was my second visit to her. As inspired by the house visits, I have determined that I will work on lesson plans for kidney disease and child development, since those seem to be the issues that family doctors deal with, and one of the doctors agreed these would be good topics.
On the schedule I worked out with my counterpart, I was also going to spend each morning with a different specialist at the hospital: gynecologist, tuberculosis and infectious disease. In reality, the only specialists I have gone to are the gynecologists, because I didn’t realize how quickly there would be requests for lessons, so I need to get them written. In addition, I am teaching English six hours a week, two hours a week at the clinic, by request of the doctors. Everyone asks me to teach English to their children, or to them, but only three people have showed up to my club. And it is really hard to explain to people that I can’t give private lessons, because I can’t give them to everyone, and I can’t accept money for them. The other four hours I teach English are at an English club run by a teacher in the town. I work with the advanced students, and just try to invent games that will keep them practicing speech, since most of the classroom education only emphasizes vocabulary. The town English club has been really great to introduce me to some of the towns most energetic and dedicated students, but it is definitely tricky to figure out two hours worth of programming for each session. I hope that the relationships I build in English club will help me involve students in health activities eventually. I want to start a girls health club. Unfortunately, I don’t have time right now, because the director of the clinic doesn’t want me to start outside projects for three months, and without making room in my schedule, it’s not going to happen.
As far as community integration goes, I just try to talk to any doctor in the clinic who wants to talk, and to accept every invitation to drink tea with anyone. The third day in town, I went out on a walk, and got invited into tea with one of the doctors. I just stepped in, and was treated to a full table display by my new colleague. The next day, a total stranger recognized me as American, greeted me in English and invited me in. Turkmen people are very “myhman soyi” meaning “guest-loving.” This hospitality culture, combined with a general fondness towards the US and mandatory English for every school child, mean that being an American here is probably uniquely favorable. Other Americans abroad talk about the burden of nationality, but here being an American opens doors. People want to meet you. At almost every house visit, I am presented with tea, candy, bread, and often a full meal. After the house visit with the doctor, the mother or grandmother of the patient always asks to come visit, but I often cannot remember ho to find the house again. I’m not sure what to do about this problem, except hope that I go on another house visit. All in all, the “community integration” aspect of my job means that I spend a lot of time schmoozing in bad Turkmen and accepting invitations to visit. I guess I could call it networking.
THIS IS THE END
14 years ago
