Sustainablity

April 5, 2017

So this post is going to be a little different. I plan to update it throughout service and post it at the end (although the release date might change because as I’m typing that I realize that’ll be a crazy long post). I’m going to date each section I’m writing so that anyone interested can see the progression of not only my project’s sustainability, but my thoughts on it. (I’m posting this somewhat with future volunteers in mind, as I think it would be helpful if I had a sustainablity road map, but I hope other people might find it interesting too.)

The name of the game during Peace Corps service is sustainability. Which basically means we want to make lasting change, change that will be here long after we are gone. While there are dozens of sustainable changes I see a need for to improve the health of the people of Guyana, whether I’ll be able to achieve them is an entirely different story. We use several tools in an effort to make our changes last, mostly focused on involving community members. This may be our greatest tool in our efforts to make things sustainable, but it also presents challenges. Finding willing community members, that want to see change and are willing to put in the effort is the first and probably most important step. That’s why Peace Corps Guyana wants us to focus on integration and discovery our first 3 months at site.

My concept of sustainable change, at least the kind I plan to make during my Peace Corps service, has already greatly changed since arriving. This is primarily due to the expectations Peace Corps has for our work and being placed in a health center.

Prior to coming I planned to essentially be providing health care and in that making sustainable changes through patient education and showing more efficient ways to perform certain tasks. Since arriving I’ve realized Peace Corps doesn’t want me to be doing anything clinical. Which doesn’t prohibit me from patient education or staff training, but changes how I’ll be able to do those things. It also means I’ll have to find a new way to establish my skills (to get people to believe what I say to be medically based and not just a cultural difference, such as healthy nutrition standards, infection control standards,etc). I’ve tried referencing research, even pulling up research studies, but that doesn’t seem to carry much weight with the people I’ve spoken to and I usually still get something like “well that may be true in America but in Guyana this is how (much rice we eat) it is.”

April 10, 2017

Last week I was able to answer health questions (primarily nutrition related to diabetes (referred to as sugar), hypertension (referred to as pressure), and cholesterol) … Time will tell if any of this actually will lead to diet change .. but it was encouraging people asked.

April 27, 2017

One of the major ways I’m considering making sustainable change is by increasing the knowledge base of the population on health issues. While there has been some resistance to change in the adult population, I’m hoping I’ll eventually be able to make progress. Until then I’ve arranged to teach a health class (HFLE) in one of the local secondary schools- hoping they’ll be receptive to learning since they’re still in school.

June 1, 2017

So I’ve been teaching HFLE for over a month and I’m really enjoying it. I definitely think I’ll continue doing this throughout my service. I see the potential for sustainability in not only the opportunity to educate the students in major health issues that will hopefully improve some of their health over their lifespan, but in creating curriculum for the school, and hopefully eventually training the teachers how to teach HFLE. The teachers just seem to be randomly assigned the course by whoever has a hole in their schedule, with no health teacher training.

In order to be able to teach these classes, I walked into the school, spoke to the headmaster, and got approval for the more controversial issues. I’m also hoping to volunteer at the local regional hospital and one of the 2 nursing schools in Georgetown.

Nurse Lee, the staff nurse at my health center, introduced me to the RHO (Regional Health Officer) at the hospital, who in turn introduced me to the Matron (the head nurse for the hospital). I’m waiting for her to let me know when is a good time to discuss areas I might be able to help in at the hospital. We discussed the focus on sustainable changes briefly and I may be able to help with staff training and possibly policy change.

I was trying to build a connection within my community to introduce myself to the nursing school, but when opportunity presented itself by me meeting with a doctor at the hospital attached to the school, I walked over and introduced myself. She seemed excited to potentially have my help, but because it is the private nursing school in town she needs to discuss it with the school’s CEO. Per her request, I sent a description of my job with the Peace Corps, background and experience, and my resume to share with the CEO. My thoughts for sustainable change at the nursing school are along the same lines as the secondary school.

June 5, 2017

This morning in our Guy30 PCV’s (all of the Guyana volunteers that swore in April 2017 together) group chat, one of the education volunteers posted this:

Hey guys. It’s been a few months since we left training. I just wanted to remind you all (whether or not you’re having a blast at site, or still struggling to get by doesnt matter) to remind yourself why you joined peace corps. We all come from various backgrounds, but we all have SOME similiar reasons for joining. One to spread altruism…but also be cause all of us realize that the best things in life come with sacrifice. Remember, nothing worth achieving came without difficulty. Keep up the good work. You can do it.

I felt like this was a good reminder of sustainability, because without our motivation to serve being at the center of what we do, what’s the point? Encouraging and helping our fellow volunteers can help bring about sustainable change too, so that our influence is not limited to the people we come directly in contact with.

July 7, 2017

Today I was in the office when most of the remaining Guy27 were finishing their out-processing. They’ll be flying out this weekend. It was really fascinating hearing them look back over their 2 years. Some who felt they made sustainable change in their communities, some in themselves, and others who weren’t sure what impact they had on their community or their community on them. At least one of their group volunteered to extend and continue working on her projects for another year; she not only sees change in her community and herself but sees the potential for more. Another volunteer worked to the very end wrapping up her projects and is so confident she made sustainable change will be going to Maldova for another 2 years with the Peace Corps. Hearing them all talk about the last 2 years and the plans they have at home it really underlined that sustainability can take so many different faces.

September 27, 2017

Being placed at a health center where there isn’t much to do, outside of the nutrition talks I’ve been doing (which you can only tell people not to eat 4 cups of rice at every meal so many times) I’ve had to find my own projects to make sustainable change. Most of the health volunteers from our batch that see their potential impact at this stage are doing the same thing, with 2 exceptions that I know of, whose original site assignment has needs they feel they can help to address.

I’m still teaching HFLE, which I definitely see a positive impact on the majority of our students from last term. Not only is their knowledge base expanding, but some of them are starting to question the source of information they’d learned previously, and they are becoming more introspective.

I have not been able to get my project off the ground at the Regional Hospital, but I think that too has been a lesson for me in sustainability. If they are not interested enough to follow up with me or respond when interest contact them then I feel it’s likely anything I might accomplish would not be maintained after I leave.

I have been teaching a Health Promotion and Maintenance at the nursing school in town. I’ve been given full control over the curriculum and evaluation of the class. This is hugely exciting to me and I feel like has massive potential to make a real sustainable difference in Guyana’s overall health. Shaping the way some of the next generation of nurses view nursing, think through medical issues on an individual level as well as on a larger scale, and teaching them why the bad habits of current nurses here (not wearing gloves, not frequently washing their hands, poor bed side manner, etc) can be detrimental to the health of not only their patients but often themselves could have have a considerable ripple affect in long term healthcare improvement.

Today I had a meeting with the the head of a Vanderbilt-run nurse training program at Georgetown Public Hospital to work with their program. The way Guyana’s health care works is on a triage level determining whether you should be treated at a Health Center or Post, a Cottage Hospital, a Regional Hospital, or be sent to Georgetown. So all of the critical patients are sent to GPH. (Unless someone is going to pay upfront for a private facility.) The Vanderbilt program is focusing on training nurses in skills to make them capable of caring for critical patients. Some of the skills the current class has already learned that the majority of nurses in Guyana are not trained in include cpr, placing an ng tube, placing an IV, placing a urinary catheter, etc. Some have already passed an ACLS course. This program is not only sustainable in the fact these nurses will have these skills for the rest of their career and will be able to train others, but it is modeled after a program Vanderbilt created to train the only Emergency Certified doctors in the country that is now completely Guyanese run. Unfortunately, the majority of the nursing staff running the training are only in Guyana part-time because they are not paid to be here and work in the states every other month in order to live. So the program is short staffed. Not to mention the student nurses are the primary workforce in the ER so each one has their own patient load, often up to 20 patients to a nurse often unsupervised. I’ll be starting to help with the training and supervising of these nurses on a weekly basis and teach one of their classes probably on a monthly basis. I am so excited to be working with this program as it addresses so many of the worst/most emergent health issues in Guyana and has already been proven successful and sustainable.

At this point in my service, I finally feel I have a handle on not only what sustainability is, but how I’ll achieve it during my service. Sustainability is making lasting change. But achieving it is a little more complicated. To achieve sustainable change as a health pcv you have to find projects that improve the health of Guyana, that will somehow continue to impact the country after you leave, that has active local participation and dedication (often the hardest element), that meets Peace Corps overall goals and their in-country objectives (and within their rules and restrictions), and you’re qualified/trained and experienced to impact.

September 28, 2017

It is amazing to me how quickly things can change during your time in in Peace Corps. Peace Corps (at least in Guyana) focuses on community level or grassroots level change. We have been encouraged to define our own communities, whether that is making them smaller to affect more targeted change or larger to incorporate more resources or projects that that our villages can benefit from. Numerous volunteers, again especially in the health sector, have had to redefine their community. This is usually because there is not the opportunity for sustainable change without expanding their area. The villages are so close together along the coast essentially all the residents utilize resources in nearby villages or towns.

This is no different in Versailles, being so close to town the majority of residents shop, work, get their healthcare, go to school, etc in Georgetown. While seemingly it has the most resources, it arguably needs the most help/improvement, especially within the healthcare field. Previous volunteers have worked on projects in town (establishing an ems service, working with the ministry, etc) as well as other current volunteers (vector control and filaria incidence reduction campaign, teen pregnancy support groups being established through the ministry, etc). 2 of the projects I’m working on that that feel have the best chance of making sustainable change are in town and most of the people living in my village incorporate town as town as a part of their community anyways.

Unfortunately there is an old rule that says we can’t work in town as 2 year volunteers and so my projects have been suspended. So I’m advocating to be allowed to continue my projects, pointing out the inconsistencies in policy to my CD, and reemphasizing the lack of sustainable project needs at the Health Center I was originally placed. As well as how my current projects not only meet my community needs and utilize my training/experience, but also meet Peace Corps overall goals and PC Guyana’s framework. We are encouraged to advocate for ourselves, not only by previous volunteers, but by some of the leaders in our PC staff. So I remain hopeful.

November 16, 2017

In the end sustainable change will look different for every volunteer. As long as they’re able to find a need in their community that their experience will help them to address they have the opportunity to make make real change. Just keep in mind to be flexible and willing to change how or even what difference you’re trying to make.

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