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Sunday, May 16, 2010

Getting there.

When I arrived in September to begin implementing the text-message based medical record program developed by FrontlineSMS:Medic, MHOP was focused on establishing the two things fundamental to it: a clinic and a community health worker (CHW) program. So, I switched gears. I picked up the slack where I could. I spent my first few months writing grants, working on clinic contracts, CHW visit guidelines, developing partnerships with other NGOs and the Ministry of Health, and generally just not knowing what was going on -- but learning.

I always felt a little uneasy though, feeling as if I wasn't accomplishing what I had been asked to do. The goal was always in my mind: whatever I was doing, I needed to be laying a good foundation for the mobile records pilot in the process. And besides, I kept saying, next month we'll be ready. Next month.

Soon, however, the CHW program was starting to take shape and I was scrambling to figure out how we could start the pilot when the CHWs began making their visits. By the beginning of 2010, it became clear that -- for various, compelling reasons -- the pilot couldn't launch with the CHW program. Again I had to switch gears. I worked closely with Leona to design the paper records system that could be easily transitioned to the FrontlineSMS:Medic program when all was ready.

The clinic opened. The CHW program launched. Oh, how anxious I was to get started. It seemed like the time had come.

But then, Mali pulled a fast one.

I spent most of February, March, and April embroiled in a customs battle with the most incomprehensible government office known to man. In January I had ordered three super cool low-power computers from Inveneo, a U.S. based nonprofit. Though they arrived two weeks later, they were detained at the airport because we refused to pay a ridiculous 52% import "tax."

Nearly everyone I knew to ask advised me that there is no import tax on hardware (to be used in health care centers no less); I told that to the customs officer. No luck. I went to the customs office with the military ID of the Ministry of Health's eHealth Director and a handwritten note asking for the computers. No luck. We tried to use a go-between to re-negotiate the price. No luck. I was at my wit's end, and so discouraged -- Mali was showing me an ugly side I hadn't wanted to acknowledge. I felt like the people who should care just didn't.

Finally, in mid-April, Inveneo stepped in and helped us get the computers out. Now, things for the mobile medical records pilot are finally falling into place.

Last month, some representatives from Orange Foundation (the largest cellular network provider in the country) came to do a site visit after Erica and I had hounded them for what seemed like ages. The Orange representatives came to learn about the CHWs' work and about how the FrontlineSMS:Medic pilot will help them do it better; our CHWs could not have been more convincing. They were impressed both by the innovation and the need. As we toured the community in their SUV (backtracking every few meters because the road became impassible) they exclaimed about the poverty, the lack of infrastructure, the extraordinary fact that Bamako could be home to a community like this.

It was almost shocking to see them shocked; you'd think growing up here would mean you knew places like Sikoro-Sourakabouogu existed. But, I am happy we got to show them. Last week Orange informed us that they will be providing the pilot free SMS credit for 2010!

Mali, I can't stay mad forever.