Multi Purpose Health Trip in N. Landhoo, 2010

NARRATIVE REPORT

 N. Landhoo Youth Encouraging Society (LYES) approached SHE around mid-November 2009 for a meeting. In this meeting they requested for awareness sessions about nutrition and other health issues. They also said the whole trip would be funded by LYES. Hence, it was decided to incorporate all components of a multi-purpose health trip in this.

1.     In progress:

They requested for the MPHT before the school opening. A proposal was sent to them and nothing was finalized due to some issues in work handover and miscommunication, until on 28th December it was decided to hold the trip on 7th, 8th, and 9th of January 2010. However, this proved to be very difficult because

  • None of the doctors contacted could make themselves free for that particular weekend.
  • Many of the staff, members and volunteers either had prior plans or cancelled on last minute.

Finally, on 3rd January 2010, it was decided, the trip would be held on the 21st, 22nd, 23rd January 2010, giving nearly 3 weeks to get ready for the trip

2.     Finding Resource Personnel:

Finding resource personnel required constant calls to all resource personnel who might be interested in joining voluntarily. Most of them need persuasion, but a few of them were ready to join. At first, it was difficult in finding resource even among staff. However, as the date grew closer, all the facilitators and doctors were confirmed, until on the 14th of January, Dr. Thasneem who gave prior confirmation, cancelled. This put SHE in an extremely difficult position as none of the other gynaes could give a confirmation in such a short notice, and also because N. Landhoo demanded for a gynae.

a.      Recommendations:

  • The person in charge of finding doctors should confirm two from each specialization, in case one of them cancels.
  • Hospitals like ADK and all the clinics should b approached at least three weeks prior to the date
  • A minimum of 1 month should be given from the actual trip date and a minimum of 14 working days should be given to find resources.
  • While finding doctors from ADK, IGMH or clinics, do it jointly with them to enhance their participations.

3.     Media:

An interview was given to TVM to Mariyad program by the coordinator. It went well.

a.      Recommendations:

  • A prominent member from the team (such as a doctor) should join the interview.

4.     The Team:

The team consisted of 3 doctors (a surgeon, physician, pediatrician), two staff from FP, 1 Staff from Lab, 2 from counseling, 1 from IEC, 1 from Admin, 1 volunteer, 4 members. One of the members was counted as a head only because his child was present.

a.      Recommendations:

  • Depending on the target number of people, the minimum team list for a multi-purpose team list will be 15 working members of the team.
  • At least two people should be solely appointed for coordination and operations.

5.     Approval from Health Ministry:

This was completely overlooked and this created a lot of problems, wasted much time of the trip organizers, both LYES’s and SHE’s time. SHE knew about this the last minute, on the day before the trip and had to run back and forth to get this done. This was extremely important because without this approval, it was not possible to hold this camp at all.

a.      Recommendations:

  • Check with the ministries and authorities to find out their procedures in holding these kinds of camps and sessions. For example, for school health awareness sessions, find out from Ministry of Education…etc.

6.     Travelling:

All the team members were present at the jetty on time. However, due to a miscommunication between launch, STO and LYES (responsible for arranging the launch) there was a delay of 45 minutes.  The launch was over crowded (with more people on the launch than expected) and over loaded (with medical supplies worth of RF 200,000). This issue was resolved by leaving the medicines behind so that it could be delivered through a boat from the island the very next day and by leaving the extra person behind as well.

The trip was further delayed by 3 hours due to bad weather, and when we arrived it was already 9pm. The night’s sessions were cancelled and the program was started the next day.

The launch crew was missing in action with their phones off, from 22nd evening (when LYES team was calling them to transfer the doctors from Landhoo to Kendhikulhudhoo) until 23rd morning 9am. LYES had another launch take the doctors team to Kendhikulhudhoo and was about to organize another launch to take the whole team back to Male’ when the initial launch crew called in the morning. This irresponsible action by the launch crew also wasted a lot of time and energy.

The travel back to Male’ was smooth and uneventful. Despite their missing in action act, the launch crew was friendly and helpful and the journey back was quite pleasant.

a.      Recommendations:

  • Do not to rely only on launch/other organizers telling us the time taken for travelling, but to use other means of calculating distance and time taken to travel as delays in travelling affects the whole schedule, and to tell the launch crew/ organizers how important this is.
  • While liaising with the launch and arranging everything about the launch was done by the Landhoo team, it is suggested that SHE coordinators also keep in touch and in close contact with the launch, or if not, the other organizing party to avoid such delays and misunderstandings.
  • No matter who is organizing it is also suggested that all logistics are always under control of SHE coordinator or person in charge. It is advised the PIC/Coordinator have direct contact with people involved in the logistics.
  • Provide food, water/juice for all members of the team during the travelling hours.

7.     Hospitality (Food and Accommodation):

Landhoo hospitality was commendable. The night of arrival, SHE team was greeted by the whole LYES committee and drinks of coconut. SHE team was quickly divided into respective houses (each member of the LYES took two or three members from SHE team to their homes and provided food and accommodation).  Evening tea and dinner was provided together on a hall. Other meals were provided at individual homes. LYES also provided water and refreshment.

Overall, all SHE team members were happy and satisfied with food and accommodation and Landhoo’s hospitality, though many team members noted the food was spicy and oily.

In one way, this is a very cost-effective method for both organizing parties involved and this also creates a greater bond and friendship between the team and the citizens of the island.  However, because the team had to stay so far apart, it created communication difficulties within the team.

a.      Recommendations:

  • Doctors should be provided sufficient rooms for themselves.
  • For rest of the team, a minimum requirement basis should be given to the organizers;
    • All team members to stay at the same quarters to avoid communication barriers and such. However, there should be bathroom for every three person to avoid delays in getting ready.
  • Give the organizers a menu guideline stating simple and healthy food which could be served. This would be more cost effective and healthier.

8.     WORK at Landhoo and Kendhikulhudhoo:

All work was scheduled to start Thursday evening at 8.30pm. However, these sessions were cancelled due to the delay in arrival. Work hence started on the 22nd morning and continued from then onwards.

a.      Information Sessions:

Sessions started on Friday mornings and continued from then onwards.  All the topics were covered in most of the sessions. All the participants were extremely pleased by the information they gained. Interests were shown by students, men and women who participated. All sessions were very lively and interactive.  Participants (regardless of age) had so many questions, and insufficient time was always an issue. Individual requests for information were also catered.

  • Number of students in the sessions: 129 (which included students of grade 8,9, 10 from N. Landhoo, Maalhendhoo and Kudafari)
  • Number of adults reached in the sessions (ages 18 and above): 38 Men, 37 Women, 12 teachers.

All the pre-planned topics were taken for all the 129 students. These include all the lifestyle sessions, thalassaemia awareness, RH, nutrition and health issues.

However, out of the adults, the 38 men were only exposed to RH and FP issues, 25 women were exposed to both RH/FP and Parenting and nutrition sessions, 12 teachers to social/lifestyle and health issues facing students and the other 12 women only to nutrition session.

One of the main aims LYES organized this was to provide nutrition demonstration sessions to about 50 women of the islands so better nutrition habits are in place and more nutritious diets are practiced in the island. But this unfortunately did not happen.

Landhoo is one of the highest thalassaemia prevalent islands; information on this topic was not given to the parents and youth who are ready for marriage. This was noticed important so that they can make an informed choice on their marriage partner. Also Lab staff felt that had this information been provided to youth and parents, more people would have tested for thalassaemia.

While the sessions were extremely informative, interactive and lively, the sessions catered only to certain age groups due to the following reasons:

  • Due to the delay in arrival, the team missed one night’s session altogether.
  • Even though LYES was pre-notified on the times the team would be needing certain age groups and such, they failed to gather people of the required age groups for the required times. So the schedule became spontaneous, catering to people who could make it at a given time, when LYES called through loudspeakers.
  • The island had a school cleaning day on Saturday morning. The whole women and a huge part of the men’s population were there the entire morning, leaving the resource team free with not much to do.  The Saturday morning was wasted except for thalassaemia screening and one nutrition session for 12 women. SHE team and the coordinator did not have any idea of this until Saturday early morning.

It is suggested that SHE team always emphasizes on the importance of gathering people for awareness session on time. And also, to take note and to find out if anything important had been planned in the island as the same time an MPHT happens.

If this could be found out and arranged accordingly, no time need to be wasted and maximum input could be given. For example, if SHE team was informed earlier that there was something else planned for Saturday morning by the island school, SHE resource team could have joined the doctors team to Kendhikulhudhoo and hold one information/awareness session for them, which would have been more productive.

Another issue was not putting up displays and posters. While all displays and posters were taken, none of this was put up.

b.     Thalassaemia Screening:

Thalassaemia screening was carried out in Saturday morning at N. Landhoo School. The usual lab fee was taken and a total of 18 tested out of the expected 30. This decrease in number was apparently because of a miscommunication between N. Landhoo and Maalhendhoo.  N. Maalhendhoo citizens came to Landhoo for thalassaemia screening on Friday, but since SHE had specifically said several times and as given in the trip schedule, thalassaemia screening was on Saturday because it would have not been possible to keep blood overnight without it spoiling, they were sent back and asked to come the next day. LYES agreed to their costs of coming and going on Saturday, but only one person turned up.

SHE should ensure that there are no rooms for such errors in the future in order to produce maximum output.

For this trip-

  • Total Number of Thalassaemia screening: 16
  • Total Number of DNA testing: 2

c.      Doctors’ Consultation:

Doctors’ Consultation started Friday morning at N. Landhoo. The three doctors (Dr. Niyasha, Dr. Shifan and Dr. Malik) worked tirelessly from 8.30am until 12.45pm. They started their next consultation at 2pm and while Dr. Malik and Dr. Shifan were done by 6pm, Dr. Niyasha’s consultation went on until 7pm.

Because of the initial delay, causing Thursday night’s consultation to be cancelled, and because the doctors could not finish consulting all those who arrived from N. Maalhendhoo as well, after several discussions between LYES and Kendhikulhudhoo, it was decided that doctors will not go to Kendhikulhudhoo Friday evening, but instead, go to Kendhikulhudhoo Saturday morning. Dr. Shifan, Dr. Niyasha, Asim, Haleem and Waheed was the team that went to Kendhikulhudhoo.

  • Total number of patients consulted by Dr. Niyasha in N. Landhoo:  51
  • Total number of patients consulted by Dr. Niyasha in N. Kendhikulhudhoo: 31
  • Total number of patients consulted by Dr. Shifan and Dr. Malik in N. Landhoo: 34
  • Total number of patients consulted by Dr. Shifan in N. Landhoo: 8
  • Total number of patients consulted by Dr. Malik in N. Kendhikulhudhoo: 17
  • Total altogether: 141

There was a wave of disappointment in both the islands because of the cancellation of the Gynecologist the last minute. Many of the people from island expressed their disappointment to our team several times.

i.      Issue of Medicines:

The medical supplies were taken off the launch because there was not enough space to carry such a huge shipment. The medicines were not delivered on time the next day as promised, because STO refused to ship the medicines without their manager’s supervision. Ironically, the manager was on the launch with the rest of the team without the medicines and hence, LYES had no way of bringing the medicines.

This proved to be extremely difficult for SHE’s team of doctors as few medicines were available on the island. However, because LYES gave assurance they would be bring the medicines from Male’ at any cost, the doctors prescribed medicines according to what was available in STO pharmacies in Male’.

Even though SHE played no role in the medicine provision part, these are important points to note. It is suggested that SHE asks the doctors for a list of medicines needed most commonly so that what is necessary is taken to the island, in case SHE plays the role of providing medicines.

d.     Recommendations:

  • Always emphasizes on the importance of gathering people for awareness session on time.
  • Take note and to find out if anything important had been planned in the island as the same time an MPHT happens.  To avoid this, keep a close contact with the health centers and schools of the island throughout planning and implementation.
  • If and when possible, send one of the coordinators to the island one or two days before the trip to find out the situation and arrange everything on the island.
  • While giving announcements to the island through loudspeakers, instead of just saying what to announce, prepare and give announcements to the island offices so there is no chance for miscommunication in announcements.
  • Doctors cannot be taken to the islands without adequate time. The Kendhikulhudhoo experience should be avoided again.
  • A3 posters should be created with doctors consultations times, thalassaemia screening times, information session times.
  • Leaflets should be distributed through facilitators and posters should be put up in the information sessions.
  • Doctor consultation and information sessions should be in the same location.
  • Develop brochures/ proposal leaflet about MPHT, with its aims, objectives, services and minimum requirements.
  • Develop and modify outdated resource/poster materials.
  • Create a mobile package for MPHTs:
    • The basic essentials for all trips, prepared before hand: Speakers, Sound System, Laptop, Projector, Projector Screen.
    • Developing manuals and other health related posters on canvas.
    • Leaflet packages (on availability).
    • Announcements.

9.     Overall Staff/members/volunteers input:

Since the moment trip was being arranged, all of SHE’s staff and their input was tremendous. Even though they did not participate, their contribution was great in help the coordinator needed such as brainstorming, drafting schedules, drafting and sending mails..etc. The following staff’s efforts are specially noted with appreciation for their input at workplace and for their input on the field to make this a success:

  • Ajmal
  • Fazna
  • Naila
  • Maeesha
  • Dr. Mausooma
  • Nashidha
  • Nanna
  • Azma
  • Leena
  • Hawwu
  • Maari
  • Zila
  • Aisha
  • Ramsha
  • Shameema

Also the same hard work is appreciated for the members who joined (including doctors as all doctors who joined were SHE members). All doctors and Dr Niyasha specially is praised for her continuous consultation and the comments from the patients proved what a good job they did.  The only volunteer Ainth’s work is also very much appreciated.

 

FINANCIAL REPORT

No

Detail

Allocated Budget (MRF)

Actuals (MRF)

Variance (MRF)

Reasons for Variance

SHE

IPPF

N. Landhoo

1

 Resource Personal (20 People)

2

 Doctors

5000.00

00.00

00.00

00.00

+ 5000.00

 All members and volunteers, so no cost borne by any party.

3

 Members/Volunteers

00.00

00.00

00.00

4

 Lab techs

1000.00

00.00

00.00

00.00

+ 1000.00

All members and volunteers, so no cost borne by any party.

5

 Counselors

1000.00

00.00

00.00

00.00

+ 1000.00

  All members and volunteers, so no cost borne by any party.

6

 Nurses

1000.00

00.00

00.00

00.00

+ 1000.00

  All members and volunteers, so no cost borne by any party.

7

 Transportation

8

 Launch

20000.00

00.00

00.00

20000.00

00.00

 Pickup

100.00

00.00

00.00

00.00

+100.00

 Pickup money was taken from miscellaneous spending.
 Transportation in the island

500.00

00.00

00.00

00.00

+ 500.00

  No transportation in the island was necessary.
 Taxi

500.00

00.00

00.00

00.00

+ 500.00

 The team list was less then estimated and only some staff wanted the taxi money, which was taken from miscellaneous spending.
 Food

8400.00

00.00

00.00

8400.00

00.00

 MRF 140.00 x 20 ppl x 3 days.  The cost covered by donations received to N. Landhoo Youth Encouraging Society
 Accommodation

6000.00

00.00

00.00

6000.00

00.00

 MRF 300x 10 rooms x 2 days.  The cost covered by donations received to N. Landhoo Youth Encouraging Society
 Stationary

500.00

00.00

00.00

100.00

+ 400.00

 All stationery was provided by N. Landhoo
 Material Development

5000.00

00.00

00.00

00.00

+ 5000.00

 Existing in SHE
Media

1000.00

00.00

00.00

00.00

+ 1000.00

 Done free by the media
Miscellaneous

5000.00

90.00

210.00

00.00

+4700.00

The money taken for advance was MRF 2000.00 instead of the estimated MRF 5000.00. It was spent as follows:*Taxi money for 6 staff = MRF 120.00

*Pickup charges = MRF 80.00

*Money for phone calls = MRF 100.00

 TOTALS

55,000.00

90.00

210.00

34500.00

+ 20200.00

 

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