After six months of eager anticipation and numerous email exchanges my work permit at last materialized. All the necessary verification protocols were concluded and I was ready to embark on my second assignment with Médecins Sans Frontières / Doctors Without Borders (MSF), after struggling to pack my suitcases to fit within the baggage allowance.
I recall vividly my mother laughing at me repacking for the third time and my close friend Lynn sitting on my suitcase so we could zip it up.
As well as my big suitcase, I also had a convenient hand luggage bag to carry the few extra neck scarfs and little Kenyan treasures I like to travel with. I hate packing as I always seem to be carrying the whole of Africa in my suitcase.
As is expected before a new assignment I experienced a mixture of emotions: excitement, anxiety, curiosity and anticipatory home-sickness.
I had taken a good break from my previous post – an interesting role in MSF’s prisons project in Malawi. Now I would be working in a mid-level management position in a ‘non-communicable diseases’ project in a rural setting in Zimbabwe.
Non-communicable diseases are sometimes known as "chronic diseases" – conditions like diabetes, asthma and high blood pressure which need careful management so that patients stay well.
I knew the new posting would be a change – both from urban life in Nairobi, where I live, and from my posting in Limbe in Malawi, nevertheless I like a challenge.
I gathered all my grit and stamina and was ready for whatever fate had in store for me, like a little Energizer Bunny.
Arrival in Chipinge
After arriving and visiting the MSF coordination office in Harare for a briefing, I stayed briefly in the city, which reminded me a lot of Nairobi hustle and life in the fast lane.
Soon I was whisked away to MSF's sub-base in Chipinge, seven hours away from Harare in the southeast of the country. The town is fondly referred to as Kumusha or “the rising star of the East”.
Looking back on that long drive I remember that Gladman, one of the drivers, was a jovial storyteller, making the last two-and-a-half-hour stretch a bit more bearable, despite the numbness in my gluteal region.
The first two months
My first two months in the project were baptism by fire in many ways: orientation to a new project, my predecessor absent, a strong and super competent team to manage, grasping project direction, struggling to pronounce the Shona names of the different health sites our team was supporting. All this, and a bereavement in my first three months.
In this whirlwind of events, I silently pondered and doubted if coming to this project was a wise decision. It felt like a huge mistake at some points, yet like an arrow released from the bow or a stone from a catapult, many things in life cannot be reversed.
As a medical doctor we undergo rigorous academic training in different disciplines. A favorite in psychiatry vivas (oral examinations) is to describe the Kübler-Ross model of grief (denial, anger, bargaining, depression and acceptance). It is however a completely different and perhaps indescribable experience to undergo loss of a loved one yourself. I cannot find words that will completely explain the emotional rollercoaster one undergoes.
I went home to Kenya for a period. Coming back to the project in Zimbabwe, I was warmly received by my colleagues and I could see the concern in their eyes. At lunch time they always made sure I ate, even when I was doing it as a polite formality.
With time as a healer and a strong interest to catch up after my time away, I started to make sense of this non-communicable diseases project.
I asked numerous questions such as “What is the objective? Expected outcomes? What? Where? Why? When? What next?”
The team was patient enough to answer my many questions and got to understand I have a curious mind and my many queries were not in bad faith. All this meant I got to conceptualize the project and the team dynamics better.
What we do in an MSF non-communicable diseases project
At the clinics patients are screened for non-communicable diseases, mainly diabetes and hypertension (high blood pressure). These diseases can be dangerous if not managed well.
Patients who test positive are initiated on treatment. Lab tests are done for baseline evaluation and follow-up tests are done to monitor patients’ progress.
The Chipinge pilot project is based in eleven rural sites within the district: two hospitals and nine peripheral clinics. This means that rather than being "centralised" at one location that might be a long way from where some patients live, it is "decentralised" – bringing the services closer to the patient.
We use a nurse-led mentoring approach to offer care to patients and to encourage them to actively manage their health. As well as this, our team gives health talks to both individuals and groups to ensure they have the information they need to look after their health.
In St Peters, Checheche we have a group of patients who come together to exercise together at least three times a week calling themselves “the gym ladies”. This is a self-empowerment initiative by patients who already accepted that they have chronic conditions and come together to embrace physical fitness as part of the management in non-communicable disease care.
Our goal is to offer an integrated model of care for patients with non-communicable diseases and HIV. By the end of March 2019 we had enrolled a total 3180 non-communicable disease patients and 7578 HIV patients into the project.
In August, Virginia, a medical doctor from Italy, joined us in Chipinge after her acclimatization in Harare Central Hospital.
Virginia has been an asset to the team: besides her amazingly high energy level and constant adrenaline, she is a skilled, diligent clinician and patient mentor with high clinical acumen. She also speaks fluent Shona, which made her very well adapted to the setting in Chipinge!
Everyone who worked with Virginia praised her conduct, including patients, mentees from the Zimbabwean Ministry of Health and Child Care and MSF staff of different cadres.
Work aside, Virginia has a great sense of humor, a warm personality and a very direct European way of delivering hard facts bam-bam-bam, which I happen to enjoy a lot.
The past nine months have been a great pleasure for the entire non-communicable diseases project to work with Virginia and we have made lots of progress in our project milestones.
From the time Cyclone Idai hit Southern Africa in in mid-March, our usual non-communicable disease activities were modified to include active participation in the exploration of needs, medical evacuation and other interventions for survivors of the cyclone.
Working on the emergency response to Idai was intense for the entire team. But the common underlying factor was our determination to reach as many survivors as possible.
All team players executed their roles with great enthusiasm and our different strengths all blended as a joint effort, guided by our Harare coordination team.
Lessons were learnt, both hard and soft, but all in all it was part of the learning curve and it was interesting to be there for the transition from the acute phase of the response (right after the cyclone) to the intermediate phase, when things were more stable.
I also observed that different members of a team have diverse coping mechanisms while under stress. These included extreme cycling to reach beneficiaries, eating with great gusto, expressive monosyllables, theatrical expressions and even extreme silence, bordering on mutism.
Weekends have been characterized by intense discussions with Dr Virginia as we worked on an operational research paper about the non-communicable diseases project. The paper documented the experience of a non-communicable diseases project in a rural context in sub-Saharan Africa embracing the unique challenges of the region.
Together we have gobbled up different scientific articles related to our work, typing and retyping with palpitations from espresso overdose.
We are consistently disagreeing only to eventually agree, both of us determined to give the scientific article we were working on our best shot. We took breaks only when the law of diminishing returns kicked in.
In between our research we squeezed in some time for the quarterly report that was due thanks to Cyclone Idai’s interruption of our normal work flow.
All this was very far from our anticipated relaxed long weekends doing some leisurely domestic tourism around Mutare. We’d envisioned hikes in the botanical gardens and hills of Bvumba, the incredibly breath-taking Small Bridge Dam or the world-renowned Victoria Falls. Anyway, such is life, especially within MSF projects!!
Indeed there is beauty in diversity and it remains my pleasure to work in such a mix of different personality types, dealing with both expected and unexpected encounters.
To Dr Virginia Maria, thank you for transforming the Chipinge ‘kumusha’ (rural) guest house to a home for the past nine months. You are an awesome friend, sister and colleague, our Italian mbamabira! See you on the next assignment.
For the non-communicable diseases project, aluta continua, victoria acerta.
To Harare coordination team: thanks for all the support you are an amazing rock-solid support system to us in the periphery (aka kumusha citizens).
To the MSF donors who make a huge difffrence in the lives of beneficiaries worldwide that you will possibly never meet: thank you for keeping the humanitarian spirit alive and thank you for your generosity. The donors facilitate provision essential health care services to beneficiaries in need, of projects by design as well as emergency interventions such as Cyclone Idai.