After 4 months in Nukus, no one asks me if I’m Indian anymore. Complete strangers now approach me with a one-word question. “America?” I guess word has gotten around. Perhaps if I stayed another 4 months, they’d even know my name. Instead, my end of mission is quickly approaching and I’m trying to stick to my schedule for the next few weeks.
I spent the last two days training government doctors how to document information about their patients on new forms. When presenting a new idea to a roomful of post-Soviet doctors who speak Russian, learn to trust your translator. I thought I was being smart by handing out monthly reports for the last 3 months. It was my offering of shared knowledge; information shouldn’t only go up the hierarchy. But this new system would mean that the doctors would have to collect the data, fill in the forms, do something outside the current task list; which they were not particularly excited about. I spent 20 minutes listening to them telling me about their already heavy work load and responsibilities.
I tried to explain that this information will help them with patient care, that they can see how the whole program progresses, that they can monitor the proportions of patients with drug resistance. Their attitude towards data collection can be summarized by the comment form one older doctor, exclaiming. “We’re just workers here, we take orders.”
How does one say, “me too” in Russian?
I just wanted to get through my agenda, but I was feeling more and more like the typical foreigner who comes to a developing country to implement some grand idea quickly and leave behind more work. I could see their point. Our MSF drivers probably make more than they do, and here I was, representative from this rich organization, asking them – no, telling them to do more.
I suppose it’s inevitable. MSF has taken on much of the responsibilities for drug resistant TB control in this region. But eventually MSF will leave, because MSF is always supposed to eventually leave. And when MSF leaves, the government doctors have to take on additional tasks. But this transition is painful. Now it seems like my biggest job is not testing the new database or migrating data from the old to the new. I have to sell epidemiology to these doctors. I have to get them to see that this information is vital for understanding how well the program is doing, and that it can only be accomplished if they participate. I have to take off the epidemiologist hat and put on the salesman hat.
Because when I leave, I don’t want to be known as that “American” who left behind more work.