wind blows deeply

I awoke this morning certain of the time for the church service. Perhaps it's because I haven't been in a while, but I was only an hour off. So I went online to find "The Call" as suggested by Atticus. While searching for other books to reach the free shipping amount for my basket I came across this one; it's on backorder but the excerpt struck a chord.

A God-ordained vision will begin as a concern. You will hear or see something that gets your attention... Unlike many passing concerns, these will stick with you. You will find yourself thinking about them in your free time. You may lose sleep over them. You won't be able to let them go because they won't let you go.

Nehemiah's concern over the condition of Jerusalem consumed him... So what did he do? Nothing. He did absolutely nothing... He chose to wait. Nehemiah knew what so many of us have a hard time remembering: What could be and should be can't be until God is ready for it to be. So he waited...

The story of Nehemiah... illustrates the truth that a clear vision does not necessarily indicate a green light to begin... A vision rarely requires immediate action. It always requires patience.

"Visioneering", Andy Stanley

This land is your land, This land is my land,
From Bonavista, to Vancouver Island
From the Arctic Circle to the Great Lakes waters,
This land was made for you and me.
The Travellers

What land do I live in? Are there parts of this land that I do not want? This is the city I live in:

Thirty per cent of residents depend on government assistance. Local food banks deal with more than 3,600 requests a month. The health authority, which last year distributed 1.8 million needles, estimates there are more IV drug users per capita than on Vancouver's Downtown Eastside. Girls as young as 11 or 12 regularly work the stroll. [The] high incidence of break and enters, car thefts, street robberies and violent assaults has placed the city at the top of Canada's urban crime rankings for nine of the past 10 years.
Canada's worst neighbourhood

We have the highest crime and murder rates in the country. Also, a few months ago, I wrote about the high cost of healthy eating in the province.

One of the most frustrating bits of being in Africa was the constant pull to tourist land. It was my messed up re-entry reverse culture shock. I was so happy to be back yet had a feeling near guilt every time I walked to the gas station for ice cream, took photos of monkeys or checked my email.

Now I'm back and living, you guessed it, in tourist land. I have done nothing to address the social injustices in my own community.

The pull to return to Africa is like a magnet; every fibre of my being longs to be there. But God said wait. Your time is done. But it seems like it would be so easy to go back. And because it seems that way, I wonder if it then becomes the easy way out. (And besides, God said wait.)

Well, I am home now. A wee bit jet-lagged this past week (I was up at 3:30 tackling some ironing) but, nonetheless, glad to be home.

A few people have asked how things wrapped up. On the 18th (Monday), in our great building blitz, we constructed the two main shelves. Tuesday, they were full of inventory and organised. Wednesday we did a bit more sorting and planning. Thursday, I discussed the project with the Chief Pharmacist and the hospital's Public Relations Officer (PRO). The Chief Medical Director (CMD) was not available due to the opening of the TB sanatorium.

The report I had prepared (I was typically writing late at night and between power outages) outlined the project over the three weeks I was there. I outlined the baseline situation of the annual pharmacy budget, and physical and human-resource constraints. Then I presented the results of the assessments I had completed during my first week. I was able to gather that the pharmacy department was fairly keen on implementing a computerized inventory system. While in some ways it would be advantageous for them, my assessment indicated that the number of inventory items, frequency of distribution and IT deficits did not make computerisation the best option. However, due to their interest in computerisation, I tried to outline a number of areas that would need to be remedied (i.e. regular updating of inventory records) before such a conversion should occur. The state of the inventory system as a whole was also discussed: inaccuracy of records, cost of expired inventory items, challenges with donated supplies, and barriers/solutions to implementing an effective system. I hope that getting the report to the pharmacist, PRO and CMD will be enough to spur change and motivation in the pharmacy department ... maybe even the hospital as a whole!

When I left at the end of the third week, the plan was to construct two more sets of shelves to hold the remaining inventory. The storeroom is completely different than when we first arrived. They even have a few more of the overhead lights working which further adds to the visibility of inventory.

Of course, there are more things they need to do. The inventory records (tally cards) need to be updated with information from the requisitions and invoices. Ordering processes and distribution on both a hospital and government level need to be examined. Additional pharmacists should be hired. And the hospital needs to be firm in how it handles receiving drug donations. While there are policies at the hospital and national level, and guidelines from the World Health Organization, the hospital continues to accept pharmaceutical and other donations that are not appropriate: a very short time until the expiration date (or already expired), items that are not commonly utilised, and items that may not have been labelled or stored correctly. These and other opportunities were outlined in the report. Hopefully, it is circulated to enough individuals in the right positions that change will occur.

The other projects also went very well. A number of people went daily to a charity centre for malnourished children. They played with the children, changed diapers, fed the children and put them down for their naps. While I was unable to go due to my commitments at the hospital, it was amazing to hear the stories from those who went. The children are dropped off by family members -- although sometimes their mother stays. Often the mothers go home to care for their other children. Being malnourished, the children are extremely small for their age and many are also sick with other illnesses. Many friendships and bonds were formed, and I heard many reports of the children start to return to health.

Others with CVM were involved with teaching at the YWAM Discipleship Training School (DTS). The DTS is home to an all-African group of students who have come to "develop in personal character, to cultivate a living relationship with God, and to identify their unique individual gifts and callings in God." Over the course of the month, various members from our group had the opportunity to be involved with teaching and sharing with these students.

A number of nurses were also part of our group. While they were invaluable in delivering our neighbour's baby during our second week (mom and baby are doing well), they were also very busy assisting and teaching at the hospital. One nurse taught a class about neonatal resuscitation. Putting the basics of this knowledge into practise was often limited by equipment and supplies (e.g. stethoscopes, blood pressure cuffs, face masks) not being available. Another nurse with an infection control background, spent much time touring the hospital and also provided in-services and promoting things we might consider common-sense: covering your face while coughing and good hand-washing. A wound care nurse was quite involved with participating in the diabetes clinic (people with diabetes are prone to foot infections), student evaluations and education sessions.

In addition to CVM's involvement in the village of Sittanunku (in 2006-2007, CVM assisted with repairing the water pump), we also started making connections in the village of Gida. A part of this was hosting a football (aka soccer) tournament between the two villages. Using these newly formed relationships, CVM hopes to begin some agricultural development work in these villages.

So there I was in Africa building shelves. Or more appropriately, having other people build shelves. (I did move some plywood and hammer and drill holes too.) I tried to motivate and change the work ethic of one person (Sarjo, the one in charge the main pharmacy storeroom). Occasionally, I was frustrated and a bit exasperated that working diligently did not seem important. I think what was most important was that I began to develop a relationship with that person. We learned about each other's families, countries, interests and faiths. On my last day, he said to me, "I don't know, maybe I am just lazy. But don't worry, I will work on those tally cards."

I began to read a book before I left for Africa which discussed two areas of missions work that Christians participate in: telling people about God and social justice. It discussed how certain Christian groups would often focus on only one of these areas and neglect the other. The argument was that both aspects are not only crucial but intrinsically connected. Part of CVM's mission statement is to "both proclaim and enact the gospel by being fully committed to meeting people's physical, emotional and spiritual needs whenever possible." So, was the trip successful? Was I able to meet some needs of the people I met? While I do think that I was able to meet some needs, my deepest hope and prayer is that the changes we were able to make would be sustainable ones.

Now that I am back in Canada, one of the things I find most difficult to respond to is hearing the statement: "Wow. Volunteering in Africa. Good for you!" The reason I find a response so difficult is that helping someone else, whether in Africa or in Canada, is not something I do to get another gold star for my wall chart. (I don't, in fact, have such a chart - actual or figurative.) Helping other people --serving-- is my life calling, my purpose, my raison d'être. What I have recently come to realise is that fulfilling one's calling really is "good for you." (I'm glad you all noticed this before I did!) So now I just respond with a smile and a nod.

And with that, I will wrap up this very long final update. If you would like to hear more of the details, or if you would like to go to Africa yourself, please do drop me a line. I would love to hear from you! I am in the process of posting photos from my trip, although they likely won't all be up for a few days.

Thank you again for partnering with me in my second African adventure. I hope that I may also have sparked an interest for you to make a difference in your own small part of the world!

This past weekend was cold! Well, not nearly as chilly as Canada (-47!) but really quite cool for African standards. Fortunately, we also took things at a bit of a slower pace. In a house with 24 other people, things get a little hectic at times. More than anything, I've been finding it difficult to find a quiet space for myself. (The sun did come out yesterday and things are starting to warm up again.)

The shelves are coming along slowly. Tools are not of the same quality as one would find in Canada. Finding a circular saw, drill bits, screws, nails etc. was also a bit of a challenge. The wood we purchased is fresh (from Senegal) ... it was cut and planed from new timber over the weekend for us. I've learned that fresh wood is a bit challenging to work with. We do have some shelves up along the perimeter of the room on brackets and have begun placing items on them. Half of the first main shelf was completed today. To the amusement of the pharmacy staff, I began the 'carpentress' today while hammering some nails into the top shelf.

Christina and I also helped start getting the inventory straightened out before we left the hospital yesterday. We found requisition slips from August onwards that have not been entered onto their tally cards. It's probably a 5 inch stack of papers that needs to be entered. Hopefully I can make some good progress on this aspect as well as moving stock back into the storeroom (once the shelves are ready).

Wednesday afternoon, our neighbours came over to tell us that a woman in the next compound was having a baby. The four nurses in our group, a grandma, Christina (the other pharmacist) and myself went over to help. The room was about 10 feet square with a single window and doorway with only cloth coverings. A double mattress lay on the floor and two wardrobe cupboards were against the walls. There was no light/electricity in the room -- only what limited light would come in through the window. Although seemingly minor, my role as flashlight and string (to tie the cord with) did play a role in the whole process. One of the nurses is here to teach at the hospital about neonatal resuscitation ... the perfect person to have around. After a couple of contractions, the mom figured out how to push correctly. It was complicated by the baby being born in posterior position. A good sized baby boy arrived at 5:10pm. There were a few concerns about mom, so she was taken to the local health centre. I got to hold the baby for a few minutes while we were waiting for the taxi to come. A beautiful head of hair and perfect tiny fingers and gorgeous brown eyes.

To celebrate Valentine's day, I grabbed some ice cream earlier and am now joining some others with some homemade cookies to watch The Lion King ... what else would you watch while in Africa?

Last weekend was fairly touristy: markets, monkeys and crocodiles. On Monday, it was time to get down to work.

My first impression of the hospital pharmacy was not quite as bad as I had anticipated it to be. Of course, it was still chaos with boxes stacked to the ceiling, larger than life dust bunnies and a mishmash of items found on any available floor space. Monday was spent explaining the project to the pharmacist-manager, Essa. Essa is the last remaining pharmacist at the Royal Victoria Teaching Hospital. There were two other pharmacists when I was here in 2006 but they have since left. Essa is on multiple management hospital committees, in charge of training pharmacy technicians/assistants, and tries to have a clinical role. Unfortunately, being a hospital pharmacist doesn't pay well. After his shift of 8-4 at the hospital, he works at a retail pharmacy until 11 to support his family. Imagine being in charge of all the medications aspects of a 550 bed hospital (also consider there may be more than one person per bed at times) ... ordering, inventory, distribution, DUE, research, clinical, training and protocol development/management ... now imagine the things that you simply won't get to because there aren't enough hours in the day.

While doing a survey to assess the appropriateness and feasibility of implementing a computerized inventory system, I learned more about the process through which the hospital procures their pharmaceutical supplies. The pharmacy department puts together an annual proposal for items to be ordered from the National Pharmaceutical Services (NPS). Similar to health regions in Canada, the NPS sets contracts with vendors for all items to be ordered by the hospital and health centres. The pharmacy department is in charge of procuring pharmaceuticals, surgical supplies, and x-ray supplies. That proposal is then negotiated with NPS and the items are adjusted according to budgetary constraints. Currently, the pharmacy department's budget is approximately one quarter of that needed (~$250,000). Once ordered, items are only shipped to NPS (and then in turn to the hospital) when the respective companies feel they have enough to warrant shipping the items. Thus, items arrive in a haphazard fashion. As you can see by this procurement process, the drug supply is often lacking.

I also had a chance to visit the NPS on Monday. While there, we noticed some metal shelving (similar to that found in many a garage in Canada) that was not being used. The pharmacist in charge of the NPS anticipated significant government bureaucracy in giving us the shelves but agreed to look into it for us. On Tuesday, I met with Baboucar (the Public Relations Officer, PRO, at the hospital) who wanted to go to the NPS. So, off we went. Again, the NPS pharmacist stated she would look into providing the shelving to us but, this time, we were able to get the name of the contractor.

Tuesday, I completed another survey in the pharmacy department to assess the existing inventory system. Preliminary results suggest that the inventory records are 4% accurate. Many of the tally sheets were last updated in November. I hope to sit down with Sarjo, who is in charge of the pharmacy stores, and find a way to improve the inventory system. One idea is that all the tally sheets are kept in a single location and are updated weekly. I will see if this is something that Sarjo might be agreeable to trying.

Wednesday we continued moving and sorting boxes. Michael, an electrician at the hospital who I met in 2006, stopped by to fix a broken refrigerator. Michael and Darcy (a team member helping with construction) managed to track down a hammer drill for Thursday so that we could start putting up some brackets on the walls. By this time a substantial part of the storeroom had been emptied and things were looking really quite manageable. After work, we went down to the beach and swam around in the ocean for a while.

Thursday, most of the shelving brackets were assembled in the storeroom. Christina, the other pharmacist and I, began making a list of the expired drugs and surgical supplies we had sorted out. Lorna is also a part of our team and has a passion for organising. After another talk with Baboucar, we got in touch with the shelving contractor. Unlike most Gambians, he showed up peculiarly early, took some measurements and promised to get back to us with a quote later that day. The quote came back -- and was far above our available budget so we opted to continue with our plan to build with wood. That afternoon, we returned to the house for measurements for the dresses we are having made. Hopefully, they are ready for when we leave.

Yesterday, we picked up some plywood before heading to the hospital. Darcy and Mike ripped the plywood into strips to place on the brackets for shelves. The shelves went up above the fridges and along one of the main walls. The 2x4's we ordered should be in next week so that the rest of the shelves can be built. Christina, Lorna and I continued our inventory of the expired stock.

It was nice to have a bit of a break today -- I definitely needed one! This morning we went for a boat cruise along the Gambia River. It was a fair bit cooler today but still nice enough to lay above deck and relax. This afternoon we went down to the beach and spent time with the Smile Team -- a group from the UK we met on Monday.

Everyone with a delayed flight has also arrived (finally), along with some of the folks who were supposed to arrive this week. We have a fully house of 23 right now ... with more to arrive this week. Thanks again for all your notes and well wishes!

I have switched the video locations; all videos to date can be found below. I anticipate more will be posted soon for your viewing pleasure.

Tour of our House
Bijilo and Cachikaly
Driving through Bakau
Sunday Service at the Redeemed Church of God
Pharmacy Storage (Hospital & National Stores)

The first full day in The Gambia has gone well. Most of the first team arrived last night at 1am (some missed flights but should be arriving tomorrow). We finally we in bed by about 4 and were awoken by a rooster an hour later. The day was fairly laid back with everyone adjusting to the new time zone and climate change. We went out for a few walks and spent some time jsut getting to know each other. Tomorrow we're off to Bijilo Forest Reserve and Bakau (crocodiles and the market).

Feel free to check out the brief tour of our accomodations I made this morning while most of the team was sleeping.

You haven't seen much of me lately. January's been a very busy month ... working, travelling across the province, sneaking in a few moments with friends and family.

And now, as I procrastinate packing, the reality of leaving for Africa is finally setting in. In a mere 13 hours I will be leaving to volunteer in The Gambia for three weeks. Assuming technology is in my favour, I hope to post updates and possibly photos from time to time.

Thank you for all your well-wishes, prayers and financial support for the project. I couldn't do this without you! Have a wonderful February ... stay warm ... and I'll talk with you soon.

I'm off to Africa this February with CVM. If you are interested, we're still looking for some funds for the projects described below. (Click here for more info on giving to CVM ... this is project CVM008)
Of course, your thoughts and prayers are much appreciated!
(Send me a note if you would like email updates.)

Royal Victoria Hospital Construction Project ($5000)
We will be constructing shelving for the hospital central pharmaceutical stores. Additionally, we will be brightening up the walls with a little fresh paint on a number of hospital wards.

Treated Mosquito Netting ($1000)
The center for malnourished children is in desperate need of new treated mosquito nets for the children. Malaria is the leading cause of death for children in the developing world and is largely preventable. We will be helping Sisters of Charity refurbish and replace old mosquito nets.

YWAM Discipleship Training School ($2500)
In addition to teaching a portion of the lecture phase, we have been asked to assist the all-African group to help cover the costs of the school. Cost covers books and housing.

One of the things that took a bit of getting used to while in Africa was a phenomenon we entitled "Gambian time". It didn't matter if work started at 8 and you showed up at 10:30 or if you didn't show up at your scheduled meeting (and didn't bother to call) or if people unexpectedly stopped in to visit. It was simply how things ran.
Being a typical North American, I am familiar with and operate quite well within time constraints. Before departing for Africa, people would ask what I would be doing for my two and a half weeks. I knew that I would be involved in some sort of pharmacist-type work but all I knew was that there was no plan. I think I'm fairly laissez-faire but having no plan made me wonder how it was all going to work out.
Yet to see those weeks unfold was most incredible; We accomplished goals, identified opportunities, networked and established connections for future trips, made friends, remained safe and healthy. God orchestrated an infinite number of details and worked me, an amateur, into the masterpiece.
This is the crux of the matter: I am learning to have faith that there is a plan in play. During our debrief, one of the guys (Alan) told me not to worry about what I thought I should have or what others might suggest I need. He said, "Look around Jenn. What you have is good. God is with you and is using you and is blessing you. What you have in your life is enough just as it is. If you needed something else, God would have provided it."

For I know the plans I have for you, declares the LORD, plans for wholeness and not for evil, to give you a future and a hope. - Jeremiah 29:11

OK, so I really am adjusting to the Gambian climate. I actually commented that it was getting cool this evening on our walk to the ocean to swim! What fun it was to play in the surf.

On to much more exciting news. Last evening, in the "new" internet cafe we found, as I was typing the last entry here, a large bug was spotted flying around the cafe. Was it grasshopper or locust was the question. After discussion late into the evening, it was decided that the insect was indeed a locust. It looked very similar to a grasshopper except that it could fly. And fly it did. Around and around and around the room. A little creeping, but my small group will definitely appreciate the locust sighting (after studying Joel over the summer). Alas, my camera was still at the house and a photo of said locust was not obtained.

While yesterday was our first official day at the hospital, it was mainly touring and meeting with the directors. Today was the first work day. We met again with the head pharmacist, Essa, got some ideas on what the processes were in place and worked out what we'd be working on for the next week and a half. Then we decided to organize the donated medications located in the main pharmacy. Everything was covered in a thick layer of dust, in random order and most certainly set up for errors to happen. Initially we were a little daunted with the task ahead of us, so we went for lunch. Beans on a bun and a coke cost us 18 dalasis ... or about 75 cents.

After a lunch in the hot afternoon Gambian sun we sorted and cleaned and classified. (I do have to say that I find myself increasingly able to tolerate the heat and humidity ... it may even be growing on me.) We only got about 3/4 of the way through the first large shelf but I think Mel, Tim and I all left with a good sense of satisfaction at the end of the day.

One of the new items on my list of "pharmacy-related things to be empassioned about" it that of foreign medication donations. Now that I have been able to see the variety of agents that are donated (without generic drug names, in foreign languages, opened containers, old prescriptions from patients, expired stock) I hope to "let the world know" how much of an issue this is. Simply the time that it takes to sort through all the individual boxes and sort it into some reasonable system would be overwhelming for a country or local clinic/hospital/pharmacy. The WHO recommendations are certainly something to bring to people's consciousnesses.

Once these medications are sorted, we will likely spend time in the various satellite pharmacies to observe the processes in place and make recommendations for improvement. At the moment, there is only one full-time pharmacist and two part-time ones. Pharmacy assistants (not technicians) do all of the day to day work: recieving prescriptions, filling the medications, checking their own work, giving to patients and limited counselling. The pharmacist simply does not have time to be involved in any of these steps. Already we have observed many potential concerns. (One thing we heard was that medication errors account for about one third of all deaths in the hospital.) In addition to sorting and observing, we may spend some with the physicians (mostly Cuban) on the wards.

Hopefully we can also put together a plan for the hospital's medication store room. The room is of average size with cartons stacked floor to ceiling and very little space to walk around between them. I'm sure they cannot have a good idea of what is actually inside the boxes. Once we have a better sense of how big the problem is, I hope that we can find pharmacists and pharmacy technicians that would be interested in coming in the future.

Friday and Saturday will be spend putting together a medication kit for a rural health worker and doing the training for this. I think we will be able to procure the medications from the community pharmacy where Essa (the hospital pharmacist) also works. Community pharmacies are a bit of an interesting thing here in The Gambia: no prescription needed -- just walk in and request whatever it is you think you may need. Sleeping pills, antibiotics, pain relievers ... pretty much anything you want.

That's enough ramblings from me right now. I'll be sure to get on my soap box again soon.

OK - gotta make this one quick ... internet is slow and everything is taking a long time tonight.

The Gambia is great - albeit hot and humid. (Per the locals - cold)

Today we went to church - after arriving about 1.5 hours late ... we still got to experience the remaining 2 hours of the service!!! After church we went to McFadi's - the seemingly only Western style restaurant around. However, Mariata has been cooking the most marvelous meals at our house. We also went to Bijilo Forest Reserve and fed peanuts to very cute monkeys. (Raw peanuts/groudnuts actually taste a bit like raw peas ... I s'pose that's how they got their name.) We also went to a local (read: not-so-touristy) market and I bartered for some rappas (skirts) and a purse. Apparently I did not too bad.

Tomorrow the other pharmacists, Melanie and Tim, and I will be heading to the hospital in Banjul to begin our work there. Still not quite sure what we can help with. Steve, Andy and Alan will be heading to a village across the river to help with a water pump and other things.

Must go. Missing you all lots. Will come back to write soon (and post pictures hopefully).

Well I'm in grey, rainy London, England. It is about 10:30pm and I've been up for who knows how many hours now. It's been raining heavily and steadily all day. Seeing as I packed for hot Gambian weather, I had no rain stuff (jacket, umbrella etc). All was a little bit damp but I managed to try it out with my room heaters cranked on high.
Tomorrow we leave to catch our plane to The Gambia. Hopefully I will be able to write more when I'm there. If not, I'm sure I will have plenty of stories to tell once I'm back.

This November I will be heading to The Gambia, in Western Africa (map), for a missions trip with Christian Volunteer Movement.

There are many exciting things which I may be involved with. However, I am excited that I will be using my expertise as a pharmacist while I am there. Along with two other hospital pharmacists, I may be involved with developing medication kits for rural health workers, attending rounds in the hospital along with local physicians, organizing the hospital’s pharmacy dispensary and medication supplies, and/or teaching pharmacology courses at the local university.

Through a discussion with a work colleague, I was reminded that despite the fact that many of us live in neighbourhoods, a sense of community is often quite lacking. As I began thinking about this conversation, the upcoming trip to Africa and how God has blessed me with great abundance, I had an idea. I have a job that both pays well and offers flexibility in having time off. So I thought, if I have the time and financial resources to make the Africa trip possible what are ways that I could also benefit the local community? My solution .... you!

I have decided to use the resources God has entrusted to me to go to Africa. In turn, I want to extend the invitation to those who may have otherwise considered supporting me to instead support their local community with their own time and finances. Of course, your prayers for myself and other group members are highly valued.

If you decide to take me up on this opportunity, I'd love to hear how you got involved.