Random thoughts on public health politics - Part 6 of 6 part series

In my previous post dated 21 June 2015, I expressed a deeper insight into what goes on and what we are not able to understand the web of public health politics. Here again, I would like re iterate that I am not able to say certainly what goes in the mind of decision makers at the international headquarters, but at least i can say - we understand the pulse of "what goes on" and "how it goes" in our local community !! Sometime, however - we are cognizance of the fact that we may subjectively feel that whatever we said and did should be right but we may not be up to the mark and fail to realize this fact !! It is therefore necessary that we need to analyse retrospectively what we do and how we think so we do not make the same mistake again and again. Time and then to keep us sane in times of confusion timely reading stories on infectious diseases gurus like Brad and David Sack encourages us to move forward in what we aspire to do. We also get encouraged to work hard and perspective in what we envision doing  in countries like Nepal.

Yesterday, I had to go through a psychological test (not in a psychiatrist or psychologist' chamber) at a personnel level. So you may ask what is this test and what does it have to do with public health politics. Well - it is about your ability to express your ideas (both at academic, programmatic or even anger or frustration)  in coherent manner. Sometime I have begun to question - does your language of expression to express your thought or ideas have any relation with public health politics or it is more than the language of expression - calculating the equation or even deciphering the intricacies in the relation that sometime exist beyond our knowledge? I know I am asking a very personal or even complex question. When in a national or even international forum - i had to face frequently the linguistic gap many of times. For example - my mother tongue is Thakali and all my childhood - i had to work hard to excel Nepali language and to be competent enough to understand science we had to learn English as one of the main foreign language. I do not want to each and every detail however I would be vocal and straight that we have to face challenges while writing and expressing our thoughts in the language other than our mother tongue !! Do you believe what I am saying? May be you may say - Oh this guy is being too emotional and ranting blah blah..... but this is one of my experience at deeper level after years year of trying to understand why we could not excel in some of the subjects that we had to learn in either Nepali or English !! I found the answer and this is definitely  language related competencies !! Along with it are its trailing competencies such as communication skills and also emotional or even social skills. And sometime - we get cornered just because we are not able to express what we think clearly in the language other than our own language. Do you agree with me?? Well, you do not have to agree with me but those who have to go through this subtle difficulties faced in their daily affairs may agree with me completely or partially. Again, you may ask, what does this language competencies or even communication skills have to do with public health politics? Well, this has a big role - and as I said I felt it acutely when approaching in such forum where you have to express your thoughts. 

Expressing all these thoughts at random - I would definitely say "Public Health Politics" has many dimensions and its equation has many variables. Among those variables - i would say language competency is the most important one. In some of the conference - we see those who can express their thoughts coherently, loud and vocal are able to bring their agenda in the forum and bring about impact in the conversation. This will, in turn, help them shape their idea through policy / decision bodies. That is why we have a Nepali proverb, " Those who speak loud and clear can sell even an item of no value, however those who do not speak can't even sell "rice" !!" With this proverb - let us start being vocal but also understand the landscape of public health politics, which is always fluid and changing within time and space - uncertain !! 

27th June 2015

 Kathmandu

Random thoughts on OCV delivery and public health politics in Nepal - Part 5 of 6 part series

By the time I am writing this blog post - my stay here in Kathmandu has crossed 45 days. The reason that I am here in Kathmandu was and is to be the part of greater Nepali family, which is what I have deeply felt from the beginning. I have never before felt this deep sense of solidarity than now to our own community, relatives, friends and people from all walks of life. This is an interesting "feeling" or "perception" which I need to fathom deeper and I guess, this is the kind of "togetherness" that we need to inculcate in our society.  Well, to put aside this soft feeling that I can hear and experience around us, we also have been the victim of "invisible hands" in what we do and what we want to do !! Myself, who was raised and brought up in rural community far away from "comforts" of urban city like Pokhara and Kathmandu, is not enough of "stories" to convince decision makers in the authority - it required more than that. "That" would be public health politics and we need to be master at it. 

Forget - big super cities !! We know how our people in the rural communities still have to suffer from malnutrition, worm infestation, common preventable diseases that have already been eliminated from high or even middle income countries. We know surveillance of these preventable diseases have to be robust supplemented by lab diagnostic facilities, while I am sorry this is still a challenge and too primitive in remote hard to reach areas of our country. Yes we know that there is such system in paper and public health leaders are cognizance of this scenario. It is not that they are unaware but these leadership are not able to enforce such surveillance in remote areas due to various bureaucratic red tape and of course, lack of "much needed" human as well as logistics resources. We also know that just observing and experiencing these diseases or even the systemic challenges in the community is not enough - what we need is evidence and that too in writing thoroughly supported by data available. However, I think - the availability of such data can be challenging in times of public health crisis or emergencies like Earthquake and Nepal's recent event is an example. 

Now, a little disconnection from above trail of thoughts - for me 45 days has been just like 5 to 15 days only - what a amazing experience so far !! Here I also like to share  - Nepal is a wonderful place to work and Nepalese are resilient people to be with. Also, I have to be straight and vocal - we are sometime disillusioned without clear goals and road map buried in our own mountain of problems created out of complacency or too many heads working like "too many cooks spoils the broth"!! Sometime in the future - I need to write this amazing experience in writing or at least as an essay.

Coming to back to topic of my post - during this 45 days period (my focused goal here in Nepal is to vaccinate the most vulnerable population) - I did not think in depth the complex processes that were in play when were working hard to mobilize oral cholera vaccine (OCV) in preparedness for preventive vaccination in heavily affected districts and that too not the whole districts but only selected villages at the highest risk. We are still trying to get the vaccine but we are not sure whether we will get the vaccine although we are prepared for the conduct of campaign. We are aware of the "seen" and "unseen" challenges that we have to face. We are prepared to accept a scenario where we are rejected from getting the vaccines. Another - to facilitate the process that we get the vaccines, we are doing our best to coordinate with all concerned and most of the partner organizations are positive except one or two organization who have reservation and we are trying our best to bring those organization on board. Somebody senior public health specialist, whom I respect a lot in his extra ordinary skill to make things happen, uses the term - "public health politics". I agree - it is more than just science and its technicality. It is however the "damn" shrewd coordination that works well if we are able to understand the "bigger picture" and landscape of interest groups in the picture. Our big picture that we know is " to protect the community through integrated preventive and control measures against enteric diseases like cholera, typhoid fever, HEV etc." As of now, our communities in the rural areas are coping well with the loss and structural damages while many children, women and weak and old are vulnerable to infectious diseases especially water borne illness, which could spread should there occur trigger factors of poor water, sanitation and hygiene. We also have to remember that Nepali humanitarian peace keeping forces were pointed out as the carrier of cholera bacterium in Haiti on record. It is therefore we want to prevent the possibility of cholera outbreak at the earliest before the monsoon starts. But we fear, time is the essence and my pnly question - are we entangled with unnecessary processes or "ego" or "arrogance" that emanates at personal level but not at organizational level? This is too tough to understand however the only caution that I am vocal about "No Jajarkot Cholera tragedy again!!" 

21 June 2015

Kathmandu