Field Note April 18, 2018

Big Little Things


Boys and girls playing in Ifanadiana District.

During my recent visit to Madagascar, I noticed little girls in the villages sitting on the ground tapping rocks together. Fara, our social team manager, explained to me that each rock represents a person – a mother, father, sister, brother, neighbor or friend. The tapping is how they talk with each other. The rocks are carefully chosen for their size, shape and color and kept as prized possessions. Fara added that she has used play therapy, observing children playing with their rocks to help them cope with psychosocial issues associated with illness and death.

My recent experience of being a patient for the first time in my life helped me gain a greater appreciation for how the little things can make a big difference and how illness often extends beyond the physical to the psychological, emotional, logistical and financial, which means many different people have important roles in providing care and creating a system of support.

Luc, manager of the referral team, accompanies a child who arrived to the hospital dehydrated, anemic, and battling malaria.

As PIVOT’s development director, I had the privilege of going again to see our work in action and it gave me a greater appreciation for the myriad of little things that members of our team do – day in and day out – to support patients and their families in Ifanadiana District.

I watched Luc and Elie, referral team members, hold a severely dehydrated and anemic little boy with malaria, one cushioning his head while the other monitored his blood oxygen saturation level, as we bounced down a rutted mud road in an ambulance, part of a first-of-its-kind referral system that transports patients to higher levels of care.

Dinary, a community health worker who supports his village 10 kilometers from the nearest health center, carefully examined a child using the integrated management of childhood illness protocol, checking on a range of ailments such as anemia, malnutrition, and edema, before diagnosing diarrhea and prescribing zinc and oral rehydration, all under the watchful eye of Eldine, a PIVOT supervisor nurse, who later offered a thorough critique and suggestions for improvement.

Eldine, a community health supervisor, reviews protocols with CHWs after observing their work.

Dr. David, our quality of care program manager, treated patients side-by-side Ministry of Health clinical colleagues asking the one or two extra questions that can go beyond surface treatment to identify the underlying problem and avoid unnecessary return visits to distant health centers.

Andres, our research manager, used a computer model to plot the declining disease prevalence in our catchment area. Such data analysis and research is helping to inform our work and measure the impact of our systems strengthening and clinical programs.

Dr. Ali, our country director, sat in long meetings in the capital, listening to debates on 30,000-foot issues while trying to advance our on-the-ground agenda such as obtaining enough nutritional supplements for the increasing number of malnourished children we are diagnosing and treating.

In Madagascar, poverty and disease run wide and deep, and so PIVOT runs wide and deep with a team of dedicated professionals, from social workers and ambulance drivers to researchers and doctors, building trusting relationships and providing care to each person – a mother, father, sister, brother, neighbor or friend – doing a lot of little things that are adding up to something much greater than the sum of its parts.