A brief trip to NYC

Some months ago I had agreed to facilitate a consultative meeting in New York City, just days before my planned trip to South Africa. It would mean arriving back home at midnight the day before my departure to South Africa. I accepted because I love such assignments, even though it was a bit of a sacrifice and there were moments I regretted my ‘yes.’

It was a consultation about getting childhood tuberculosis considered as part of a broader package of maternal and child health interventions as the local level. This may sound simple but it is far from simple. Local level ultimately means the community level. This is the level where, in many developing countries, the usually unpaid community health workers are fulfilling the most basic tasks of prevention, diagnosis and treatment of illness. These people often have little education and sometimes aren’t even literate.

They are trained to fulfill their various tasks through vertical programs: the malaria people provide materials, pictorial algorithms and instructions, training sessions and reporting forms. And so do the health education people, the maternal and child health experts, the HIV people, the TB people, the nutrition people, the vaccination people, and so forth. A participant from Uganda told us that she has seen community health volunteers who have to fill in 11 registers to show their task masters what they did each day or week or month or quarter.

The purpose of the consultation, led by UNICEF and the TB Alliance, was to learn from other experiences of integration and consider the upstream implications of integration at the base: the health system functions, the financing, the evidence and identify the research agenda that would give guidance on how to proceed and avoid mistakes of the past

I took the train to NYC, having calculated that plane or Acela train would take about the same time and cost about the same as well. Sometimes we hear about Amtrak trains derailing because some system was poorly maintained or the conductor was driving too fast. These things happen and make a big splash, but they are rare. I boarded the train hoping all systems were maintained and the conductor had had a good night sleep and followed the rules. I arrived safely at Penn Station, though the trip took a bit longer due to a few glitches that were annoying rather than deadly.

I arrived at UNICEF just when the place emptied out for the day. I finally got to meet my team mates in the flesh (though one I had met nearly 20 years ago in South Africa). We did the finishing touches on the design and flow of day 1 and identified what still needed work for day 2. Since all my team mates were lodging in places far apart I was on my own for dinner and too tired to visit anyone. I consulted Trip Advisor and found an authentic Japanese/Korean restaurant across the street. It was full of Japanese and Koreans, which confirmed the rave review, and I was greeted by all staff the way I remember from Japan. I also discovered a Japanese convenience store a few blocks away and stocked up on some delicacies to nibble on later, while watching TV in my tiny ‘central location’ hotel room.

I watched an amazing PBS program in which Stephen Hawkins turns theoretical constructs into a series of ingenuous experiential exercises for teams of three young scientists. The take away message: we are infinitesimal small in the greater scheme of things. It was another reminder about keeping perspective.

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