Photo of the Week

Taken outside a health center after one of my supervisions.  Health centers and schools are very serious about keeping gardens.

No Time to Stop and Smell.

Rainy Season in Rwanda

Taken from our office's balcony.



Ten minutes later:

A Jug of Milk

Picture the contents of your refrigerator.  If you’re one of those young people whose refrigerator contains only an empty bottle of ketchup and a few beers, I want you to picture your mother’s refrigerator instead, resplendently filled to the brim with food.  If your mother’s refrigerator doesn’t fit this description, I’m sorry, I guess I just won out in the Awesome Mom category.  Now, inside that full fridge, I want you to find a commonly-used item, the milk. My Awesome Mom’s refrigerator has regular and soy milk, but for the purposes of this exercise, I’ll just picture the jug of regular milk.  Now, as you’re picturing that jug of milk, answer this question – do you need to buy more?

You probably instantly thought of several other questions that need answering in order for you to decide if you need more milk.  How full is the current jug?  How many people are drinking it and how often do they drink it?  I don’t particularly like milk, so a half-full jug would last me a week at least.  With my boyfriend around, it wouldn’t last until dinner.  Is there perhaps a second jug hiding at the back of the shelf?  How long will it take you to get more milk?  Is it something you can get at the corner store next door, or does it require strategic planning in advance? 

When you manage the milk in the fridge so that you always have the right amount, you’re doing supply chain management.  In fact, you do a simplified version of supply chain management any time you analyze items in your house and decide whether or not you need to purchase more.  My fellowship with the Clinton Health Access Initiative here in Rwanda focuses on improving the supply chain for pharmaceuticals within one of Rwanda’s thirty districts - Burera.  Why only in one district?  Our partners in the Pharmacy Task Force at the Ministry of Health hope that I might find some useful methods for improvement that might be ‘scaled-up’ in other districts in the future.

Stock on the shelves at CAMERWA

Historically, development organizations like SCMS (the Supply Chain Management System) have taken a top-down approach to improving pharmaceutical supply chains.  In Rwanda, they’ve done a fantastic job of improving the inventory and functionality of CAMERWA, the central medical store.  In our milk supply chain metaphor, this is akin to the manager ensuring that she orders milk, that it arrives well before its expiration date, and is available on the shelves to customers.  However, as a consumer, you know this is not the complete picture of how you manage your milk supply chain.  Imagine that you buy a gallon of milk once a week, regardless of how much is consumed.  What’s wrong with this approach?  Perhaps you run out of milk halfway through the week, and should actually be buying milk twice a week or two jugs at a time.  Maybe a jug a week is way too much, and pretty soon you’ve got nothing but half-drunk cartons of milk taking up all the space in your refrigerator. 

As you can see, the consumption component of supply chain management is a vital one.  In cash-strapped facilities like rural health centers, it is crucially important that monthly orders for drugs accurately reflect client (patient) consumption.  At the facility level, if you over-order on a drug that’s costly and not used frequently, you’re going to have a lot of expensive waste sitting on your stock shelves.  From a government perspective, getting drug ordering right is highly important. 

Pharmaceuticals make up the largest share of the Ministry of Health’s budget in Rwanda.   Let’s say that when a health facility does their monthly ordering, they over-order by $30 worth of drugs.  This doesn’t seem like a big deal until the $30 problem is magnified by more than 400 health facilities, leaving the government with over $150,000 in wasted cash per year that could have been saved if the system were tightened up.  Even if drugs are donated for free to a country, like antiretrovirals to treat HIV and AIDS, the donor organization is still expecting their valuable gift to be managed effectively.  After all, even if the government doesn't pay for them, someone does.  With the Global Fund reporting that they’re experiencing a shortfall in funding for AIDS drugs, you can bet they’re going to expect an even greater level of oversight when it comes to their list of expenditures, and drug expenses are near the top, if not first, on that list.

That’s a big picture view of the situation, but the point I want to drive home is that after governments take the crucial step of making drugs available, it becomes incredibly important to ensure that ordering is appropriate based on patient consumption.  Don’t buy two milks if you really only need one, but make sure you always have what you need.  This is the essence of my work in Burera District – getting down to the nitty gritty of things and working to improve ordering from the lowest level – the health facilities.  If I’m successful (and that’s a big ‘if’), I’ll be able to give the Ministry of Health some ideas about how to improve the drugs supply chain system from the bottom up so that it can meet the top-down organizations in the middle.

In closing, I’d like to leave you with a picture I took last week on a data-collection visit.  It’s a consumption register from the distribution pharmacy of a health center and represents one day’s worth of drug distribution to patients.  The entire pharmacy system in Rwanda relies on registers like this one for a crucial component of the supply chain – consumption – how fast the milk is being drunk. 

Note: This post can also be found on the Global Health Corps blog, where my fellow GHC crew are writing about their own experiences, debating development, and generally saying interesting things.

Photo of the Week

Taken in Burera District, right outside a health center.

7 Weeks Until Christmas - Personal Stuff You May Not Care About

Hi everyone!  I've been away a bit - work got busier and my online microeconomics course started taking up a lot of my time.  But I'm BACK!  Maybe not better than ever, but back.  I've got seven weeks until I fly home for about half a month for the holidays.  I keep telling all my friends here that it's going to be two weeks of eating, drinking, dancing, and general happiness.  My boyfriend, Alex, and I will head down to my mom's house in North Carolina for Christmas after a few days of catching up with friends in D.C.  About a week after Christmas, we're heading to a tiny cabin out in the Appalachians.  I'll finally get to see UVA, which is where Alex and my good friend Dan both went to undergrad.  And Monticello!  And hiking!  I'm so excited! 

In other news, I'm more tan than I've ever been at the end of October, especially since I found out the pools don't charge you to lounge in their beach chairs.  You only have to pay if you actually jump in.  This means I spend many Saturday mornings in my bathing suit, reading by the pool, and ordering the cheapest sodas on the menu so no one looks at me disparagingly.

Work continues to get more interesting.  Look for a post soon about it!  If you want to know about the details of my job, please ask, but I generally assume that most people feel young folks talk too much about their jobs that no one actually cares that much about, so I'm trying to avoid that trap. 

Otherwise, life is pretty uneventful and predictable, which I'm thankful for.  The biggest excitement I've had recently was thinking my box of amazing stuff from Alex had arrived, only to find that it was actually a package of three chocolate bars from my predecessor to our office.  Bummer.  The chocolate, however, was fantastic.

A critical analysis of four insanely popular African songs.

Warning: This post is long and full of stuff like African music, pop culture, music videos and analysis of all three.  If you dislike two or more of these things, you may not find this interesting.  (It's interesting).

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If you know one thing about me, you know that I love to dance.  When I first came to Rwanda in 2005, I was exposed to an entire new world of music and I promptly fell in love.  Americans, for the most part, listen to American music.  Rwandans are glorious music sluts; they  listen to anything they like - from local Kigali artists to Kenyan rappers to Congolese dance music to the brilliantly romantic Caribbean zouk.  Without fail, I always have more fun dancing to non-American music when out on a Friday night here in Kigali.  The four videos below are incredibly popular in our fair capital city.  On any given weekend night, there is a 125% chance (because you'll hear at least one of them twice) that dj's will play all four at some point.  Before each video, I give a little context on the song.  Below each video, I've included some commentary on the video/song, because I enjoy over analyzing pop culture (it should not surprise you then that I'm a big fan of Lady Gaga).

Video 1 - E No Easy by P Square

The pop sensation of P Square - identical twin brother duo of Peter and Paul Okoye from Nigeria - are kind of like the Usher of Africa.  Clean cut, cute, mostly harmless lyrics, and good dancers.  Girls, including myself, are obsessed with them.  This song, from what I can gather, is about how it's not easy ("E No Easy") to make it big in music.  Basically, they worked hard, were dedicated, and now get to pop champagne in rented stretch SUVs with beautiful light-skinned girls in tacky dresses.

Video Comments:

• At 0:13 - that Bentley is rented, those jackets are amazing.

• At 0:45 - have people really not come up with anything better to display wealth and power in a music video than a pretty girl in a short dress and sunglasses fanning herself with cash?
•  At 1:27 - he's holding a bottle of Chambourd - a raspberry liquor which is really delicious in cocktails, but awful on it's own.  I'm pretty sure they used it because the bottle looks expensive.  It retails for less than $30, so I'm not really convinced.
• At 1:34 - are you nearly as impressed with the girl in the purple dress as she is with herself?
• At 2:32 - it is essential that you know how to do this move when dancing to this song in a club.  I love impressing people with it - somehow it seems to be a marvel of white girl coordination in their eyes.
• At 2:49 - is the implication here that you must be really, really wealthy to have Asian assistants on standby?  I find this part of the video - especially the bowing - to be kind of fascinating.
• At 3:27 - let's play 'Where Are the White Girls?'  Ooh!  I think I found one.  (The white girl presence means this video was almost definitely filmed in South Africa and not actually Nigeria where P Square is from.

Pedestrian music video aside, this song is amazing and extremely danceable.

Video 2 - Fall in Love by D'Banj

Another Nigerian artist - D'Banj - with a highly catchy and danceable song.  The short soap opera scene at the beginning of the video is reminiscent of Nollywood movies.  Second only to Bollywood in numbers of films churned out each year (the States comes in third), Nollywood specializes in straight-to-DVD low-budget productions which are highly tailored to local values and culture.

• At 1:34 - he calls her his "sweet potato".  Coincidence that sweet potatoes are a staple food across the continent?  I'm going to go with 'no'.
• At 1:34 - 1:54 - if you noticed, he ends almost everything in this section with the sound "-o".  Mind-o, blind-o, life-o, deny-o, wife-o.  This is typical in Nigerian culture and is kind of a joke on the continent - including among Nigerians themselves.
• At 2:37 - he talks about taking her to see his 'mama'.  Taking a girl to meet your mother is a huge thing in many African  (and African diaspora) cultures, and people don't take it lightly.  He must really like her.
• At 4:06 - proposing to someone is a great way to make up for infidelity.  This actually happened to a friend of mine once - she was the unwitting other woman and he decided to fix his mistakes by proposing to his girlfriend.  They were all Nigerian.  I'm just sayin'.
• At 4:28 - of course, why propose to one girlfriend when you can propose to BOTH of them?!  It'll be half the fulfillment of marriage with twice the effort!  Brilliant.  Someone failed math class.

Video 3 - No One Like You by P Square

Why two P Square videos?  Because it seriously feels like they control about 50% of play time in clubs.  Plus, their songs are infectious.  This video is decidedly different from the "E No Easy" video.  No liquor or white girls in sight.  Just "gele" head wraps, babies, and balloons.

Side note: The Gele (geh-leh) is the fiercest diva head ornament on the whole friggin continent and it pains me to admit that no white girl can pull one off, or should attempt to.

And now to the video:

• At 0:15 - By only fifteen seconds in, I'm already in love with this song.  The beat, the melody, it's perfect.
• At 1:08 to 1:32 - the focus on family here (especially considering this is a mainstream MTV-Nigeria video) is really amazing to my American eyes.  I love it.
• At 2:10 - damn those girls are gorgeous.
• At 2:53 - do you think if I paid my brother enough he would learn this dance for my wedding?
• Given the cheese factor of the video, I'm a little embarrassed to admit that I've listened to this song no fewer than 50 times in the past two weeks.

Video 4 - Waka Waka by Shakira

I hadn't heard this song a single time in the United States.  Then I came to Rwanda and heard it about once every half hour.  The official anthem to this year's World Cup, this song is so infectious I've heard dj's play it back to back.  It's by Shakira, who's not from the continent, but the beat and the background vocals (a local South African group called Freshlyground) are pure African.  If you haven't heard it before, it might surprise you to see that the YouTube video has been viewed over two hundred million times.  Yeah, it's really that popular.

• At 0:15 - perhaps the "African" call is a little heavy-handed, but damn it's a great way to start a song
• I kind of hate to admit it, but in these opening shots of various World Cup moments, I almost get a little emotional about soccer.
• At 1:03 - 1:09 - another easy dance worth learning because everyone is somehow amazed that you can manage to coordinate your limbs in such a way.
• At 1:11 - damn I want that t-shirt.  Too bad they're only sold in about four stores worldwide.
• At 1:57 - 2:11 - it's really cute to hear everyone (including myself) make up sounds that they think somewhat represent the words she's singing here.  Apparently the correct words are "Tsamina mina zangalewa".  I have no idea what this means.
• At 2:18 - look at this woman.  She's beautiful!  And talented!  And not underweight as a function of appealing to both her record execs and the masses.  I love it!  Her dress, I love that also.

I double dog dare you to not to feel great about multiculturalism and globalization for the few seconds at the end of the Waka Waka song.  I have seen this melody bring South Carolinian frat guys and Rwandans who've likely never left the country together for a brief, sweaty, wonderful moment on the dance floor - pure happiness on everyone's faces.  What can I say?  Pop music is supposed to be transcendent and sometimes, it is.

This time for Africa.