Design and Research Methods

I am thinking about design today.

As I move forward with developing the methods section for my master’s thesis, I am going to have to spend a good amount of time considering design.  What are the best questions to ask, to explore my topic?   What are the best ways to ask those questions?  Who should ask the questions?

Talking about design is a conversation at the forefront industry.  I would argue that this conversation was started by Steve Jobs who labored over design elements like the best “color gray” to use.

Laboring over study designs for research is less glamorous (for now anyway).  But design works, and this topic is popping up in unexpected areas.  For instance, I just read “A Whole New Mind: Why Right-brainers willRule the Future.”  In this book author Daniel Pink explains that the most marketable skill sets in the future are the ones that incorporate elements of design and cultural sensitivity into products.  I also just found an article by Rebekah Chang is an intern for Kiva’s Strategic Initiatives which highlights some comments on design by Tim Brown the CEO for IDEO:  “…things that work well are usually developed with a lot of thought to the “how” factor and with a deep understanding of the communities being served.”

Picking up!

It looks like I'll be going back to Panama in February of 2013 to conduct some research for my Master Paper in Health Policy and Management at UNC! 

Spinning of of the HIV project that I helped out with in Bluefeilds, I have developed a research project that will look at who is electing to get HIV testing and why.  I am lucky to have the expertise of Harsha Thirumurthy  and Stephanie Wheeler  who are helping by pushing me in the right direction with contacts and ideas.  

So I am picking up the blog again.  The Masters Paper research is relevant to the work I have done in Panama.  I also think that it will be interesting (even though it is terribly frightening) to write about the trials of conducting my first research project and of course the production of the Masters Paper.  

Whew..... ready?  I am not sure I am, but why not explore this together?  I'd love any comments and feedback you have on the project.   

Source of Wonder

What is extraordinary?  The ordinary.

Closing in on nearly 2 months of living in Panama and working with Floating Doctors I am finding that this place feels kind of ordinary now.  Of course it is not, but I am not shocked by things as much any more.  Which as led to my joking around for the past few days about how Ngobe I am becoming.  For example, walking home with groceries on my head - how Ngobe of me;  caring a little bit less about having a bug crawling on me - how Ngobe of me; not being upset about having to walking around the city barefoot because my sandal broke- that's my Ngobe side just coming out to say hello. 

But adaption has its draw backs.  (I am hoping that worms is not one of them).  Including that I see less details or at least they are not as striking and as crisp as they were when I was just starting here.  The culture becomes a backdrop and less of a source of wonder.  

Cabin Fever

It is the rainy season here in Panama so of course it will rain.  However, some days it  pours.  When that happens it is nearly impossible to hold mobile clinics since our mobile clinics are held outside under shelters with thatched roofing.

So it ends up that most of our days off are rainy days.  So instead of getting some time at the beach we end up with cabin fever.  This particular day we found some duct tape and ended up (of course) taping each other on to chairs.

Resident Floating Doctor

Every little bit counts!

Sometimes Public health is glamorous.  Other times you end up in a warehouse, with an Excel spreadsheet, counting toothbrushes to Adele.

 Does this sound familiar?  Inventory.

I have never done inventory in my life so naturally I decided to lead this project. My ambition is due perhaps to a few reasons. First, I love organization. Second, it really needed to be done.  Third, it gave me the opportunity to geek out and make a really cool spreadsheet.  (I am now secretly hoping no one reads this blog).

I didn't really think I was a researcher until I realized how much I liked data.  But it is actually not the data that is interesting - it is the story that it tells.  For example the inventory of medications and supplies for Floating Doctors currently tells us what we have in stock.  My new spreadsheet elaborates on this data and will tell a bit more.  Once all the data is entered, we can track how much medication is used every month, which will tell us about the types of diseases are being encountered.  The new inventory spreadsheet will have targets amounts of each medication so we can quickly see which medications we are running short on and order more.  This information will help prioritize our requests for donated medications.  Later, I envision that we can use the inventory spreadsheet  to help locate items in the warehouse.  Which will help speed up future inventory counts, locate medication that is kept in small supply and will help new volunteers locate medication quickly.

Inventory!

What do Boxers and Midwives have in common? Public Health!

This week we have been rolling out more public health in Panama.  First with a youth boxing club and then with the partera of Valle Escondido.


For the boxers, we did a short EMT/Sex Education course.

Captive Audience at the Boxing Training

Practicing the Heimlich

Condom Demonstration

 We covered the following topics with the boxers:

Choking/ Heimlich Maneuver
Wound Care
Burns
Sprains

Sex Education

For the parteras we focused on nutrition.  First, we interviewed them to see what kinds of foods they were eating and how often.  Jenny has been a volunteer for the past few months and she did an excellent job with explaining the best food choices.

One topic that was discussed was the nutritional difference between a potato and a bag of potato chips.  To my surprise, the women were shocked at the discovery that a bag of potato chips would be less healthy than the potato.  They had no idea that there was so much salt and sugar and preservatives.  The women were so excited to learn it was fantastic. 

In addition to our discussion, the parteras demonstrated how and what they cooked.  They made a delicious, traditional soup called "rondon" with plantains, acorn squash, bread fruit, fish and coconut milk.  We also ate the leaves of yuca, a mashed banana and coconut milk, and some hot chocolate.  It was so delicious and I cannot wait to try making variations of these dishes when I get back home to my kitchen in North Carolina.

 Talking about nutrition with the Parteras (photo by Cybill Esguerra)

What's better than good?

"What's better than good?   Not doing harm."

It could be my background in Anthropology, but I couldn't get that thought out of my head  as we were in Ensanada a small community of ~350 Ngöbe people in Bahia Azul.

In addtion to running the mobile health clinic, we had a public health team perform a survey to assess the level of understanding in the area regarding HIV/AIDS transmission.   Our most excellent public health team went out door to door.  We crossed  the bay in a kyukas, traversed across logs, went into the mangroves, trekked through swampy mud , and got attacked by large black ants during the day and blue crabs in the middle of the night.  Some houses would welcome us in, sharing snacks or bananas.  Other houses were understandably skeptical and would turn us away.

Most excellent public health team

Gift from a home I visited

There was a Peace Corp worker in Ensanada who at least twice a day would gently remind our group that our goal should be to "make sure everyone felt good about us coming to visit even if they learned nothing about HIV/AIDS".  It was the best advice.  Sending love and opening ourselves to this community was a demonstration that we can be trusted, which will pave the way for the next public health team that goes out.  

The long-term goals of this project is to get this community tested for HIV/AIDS and then get treatment for those who need it.  Currently, there is a confirmed case of HIV with a 3 year old girl.  Her mom died last year from AIDS.  A total of 3 deaths in the community last year are thought to be from AIDS though this is not confirmed.  However, AIDS is of particular concern in this community where the Ngöbe people are tolerant of infidelity and there is essentially no access to medical care.  Women are aware that their husbands, who leave for work for weeks at a time, will have relations with other women.  While men and women are using condoms some of the time, it is not happening consistently because there are not condoms readily available.  If they are using condoms they may not be using them correctly.  One Ngöbe man said that he was using 3 condoms to be extra safe.

Interviewing a house

Of course the primary goal of this trip was to hold a mobile clinic.  This was going on while the public health teams were out in the community.  The clinic team consisted of two doctors, two nurses, and a future medical student.  I am not sure what the final patient count was, but I believe they saw around 120 patients in 2 days.  Everyone did an incredible job especially the two doctors.  Seeing how hard they worked for 10+ hour days in 90 degree heat gave me a new-found appreciation for the medical staff at Floating Doctors.

After a full day in the clinic the clinical team made house calls to see patients who were too sick to walk to the clinic site.  I need to emphasis that these "walks" to the house calls are not leisure especially if you are going after dark where footing can be misleading with only a headlamp.

"Leisurely" walk to a Ngobe house

One of our doctors working with a Ngöbe woman

After the long days we had some fun with my camera and I took some long exposure shots of the stars which turned into some shots of kids running around with headlamps/flashlights.  I also had the amazing experience of swimming in bioluminescence which cannot be captured on my small point and shoot - but, of course, I still tried.

Abundance of stars!!

"AMOR"

Bioluminescence.... of course!  

Bahia Azul Preparation

Today was spent in preparation for our trip tomorrow out to Bluefeilds (Bahia Azul).  We had to get food, shelter, and medical supplies packed up for a 4 day trip.  We plan to hold 2 full days of clinic for this remote population. While we are there I'll be going out with a team to provide educational materials on HIV.  

(Thanks GoogleMaps!)

I have heard that it is going to be a choppy ~5 hour ride over there in our panga so it should be interesting with the crew of 13 + supplies.  Regardless, I am looking forward to it.  We will be primitive camping in hammocks on the beach so I will not be taking my computer.  I'll be sure to flood you with photos when I return on Wed June 20.  I have been told it is very beautiful.

Here is a photo from the local grocery.  This little fellow was just hanging out in the store.

So much depends upon the can-opener, glazed in water, in the kitchen

After a long flight, and multiple longer bus rides I made it to Bocas del Toro a little over a week ago.

Since then I've been getting settled in and learning more about the Floating Doctors organization.  It has already been a busy week and I can see that things are only going to get busier.  This group is incredible and very generous.  I can see why in only 3 years they have been able to build so much success.

This organization largely runs on volunteers which is unique and new to me.  My first thoughts on this are that (1) everyone working here is as excited and motivated as I am, (2) everyone here has a big heart and has gone out of there way to be here and make a contribution, (3) the burn out rate is non-existent since everyone is transitory for the most part, and (4) no one knows where to find a can-opener.  

Why is the location of the can-opener important you ask?  There are 8 volunteers on the boat right now and I'd hedge my bets that there are only 3 people who know where it is.  From a management standpoint, if you have volunteers coming in and out of the boat (sometimes in as little as a week) then organizing and following procedures becomes a daunting task.  

This is one of my great tasks - how can we make procedures and organization so obvious that someone fresh off of the street will easily jump in and know how to help?  Also, how we encourage everyone to follow protocol and practices because- yes, that data point is important to collect and yes, returning that bottle back to the shelf where you got it is important.  These details which are not immediate gratification are difficult to instill in people especially when they will not be the ones to gratify from the extra work.  

On another note.  Here is my photo of the day.  It is the "Southern Wind" the boat I'm currently writing from.  I snapped this photo on the way to Red Frog, an amazing nearby beach.