Saturday, December 11, 2010

My job, pt. II: So what do you actually DO?

This is Part II of a three post series introducing the work component of my life as a PCV, in which we’ll look at my program’s objectives and major projects at the general level.   The series is moving from the broad to the specific; Part I is a general introduction to the public health situation in Moldova and Part III will conclude by a look at what my work involves on a daily basis.

Every Peace Corps Volunteer worldwide works in a program; here in Moldova, I work in the Health Education in Schools and Communities (HESC) program.  My formal title is Health Education Specialist – yes, even as a volunteer one gets a snappy title.  In PC Moldova parlance, I’m referred to as a “Healthy.”

As a HESC PCV my primary work focuses on building local capacity for the educative aspects of a public health program.  As I explained in my previous post, Moldova has one of the highest health care provider ratios in the world, but the concept of public and preventative health is still taking root here.  It also has a decent public education system, considering the local resources available.  But again, health education is still struggling to be integrated in an intentional and coherent manner.  The local providers, in short, aren’t yet accustomed to being educators, and the local educators aren’t yet accustomed to the specifics of health education.  I’m here to facilitate that step.

That step is broken down into two overarching goals and seven objectives:
  • Goal 1: Improved Health for Youth
    • Objective 1.1: Develop School Health Educators (i.e., teachers)
    • Objective 1.2: Improve Students’ Learning
    • Objective 1.3: Promote Peer Education in Extra-curricular Activities
    • Objective 1.4: Increase Parental Involvement in Schools
  • Goal 2: Improved Community Health
    • Objective 2.1: Develop Community Health Educators (i.e., medical staff)
    • Objective 2.2: Enhance Community Involvement in Community Activities
    • Objective 2.3: Improve Use of ICT to Support Community Health and Education

Peace Corps is different from a lot of development work in that we do nothing, absolutely nothing, alone.  I’m not here to teach classes, lead seminars, or organize public health campaigns, but rather to assist Moldovans to do that themselves.  In practice, I transfer skills by doing these activities with partners, i.e., co-planning classes, seminars, and public health campaigns.  This distinction may seem subtle, but there is a world of difference between doing for the sake of teaching students, and doing in order to teach a partner.  Whereas the former collapses the moment the PCV leaves, the latter is (hopefully) sustainable.  It’s not that PCVs always accomplish the latter  – it’s a much harder mission than just doing things oneself – but that’s the bar we aim for.

Consequently, PCVs are embedded in host organizations and paired with specific partners who are selected by program staff before we arrive at site.  Reflecting the dual nature of my program, HESC is unique in that we have two partner agencies: the school and the local health center (the community aspect).

At the school, we work with two partner teachers, with whom we co-teach 8 hours of health education plus a youth health club.  This work is designed to accomplish goals 1.1-3, which can be thought of as teachers, students, and peer-educators.  A lot of the second and third objective resides in implementing participatory teaching methods.

At the health center, Healthies work with a nurse partner for about four hours a week.  Much of this work is focused on objective 2.1, or helping the medical staff develop health education programming for the community.  This can range from seminars to public campaigns.  The Ministry of Health has recently started requiring medical staff to conduct activities to promote healthy lifestyles, but didn’t really provide the training to go along with this requirement, so my work in this domain also ties in with broader government objectives.  Objective 2.3 – ICT use – is something that happens almost inevitably as partners observe how much work volunteers accomplish electronically.

That is my program in its basic design.  Each program varies in how similar volunteers’ work is, in the Community Organization and Development program, for example, volunteers’ work varies from youth development to local government. HESC happens to be a program where volunteers all start out with a very similar structure.

On the other hand, regardless of one’s program, Peace Corps always emphasizes making one’s service one’s own.  So, even from our similar starting point there can be a lot of variation in the health program.  And of course, no program is perfect.  The HESC partnerships are well designed to handle objective 1.1-1.3, 2.1, and 2.3, but the partnerships are a little weaker on 1.4 and 2.2.  To what is written here, then, I’ve already added a few extra partners, most importantly the primaria (mayor’s office and local public administration).

There are four programs currently running here in Moldova.  Besides HESC, there is: English Education (EE), Community Organization and Development (COD), and Agriculture and Rural Business Development (ARBD).  Education tends to be more structured, whereas COD and ARBD rely more on volunteers’ initiative to find their own work.  There are pros and cons to both.  One of the big challenges of the HESC program is that we somewhat straddle programs.  Our work at the school is highly structured, but at the health centers, it’s very open and flexible.

Ultimately, health education tends to aim at one specific domain of public health: behavior change.  Health knowledge, after all, is not an ends, but rather a means to a healthier lifestyle, and that almost always involves some element of change.  (How many of us, after all, have perfect health habits?  Now imagine those habits in the context I described in Pt. I…)  Knowledge may be power, but only if acted on.

As alluded to in the previous post, given that Moldova is already doing well for its economic context without much public health education, its prospects are truly bright indeed.  The bad news, however, is that the medical workforce in particular is aging, and it has never been asked to be teachers before.  Moreover, behavior change in health domains is incredibly hard to achieve, which can make motivating that workforce very hard.  But the challenges of how are ultimately issues to be tackled in future posts.  For now, it’s enough to have started answering the question what it is I’m trying to do.

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