Thursday, June 14, 2012

The Little Engine That Could


Optimistic realism is the name of this game. One would not bother with this public health business if one believed it were futile to attempt changing the status quo, yet one should also not assume people will roll over for you when you do attempt that change.

And so it is that I find myself attempting an evaluation based on the WHO “Adolescent Friendly Hospital” standards in an establishment riddled with financial concerns, disgruntled personnel, empty research, and need I go on? I had thought this project would be a natural and logical continuation of the school research. A sort of self-reflection on what the hospital itself can do to improve and promote adolescent health, particularly sexual and reproductive health, in the area. And so I researched the standards, how and where they’ve been implemented, how to evaluate the establishment pre and post implementation, and what tools and resources are necessary. I had a plan. I was armed and ready. Or so I thought.

Turns out optimists write “standards” and “evaluation tools.” Optimists say things like “provider feedback should be sought at every level of evaluation” and “include adolescents in evaluation process.”

Realists show up at doctors’ meetings shaking in their flip-flops and try to talk about “hospital evaluations” without sounding like La Blanche who will tell you everything you’re doing wrong.

That critique about not acting on research from my last post? Well, here we go again. Research is the easy part. I could waltz in to just about any school here and distribute questionnaires and hold focus groups and get people talking about adolescent health and everyone back home would think, “Wow she’s really making a difference.” But actually doing something about adolescent health? Actually giving out 200-page WHO guidebooks on treating adolescent health problems? Actually holding a training using WHO “standardized” training tools for health care providers who treat adolescents? I might as well suggest we all walk around wearing underwear on our heads.

And so this little engine will continue chugging along the precarious incline of La Blanche who goes to the people and La Blanche who pushes her own agenda for change.

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