Delays to my project startup have given me a great opportunity to experience a very different Africa from the dry, sparsely populated terrain of Eastern Ethiopia originally planned. Instead, I had the opportunity to go to Lagos in Nigeria, a teeming, hot and humid city of 21 million (or 11 million, depending on who you believe!).
My tools and training materials carefully prepared over months for a general immunisation assessment prior to re-invigoration interventions amongst nomadic peoples, remained ‘in waiting’ for a project which won’t start this year after all. Instead, they were rapidly adapted to assess readiness for introduction of a new vaccine in crowded communities within Lagos, where small primary healthcare centres may each immunise over a thousand infants per month. Well, they do say that PULSE assignees need to be both patient and flexible!
I found Lagos to be a megacity of sights, tastes, colours and sounds. From the longest bridge in Africa, 11km on piers above the waters of Lagos , the contrasting sights can be seen. The thousands of wooden fisherman dwellings with rusty iron roofs, on stilts so close to the waters surface, yet amid a smoky haze of cooking fires, give way to a thriving metropolis of skyscrapers, commercial premises and private islands with luxury dwellings. The market stalls of edible ‘logs’ ( actually yams) stand next to the smoked fish largesse of the lagoon and the typical Jolloff rice dish laced with the colours of the vegetables in the local market. The vibrant colours and patterns are again reflected in the wonderful dress and head coverings of the Nigerian ladies (sadly, I did not think they would work quite the same if I was to wear them, so no souvenirs). The sounds of bargaining in the busy market mix with the horns of the cars in the 3 hour traffic jams. It’s a crowded city!
My first 2 days were spent training the field assessment team, and within the first half hour a came face to face with one of the challenges of even urban Africa – power failures during the PowerPoint presentation. What should I do as I paced agitatedly around while everyone else calmly sat – just talk the delegates through? They clearly knew best, after a short while the electricity came on. That was the first of so many learnings during my visit. Schedules and plans are one thing but being ready to adapt when circumstances (traffic jams, failed internet etc) require, which is almost all the time, is a key skill.
The general experiences gave way to the practice of ‘Gemba’ in the actual health clinics, to talk, listen and see what actually happens in the immunisation service. That will be the subject if my next blog as my time on PULSE rapidly draws to a close.