Learning to See Clearly

Jamie Clearfield's Musings on Evaluation and Development

Nepal Thoughts from the Field: Trying It on for Size

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Life is a mix of things here in Nepal – overwhelming beauty, grace, poverty, hope, things known and unknown. After three weeks in Kathmandu, Z and I are currently in far western Nepal based at a rural eye hospital. Kathmandu was everything a developing capital city coming off a decade long civil war could be expected to be – a mix of chaos and blaring horns with temples and shrines on nearly every street corner, millennium-old Buddhist stuppas and glossy new malls beckoning the emerging middle class. Tradition and culture continually struggling against rapid urbanization and globalization; we wondered a lot what Kathmandu will look like in 10 years time.

A stuppa we stumbled upon when we got lost coming home from work...

A stuppa we stumbled upon when we got lost coming home from work…

In Kathmandu, We were attached to Tilganga Eye Hospital – a renown eye care center that provides efficient and effective eye care services in Nepal. Their model is similar to the Aravind Eye Care System has perfected over the past thirty years – a high volume cost recovery model where everyone receives the same quality of eye care, though those who cannot pay are not turned away. Instead those who are able to pay or who wish to have certain amenities (such as a private hospital room, an appointment time rather than walk-in service, after-hours service, etc.) can do so. I could on and on regarding the Aravind model, but I suggest for those interested, to read the case studies and other reports others, much more eloquent than I, have already written.

While my spouse was attached to various specialty clinics and the operating room to learn new a different cataract removal technique widely used in the developing world, I was attached to the hospital’s academic and training department to review their training programs for international ophthalmologists and allied personnel. A major focus for the hospital is developing and broadening the skills and knowledge of medical personnel, both in Nepal and internationally. Doctors, nurses, technicians, biomedical equipment engineers, and more from Ethiopia, Ghana, Bhutan, Indonesia, North Korea, East Timor, Vietnam, Cambodia as well as Australia and the United States have come to Tilganga for a wide variety of training and surgical exposure. Managing all the different logistics and visa difficulties of getting these personnel into Nepal is an incredible feat in of itself. Training so many different people, personalities – each with their own expectations and experiences – is another accomplishment all together. Nearly 150 ophthalmologists from over 20 countries have received specialized cataract training since 2007, in addition to over 70 nurses and scores of other paramedical and nonclinical staff.

Despite the efficiencies already in place to keep the hospital running and solvent, little evaluation work has been conducted with the training programs. While the hospital has a monitoring and evaluation office (currently a department of one!), it is mainly focused on the clinical aspect of the hospital, and ensuring that the numbers are there for the monthly reports to donors. This is not something new or even surprising – as we all know, educational evaluations are involved and are not straight forward. Determining what metrics to use, how to collect them, and how to determine the impact of education is an ongoing challenge as we see from the continuing education testing saga in the United States. To date, the training programs at Tilganga have participants complete a feedback form. The form is reviewed briefly as the person leaves. It is then filed in a 2-ring binder labeled with their country of origin; the binder than sits on a shelf.

In speaking with the training officer, there has yet to be a longitudinal review of the feedback forms, or any type of major follow-up of participants once they return to their home countries beyond a few emails with their sponsoring agency. I had found my job… even if it did mean digitizing 6 years worth of old feedback forms…

Back to the world of paper evaluations...

Back to the world of paper evaluations…

Currently, in the jungles of far western Nepal, I am reviewing and making sense of the data. The  hospital also asked me to help put together some of the training departments strategic planning  notes, for which the feedback forms will be helpful as well. The data proves interesting, the days  here are slow – cups of tea and a backup generator allow for the work to go on…

Coming in to Tilganga has been an educational and if truth be told, awkward experience. For years  working abroad, I chose positions where I would be present for a significant period of time, be able  to stay and live in the community to build relationships and trust. This type of work and  evaluation smacks a bit of everything I learned “not to do”. Not fitting into any label that the  hospital is used to giving to a visiting foreigner (Doctor, medical student, journalist…) – my  presence at Tilganga was stilted though over the weeks we developed a good rapport of sorts.  Reading the strategic planning notes and trying to make heads or tails of meeting minutes from a  workshop this past spring is like reading a book with the pages all mixed up; a not uncommon  challenge of evaluation and I suspect external evaluators globally. It was exciting to sit with Ravi,  the M&E officer and pass ideas back and forth. He loved getting links to EvalCentral, AEA, and other  evaluation blogs and resources (though I’m not sure how well Chris Lysy’s incredible evaluation  humor translates!). And yet… seeing so many people in need of immediate tangible care, while I sit  at my computer day after day, it is easy to be swayed that there is perhaps a better use for my  time here. My previous roles internationally were much more varied and engaged on the ground–   teaching, developing and giving workshops, implementing, as well as conducting monitoring and evaluation.  Having chosen one                     label is a new and interesting challenge, one I am currently unsure of but am trying on for size…

Thoughts and comments as always are welcome! Feel free to shoot questions about Nepal and our work overseas my way, I’ll answer the best I can.

Himalayas peaking through the monsoon clouds...

Himalayas peaking through the monsoon clouds…

Author: jclearfield

My name is Jamie Clearfield and I am learning and exploring the worlds of evaluation and non-profits. My experiences have taken me from Boston and Pittsburgh to across East Africa, learning and sharing wherever possible. This blog is another way to learn, share, discuss, and grow within this field!

One thought on “Nepal Thoughts from the Field: Trying It on for Size

  1. I love your posts Jamie, always so honest and interesting. Thanks for the shout out, there is definitely a cultural component to humor (and a personal component as well). Find out the kinds of M&E things are important Ravi, and what leads to a smile, and then maybe we can create a cartoon 🙂

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