Rolling With the Changes

There have been a lot of changes in my life over the past month. Yeah…that can be my excuse for not updating in nearly 2 months…

Work Life:
First of all, I have officially switched jobs here in Jordan. I’m aware that I never actually gave the full story on what I was doing here earlier this summer, and how it all worked out, but it is a really great organization and I think more people should know about it!! So, allow me to make up for lost time:

When I first signed up to come here to Jordan, it was to work on a project for which my advisor is the PI (principal investigator). It worked out perfectly with my time availability, and was in my field of focus: child protection in emergency settings. I immediately began plans to come here. However, we learned a few weeks before my intended departure that the opening of the new camp for Syrian refugees in Jordan had been postponed indefinitely, though we knew it would open at some point before the end of the year. This opportunity was everything I had been looking for in a practicum, and I decided to take a risk and come to Amman anyway, as planned, and do some work in the meantime, while the camp construction was completed.

Which brought me to UNRWA – the United Nations Relief and Works Agency for Palestine Refugees in the Near East. It was not a UN body I knew very much about, and I was largely uninformed about Middle East politics prior to arriving in Jordan (something I have tried to rectify while here, but continue to find myself confused by all the factions, and religions, and sects, and governments, and alliances), so I considered this an interesting opportunity for many reasons. For those who are unaware of UNRWA’s mandate (as I was): a summary.

UNRWA
UNRWA was established in the wake of the 1948 Arab-Israeli conflict by the UN General Assembly resolution 302 in December 1949, “to carry out direct relief and works programs for Palestine refugees” (www.unrwa.org). UNRWA’s scope of services encompasses: camp infrastructure and maintenance, schools, health care, relief and social services, microfinance and emergency assistance for the approximately five million registered Palestine refugees in their five fields of operation: Lebanon, Jordan, Syria, Gaza and the West Bank. I worked in the health department, helping to evaluate the success of the new Family Health Team approach, which has been rolled out in over 50 of UNRWA’s 139 health centers.

The health reform, and ultimately, the FHT approach was initially embarked upon as a result of the demographic and epidemiological transitions that have occurred among the Palestine refugees. In non-public health speak, this means essentially that populations are living longer, and their health problems have become increasingly chronic and “lifestyle” related, rather than infectious and acute. Non-communicable diseases like hypertension, heart disease and diabetes now account for the overwhelming percentage of illness among the population, while communicable diseases like TB, measles, mumps, rubella and polio have been all but eliminated from the population.

All of this means that the way the health centers had been run for the past 60 years was no longer an effective strategy for the new demographic profile of UNRWA patients. In order for doctors to focus more on primary and preventative health care, and on trying to change the lifestyles of patients that lead to NCDs (smoking, poor diet, no exercise, etc..), the healthcare model needed to change. Using elements of successful similar programs in Brazil, Canada and Egypt, UNRWA adopted the Family Health Team model, which they began to roll out in select health centers over the past two years. The FHT reform was meant to not only focus on a primary health care model for patients and their families, but also to reduce the logistical burdens present at UNRWA clinics – over crowding, long wait times, and short consultations with the doctor.

So, the project I focused on during my time at UNRWA dealt with documenting and quantifying the improvements brought by the FHT model, as experienced by the patients themselves. Using a participatory methodology I learned last year, the Deputy Director of Health was able to conduct a series of mini-focus groups with groups of patients and staff at health centers in Lebanon and in the West Bank that had been implementing FHT for 12-18 months. I was able to discover some very interesting results, both those expected by UNRWA staff, and others that came as a pleasant surprise. While it will be hard to measure the impact of reducing the NCD burden among the Palestine refugee population as a whole, these discussions were encouraging for the health department to further understand the benefits of the new health care model, and to develop an evidence base for continuing the health reform in the remaining health centers.

One of the health centers in Amman

One of the health centers in Amman

Overall, I had a great time at UNRWA, and was able to use some of the skills I learned in the classroom last year.  I think the data I collected and reports I produced were helpful for the UNRWA staff, and I learned about an incredibly important organization that is operating on behalf of one of the most vulnerable populations here in the Middle East. In addition, I was lucky enough to travel to both Lebanon and the West Bank to collect the data, trips I did not anticipate getting to take work trips while here, which was a lovely surprise.

So anyway, now that I’m no longer working with UNRWA, you have an idea of what I WAS doing June – August.

Child Friendly Spaces Impact Assessment
This is the project that initially brought me to Jordan. I was given the opportunity to assist in an impact evaluation of child friendly spaces among a Syrian refugee population, and I think it’s safe to say that I jumped at the opportunity. Protecting the rights of children is what inspired me to pursue my Masters in Public Health in the first place, and it became more apparent over the course of the spring semester that while there are so many important areas to focus on within the sphere of public health (especially as they relate to communicable diseases, water and sanitation, maternal and child health), that child protection, especially in situations where they are particularly vulnerable – like disasters and war – was my passion.

My work with UNRWA ended last month, and since September 1, I have been preparing full-time for the start of the data collection period (which is determined by either the new refugee camp opening in Jordan, or by a child friendly space in a host community opening). Because the research is underway and I am technically a representative of Columbia University, I can’t be too explicit about what it is we’ll be doing on a daily basis, but suffice it to say, that I will be in the field quite a lot, and will get to facilitate, or at least help facilitate, community based participatory activities that will help us understand what it means to be a child in the context of the ongoing crisis in Syria.

Similar projects by my research team (of which I was not a part) have been completed in Ethiopia and Uganda, and there are several more underway in the Middle East region. The Jordan leg of the research is part of a larger project to help develop a stronger/wider evidence base for the positive impacts of child friendly spaces on children’s psychosocial wellbeing and mental health. As the data has yet to be collected and analyzed, I can’t make any sweeping statements about what we will find in Jordan among Syrian children…but obviously, we hope to see some positive effects.

This is great for me, since I would like to resume my career in child protection (now that I know there is a fancy name for what I was doing with Flying Kites) after graduation, this time with three initials after my name – initials which will hopefully help me get a job right away…hopefully one that will help make a dent in my mountain of debt!! Hey, a girl can dream, can’t she…?

So, even though things are going a little slower than planned, I still couldn’t be happier to be here on a daily basis, just absorbing the expertise of everyone around me. Osmosis. That’s my game plan. Don’t worry, I’ve thought this through.

Weather
Perhaps the most welcome change so far, has been in the weather. The turning of the seasons seems to mirror those in New England, though the weather patterns themselves may be slightly different. As I described in an earlier post, the summers are hot and dry. They aren’t unbearable in Amman, but they aren’t particularly pleasant, either. Like, you don’t want to go for a casual jog at noon in the middle of July…though, I have found that the late afternoon sun (3-5pm) is the wooorst. What people back home seem to be surprised about, however, is the fact that there was not one drop of precipitation all summer. I have not seen or heard or felt rain in nearly four months. Additionally, there is never a cloud in the sky. At most, there may have been a wisp of a cloud – a little piece of cotton candy that blew away in the wind. An afterthought of a cloud, really.

But, after a week of “Indian summer” in the middle of September, where I would wake up in the middle of the night drenched in sweat, it has thankfully cooled down. The air in the mornings and evenings has a bit of a bite, while midday is still pleasantly warm. Last week, there was about 10 minutes of rain in the evening, and it dawned on me that it was one of those things I didn’t know I had missed until all of a sudden I realized how much I missed it. But, alas, there has been no rain since – though sometimes I think I hear it in the middle of the night, when I wake up. Apparently, at some point this fall, rain will become a much more regular thing, and I will probably be lamenting it, but for now, I’m grateful for a change of climate. I still miss the leaves turning brown, apple picking and the “smell of fall,” but I also don’t live in a romantic comedy, so who am I kidding – I don’t see this in NYC anyway.

Neighborhoods
I also made a move within Amman. The apartment I lived in this summer was more than I could have asked for. There were three bedrooms, two bathrooms, a terrace, grape vines (with fresh grapes!) and tons of couches and chairs to lounge in. I lived with three great girls and had a lovely summer. We lived a few minutes walk from two huge malls, a massive grocery store, our favorite frozen yogurt shop, schawarma and falafel stands, etc… However, once the girls moved back to the states, I could no longer afford the rent on my own, and realized that while I was living in a nice, suburban, upper middle class neighborhood, I wasn’t doing myself any favors in the whole “meeting people” department.

The entrance to my old apartment

The entrance to my old apartment

Our beautiful terrace at the old place

Our beautiful terrace at the old place

So, I made the big move to a neighborhood closer to the “downtown” section of the city, and more populated by a younger, expat crowd. The neighborhood is much more walkable, and I often end up at one café or another, typing away on my laptop or having a coffee, surrounded by a ton of people my age doing the same. I have still not made even a smidgen of effort to meet people, which I am 100% okay with. Being anti-social and alone has been glorious, and while every once in a while I get pretty serious FOMO regarding the happenings back in NYC, I’m really enjoying the isolation this practicum has afforded me. It’s like I’m storing up reserves of rest and relaxation from which I will be able to draw next semester when I’m back to working and school and socializing, desperate for a weekend off.

I feel as if I’ve started in the suburban, family-friendly, spacious upper west side, and then made the haul down to the lower east side…where apartments are a little seedier, the rooms a little smaller, and the trash a little more prevalent. I’ve had to make the switch to earplugs and an eye mask, as the neighborhood children have a tendency to be loud, we live in between two schools who have announcements over the loudspeaker in the morning, and, oh yeah, our landlord runs his shipping/moving business out of the bottom floor apartment, so I’m woken up as early as 6:30am on the weekends by men loading a flatbed truck. This morning, a group of boys kicked a number of tin cans up the hill in front of my bedroom window on their walk to school. That was a pretty rude wake up call. Additionally, my bedroom is east-facing and curtain-less, so it’s insanely bright as of about 6am everyday (and until recently, was too hot to sleep past 8am on the weekends, though thankfully the cooler weather makes it more tolerable).

Anyway, I’m happy with the move, overall, though as luck would have it, the new office I commute to everyday is practically walking distance from my old neighborhood, but I think it’s worth it in the long run. I’m closer to the places I go to dinner and can walk to restaurants on my own, and there are several Arabic language courses available in the area…after 4 months, I’m finally taking the plunge (better late than never, no?).

It also turns out that the timing of this move is incredibly good, as the old apartment got little direct sunlight and stayed dark, and cave-like all day and night, a real selling point during the hot summer months when direct sunlight can be brutal. However, it would have been hard to keep warm in the winter, as heating and insulation is notoriously bad here in Jordan, and people have been warning me for months that I will need my long johns and winter coat just to go to sleep at night. The direct sun my bedroom receives will hopefully compensate for the cold air, and give me a little respite from the winter chill.

My new apartment building

My new apartment building

New view from my bedroom!

New view from my bedroom!

 

Evolving Amman Impressions

Given my new neighborhood and ever-expanding knowledge of the city, some of my first impressions have begun to change. While I initially enjoyed the decadence of two full weekend days with no work, very little social life and no errands to run, I’m starting to get restless. As someone who is lucky to have five free hours a week back in NYC, between school, homework, waitressing and socializing, I appreciated the break, but am ready to get back into the swing of a busy schedule. Luckily, the new project I am working on helps with that, as the working day is longer at our partner office, and I often stay later, or do work in the evenings.

So, to the end of reducing the amount of time I spend lounging on the couch, I have begun volunteering on Saturdays with a group organized by a girl I met in a shared cab on my way to the Palestine border. We make our way to Baqaa, a camp for Palestine refugees just outside Amman, and both my commute to the departure point and to the camp itself (on a public bus, which it’s nice to finally feel comfortable riding) have shown me a whole other side of Amman. The first neighborhood I lived in, as I have said, is incredibly nice, very well-appointed, and full of fancy cars and well-dressed Jordanians. The hotels we attended UNRWA conferences in were four star, and the malls we shopped at were full of familiar stores. I now realize that my first impressions of Amman and Jordan as a whole, while not inaccurate, were limited.

The city, while certainly well-appointed in parts, is also a little seedier in many, many others. I wouldn’t necessarily go so far as to say that poverty is in my face the way it has been in other countries, but there is a sense that not everyone owns a luxurious apartment with a Mercedes parked in the driveway. Though, there is an Ashley Furniture, if you’re in the market.

Living room set, anyone?

4 piece sectional, anyone?

I’ve had the opportunity to travel throughout the country on two occasions, once when a roommate’s friend visited from Lebanon, and the other more recently, last month when a friend from the restaurant I work at in NYC came to visit for a week. The hours and miles we spent driving through the middle of the country to the southernmost city, and back up the west coast have given me a much better appreciation for the diversity of lifestyles here in Jordan. There are plenty of small, thriving city centers, juxtaposed with miles and miles of desert as far as the eye can see. Bedouin tribes, the indigenous inhabitants of much of the Middle East, still live their traditional lives in tents along the roadside, in between housing developments along the highways in Amman, and in the vast deserts of Wadi Rum and Mujib.

I don’t know that I could ever live in Jordan long-term. The ubiquitous nature of cigarettes alone is enough to sour me on the idea. It’s a true testament to the anti-smoking campaigns in the US that every time I inhale someone’s secondhand smoke, I picture my lungs blackening a little bit more. Clearly, I am a hypochondriac, but you know what I’m saying. I also need to live in a city where public transportation is easy, comfortable and convenient. I want to be able to walk around my neighborhood and don’t want to be reliant on a car to get from point A to B. however, that being said, I have been loving my time here so far, and feel so grateful and privileged to have such an amazing opportunity.

 

That’s all for now, folks. I’ll promise, as I always do, to update more regularly, but at this point, we all know that’s a croc of shit.

Love, from Amman

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