starting in the clinic Monday!

Just a brief entry. We met with Dr. Nacro this morning, and we're all set to start at 7:30 am Monday. We'll begin as observers, but hopefully this will help things progress a bit further. And we will all be happy to start seeing patients. I will be starting in a regional medical center - a CMA, in the northern part of the city. Dana & Leah will start in pediatrics, and Suzanne will start in Maternity. I'm nervous but looking forward to starting the clinical work at long last.

A couple photos here - the first is an example of the scenery here - its about the same, all the way from Bobo to Ouaga - in the wet season, that is.

The second is my nascent vegetable garden - doesn't look like much, but considering this was a patch of red dirt 2 weeks ago, I'm pretty impressed. The tall things along the back are the tomato plants, with lettuce in the foreground and onions off to the right.

Hope you all have a peaceful & restful weekend.

Doni doni kono nita niama

That is Jula for “slowly, slowly, the bird builds its nest”… little by little things come together. Very, very slowly.

On Wednesday we visited the CREN, or outpatient malnutrition ward. This is also where the kids above age 18 months who have HIV come to be checked in and have weight and temperature checked. Its all open air, with a tin roof and is made up of a cooking area, where they make breakfast & lunch for the kids every day over an open fire (with smoke filling the rest of the area), a weight / visit / education area and a paillote or palapa for eating in (funny that I know French & Spanish words but not an English word for that – it’s a conical roof structure, with low walls so its open to the breeze but the roof shape is cooler than a flat roof).

The kids are weighed every Wednesday, and their weights carefully written in their carnet de santé and their CREN chart. They come each morning for their breakfast & lunch, and the parents theoretically find dinner for them somewhere else. They have education sessions once every 2-4 weeks, things like how to prepare nutrition meals with local ingredients, etc. Some of the kids are losing weight even while being followed in the CREN… its not clear if anything different is done for those kids.

It was upsetting to see kids that are losing weight even there; two kids stand out. One had puffiness around his eyes and feet that suggested kwashiorkor; he was listless and a bit fussy. The nutritionist dutifully wrote down the weight, no plan to do anything else. The second was a 2 year old who weighed 4.9kg, and who’s weight has been decreasing steadily for 2 months of weekly weigh-ins in the CREN. When his mom put him on the scale to be weighed, he puckered his face as if to cry, but there was no energy to actually cry. He tried to raise his arm to his mother, but the tiny arm of skin & bones, only made it half way up before he couldn’t raise it any further. His skin hung off him in folds. His mother was cachectic (looked like she was starving herself). The morning brought home to me in a very painful way that we have been here 2 months and are not yet seeing patients… while we could ask about the kids, suggest they be referred, there was nothing we could actually do. When I got home, I cried.

On the optimistic side, we should be starting work in the hospital on Monday, so we will be spending 7-2 every day there, and then in the afternoons work on the meetings and relationship building that we need to do to get to know the players and the system and to integrate our project well. (And if you’re wondering why we’re not being pushier at this time, its because if we did that we could be creating bigger problems and roadblocks for ourselves, so we’re trying to do things the ‘right’ way).

On a totally unrelated, frivolous note…

I got a package from home! What a treat to get some mail. My dad sent me the DVD Capote, and my East Africa handbook. It took only 2 weeks, which was much faster than expected. And it cost 150CFA to liberate it from the post office… I think if it’s a high value package there may be taxes to pay as well, but there wasn’t on this package.

My garden is coming along, the zucchini & cucumber from seeds are coming up, there is are several tomato flowers and a small tomato on one of the plants, and I got some flowering bushes and a frangipani (my favorite flower, native to the Pacific) to put in the front yard yesterday.

It seems that every time I turn around I'm having a plumbing or electrical problem. Monday, blocked sink & 3 running toilets, Tuesday a broken light fixture cover, Wednesday a blown fuse, Thursday the kitchen tap started making bizarre sounds and then this morning after my shower I heard a "drip drip drip" and my hot water tank was leaking... so for the 2nd time this week, I had the plumber here and the hot water tank problem was easily fixed but the strange sounds from the kitchen tap signified a dying kitchen tap and so that I've had to replace for $50. Ugh! Good thing labor is cheap here - the electrician visit for the blown fuse (it’s the kind you need to replace the actual fuse) cost $1.50 for the fuse and $1 for the labor. Not the same as at home!

I hope everyone has a safe & relaxing weekend. Feel free to write comments on the blog!
With love,
Laura

The Burkinabé health care system

Cristina asked in her email about the health care system, and I thought it was a good question, so I’m including my response here.

The health care system is based on a hierarchical, fee-for-service model. The first level of care, present in many villages and communities throughout the country is the “Centre de Santé et Promotion Sanitaire” or “CSPS;” these are health posts or clinics, and have health worker +/- nurse +/- midwife working there. They do IMCI (an algorithm-based strategy for looking after sick kids used by health workers), vaccines, and health teaching, and some supervision of tuberculosis therapy (Directly Observed Therapy, or DOTS). If they can’t handle the problem, the patient is referred to a “CM” or “CMA” (Centre Medical) which is like a small hospital that may have a basic lab, staffed by a physician. They can refer to regional hospitals (which have at least the capability to do blood smears for malaria, sputum smears and a few other labs), and there are 3 reference, “tertiary care” hospitals. In Ouaga, a general hospital and a children’s hospital and here in Bobo a general hospital. The large general hospital has several pediatric subspecialities.

There is little provided for free, although some preventive care and TB care theoretically is. Cost is a huge barrier to seeking care (from what the pediatricians say, and what’s in the literature as well). The pediatricians and GPs at the workshop this weekend were adamant that care of kids & mothers with HIV should be free but the government seems equally adamant that it should not be. Many people have no income; more than half of the people in the country make less than 500CFA (1 USD) per day. An outpatient visit costs 2500CFA. A hospitalization (which includes tests but not medicines) costs at least 2000CFA per day. HIV PCR, a test to diagnose HIV in kids under the age of 18 months, costs 10,000CFA. Almost no parents will pay for that; they can’t afford it, and if there is that much extra money around it rarely goes to that sort of thing. I think that antenatal care, including theoretically available PMTCT (Prevention of Mother to Child Transmission, which includes HIV testing of the mother and single dose nevirapine for mother and baby) is free though we got conflicting info on that. ARVs cost something like 10,000 / month. A normal delivery costs 4500CFA, and a cesarian section 55,000CFA so very few women go to a health care center for their deliveries – they can’t afford it and also, women’s & children’s health isn’t valued all that much. 1000 in 100,000 women here die in childbirth every year, and a woman has a 1 in 12 chance of dying in childbirth in her life… compare that to Canada, where 6 in 100,000 women die in childbirth per year, with a 1 in 8700 lifetime chance of dying in childbirth (its 17 per 100,000 or 1 in 25000 in the US).

While we’re talking about health statistics, did you know that 20% of kids born in Burkina Faso die by the age of 5? (Under 5 mortality rate of 192 per 1000 live births). In Canada its 0.6%, in the US 0.8%. By every measure, Burkina Faso has poor health status.

We got a tour of the Children’s Hospital in Ouagadougou on Friday, which was really interesting. It is new, built in 2002, and has nice wide paths, nice looking buildings and is likely the best equipped hospital in the country. The rooms are mostly 4 beds (exept the expensive private room, for 10,000CFA / day, for which you get a private, air conditioned room). They have a working XRay machine, but their ultrasound machine that has been broken for 2 years. Their hospital equipment maintenance guy died a year ago, and there’s no one to replace him, so all the equipment is slowly disintegrating… and that’s in the well set up children’s hospital! In the ICU they can provide oxygen and more intensive nursing care (frequent vital signs etc). There is one dialysis machine, for acute renal failure.

We’ll be working most of the time in the general peds ward & clinic at the Bobo hospital; I think it will be really challenging. Just to give you an idea of what’s available here … there is an x-ray machine; but it broke, some months ago. No one knows when it will be fixed. We haven’t had an official tour of the hospital here yet, but saw bits of the general peds ward when we were there for some meetings. Its got that African hospital smell (I don’t know what the smell is, but the Children’s ward in Mbarara, Uganda smelled the same). The rooms have 4 beds each, and the day we were there, there was less than 1 kid per bed. I didn’t see any sinks for handwashing anywhere. We will be spending some time visiting the CSPS, CMA and CHRs to get a better sense of how everything works in real life.

bureacracy & poverty

Sometimes I can forget that I’m living in the 3rd poorest country in the world; my house is quite nice (this is the living room & dining room) and some things things start to seem so normal, like the rutted dirt roads, the mud brick houses in the “district populaire”, the chaos of the market.

And other times its unavoidable; the skinny, stunted kids with clothes that are disintegrating on their backs, the beggars, the desperate merchants.

We had to fire our driver yesterday (the one who went with us to Ouaga), and he was so sad, and so disappointed. And I know he really needed the work. So, it was really hard on me to say, I’m sorry but we gave you many, many chances – but he wasn’t honest towards us; he lied about the condition of the car on Saturday (it had broken down again), and then failed to either pick us up or call us and let us know.

I’m one step closer to having a land line – I actually have a phone number though it won’t be installed until later this week. In theory. So, if anyone has an urge to call me here in Burkina Faso, my land line number will be +226-20-98-52-83 (226 is the country code). (And for those who’ve forgotten – my snail mail address is 01 BP 1243, Bobo Dioulasso, Burkina Faso). Internet at home will hopefully be in the next 2-3 weeks (so then I can make / receive calls on Skype)... however, despite people telling us it is easy, our chart has to be transferred from one department to another, then we have to pay a deposit, then they will do the next step, whatever that is. In the meantime, there are not enough "cartes" (some crucial piece of equipment for us to get DSL at home) in the country, they are sitting in Customs in Ouaga. They should be arriving next week. Inshallah.

If its not a good time, it’s a good story…

Our trip to Ouaga was very successful (although the transportation was a disaster). We met with a bunch of different departments of the Ministry of Health to discuss our project, and learn about how the Burkinabé health care system works. We also took part in a workshop that looked at the organization of the scale up of management of pediatric HIV in Burkina Faso; that was useful because of the presentations on the first day, and the chance to make lots of good contacts. We also got to tour the children’s hospital and talk with the physician who looks after the HIV patients in Ouaga who is really dynamic and knowledgeable.

We sampled a few of the restaurants of Ouaga, which offer considerably more variety than Bobo… Chinese food, amazing lasagna (would you believe I had the same thing for 2 dinners & a lunch), great pizza, all within walking distance of our new hotel. And there’s a home décor store with stuff that “appeals to western tastes” as the guidebook puts it (Dana & I were like kids in a candy shop).

From the get go, our rental car was a disaster; I already described the trip to Ouaga. Monday, Soliman drove us to our meeting, then failed to show up at the end of the day. Tuesday & Wednesday he spent the day getting the car fixed, so wasn’t available to us. We debated firing them, but I argued with the group that it wasn’t his fault that his car broke down, and that he was trying hard, (and his stereo was stolen) so we should give him the benefit of the doubt. Thursday & Friday he was able to drive us around again, although he failed to show up to pick Dustin up from the airport on Friday afternoon. (He came an hour late, saying he was getting more repairs done and it took longer than he thought). He was to pick us up for the trip home at 8am the next morning.

Soliman came at 7:20 with a story about his papers being taken by the police and he had to retrieve them, but he would pick us up at 10am. At 10:45, he phoned and said that he hadn't got them yet, but would have them for sure by 2pm. We threatened to take the bus but he said no, no, no, he would be there. For sure. So we agreed that if he didn't turn up at 2pm, we would find our own way home, and not pay him for the last 3 days. Leah & Dustin took the bus, but Dana & I agreed to give him one more chance. At 1:45 he called and said he was on his way. At 3pm, no sign of Soliman. We decided to stay in a hotel, and take the 7am bus on Sunday... but we foolishly let the guard convince us that his buddy could drive us, and the price was only slightly higher than what we would have paid our driver. So off we headed... 2 hours into the drive, we hit a traffic jam as they retrieved an overturned, squashed bus out of the ditch (the actual accident had been 2 days before), and watched while they righted it, and a group of 15 men started pushing it down the highway; the wheels still turned just fine, even if the top of the bus was squashed. It got dark. We weren't making very good time. And then, about 80km from Bobo (it’s a 400km trip), on a dirt road detour, the lights faded, dimmed, and the car stopped. So, there we were, broken down car, at night, in a tiny village, 80km from home. Long story short, a kind passer by tried to tow us, but the rope kept breaking and eventually we left the car & driver in the village, and the stranger drove us home. We got home at midnight. While we were on the road, Soliman called Suzanne (who'd returned home the previous day) and said that he was ashamed to call me, since his car had broken down again. She got the update from me, and he later called her back and was surprised and dismayed to hear that we'd left without him, as if we hadn't already given him the benefit of the doubt, only to have him not come through, at least 4 times in the previous days. What did he expect!!!

Transport back and forth to Ouaga is a huge problem. The bus is cheap, but very uncomfortable… and we would be the only NGO other than Peace Corps to be using the bus as our method of transport. Flights are available only 3 days / week and of course are really expensive. And our attempt at a rental car was a huge disaster. I was the one who found the contact, so I feel somewhat responsible for that. There are rental agencies that will rent a 4x4 & driver for >$150 / day plus gas but that is too exhorbitant. But we don’t have the contacts here to get something reasonably priced and reliable.

back to Ouagadougou - again.

It’s been an eventful few days. The totally frivolous, eventful thing was that my garden is all done; well, everything is planted. From pile of mud (first photo) to a donkey cart with topsoil (second photo) to yard filled with baby plants in 3 days (third photo). The gardener comes 1-2 times a day to check on everything because it’s so new. By the time we arrive back from Ouaga, the sparse ground cover should start filling in a bit. I may need to get another few bushes for the front yard though – it doesn’t look as filled in as I was thinking it would. I have 4 papaya trees, 2 banana plants and a plantain, a cherimoya, a pomegranate and 3 pre-existing mango trees. And a large vegetable garden – too large for a single person. I suspect I will be feeding Maimone’s family with all that!

We had another meeting with the Director of Pediatrics, Dr. Nacro on Saturday; he seems like he is very passionate about working for the kids of Bobo Dioulasso – and passionate about his frustrations about some of the problems in the system here. In fact, much of what we talked about was that; we hardly had a word in edgewise to present our ideas about our work. He made a comment that I think will make him good to work with from a North American’s point of view – basically, he said “People say I’m impossible to work with, but I tell it like it is – even though that’s not what’s done here in Burkina” – but I’m glad to have a colleague in a key area that will openly communicate with us. Often what happens if you annoy people is that they won’t tell you that you’ve done something wrong; but you just find that it gets harder and harder to do anything. Dr. Nacro wants to keep that from happening to us, which is nice.

I stopped at the internet quickly just before heading home and discovered an email from Dr. Sanou, the Director of Hospital Services, who is turning out to be another of our key contacts and allies. She was going to organize some meetings in Ouaga for us, but we hadn’t heard when yet. We discovered Saturday afternoon that they’ve been organized for this coming week!! So we had a bit of a scramble to arrange transport (we’re trying a private car / driver hire this time), accommodation and things like canceling Dioula class and finding someone to feed Leah’s cat. But despite the last minute scramble, we’re glad we’re heading back there this week – the sooner we have those meetings, the sooner we’ll be doing clinical work.

So, at 7am Monday morning, our driver, Soliman, picked us up, and we ran errands and by 9:30 were on the road, in plenty of time for our 3:30pm meeting (after all, it’s a 4 hour drive in a private car). Or so we thought. The first sign of difficulties was at Boromo, about half way to Ouaga… we pulled off to a gas station, and Soliman did something under the hood, and within 5 minutes, we were off… stopped again at a toll booth just outside Boromo, and it was clear that the car was overheating. We stood in the shade and made small talk with the toll booth guys (one of whom is a huge Fifty Cent & Tupac fan), and 20 minutes later got on the road again… 20 minutes after that were pulled over to the side of the road overheated. So, back to Boromo where they fixed the fan but were unable to fix something else… so for the next 4 hours, we drove about 45 minutes at a time, no faster than 50km/h, with frequent overheating stops. At one stop, some village boys brought us water for the radiator… they didn’t speak Jula or any French, really. One little boy (about 6yrs) was attired in a pair of shorts, so worn that there was literally no bum in them… he always stayed so he was facing us, not wanting us to see the gaping hole in the read. It was a relief to finally get to Ouaga and get to our hotel rooms. Somehow, though, the hotel rooms at our new hotel are not all equal – I have a deluxe room complete with bathtub… Dana’s room the hot water didn’t work and is half the size, Suzanne had to change rooms because her cold water didn’t work, and Leah’s air conditioner was marginal… I feel a little guilty about that! But last night we had one of the best meals since arriving in Burkina Faso. I had lasagna that was truly wonderful, in a lovely courtyard setting.

Today’s meetings were really interesting. It was day 1 of a 3 day workshop on the development of a plan of pediatric HIV treatment for Burkina Faso; until now, kids have largely been ignored from the HIV planning. So we are really excited to be part of this forum even though we are totally new here. There are no other NGOs present at the meeting, even though there are several providing HIV care in Burkina. Today was a series of presentations on the status of pediatric HIV treatment here. In fact, they have a clinic in Ouaga that follows a very similar model to the COE clinics, which is interesting. We are going to try to spend more time with them to see what they are doing.

Anyhow, I have work to do yet, so I’ll sign off here.
More later!
Laura

movement on home & work fronts

Thursday I met with the gardener, Moussa & his brother. They came at 9am, and we chatted for an hour about what I wanted in my garden, we came up with an estimate, I paid my deposit – and within 10 minutes the weed clearing started, by noon, the topsoil & compost were delivered by donkey (!) and so the work continues – they thought they’d have most of it in today! And in fact, by the time I left the house at 9:30, a good part of the garden was planted. Its amazing how some things can be done so very quickly (one wonders if they had the team of people and the donkey cart waiting just outside the gate while we talked…) and yet trying to work in the hospital takes weeks!

The cost of my garden, which includes 2 months of labor plus topsoil & compost, and the plants - papaya, cherimoya, pomegranate trees, ground cover, bougainvillea, and a vegetable garden (tomatoes, lettuce, cucumber, chili, green pepper, zucchini, basil, onion), and a compost pile for me – will be about $140.

Friday morning, we finally met with the director of pediatrics – yay! And we will propose a work plan to him tomorrow morning, with us at first rotating through the pediatrics (1/2 time), maternity & internal medicine (1/4) and peripheral centers (1/4). Plus, meetings etc with lab, pharmacy, etc. And my plan is that within that, we will start identifying new patients and hopefully start with a one day a week transitional clinic for new HIV patients (without a pediatrician) too. I am glad to finally have some movement. He warned us in strident terms that there are very many problems, at all levels from both lack of funds, and to a certain extent poor use of the funds that are available. And that children are generally excluded from HIV planning in this country. Not to mention health planning in general – despite the fact that 48% of the population is under the age of 18!

My first impressions of the hospital… well, the grounds are really nice, wide covered pathways, with several 3 story buildings, some flowers etc. on the grounds. The inside of the children’s ward had that particular African hospital smell that reminded me of the Mbarara hospital, and there were patients waiting everywhere to be seen. The patient rooms (which we looked at as we went by) have rows of 6 beds, and at least this morning seemed to only have 1 patient per bed. This will be really tough. But I’m excited to get started. More later!

By the way – in response to a comment – “ARVs” are anti-retrovirals, or HIV drugs for the non-physicians in the bunch (I try to use normal English but it doesn’t always work out! If I’m not making sense, let me know.)

Another attempt at photos from the trip… its been a bad few internet days Along the highway we passed a dozen of these “bush taxis” – impossibly overloaded, with 4 rows of seats, 4-5 people in each and often 2 in the front. And an incredible array of stuff piled on the roof. Like this bush taxi, its common to see one or more motos, some bikes, wheelbarrows, and assorted furniture piled precariously on the roof.

The second photo is another classic Burkina shot… I was trying to take a picture of the gas station with its gas in used pop bottles (on the left hand edge) but also caught this van – notice the upside down chickens (they're the feathery things at the front & in the middle)?! Apparently, hanging upside down is the preferred way to transport one’s chickens, as it stuns them and they hang quietly there for the duration of the voyage, in this case flanked by sacks of potatoes, bicycles and goodness knows what else.

images of Burkina

This is the first of the photos I wanted to include last time… today is still slow, so I'll insert just the first one.
Driving through Ouagadougou is fascinating because it gives a glimpse of everyday Burkinabé life… from the fancy looking billboards, to the ubiquitos green taxis, bikes and motos, to the water delivery wagons (bottom left hand corner), this photo is a snapshot of a normal streetcorner, like a thousand others. The red dirt is ubiquitous and penetrating.

I got more food & necessities of life today... its such a pain not having transportation here! But I'm slowly collecting the things that I need for life here. Each time I go to town, I return with an armload of stuff. The four of us are the only foreigners in town (besides the Peace Corps volunteers) who don’t have cars or motos. In fact, everyone asks us if we’re with Peace Corps, as they assume that anyone foreigner who gets around on foot / taxi must be with them.

Our "fixer", M. Cobre was meeting with Onatel (the phone company) today to see what needed to be done to "help" our phones get connected - we will give him a little money "for gas for his moto". As an aside, M. Cobre is a fascinating older man maybe in his 60s or thereabouts) - clearly not wealthy but always elegantly dressed, and totally on top of getting things done - he found 2 of our 4 houses for us, and will be working for Leah & Dustin, while his daughter will work for Suzanne. His French is really hard to understand (between the 4 of us, we often only get 2/3 of what he says), and I think he sees us as as a bit helpless. His services have been invaluable.

Anyhow, I'd better get back to work - I have a fair amount to do today for a change! Its good to be busier again, though I also want to make sure I keep some balance. Its harder to keep balance here with not as many distractions, no movies, few friends, rarely go out at night…. that makes it easier, since if to work all the time I don't feel like I’m missing out on things as much.

The bus ride home

Well, after a whirlwind few days, we’re back home again. Despite being in the big city, the only place we ate in Ouaga was the hotel restaurant & room service – the food was better this time than before, but still totally overpriced. But every night we were just too wiped out to want to go out. And also, no one wanted to leave the in-room internet access – its such as switch from our daily trek to the internet café!

After a disrupted sleep (don’t ask), I dragged myself out of bed and to the breakfast buffet… to enjoy one last pain chocolat before returning to Bobo. We checked out, which takes a surprisingly long time, and flagged the taxi. He was surprised we were going from the Sofitel to the bus station. No one goes between the Sofitel and the bus station. So, the 5 of us (minus Dustin, who is away on a business trip) crammed into a taxi for 4 and off we went, our driver trying to convince us that next time we go to Bobo we should rent his SUV, for 40,000CFA each way. The bus cost us 11,000CFA each, so 55,000 for the round trip in total. But in retrospect – the rental SUV would be worth it! Next time, we’re doing what the other NGO’s do: rent a car or fly.

We pulled up to the bus terminal, and the car was surrounded by people trying to “help” us – for a fee, of course. We scuttled around to the back of the car and grabbed our bags without letting anyone touch them… the “helpers” will sometimes try to take you bags right out of your hands if you’re not aggressive enough and then of course feel they deserved to be paid regardless of whether you wanted or needed their help. Although I am sure there are some pickpockets and petty criminals, I once felt grateful that Burkina is generally so safe, while we were in the crowd of people. We made our way into the terminal and there are no signs, no waiting areas, no one to ask for directions… but we asked a few people and stood with the other more nicely dressed people and eventually the air conditioned bus pulled in. At least, we paid an extra 1000CFA for an air conditioned bus. After we got on, it became clear that while it was certainly a bus with an airconditioner, this feature wasn’t actually working. So, bus loaded, we drove to the bus yard to sit for 45 minutes while they fixed the air conditioning. We finally left Bobo and shortly thereafter were stopped at a checkpoint, and the police started going through the luggage compartments… again, yay Burkina – in most places in West Africa, this process is one in which the police always find a few people who’s documents (or something) are not in order, and for the bus to continue, a fee must be paid. But here in Burkina, the police inspected the bus, and we were on our way.

Along the highway we passed a dozen of these “bush taxis” – impossibly overloaded, with 4 rows of seats, 4-5 people in each and often 2 in the front. And an incredible array of stuff piled on the roof. Its common to see one or more motos, some bikes, wheelbarrows, and assorted furniture piled precariously on the roof.

Despite the occasional interesting vehicle or village, the scenery is fairly monotonous and absolutely flat for most of the 5 hour drive… red dirt, trees, puddles and the occasional pond, with cows and goats here and there. We stopped in Boromo at the big bus station; the specialties of the bus station in Boromo are sesame snacks, bagnés, eggs (either hard boiled or an omelet sandwhich), bright orange drink that looked like fanta in coke bottles, baggies of water and ginger juice and onions. Piles and piles of onions. More onions than all the rest put together, its really odd. It was pouring rain, so as the vendors approached the windows and leaned in the door and shouted “madame, madame, cent francs cent francs” which is the price of several of the items. It doesn’t matter who you buy from, there’s always another girl suggesting you need to buy some from her too…

It was nice to be home, make a big bowl of soup and fall into my bed… I slept for 13 hours! And finally was able to put away my clothes with the hangers purchased the day before we left. And joy of joys, I finally unpacked, washed and used my espresso machine today. It was such a treat to have good, dark roast coffee this morning. Yum.

We’re hoping to have internet connected at home before to long – which will be good, as this daily trip to the internet café is getting old. Today is a slow day, and I have lots to upload & download so the photos I was going to include have been canceled. Next time, in shallah. Speaking of home, I’ll attach photos of my house on the next entry. (too many photos at a time makes it impossibly slow).

the end of leisure

After some very laid back weeks, suddenly I feel like I've returned (somewhat unwillingly) to my previous pace of life... the last 5 days have been really busy!

Monday night I moved, at 9pm, after hourly calls to the guy who was supposed to bring my keys, from 5pm onwords... its great to be partially unpacked, and to be settling into a home again after 3 months of living in suitcases.

Wednesday we took the bus back up to Ouaga (pictured in the photo), a 5 hour ride that even in the air conditioned bus wasn't, well, cool... I've realized that Bobo is really much nicer than Ouaga!!

Thursday & Friday we met with the Ministry of Health, and much to the frusteration of the BIPAI staff who have had many meetings with the Burkinabe ministry of health before found themselves having to re-explain everything about the project as if it were new information. However, after a shaky start, people seemed to become more enthusiastic. We put together a list of our learning and work objectives for the next few months (focusing on what we need to learn to truely integrate into the Burkinabe health care system - and ensuring that we send the message that we do respect their expertise and programs) and I spend several hours translating into French... then had to give a 15 minute presentation on it. In French. Did I mention that the last time I did any public speaking in French was in 1989!?! Talk about nerve wracking... I'm sure I sounded a bit like a dull teenager in my language choice... but despite that, they clearly appreciated the effort for me to present in French (the chair even joked that since I presented in French, then all the questions therefore should be in English!) and we had some good and, I hope, fruitful discussion about next steps.

Hopefully next week we'll be meeting with the hospital director, pediatrics director and a number of other relevant players to sort out our work for the next while. Likely to be a combination of some general peds, with identification of HIV+ kids and starting to recruit for our transitional clinic (which will be at the very least HIV & TB). We will also be working on getting to know the various NGOs and other stakeholders (did I really just use "stakeholders" in a sentance... clearly the JHSPH brainwashing worked...).

Anyhow, overall some positive movement. And we also met with the UNICEF Country Director for Burkina, who has as one of her main goals to support the rollout of pediatric ARVs, including training etc. So that should be a great partnership!

We've been really enjoying having good internet access for a few days here at the sofitel... tomorrow its back to the internet cafe again sadly. One of the tasks for next week is to see what needs to be done to "help" get our phone lines going.

Anyhow, more later. Take care! L.

Moving day (?)

Well, I think today is moving day, as long as the hot water heater is replaced, the blown fuse repaired and the broken light fixtures replaced. Guingane, who is the "fixer," went through everything with me this morning and when we left the house the plumbers were there installing the new water heater. Now I have to face the task of squashing everything back into my suitcases again. ugh. But I am really looking forward to unpacking and having a place for everything.

This photo is one I tried to post earlier when the blog wasn't working well. It is the 6 of us in our shared temporary house, at our first meal together. We've been taking turns cooking dinner most days. I am the first one to move out of the shared house. Tomorrow, I think work will begin on my room to install air conditioners for Suzanne who will be staying there.

I have found a new internet cafe, that has a faster connection - and wireless yet! - and so uploading photos may become more doable.... now i just have to take some photos! Anyhow, I'll let you know if I'm actually able to move.
L.

moving preparations

Well, my lease is signed, my deposit has been given, and the house is almost ready to go… except the electricity.  I made the application to have the electricity turned on, but if you don’t do something to “help the process along” then you will be without electricity a very long time.  So, Guingane, the helper of my landlord, has been doing what needs to be done to turn on the electricity as that is all that is standing between me and my new home.  I fear we may have to embark on the same process to get the phone hooked up.  I may be meeting with someone today to interview her for the job of helping me with laundry, cleaning, cooking – but above all laundry.  Hand washing my clothes is another non-strength of mine!  Families often have a couple people to help with those things (one cook, one cleaner, one laundry person) but as I am one person living alone, I certainly don’t need all that!  If someone would just go to the market for me, I’d be all set…

Dana & I went shopping Saturday, to get some of the necessities of life… cutlery, bowls, a water filter, buckets.  Most of it we bought in a fixed price store, but the buckets I had to bargain for in the market.  So far, bargaining is not my strength.  My friends tell me you just have to know how much you’re willing to pay… but how on earth do you know what a fair price for things are? That’s what I can never sort out.  I do know that the price is always inflated for us, “les blancs”.  We certainly attract more attention in groups than singly.

The internet café is becoming our home away from home.  The staff all know us, and are becoming sources of advice for whats going on around town.  We each spend an hour or more most days there… its become a big part of our daily routine, the trek into town with our computers to connect to the outside world.  We are all really looking forward to being able to check email from home.  That may be a month away though!

I’m learning that although I generally avoided bringing white clothes here, beige pants & skirts aren’t a good idea here.  Many days we get caught out in the rain, and with the rain comes this pervasive red mud that is really tough to wash out of beige or light coloured clothes.  So for those coming to visit, bring darker coloured or patterned clothes that won’t show red mud. 

Well, I think I’ll sign off there – not much interesting to say, as things are pretty routine right now.  But next week we’ll be going to Ouaga and hopefully after that we’ll get to start work.  Take care & keep in touch.

 

And then it rained.

So, you know how I wrote that the farmers were in distress because it wasn’t raining?  Well, the last 4 days have made up for it.  Life here just stops when it rains for most people.  On Monday afternoon, I headed out on foot for the 20 minute walk to my house… not even 5 minutes into the walk, the heavens opened up.  Horizontal rain, coming down so hard, I could hardly walk… by the time I arrived at the meeting I looked rather like a bedraggled wet rat, soaked and splattered with red mud.  It rained for an hour.  Then, yesterday morning I had every intention of leaving for the internet at 8am, to get on with my day… but the torrential downpour started at 0400 and continued through ‘til noon.  And now, as I write, the rain is coming down, and the sun is setting so the light is that beautiful twilight that is very soft, but at the same time strangely distinct.

Today, I finally gave my deposit on my house.  I am trying desperately to extract my rent from Bank of America (its my money!) and have it sent here… Joanna is helping me out, thank goodness.  Otherwise I may be homeless!  But its been another exercise in frustration and the American system….

Tuesday Dana, Allison & I decided to take advantage of our leisure time and explore a bit more of Bobo Dioulasso.  We walked for about 2 hours, and made some great discoveries like the teak furniture store, a seed shop for veggies, and the pottery neighbourhood.  But really, what was really enjoyable was just seeing more of daily life of Bobo, away from the touts downtown who harass us all the time (though already that is getting less).  Women walking with incredible loads of vegetables on their heads, girls of 7 or 8 helping their mother sell corn with a baby strapped to their back, bicycles passing by with impossible loads (like the guy who was carrying a 15 foot length of pipe).  A crowd of little kids running up to us yelling “Toubabu! Toubabu!” and wanting to shake our hands.  There are an incredible number of small merchants here, small stalls stuffed with all sorts of crazy things.  We wonder sometimes who actually buys anything when most people have so little formal employment… but there are literally hundreds of sellers of cell phone recharge cards – one every 50m or sometimes more!

Some of the things I’d hoped to get here may prove to be tough to find, but other things that we thought would be a problem are plentiful.  So I lugged my good frying pan all the way from Baltimore only to find a whole t-fal section of the grocery store here!  And yet a ceramic candle water filter has proven much more elusive. 

Thanks to all those who have been writing & leaving comments! I love getting emails & comments from people, it makes me feel much more connected.