Our first 4 patients!!!!!!!

This was a huge day for us: after 6 months of work we finally started seeing our own patients. We had 4 new patients today; 3 HIV infected and one HIV exposed. As any first day of something new goes, it was hectic and disorganized. But, we started finally. The Burkina Faso Pediatric AIDS Corps doctors have worked incredibly hard at building the relationships we need to get permission to do this. We have found sources for medicines, consumable medical equipment and the supplies. We've figured out how to estimate as best we can lab and drug needs and are trying to make sure those needs are met. We have developed a health record system (that has some glitches to work out) based on the forms used in the other Baylor countries. We have built liaisons with peripheral clinics and groups of Persons Living with HIV & AIDS.

One of the biggest challenges is knowing the theory of what to do (first needs assessment, then collaborative planning, then find the resources needed, then start & reevaluate)... but having never done it before its hard to know if we are doing in right. Its very trial and error. But we are trying our best, even if it isn't always quite right.

I want so much to provide the best possible care for these kids, given the limited resources, and the systemic challenges. I hope we can do it but at times I despair. We still have an enormous task in front of us, and many more long, long days. We will keep working at it anyhow.

workshop cancelled - AGAIN

I went to Ouaga on Tuesday for 2 things; a 3 hour meeting with Clinton Fdn, UNICEF, CMLS and representatives from a number of hospitals and a 3 day norms and protocols workshop that has been scheduled and cancelled every week since my return from Canada.

In both cases, the CMLS invitation letters didn't go out until the last second, so that the required people weren't present.

Despite that, we continued with the Clinton Fdn meeting but the big outcome was that CMLS needs to follow the formal channels to engage people in this UNITAID donation (a huge donation of 1st & 2nd line ARVs, lab testing supplies and nutritional supplements for 2000 kids), otherwise they will block it. That's just the reality of life here; very formal, very hierarchical. Even trying to organize a donation; there are lots of examples of donations being sent back / thrown out / put in a cupboard never to see the light of day not because they weren't needed, or useful, etc, but because the director (or whichever person at the top of the pecking order) wasn't officially informed.

The workshop was cancelled - on the morning it was supposed to start. I am SO annoyed that I went all the way to Ouaga for that! Then i organized some things for today, but they too got cancelled so I hopped on a bus and came home. I'm in my own dining room now, glad to be here.

I did have some really useful informal meetings with Clinton Fdn & UNICEF, so it was actually worth the trip, I think. Still aggravating though.

Ouaga has a new Indian restaurant, so I had chana masala & naan & chai & gulab jamun for lunch today - expensive but really tasty. What a treat!

quiet but relaxing weekend

It was a nice, though quiet weekend. We had a meeting at a nearby restaurant - its a lovely spot, under a thatched roof with a swimming pool and lots of tropical plants. And pretty good pizza. I did some knitting, finished another novel (a fun mystery novel called "Charm City" set in Baltimore... the descriptions of Baltimore and its places are great), had naps. I didn't get as much work done as hoped.

As a resident, when there are endless patients to be seen, and your pager is going off, and you're running from one thing to the next you manage to keep going (though it often stalls when you sit down)... here, if I'm really tired, I find it suprisingly hard to force myself to work. Today I had a particularly long day (started at 0730, and its 8:30pm now) and I'm still supposed to be working.... but am really struggling to force myself to do it. even though the sooner I get to it, the sooner I can go to sleep.

I was pleasantly suprised to meet the pharmacists - they are really friendly and seem like they will be supportive to our efforts. I'm preparing for my Ouaga meetings - forecasted patient loads, medication and lab needs. Plus I have a bunch of questions to address with respect to the national norms and protocols. However, I think I'm not going to work any later than 9:30... enough is enough.

Its crazy, the Ministry of Health people swear up and down that there is enough cotrimoxazole for all who need it - HIV exposed infants and HIV infected kids. The pharmacists and Dr. Nacro say that the gvmt doesn't even provide enough cotrim for the HIV infected kids who need it... somehow between the two is an immense gap that I don't begin to understand. However, I'm getting better at asking everyone I can think of about the problem, and its starting to become very slightly less murky... at least the pharmacists are game to work together!

Have a good week. I'll write again when I return from Ouaga again.
Laura

learning patience

I have a weekend home in between Ouaga trips.... have to go back on Tuesday again for more meetings and a workshop on national pediatric treatment guidelines.

Our goal is to treat kids with HIV but actualizing it is harder than you would think. We were led to believe that we'd arrive in country and start seeing patients. And even though from early on I knew that wouldn't be the case, I keep hoping we can get to that part.

But, in fact, what we're doing is really important. In a setting where there is a lot of hostility and distrust towards foreign NGOs and workers, we are working very hard to build good working relationships with our colleagues. Making sure they know that we realize that they are the local experts - we're the spare hands, trying to push things along. Making sure its clear that we respect their knowledge and expertise (even if we sometimes disagree... though that can be challenging). We are trying to set up our clinic from the outset so that it will be sustainable, with solid partnerships.

Another challenge is that we are here as "experts" in HIV care of children - but I have only very limited experience for the kids we have in Toronto are all stable and well on their ARVs, for the most part... and I have significantly more experience than my colleagues! So despite having studied and read a great deal, there is knowledge that comes along with experience that, well, we don't have yet.

The meetings this last week in Ouaga were productive. I met with people about malnutrition care in Burkina, and learned that there IS a national plan to try to address some of the challenges currently being faced. Within the next few months (inshallah), UNICEF and the Ministry of Health will be rolling out training programs and then providing the supplies needed, like therapeutic formulas, vitamins and supplies.

I also found out that there IS vitamin A out there if you know who to ask... so starting Monday I will see if I can get our hospital staff to ask for it. As a foreigners, we can't ask for it - the request must come from the hospital - but according to my sources, there is enough Vit A donated by the Micronutrient Initiative - a Canadian group - to provide it to ALL kids who need it.

And it looks like the big UNITAID / Clinton Foundation donation will be available within the next couple months, which will provide us with anti-HIV drugs, cotrimoxazole (to prevent infections in infected kids) and testing supplies. And, I found out that there is a supply of other medicines available for HIV positive kids for free.

While I was doing that, my colleagues were meeting with the peripheral centers around Bobo and the surrounding areas to discuss HIV care and let people know that they can start refering patients ASAP. (We don't have any "motivation" so we're depending on people's good will to actually refer patients... hopefully that will work).

So, all in all I think that was some good progress. We keep revising our target dates further and further back because of various delays. Now we're hoping for our day hospital renovation to be finished at the end of April / early May (the initial estimates were for end of Feb, but has it hasn't started yet, I don't think that will happen).... every time I start to have a little optimism, something happens to dash it. Either a colleague points out the obvious, or something happens to push things farther back. But I keep hoping that my year here won't be in vain. That in the end we will make some small difference for at least a few kids. Because really, that's why I came. For the kids who deserve to have a chance at life. For those 20% of Burkinabe kids who die before age 5.

life outside medicine

I've added 2 more Groundbreaking ceremony photos, taken by my friend Allison (Dana's husband). The first is the 4 of us, plus four of our 'bosses' from BIPAI; Nancy Calles (in the pink shirt), and in the back row, Mark Kline, Mike Mizwa and Gordon Schutze. The second photo is us 4 pediatric AIDS Corps doctors at the future COE site.

Over the last little while, I've been trying to do more social things outside of work. Its easy to do nothing on weekends and evenings except play on the computer, watch DVDs, etc. This weekend, I've been doing lots of knitting which I am finding really relaxing and its nice to be producing something. I listen to CBC podcasts of Dispatches and As It Happens.

Also this week, Suzanne & I went to the Fete de l'Eau - the water festival, which is a sort of new years festival. We went to one of the "quartier populaires" called Balamakote, and wandered the streets a little (there are rarely tubabous who venture into that area, so we attracted quite a crowd of kids at times). The young girls (before they've had a baby) were dressed up for the dancing - they have a tall headdress, sometimes 2 feet high that is covered in shiny, sparkly garlands, and a bra (no kidding), and a very very short skirt, barely covering the underwear (in a place where skirts showing the knees are incredibly risque!). In fact, we didn't stay for the dancing, because there isn't a set time... it can happen any time between 9pm and 2am and happens at the whim of the Griots - a caste (that is present in most West African cultures) of performers. Half the fun was just watching the kids chase each other around, and see what night life looks like in les quartiers populaires. There are few women out, other than the girls who are dancing. Mostly, its the men who are cruising around.

Saturday night we went to a movie screening at the house of a friend. A French couple is staying there for a week who were here for 8 months last year, and the woman, Sophie, worked with HIV prevention projects including one group that has a big screen and DVD projector who hosts HIV prevention films in a number of villages. We watched a French animated film called "Kirikou" that is set in Africa, and features a very smart, tiny kid who saves his village. Its a cute movie. There were probably 75 people there, many of our HIV-association contacts, a few of the doctors from the hospital, etc. There was a big meal of rice and sauce, with meat. It was lots of fun.

Today was another big day - got a haircut! (don't worry, just a little trim). There is a woman who knows how to cut toubab hair who comes to Bobo once every few months, so Suzanne, Leah, & I all went to Nanette's where we each had our hair cut (as did Nanette and her kids) and had tea and visited. It was nice (and I'm glad to be able to get a comb through my hair again).

Take care & please keep in touch - I can't tell you how much I treasure the emails from friends & family.

Love

Laura