Back to the grind

After a lovely vacation, I'm back to work again (actually, have been for over a week already).

Last week we finally had the long awaited workshop on pediatric HIV guidelines - now I have to spend some time working on the draft to get ready for the next workshop. I'm glad the process is moving along. The participants were mostly public health folks, who had much to say about formatting, style and questions of organization of health services, but little to say about medical dilemmas or controversies. I was hoping to have some active discussion about a few issues, but in the end it was just Alice & my ideas that were kept.

This week I'm back in clinic, and I'm enjoying that. No exciting or complex patients yet, which is OK as we get the hang of things.

When I think back, I think we have really accomplished a lot over the last 7 months, even though at times it seems we're hardly moving.... Leah was reviewing what we've done so we can orient our new administrator (HOORAY - administrative support!!!!!!!) and we realized that from August when we had no connections, no idea about the situation in Bobo (besides the national level statistics that are published) and really weren't welcome in the hospital we have managed to:
- learn about the practical situation on the ground of pediatric HIV care, in part by visiting every public health clinic (~30) in the Bobo area, assess their pediatric HIV care needs and let them know of our program and visiting every local association (~10) who provides services for familes & children with HIV to find out what they do and let them know what we do
- built liaisons with the department of pediatrics (most important), the lab and pharmacy at CHU-SS as well as CMLS (Committee Nationale pour la Lutte Contre le SIDA)
- participated in general pediatrics care and in Suzanne's case, general internal medicine
- built partnerships with the Burkina Faso HIV branches of UNICEF, Clinton Foundation, WHO, ESTHER (a french NGO) and to a lesser degree, WFP, Helen Keller International, PSI, SOS Children's Villages
- built a health records system & monitoring and evaluation plan
- organized a renovation of 10 rooms of the pediatrics ward for an HIV day hospital
- figured out a source of ARVs and cotrimoxazole
- helped push forward the national pediatric HIV training agenda (by first participating in the norms and protocols).

Sometimes we have struggled to know what we are supposed to do - how do you start a new program in a challenging environment? What do you need to do to make those partnerships. And while there certainly have been challenges, delays and inefficiencies along the way, I am pleased that we are making progress and that we are helping strengthen the Burkinabe health care system. Every day I learn new lessons. I hope these next few months we can increase our numbers, complete the renovation, and continue to work on our education mandates - both ward-based education of the interns and national level guidelines and training.

I appreciate the support given to me by those at home. The comments and emails are really encouraging.