Traveling part 2: Tiebele

The second part of the weekend trip was to a town called Tiebele, which has really uniquely decorated houses. The shapes of the houses are similar to those in other parts of the country, but the decorations are unique to Tiebele. We stayed in a local-style mud brick auberge, and had a lovely, and cool, night sleeping on the roof.
This first photo is taken in the royal compound, of the king of the Gouramance people. I loved the juxtaposition of modern laundry and traditional construction. The small building in the center is a granary.



This next pic is a village compound nearby... the cows live in the center of the courtyard every night, the people sleep on the roofs in the hot season, and chickens wander all around. You can see the millet fields in the background.

People cook with little outdoor stoves, made from recycled tin - often oil barrels that have been rewelded to make stoves. They use charcoal or wood... there are few trees in the non-protected areas of Burkina.

It was a fascinating weekend for both of us... though i think that the highlight for Claire was finding a stall in the Po market that had about 100 Canadian baseball caps from places like Thunder Bay, Calgary, Aylmer... from goodwill in Canada to a cargo ship landing in Lome, Togo and then by road to Po, Burkina Faso! And one will make the return journey back to Canada...

Take care & have a good week.

Traveling sisters!

Sorry for the silence of the last few weeks - Claire arrived a week ago, which has been really really wonderful - but seriously cut into my blogging time.

She's enjoying the sights and sounds of Burkina, and the slower, simpler pace of life... though downtown Ouaga & Bobo are both hectic.

We had a great weekend going to the Southeast part of the country.

Nazinga Ranch... safari to see elephants, baboons, crocodiles and many cervids. (So, there aren't that many animals to see in Burkina unless you count the urban donkeys, goats and sheep and thousands of chickens) - we even had an elephant charge the motorcycle passing us as we watched them.

More later... Tiebele, the market, and catching up after a year apart!

Pats on the back

Sometimes in this sisyphean task its hard to see if we're actually doing anything good. We work & work but the results seem small.

But today from a number of fronts we got some nice feedback. A counsellor from an association that we haven't been in touch with before came to ask us to see a child, and mentioned that rumor has it in the HIV world that we're doing a really good job. And a counsellor from REVS+, one of the biggest associations, said that their mom's are reporting to them that they are really happy with their care and the work we're doing.

Some mothers are scared to see us as its generally known now that the white doctors see HIV patients only and they don't want to be seen coming into our office.

And, our renovation started finally!!!!!!!!!
I can't say how glad I am that this is finally moving forwards. Actually coming through with something will be important for our credibility here. And it will make our work WAY easier to have a drug room, 3 consultation rooms, a blood drawing / procedure room and a waiting area all our own. YAY!!! Leah has spent many, many hours getting this up and running - she's done a huge amount of work for this. So, by mid-August we should have the CHU-SS / BIPAI Pediatric Day Hospital up and running. YAY!!

AND my sister is coming tomorrow! So its all good for right now.
Take care
Laura

Happy Father's Day!!

Well, as other kids abroad are doing today, I am certainly thinking of my dad - who is working in the NICU on this Father's Day.

I can't do justice here to the admiration & love I have for him but at the risk of embarassing him (and boring other readers) I will try. Both being pediatricians, we share a special bond above the normal father-daughter relationship.

When I started in medicine, I gained a whole new respect for how people outside the family saw him - as a University of Calgary med student and then pediatrics resident, people from every part of the hospital took pains to tell me how much they admired my dad, and how well liked he is.

The NICU is a scary place for most residents - the kids are so sick, the parents anxious and stressed out, and the nurses a force to be reckoned with. At the Foothills NICU though I had an unfair advantage over my colleagues - being Dr Sauve's daughter sure gave me a leg up. How could his kid be anything but awesome? (Well... ) The nurses got a kick out of writing entries in the chart like "Pt. has fever. Dr Sauve junior aware".

I went to Australia thinking that I could be just an ordinary peds registrar. Imagine my surprise when the first thing my new boss said to me was, not hello, not welcome here, but "How is Reg doing, anyhow?"

My first Canadian Pediatric Society conferences were marked primarily with being Reg's daughter too - though now the tides are turning and he's starting to be known as "Dr Sauve's father" in the international health circles!

My dad is so liked is that he is intelligent, wise, kind, thoughtful. I only hope I can live up to his example at work and at home.

My dad isn't as adventurous as I, and I know I have contributed to his quota of grey hairs over the years. Yet he always supports me in what I want to do even if it worries him. From sailing to the South Pacific, to moving to Africa, he is always supportive and even joins me for the adventure! I've been lucky to have him come visit me in the Pacific, Australia, South America and Africa. (Not to mention he was one of the only people who braved the murder capital of America to visit me!).

I hope you all have had a good Father's Day weekend.

Laura

A day in the life...

6am... alarm sounds... UGH... I'm not any better at early mornings, no matter how many days in a row I get up at 6am.

7am... arrive at hospital, squish moto in the crowded Parking, and stumble into the hospital, still half asleep. Say several "Ani sogoma"s to people as I head in. If patients have arrived, start seeing patients.

If no patients, at 7:30am we go to "Staff" or morning report. (At least one of us goes each day). The Intern who was on call over night presents... "3 cases of severe malaria with anemia, 2 cases of severe neurologic malaria, 1 case of malaria with jaundice"...

Discuss differential diagnoses... as far as the interns can tell, every child either has "malaria" or "meningitis"... despite all our teaching and encouragement, their diagnostic possibilities never get any broader.

Discuss death... a common scenario: child arrives, the intern assesses & recognizes that the child is in shock, writes prescription for IV, tubing, fluids, quinine, maybe antibiotics. The parents head out to find the money and then find pharmacies that have the above items. Sometimes it takes 3 hours. Sometimes on their return, the child is dead.

8:30... Sort out the one or two rooms between 2-4 MDs. Start seeing clinic patients. When one child leaves, the next one comes in... so sometimes they come in order of who has the pushiest mom rather than first come first serve. If a kid doesn't come in, we head into the main waiting area and try to figure out which ones are "our" kids without asking anyone if they have HIV.

Draw labs (or help to do so). Search for porter, don't find, so run samples to lab myself. Write ARV prescriptions. Count pills. Weigh kids. Dispense medications, explain medications.

9:30am... A child comes late for their blood draw (or isn't sitting with all the rest and gets missed)... draw blood, run back to lab, beg lab techs to accept the sample after the 9am deadline. Run back to room. Write ARV prescriptions. Count pills. Race to pharmacy to try to get needed medications for OIs. Weigh kids. Watch kids losing weight despite faithfully attending the CREN. Realise that a crucial piece of information is in the other room, 100m down the hall. Dodge slowly moving mothers to get to the other room. Try to take history but unable to because counsellor has gone somewhere and mom doesn't speak French. Look for counsellor, ask her to return to consultation room. Try again to take history. Dispense medications, explain medications. Try to fit in some HIV teaching. Receive lab results & write in chart & file in binders. Realize that the child I've started to see isn't "one of ours" - send them back to wait for the other room, knowing that the consultations in that room are done and that the patient won't be seen before 3pm now. Go back to lab searching for missing lab results. Wash plastic tongue depressors & "single use" ear speculums (at least we only use gloves once!). Bring home hand towel to wash at home.

13:30... wait a minute, how can it already be 13:30?!? Finish paper work, file charts. Head home, desperate for a drink of water & a bathroom break.

Lunch & siesta if at all possible (it really makes the afternoon better!) then some rushed preparation for the afternoon's activities.

15:00... meetings or med student teaching most afternoons. Then, work on designing clinical protocols for us, the health records system, the drug procurement, the lab protocols and partnerships, prepare teaching sessions, find articles for HIV Staff meeting, provide feedback on colleagues work.

17:30 - yoga break (yay for yoga video podcasts!)

19:30 or so - stop working, phone family, do personal emails (wish for more emails from home), watch DVDs, surf the net. Suddenly its past my bedtime and it all starts again. Speaking of bedtime... time for me to say goodnight.

ps... the photos are of a kid from clinic today with Justine in the background, and his attempt at being the photographer with me as the subject.

Books!

This has been a bookish week...

We received a huge box of text & reference books from BIPAI this past week. What a treat! We are really grateful for the references and they will be really helpful.

The English speaking community in Bobo (5 of the 6 BIPAI-associated folks plus our friend Nanette) got together for a book exchange today, for novels and fun books. I've really been enjoying having the time to read more novels in the last year than in the previous several years. Since there aren't any sources of English books here, we trade books from time to time. One advantage is that it gets us reading books that we wouldn't choose otherwise but that are often enjoyable.

Have a safe and enjoyable week.

Quote of the day

I paraphrase a comunity physician from a meeting today:

"Its a bad idea to test kids for HIV because if they're positive, then we'll be obligated to look after them".

Is it not a worse idea to let them die undiagnosed? Or wait until they present with obvious AIDS, at which point they may be too ill to save, or they may end up with permanent side effects? (He seemed to think that preferable).

But part of his point was understandable; they don't want to create a visible need if they won't have the resources to deal with it. So we tried to reassure him that we were happy to look after any seropositive kids he found if he did decide to test kids. On one hand, I can understand his anxiety... but if we don't test kids, we won't know how many resources we need to advocate for.

on being discouraged

I try very hard to celebrate the successes, to be thankful for what I have and I've been really working to keep the positive things focused on the blog lately but as evidenced from the weekend's entry, I'm not always successful.

But it gets discouraging here because everything, every single thing, is so hard. Some days its hard to have the energy to keep fighting the battle.

Why should it take 4 months, >10 meetings with 3 NGOs, 2 UN agencies, 4 MoH departments. 2 hospital departments and two weeks of stalking a pharmacist to get a drug that is provided by the Canadian government FREE for all Burkinabe kids (vitamin A)?

I keep hoping that something, anything, just one thing, will go smoothly, easily. That PlumpyNut will rain out of the sky. That we will get the liquid kaletra before Aimane dies.

We are all trying so hard, working such long days and nearly every weekend and it is never good enough - that's probably whats hardest. Maybe that's part of why most of our local colleagues throw up their hands and say "it can't be done" - like the Vitamin A story (at the beginning, several people told me that Vit A was not available to the hospital, that there was nothing that could be done about the fact that we didn't have it).

We do have victories and despite the fact that i am really discourged, I think, I hope that we are making progress; but none of this comes easily.

Omar & Fofana

OK, so although I have been feeling a little discouraged, we had two kids come in for followup today...

Omar is 13 and he was our very first patient; when we first met him, he weighed 24kg and had severe tuberculosis of his right lung and pleura; his CD4 count was around 120. He is an orphan, and lives with his uncle and grandmother. He stopped going to school earlier this year because he was too sick.

Today, after 5 months of anti-TB therapy and 3 months of ARVs, he weighs 32kg, and doesn't have that skeletal appearance any more. His adherence is 100% and he even asks good questions about his treatment sometimes. He's feeling better, and able to do more. Its wonderful to see the change in him!

The second child, Fofana, is about 2; equally, when we first met her, she was already on ARVs but really malnourished and sickly. She hardly lifted her head, much less played. This morning, she was exploring around our office like a healthy kid, with a mischevious grin and even a bit of a fat tummy.

Those are the things that make this job worth while. Seeing kids start to get better, start to smile and be normal kids again.

Foiled again

So, as feared, the PlumpyNut was just a pipe dream. Its being sent elsewhere in the country (to where a higher percentage of the kids are malnourished).

People from the other BIPAI sites write positive, upbeat posts about their kids who are doing so well on ARVs. That's what I want to be writing, really, it is.

We do have a few successes - one of our malnourished patients gained a little weight last week after weeks of alternating between weight loss and holding steady. And our very first patient who had TB & HIV, who we started on ARVs is gaining weight, feeling better and doing pretty well. And we are helping look after a whole bunch of kids who were terribly sick before they started ARVs and now are doing well.

But what haunts me when I go home at night are the ones who aren't doing well.
In our one room clinic (for 4 doctors) in a cockroach-infested hospital, without nutritional supplements, we continue to watch kids waste away for the forseeable future.

It makes it worse to know that in the other BIPAI sites, they work in fancy new buildings, they have nutritional supplements, PCR, second line drugs, a computerized health record system, other needed medications usually available. They get things like text books, and drug dosing cards. They have receptionists and a waiting area. And nurses. They even have bathrooms! (we have none of the above).

We do have 1st line ARVs, 1st line TB drugs, and a few other drugs - many places in Africa don't even have that, so I am thankful for that. And we can give them vitamin A now!! And we have our textbooks from home, and our own computers.

But often, we write prescriptions for meds that we know the parents won't buy because they can't afford it. We send them to the CREN, knowing they don't get adequate calories there and yet that is the official government system for now.

From a fancy hotel, or a business class plane seat, or a fancy white SUV, its easy to talk about taking things slowly, not "rushing things" or pushing to hard.

But how do you do that when the kids you are looking after are starving before your eyes? While a shipment of PlumpyNut expires because it's not being used. How do you cope with that?
If you think you can change it or that it will change, it helps - that's what has sustained me for the last 6 months. But if there is no relief in sight, what then?