Capacity building & neo-colonialism.

The last few weeks have been obscenely busy.

We had 6 of our South African colleagues here, and had a conference to seek broad input into the planned project. I was the key organiser, though had a ton of help. We got a lot of good feedback on the study, and I think we made progress. However, one of the key issues that will keep reoccuring is capacity (and the lack thereof) and neo-colonialism. Its a challenging problem that i am not sure how we will resolve in this context.

Our South African partners are some of the world's most important TB experts, and its an honour to work with them. Within South Africa, there are few senior researchers in ID, and those that are there are hugely overworked. And worse yet, there are few people coming through the pipeline, particularly in the cultural groups that were excluded / disadvantaged during apartheid.

On the other side, we are a Canadian group that would like to help build capacity, and collaborate with South African's to get this large study off the ground. In our minds, this should be a true collaboration... but our South African counterparts have been victims of many "collaborations"... where they participate, and even spend much effort on a study only to have the data taken and publications (and hence academic credit) written by the developed country researchers. They are - understandably - very leary about entering into partnerships, having been burned before. Groups often go to SA thinking they know what's best in the South African setting, trying to do things in their North American / European way.

... and so i can understand their reluctance, and their unwillingness to be taken advantage of, or be put down by rich world researchers...

but how do we build capacity without taking resources, without imposing our rich world outlook?

We talked about PhD students & post-docs; the South African's stated bluntly that they feel there is no role for Canadian students / post docs. So, we suggested, what about having South African students / post docs involved?... but no, they responded, going on to say that they don't have the capacity to train them themselves.

The balance of offering help without being labeled a 'neo-colonialist' isn't an easy balance, and i think will be a challenge throughout this process even though we're going in with eyes wide open.

Settling in again

I just wanted to write a quick update for those who are checking this and wondering if I'd dropped off the earth...

I've started my new job at BC Children's Hospital. I'm hoping I'll get paid for it too. (long story). But the department seems great, everyone is friendly. Fortunately I can still do some global health - with the South African project i mentioned before. More on that later.

I've found a place to live, and, despite moments of real culture shock, I am thrilled to be here and I hope I can learn a lot, contribute, and find my niche in Vancouver. And hopefully won't have to move again for a long, long time.

The plan is to keep this going - more about South Africa, and the challenges of working there. And about other things I get interested in here.

Thanks for the ongoing interest!
Take care
Laura

Imagine if this happened in Canada...

Flooding: 1,5 million people have been left homeless / cropless / school-less. 250 reported dead (I would guess that's an underestimate). The loss of crops is setting the stage for wide scale famine over the next 8 months.

What, you didn't hear?
Its not making headlines in your city?

Flooding has severely affected people in many of the poorest countries on earth - Burkina Faso, Ghana, Guinea, Senegal, the Gambia, Ethiopia, Uganda, Rwanda, Kenya, Sudan... all countries who can ill afford the damage.

In Burkina Faso, most villages are made from mud brick homes. The schools, the homes, sometimes even the clinics. Imagine what happens when a mud home is flooded.

Throughout the region, families barely scrape by - each wet season that things go well, they almost grow enough food for ever growing families. There are no savings, no grocery stores to buy more food, no social services to pitch in. Now, imagine what happens when the crops are gone. No harvest now, nothing to eat until the harvest next year... but these sorts of floods often set the stage for locust invasions, so maybe next year there won't be a harvest.

I know the flooding is going on because I look for it. If I was depending on CBC for my international news, today I would have read about the value of the loonie, 4 stories on the US - including a crucial story on OJ Simpson (why are we still hearing about this man?), climate change & its effects on North America including a tropical storm that isn't, several stories on the middle east & afghanistan.

And nothing about the entire continent of Africa.

Fortunately despite the rich-world apathy, several NGOs - World Emergency Relief, World Vision, Catholic Relief Services and others - are moving in, trying to do what they can within the challenges of the region.

Imagine the news coverage if this happened in Canada. Or the US. Something to think about.

next: Cape Town!

I've been debating what to do with my blog now that I've left Burkina Faso. After all, I'm not a "burkinadoc" anymore. But I think i will continue this - though likely at FAR less frequent intervals to document my next project.

Well, my current project is finding a place to live in Vancouver - what a nightmare. My choices are too expensive or too small or too run down. Its more expensive than Toronto. ugh.

So today, I treated myself to a haircut - first one in a year - and manicure & pedicure. Nice to treat myself. And everyday this week I've gone for an awesome walk with my uncle - enjoying the hot (for Vancouver) weather - 25C every day. And then spend way to much time driving back and forth between the North Shore and the West side, where I want to live - it takes at least 30 min when there's no bridge accidents.

Anyhow, what is next you ask? Well, for one thing, living in the same city hopefully for a long, long time. I don't want to go through this moving chaos again for a while.

But the exciting thing about my new job is the South Africa project. My Vancouver colleagues-to-be (below - at the top of Table Mountain, in Cape Town) and I will be working with an amazing group of researchers on an enormous, 10,000-child, 20-year birth cohort study. For those of you who aren't medical types, basically it means we are going to follow and take measurements on these kids over 20 years and try to figure out questions like, what are the genetic differences between kids who get sick with TB and those who are just infected? And what about asthma, pneumonia etc? I'm really excited about the project.

Cape Town, South Africa is NOTHING like West Africa. In fact, I felt like I'd already returned to the resource-rich world when I was walking around there. Skyscrapers, fancy restaurants, malls with familiar stores... it all felt very foreign but i sure was loving the seafood!!

While we were in Cape Town for meetings, we did find time to climb Table Mountain and enjoy the spectacular views

So, stay tuned for more updates on my South African adventures - and hopefully some traveling stories too. And the odd entry about life in Vancouver in general. My next trip to Africa will probably be in January, so in the meantime will be preparations and getting things set up.

Thank you for all the lovely comments & feedback about the blog - its nice to know people are reading it. It was a substitute for a journal while I was away and it will be interesting one day to go back and read through things as the year progressed.

Take care & until next time.

winding down

My last days in Burkina were too busy to allow blogging, so I apologize for the silence. I’m actually struggling to keep my eyes open to type this entry.

Wednesday evening we had a going away party for me. When it started pouring rain right at the appointed hour for the party, I was worried that no one would come – rain stops nearly everything in Burkina. In fact, Claire and I had been just about to leave home when the rain started, and as we were all dressed up in our finery we didn’t want to brave the rain and mud of driving there by moto… so had it not been for Bertrand who kindly came and fetched us, we’d have been much later than we were. But our friends braved the rain and the turn out was really good – the 4 counsellors, the 3 Kesho Bora doctors, 2 of the pediatricians, the pharmacist – and of course, Bertrand, Siddiqui and his kids and Amadou. They gave me 3 very nice gifts, and Dr Tamboura – the neonatal ward pediatrician – made a nice little speech.

The next two days were a blur of packing, and tying up an seemingly unending list of details. Why oh why do I always seem to do this sort of stuff in such a rush? Predictably, each task took at least twice as long as I’d anticipated… with Claire’s visit I definitely did not start actively doing the things on my list soon enough. Procrastination makes everything much more stressful than it needs to be.

Thursday I sorted my clothes & toiletries and told Maimouna she could take whatever she wanted of the clothes I turfed; she took them all – if she can’t use them, her sisters or friends can. She filled a bucket with clothes, plonked it on her head and headed home.

Friday was not an easy day. Rising at 6am, we started trying to finish up the suitcases, pack up the kitchen stuff to bring chez Dana, etc. As luck would have it, Friday was the only day of our entire time together Maimouna was really late – wasn’t feeling well. Normally this wouldn’t be a problem at all… but I had counted on her help to get the kitchen finished up. At 9:45 we dropped Claire at the bus; I was sad to see her go, knowing it will be a couple months before we see one another. I really, really enjoyed having her here. After that, stopped at Onatel to pay my final bill – unsuccessful … on arrival I took my number: 648. Unfortunately, they were serving only 522 and not advancing quickly at all, as there was one clerk. I left the money and bill with Julien. It went on and on.

I was worried when I showed up at the airport with my 3 suitcases weighing a total of 43kg – for a flight with a strict maximum of 20kg (can’t even pay extra baggage). Being a regular helps – they were kind enough to wave me through. I feel ridiculous lugging all this stuff to Cape Town for 4 days – but most of it is actually handicrafts and gifts with a few clothes, and a handful of leftover toiletries (the bulk were given away). I also mailed 2 boxes of books and artisanat to Veikko’s.

And then, the time was there… for the last time, I chatted with the luggage staff and went through the worlds craziest airport security (remembering we were going to an area with a simmering civil war): the passengers line up in front of men and women’s doors. You go into a tiny room with the gendarme, and they look at your visa, your plane ticket and ask if you have anything to declare. Rarely, they ask to open your suitcase and they look at the top layer of stuff. They virtually never check the hand luggage. Then, you check in. Then, you go to the security check – the xray machine has been broken for years. So, you hand your hand luggage beside the metal decector, and then you walk through – they are very thorough with making sure that you don’t beep going through the metal detector, divesting you of shoes, belt, whatever it takes. (But you can bring anything in your hand luggage!). After our last trip to Ouaga I realized that I brought a Swiss army knife as carry on – three times! – without it being noticed.

I closed my eyes and rested, and then the plane was there. And my time as a Burkina Faso PAC doctor was over.

At the tailor

Claire and I did something this week I've been intending to do for months... bought clothes. Like everything here, not as straightforward as you might think.

Step 1: Go to the market, look through piles and piles and piles of fabric. Discuss prices. Get followed from one stall to the next by hopeful merchants. Or, alternatively, go to someone's house, and sit on the patio discussing fabric colours and prices.

Step 2: Head to a tailors, and examine posters and photos of clothes models to choose a style. Get measured. Discuss potential pricing.

Step 3: Go back 2 weeks later to check on progress. Worry that clothes won't be done on time.

Step 4: Go back another week later and pick up clothes! Discuss potential pricing. Bring home 5 custom-made outfits (top & bottom) for $60 plus fabric costs.

Step 5: Go home and enjoy new clothes!

Farewell tour for les jumelles Sauve

Claire and I have decided to identify as twins here, since everyone we see asks "vous etes les jumelles?" - here in West Africa its good luck to give twins "donations" so we were thinking of setting up shop outside of one of the grocery stores with the other sets of twins.

This week has flown by and while I worked lots, we still found time to visit the old town and the vieux mosquee. The old town has been inhabited since about the 1400s. The quartier is a warren of mud brick buildings, with sheep, chickens, kids everywhere and fetishes (sites for animist sacrifices), not to mention the sacred catfish pond - so murky that the only sight of the catfish is their mouths and whiskers as they surface for food.

People live as they have for generations, including brewing millet beer from red sprouted millet seeds in hand-made pots, boiled over a mud brick oven for 3 days before setting down to ferment.

After the vieux quartier, we visited the mosque - a mud brick mosque dating to the 18th century. The posts sticking out are steps for cleaning / painting the facade.


After the week flew by, we had another great weekend. Friday night we flew back to Ouagadougou to have a little big city action before leaving. We dined in great restaurants, shopped up a storm and said goodbye to friends...

Saturday we had dinner with Alice Zoungrana, the HIV pediatrician in Ouagadougou - we've worked in many national meetings together. She is a determined, strong person (you may remember my blog about her mother who started the association for widows and orphans back in the 70s).

Since October, we have been using the same drivers in Ouaga for each trip - so I've spent a lot of time in the cars of Augustin (second from right) and his son, Hippolyte (far left). They took my dad and I exploring around Ouaga, have waited through numerous meetings and have even done things like rescuing my errant suitcase from Air France.

As always in Ouaga, they were hired for the weekend. Saturday evening, they took us for a beer at the maquis across the street from the airport, the last stand for a lot of travelers before they hop on the plane . It was really fun to sit and chat while fending off vendors of necklaces, carvings, batiques, sports coats and irons (?!).

Sunday we tried to leave early in the day but realized that our plane tickets were actually for Saturday's flight (yikes!). So we went exploring in a local park where all sorts of youth hang out relaxing - eating, playing drums or stereos (complete with amps & speakers), singing, and dancing. Students use the park as a study hall, escaping the busyness of homes with many kids and little space.

Fortunately, the Air Burkina folks were totally laid back about the plane ticket problem, and we made it back home again on the 5pm flight.

Its hard to believe how quickly the days are speeding by now. Our departure is this coming Friday!

Banfora & the hipppos

We had another great weekend away. Dana joined us for a lovely trip to Banfora, about 90km from Bobo. Its towards the Cote d'Ivoire border and the area is much greener and lusher than where we are. The rainy season is truly upon us, and we are reveling in the cool weather - down to 22C at night, and only 29-30C during the day... in the mornings one can even wear a long sleeved shirt!

We had a great expedition to see hippos on Lac Tiengerela - they were so close we could see their ears moving, and hear them groaning!

On Sunday we enjoyed the waterfalls, the rock formations and the Sunday market - smelly and chaotic as always.

The domes of Kafiabougou are also quite neat.

Now we're back in Bobo for the week.

I am actually finishing up my time in Burkina Faso; next Friday I will be moving back to Canada. I have a really exciting new opportunity at the University of British Columbia, and will be doing research in Cape Town, South Africa. I am really excited about the upcoming events, but it will be sad to leave here before our clinc renovation is even done.

So the other reason why my blog entries have grown sparse is that between trying to get ready to move, spend time with Claire, and still work full time in the clinic, I've had little time for extra things.

Take care.

Happy Canada Day!

We're far from home, with fireworks displays and Canada Day BBQs. But we are will toast Canada's 140th birthday tonight.

People here in West Africa are big fans of Canada - they see us as playing a really positive role in the region. Especially Mali - where the Governer General recently visited to a hero's welcome - but here too.

We're so lucky to come from a country that's wealthy, peaceful, equitable... despite the challenging climate.

Have fun today!

more sister time

The days are flying by... little time to blog these days.

Our current group of interns finished their 3-month pediatrics rotation Friday. We did Pediatrics Jeopardy... weren't sure how that would go here in Bobo but they totally got into it and seemed to really have fun. It was a little distressing to realize they still can't calculate maintenance fluids though...

Actually, their knowledge has really improved. In typical Burkina style, there were speeches at the end... Dr Kientega, one of our colleagues, thanked them for their work and congratulated them on their improvement. And then Masembo gave a little speech saying that they'd been really apprehensive about this rotation but that in the end they learned a lot and found the environment to be a really supportive one.




Friday night Claire and I headed to the Balafons with Sidiki and Amadou, which was fun as alway - I've mentioned them before but here are a couple photos:

The first is Sidiki, Claire and Amadou, the second is the group playing. (For the uninitiated, balafons are xylophones with gourds underneath to project the sound. They are the typical west african musical unstrument.

More later on the weekends adventures!

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?