The ongoing struggle in Burkina Faso

I haven't written anything about good old Burkina Faso for ages.
Out of the initial four MDs that were there, only one remains - she's really dedicated to West Africa and really perserveres despite everything.


Here is an article from the Houstone Chronicle about Suzanne's ongoing work - the patient mentioned was diagnosed and started on treatment about a month before I left Burkina.
http://www.chron.com/disp/story.mpl/headline/world/5986438.html

Reading it makes me quite homesick for Bobo Dioulasso - the work was often so frustrating and discouraging, and yet there are moments of triumph, and that is the work I feel so passionate about.


The stakes are so high. It makes it hard for me to relate when people here complain about not having weekend access to fancy tests (as happened this weekend on call), and about the "lack of resources" in one of the worlds richest - and best funded - public health care systems. Our system can always improve, and there is needs for more and more. Despite being in a city where there is a lot of relative poverty, we are really lucky. If someone comes here in from the street they can get the same care as everyone else because its not based on what you can pay.

In the year since I've been back, I haven't seen one child who was severely malnourished. Not one who died because basic health care services weren't available, or because they couldn't afford $4 worth of antibiotics and supplies.

We can always work for better, but we really are the most fortunate of countries. And we need to protect that at all cost.

Heading home

Well, I can hardly believe it but this 2 month stint has gone by, and in a couple hours I'll be headed to the airport. I've nearly finished the task for fitting my life back into suitcases. Again. As I was packing I was cognisent of the fact that i have way too many warm weather clothes here - I hadn't realised that not only is it cold here, but there is no heating in most places. Brrr! So I only wore the warmest clothes I brought, other than the few days in Uganda. Ah well, live and learn.

Take care & I'll be in touch again soon.

Mbekweni & Fairyland

I spent the day today working with the home health workers from Drakenstein Hospice, doing home visits into the townships and informal settlements of Mbewkeni and Fairyland (a cute name for a dismal looking place), as well as to a farm (to visit the farmworkers).

The home health worker, Myrtle (wearing the vest, right), was really amazing. She used to have a better paying job in a private hospital and gave it up to work for hospice - she is amazingly dedicated to the families she works with. She brings food to them every visit out of her own pocket - little things of yoghurt, or a sandwhich. She sometimes pays for gas out of her own pocket to bring kids to the hospital in town when they need to go. Here, we are measuring and weighing one of our little patients.

The thing is - I think they're all like that. Doing amazing work with few resources, just a lot of caring and love.

Some of the mothers / grandmothers / aunties we talked about in rounds have been really amazing, taking in other orphans and looking after their own and other kids. Others struggle.

One family (a grandmother, her son and her 6 or 8 grandkids) had been doing really well, with a small meat selling business in a container. (containers, like shipping containers, are often used here as little shops). About 2 weeks ago, during the xenophobic attacks, her shop & home were attacked, her husband shot, and all her furniture, fridges & freezers stolen. So now they have no income, no food, nothing. (Incidentally, they are not foreigners!).

It was a day when the inequities of life here were so blatant. The photos are taken beside some shacks, just 25 m from a train track. We visited a daycare - basically a one room shack liket he ones you see in the photo, with 9 or 10 preschool kids wandering around. These two little kids on the left were not in the daycare - they came to see the commotion and watched as we gave out little things of yoghurt, so I had to give them some as well. The big brother could hardly carry the little brother strapped on his back.

It was an exhausting but illuminating day.

Hermanus

Last weekend I visited our landlords cottage in Hermanus, a whale watching town about 2 hours drive from Cape Town. What a beautiful area! With mountains on one side and the ocean on the other, we had lovely walks along the beach. One of the highlights was seeing some early Southern Right whales breaching and playing in the waves. Usually they're not around for another month!

There seems to be some lovely restaurants and shops in the town as well, although we ran out of time to do any poking around in the town.

Its really lovely to do some exploring of the region.

Pediatrics Ward

I spent yesterday with the pediatricians in Paarl Hospital, the secondary level hospital that provides care to the children in the Drakenstein Valley. Its actually split over two sites, one depicted above, the TC Newman / Paarl East Hospital, and the main hospital. I spent the morning on rounds with the house doctors (residents / registrars / locums) in neonatology, the main children's ward and the gastro ward.

The hospitals look a little run down but they have MUCH more available than in other places I've worked. One chronic problem they have is a shortage of doctors, including consultant pediatricians. The ones they have work SO hard! They were really friendly & welcoming, and enthusiastic about our study.

The big problems there? Acute respiratory infection, gastroenteritis, malnutrition. Prematurity and low birth weight as well. They do have access to the usual tests and antibiotics and some of the high end ones - there were 3 kids on Vancomycin & Meropenem (the really big guns).

The day provided a real boost for my spirits, to remember what it is I am doing here.

The "what else"

This has been a quiet week - I've been working on our pilot protocol, mostly sitting by myself at a computer. Not so exciting!
Maybe this is a good time to think about what I am doing here at all.

Did you know that 10 million children under the age of 5 die worldwide every year? And that the number one killer is pneumonia. Why does that happen?

Its a whole lot of complicated things working together - a combination of malnutrition, crowded living environments, smoke in the home, genetics, delayed presentation to health care services and maybe incorrect treatment when kids get there. And the spectre of HIV looms over all. Our study is looking at trying to tease apart some of these factors. For example the organisms (viruses, bacteria, etc) that cause pneumonia don't happen in the same frequency as in North America so we need to know which ones are more important here.

Part of our study that I find interesting is the "ancillary care" ... the idea is that we can use a study and its infrastructure to help improve care outside of our study. Communities aren't necessarily excited to participate in research - for really, what benefit does it give them. When you're living on the edge, helping science isn't that interesting. But the "what else" can hopefully be an avenue where we DO something other than study. Where we can provide (hopefully) a tangible benefit. That's what we're aiming for anyhow.

Wine Tasting

There are hundreds of wineries around this region of South Africa and since driving around by myself to taste wine just doesn't seem like a good idea, I took a tour, where we visited 3 wineries (4 if you include the cheetah project where we didn't taste wine).

It was nice to get out of town and explore some new places. The town of Stellenbosch, where the main campus of Stellenbosch University is, seems to be a really beautiful little town with gorgeous Cape Dutch architechture. We also visited Franschhoek, a French town founded by the Huegenots, which has lots of nice little stores and restaurants.

It provides such a contrast to the way we've been thinking about the wine regions... for the last month, I've been thinking of alcoholism, the troubles of the farm workers, the "dop" system (a long outlawed system where workers get part of their wages in alcohol instead of money)... this is the other side of the coin. You would never guess there were any challenges at all from the descriptions of the tour guides.

At any rate, it was a beautiful day and we had some lovely wines - the expensive ones were in the price range of R50 - about $7. I bought a bottle of Sauvignon Blanc on sale for R10 (just over $1)! And while its not as complex as some, it's a tasty wine (I opened it tonight to have with dinner).

Salud!

new troubles

I'm glad to be back in Cape Town; but it saddens me to hear about the terrible xenophobic violence that's going on in other parts of the country. People who have fled disintegrating economies or war in their country of origin and seek refuge in the wealthiest corner of this troubled continent and are now chased away.

Wealthy parts of Cape Town is an oasis of peace, but also I am in a position of privelege - the people being targeted are not (relatively) wealthy academics but the poorest of the poor. Just down the street is plenty of violence, just not targeted against foreigners.

It seems to my uneducated eye that this ties back again to the difficult history of this region and Africa in general.

Its front page news here ... but i wonder how (or even if?) its covered elsewhere in the world.

Source of the Nile & Chimp Sanctuary

I took a rare few days of tourism over the last few days, which has been lovely.

A group of us went to Ginja, where the Nile starts its long journey from Lake Victoria. The drive up was green and beautiful, and it was neat to see a window on Ugandan life passing villages from the highway. I was surprised to find out there's a full-on mall here - they can't be escaped!


This is "the" source of the Nile - what used to be a spring in the lower right hand corner was overtaken by the lake after a dam was built, but you can see the clear water welling up from the edge.

We got to see lots of various birds - kingfishers, egrets, cranes, weaverbirds. And even a troupe of monkeys.
In the mouth of the Nile there were lots of men in fishing boats like the one shown here...

We also took a walk in a protected forest and stopped at some rapids, where we had coffee in a lovely riverside lodge. By the way, the coffee here has been generally excellent. Strong, dark roast - yum!

A few days later, a different group took a 45 minute boat trip to Ngamba Island, which has a big chimpanzee santcuary - a group of 45 chimps that have been confiscated from smugglers or orphans found with their parents poached live on the island. On one small tip of the island, their caregivers live, and funds are raised for the food, vet care, etc by having tourists come see them.

We learned about the chimps, and then saw a chimp feeding, where they come to get their thrice daily fruit. It was just great watching them catch the thrown fruit, squabbling over it, and chowing down. The caregivers know them all (and their personalities) well. Next time I'm in Uganda I'll try to go back - you can stay overnight there and go for a walk in the chimp enclosure in morning.

Its been a lovely break here, and early tomorrow morning I'll be heading back to Cape Town. I'm looking forward to getting back into a routine again.

Until next time!

Research and sub-Saharan Africa

The first days of the conference have been long but interesting (at least, parts of it). I was not as excited about the dozens of slides of graphs of green and red dots that demonstrate the results of microarrays and various molecular technologies.

But there was a great review of the state of the art of malaria research, TB and novel HIV vaccine targets.

The workshop on building research capacity in Africa was great though. The perspectives ranged from very accomplished, well funded, well respected researchers to very disillusioned people saying essentially “the man with the key is gone” (a uniquely Ugandan way of saying the problem is out of my hands). While some speakers complained that there was no funds available for Africans to contribute to research, a Sudanese physician and research leader (who sits on review boards, trains students and is involved in international research) who sits on funding review boards remarked that he feels that there is much potential funding that African researchers don’t get because of a lack of quality proposals.

One message that came through loud and clear that one of the needs was in teaching African medical students, residents and health workers about how to write a good proposal, execute a study and then write it up which is the goal of one part of an upcoming UBC – Makerere collaboration. The lack of skilled mentors was also mentioned as a concern. So it seems like an ideal time for UBC / CICH to be working on such a project.

Rainy season

Its rainy season here in Uganda, and this morning lived up to that. Rain fell in sheets, and at first there was still sun shining on the leaves giving a surreal look. In the afternoon the clouds disappear and it becomes sunny and hot again.

Everything is so green and lush here, with spectacular flowers throughout the resort; beds full of birds of paradise, and amazing varieties of hibiscus. Right now its still the tail end of the dry season in Cape Town so its brown and dry there.

People are gathering for the keystone conference, which starts later today. When I am registering for these things I’m always enthusiastic but when the time comes I am reminded that I find networking really stressful. I don’t know anyone here, so I don’t have that to fall back to. Ah well. Another AFLO.

To have a break from the artificiality of the resort, I went for a great (but warm) walk through the town of Munyonyo. Its really not a big town, but there is a church, a health centre, a primary school and even a pre-school. There are only a handful of shops with no one selling anything by the side of the road. I only saw a couple wandering merchants – one with bednets, and another with bowls. Small kids waved and shouted “mzungu, mzungu, how are you” just like I remembered from my previous trip to Uganda. Some seemed frightened of me, others were excited to say hello – but no one came up to me, they all stayed in their yards and shouted and waved.

back to the origins

The first African country I ever visited was Uganda, back when I was a resident – several lifetimes ago. Tonight, I returned, and some things seemed familiar but so much has changed – here in Uganda and even more in my perspective.

I was excited to be back to somewhere warm (Cape Town is really cold) and, well, African. The drive to the resort took about 1.5 hours, through just crazy (very slow!!) traffic, with overloaded matatus (minivan shared taxis, each PACKED full of people), boda bodas (motorcycle and bicycle taxis) and trucks. By the sides of the road or in one-room businesses just beside the road, in the dark, life was going on in full swing – people sitting around kerosene lanterns drinking or eating, women walking by carrying big buckets on their head and a baby on their back, hair stylists, pool tables, etc etc… it was such a neat snapshot of suburban society here.

The resort where the conference will be was not what I expected though – its just HUGE and really fancy. But some things still don’t work as you expect despite the fancy surroundings to act as a reality check.

The other fellow in the shuttle asked me what my ‘area of research’ is and I floundered a bit – I need to come up with a 2 or 3 word statement to describe my “area”. Child survival is just way to broad, but I don’t have any other slick idea.

Anyhow, I’ll be conferencing for a few days then on to Mulago Hospital to meet some of our Ugandan pediatrics colleagues.

Cheers

On keeping in touch

So, the upside of moving around is all the great friends I've made in many countries. That is one of the beautiful things of living and working overseas.

The downside is that it is sometimes hard to keep in touch with people. Compared to my first times working abroad, it is much easier to do these days with email and the web.

However as I have only brought my work computer to Africa I am missing a bunch of email addresses. If you haven't heard from me in a long time it could be because I lost your email address. Please either add a comment or email me at my 'temporary' address "burkinadoc 'at' yahoo.ca" and I will respond from my real email address.

Thanks!
Laura

Humbled, as always, by our local colleagues

Our nascent study, tentatively called “Drakenstein Child Health Study” (not too catchy – suggestions are welcome!) will be in the Drakenstein valley, an area with rural areas and farms (wine growing) and some urban areas. I went out to spend the day with Jenni, our anthropologist who did the first stage of the community engagement and meet some of our colleagues out there.

We visited Emporium of Care, which I described last time, Drakenstein Hospice and a local pediatrician’s farm.

Drakenstein Hospice is an NGO in transition. It traditionally provided classic hospice care – helping people die with dignity and trying to alleviate their suffering as much as possible. In the pre-ARV era AIDS was a universally fatal disease causing great suffering and hospices were crucial parts of the care. But today with increasing access to ARVs, Drakenstein Hospice is finding that the needs are changing and so the leaders, Elizabeth and Maria, are working to open Butterfly House – that will support people living with HIV / AIDS. Income generation, day care, pre-school, education, food supplementation & nutritional education are all planned as part of this new program.

They’ve invited me to spend more time with them, and I think that will be a great opportunity to learn more about the community we’ll be working in.

another new home

Somehow, the flight between Western Canada and Africa never seems to get easier; Vancouver to Cape Town feels really quite long. But I have survived another journey, and am excited for this new adventure.

What a difference from the last time I lived overseas. Sea Point, the neighbourhood I live in, could really be anywhere in North America or Europe. The first couple days I had trouble with my internet access so I walked along the beach to an internet café with free wireless that wouldn’t be out of place in Vancouver. At Pick & Pay, the local grocery store around the corner from my house, one can get everything, from breakfast cereal to all sorts of pre-packaged food.

I did feel like I was in Africa this afternoon when I staged a sit-in at the car dealership that is trying to fix our car, and I heard the list of excuses of why the car isn’t ready. I extracted a loaner car out of them… I definitely feel a bit nervous driving on the left after several years though.

South Africa is such a study in contrasts. I feel like I will need to spend time doing some things like home visits with the hospice program to really get a feel for the South Africa that most of the citizens experience. Its odd, a bit uncomfortable, to be in this rich enclave yet knowing that most of the people live in extreme poverty.

I’m not sure exactly how often I will be writing in the blog; much of what I will be doing is computer work – writing a proposal. That process won’t be interesting to write about in a blog! But as I do learn things, and have new experiences I will try to keep it up to date.

Take care & keep in touch!

the Emporium of Care

In a disused boiler house, Nils Groebler and his colleagues have built the Emporium of Care - what started out being an ARV treatment program now has ARV treatment plus income generating activities, skills development, VCT, spiritual care, a playroom for kids and the newest project is a community garden. The tables you can see in the foyer are part of the tea shop - a place for PLWHA (People Living with HIV / AIDS) to sit and chat with people who really understand what they are going through.

To me this is the ideal of where we should be aiming for HIV treatment programs - without an income and food, all the ARVs in the world won't help. The Emporium of Care really tries to be a holistic community and care centre.

Robben Island

I arrived home two weeks ago already, but didn't have the time / energy to return and add my photos. In a few weeks I'll return to Cape Town for 2 months - and I expect that my blogging will increase again since I will have more time to do that sort of thing. And interesting observations to make!

Cape Town from Robben Island; with famed Table Mountain in the background. (I climbed that once).

Robben Island: the notorious Western Cape island prison, for political prisoners during the struggle, including Nelson Mandela.

The visit to Robben Island was excellent. For me it was an emotional thing, to see the quarry where the leaders of the struggle spent their days, moving rocks from one place to another and yet still teaching each other to read, and leading the struggle. To see the cell, where Nelson Mandela spent so many years of his life. To see how truly shamefully we humans are capeable of treating one another on the basis of the colour of someone's skin.

A Canadian colleague recently mentioned that in the late '80s / early '90s he was hardly aware of what was happening in South Africa. From what I remember, it was hardly covered in the western media so you had to be interested to know what was going on. I remember it - seeing news footage of riots in Soweto, hearing of the school strike, seeing masses of youths doing the toyi-toyi.

But it didn't seem real, in a way. But when I now am spending time in South Africa, I am humbled by the strength and determination of those involved in the struggle.

The ex-political prisoner who was our guide talked about how the guards worked to 'divide and conquer', driving wedges between prisoners using access to 'luxuries' such as newspapers, extra meat. He showed enlarged mockups of the cards that ruled everything in their lives.

Even in prison, there were huge differences between how the apartheid-defined racial groups were treated. I just have so much trouble understanding how an entire country was run on those bases for 50 years - true democracy only started in 1994 in South Africa!

As I continue to work in South Africa I will surely learn more about it; but as a privileged, white foreigner will never be able to truly understand.

Anatomy of a collaborative study

I’m here in South Africa for two workshops on the development of a huge planned study. Its challenging to bring together such diverse groups to work on one study, to communicate and truly collaborate. And the politics can be such a minefield, often tough to negotiate – though for now its not me who will be doing that. Again the time “before independence” defines a lot of how people relate and its hard for the foreigners to sort it all out. We’re often making inadvertent blunders. Luckily we have two young South Africans on our team, to help us negotiate all that.

The site visit yesterday was just great. It was so helpful to see to a certain extent what the level of care is like here, and what is available. The Drakenstein valley is really beautiful, in a basin surrounded by mountains with wineries all around. The hospital & HIV clinic we visited was much better resourced and better developed than what we had last year. The “Emporium of Care” provides a variety of health care services, social support, spiritual support and income generating activities. Its just a really neat holistic facility. Our conference badge lanyards were made by the beadwork project from there – www.kidzpositive.org

Yet the health care workers all talked about being discouraged with the system and how draining it is. I wonder if part of that is the fact that there are such riches here.

I’ve been struggling a little with what my role really is; I’m not an expert in any area and I sure don’t have any experience in designing and implementing any large study much less one of this scale. So I find myself wondering what I can really contribute.

The anthropologist that has been working with us has been really good – although she’s just working on her Masters, she’s worked on a number of prior studies in the area, and in other parts of Africa.

One of the challenges has been to establish “community participation” and “community driven” … no one in the core group (especially of the Canadians) has actual experience in doing that in low and middle income country settings. Yet how you go about community engagement is different if you are selling / engaging them on a study that is essentially already designed is quite different from really finding out what the community wants and studying that. My public health hero, Dr. Bang has taught us about projects that ultimately fail when they didn’t take into account the community.

Anyhow, there are no easy answers, that’s for sure. We’re all learning incredible amounts along the way though.

Welcome to Cape Town

The last blog entry that I wrote related to a trip to Haiti. How I’m onto the next big project… a tri-university collaboration in the Western Cape, South Africa.

I’m writing this first update from South Africa, halfway through a 10 day visit. The weather has been just beautiful – this is a great time of year, not too hot (about 26-30 in the day) and sunny. (In Vancouver there is snow!)

We arrived last Thursday, and spent the next two days delving into a psychosocial pre-workshop.

Sunday I went with some colleagues to Robben Island – the prison where Nelson Mandela stayed for 18 of his 27 years in prison. It’s a national historic site now. I really enjoyed the trip although it was pretty exhausting – even as a foreigner its hard to understand Apartheid and how it affects everything here. But to hear the stories of political prisoners is really moving. How can a society heal from the wounds of such discrimination and of so many years of oppression of the majority of the people? People here refer to the end of apartheid as “independence” and the time since as “since democracy”.

Cape Town is a strikingly beautiful city and it’s a little hard to come to grips with the poverty that lies underneath the city that looks like any Western port city – Vancouver, San Francisco, etc (but with sun!). The waterfront is a quaint area of lovely restaurants and shops nestled in a working harbour. Table Mountain is the anchoring landmark for the whole city. There are malls with all sorts of fancy shops.

Yet… nearby are places where people live in shacks cobbled together with whatever they could find, no electricity or running water. There are towns that have some of the highest rates of fetal alcohol syndrome in the world. The culture of violence is incredible and effects everyone from the bottom to the top of the social ladder. The poverty is pervasive in this society, yet hidden from view. There are such riches, yet 6% of kids don’t get to go to school at all. There are some amazingly brave and resilient people and some that crumble under the pressure. It is a country of contrasts, of dichotomy and I think it will take my whole career to even scratch the surface of how it all works.
What a learning experience!

ICC & the 40th Anniversary Celebration: what someone can do without leaving their home

I want to mention our hosts of this little sejours - "International Child Care" or ICC (see http://www.intlchildcare.org/) is an NGO focusing on Haiti & the DR for the last 40 years. One of the best parts of this week was getting to know members of the American board - ordinary Americans who have been touched in one way or another by Haiti & the challenges there. They are salesmen, nurses, physiotherapists, from all over the US and many had never thought of the world outside their borders before they got involved with Haiti. The American & Canadian members donate a great deal of time and effort to fundraising, while the local organisation and board focus more on programming - with dedicated Haitian staff throughout the country. At the two 40th anniversary celebration, many spoke of their pride in the organization and the lives that it impacted.

ICC has both the Grace Children's Hospital in Port-au-Prince, and community health centers and activities throughout Haiti, with activities like primary care, vaccination, and income generation / microcredit schemes.

Chuck Phelps & Jeannine Hatt acted as our hosts - they've been to Haiti at least twice a year for a number of years, and are very dedicated to the cause. They were incredibly warm and welcoming and put a lot of effort into ensuring that the two 'newbies' - myself and Sarah Kim (another former Pediatrics AIDS Corps doctor) - had a chance to see more of Haiti. (Photo, left to right - Sarah Kim, Jeannine Hatt, Claudy St Juste, Tyler Bloom, Chuck Phelps, Mesa, our driver - lunch stop on our medical tourism day).

Claudy St Juste was the master organizer - what a headache he had to organize 30 North Americans, the details for the congress, all the transport, etc. And yet he was consistently welcoming, friendly and gracious - and clearly dedicated to the organization.


Friday night was the formal celebration, with speeches, a video and excellent Haitian dancing by a group of young adults at least of some of which were former patients at ICC. This photo is the North Americans who came to speak in the conference.

Day 4 & 5 - Congres Medicale

The conference was really interesting. I really enjoyed hearing the Haitian presentations on HIV care, prevention of mother to child transmission, etc. There seem to be many NGOs here providing HIV & other pediatric care, and they are able to do things like TB prophylaxis for children of adults with TB. Haiti is an HIV vaccine study site and Dr Joseph provided an interesting overview of both the study (now stopped due to lack of efficacy) and the HIV vaccine process.

The medical congress was remniscent of being in Burkina Faso (though thankfully, the question period is less painful). We arrived around the scheduled start time, and things got rolling an hour or more later. Each speaker took more than their alloted time, so both days the conference finished 2 hours late.

I gave my talk - on the interaction between parasitic infections & HIV - in French, which was a little painful for me but I think went over well. It was intersting to review the topic in detail.

The congres was at the fanciest hotel in Haiti - perched on the top of a hill, the beautiful hotel was surrounded by lush gardens. Another world from the poverty below.

Haiti, day 3 - "Fete du 40ieme anniversaire de ICC"

"Fete" may be a bit too strong a word for 4 hours of speeches.
It was the hospital celebrating their 40th anniversary, in the ceremony for the hospital staff. The staff really do deserve a pat on the back, for they have a great hospital and clinic. The speeches were followed by a feast - you should have seen the heaped plates!

Driving around this city is fascinating. The roads are really narrow, and the even narrower sidewalks teaming with people and goods for sale. Everything from doves in cages, to plastic chairs, to piles of avocados and oranges. The streets are filled with potholes.

The "tap-taps" are the local public transit system; many of them brilliantly painted, with great names. They are mostly small pick up trucks, with a canopy that has been raised by two feet to allow people to sit on benches along the sides. As in many countries, there seem to be impossible numbers of people in the vehicles.

Electricity is provided by generators - the government doesn't provide it consistently. And water of course is always suspect.

I really like Haiti so far... its got a little of that island feel, and yet the needs are great. I hope to do more work here in the future.

The other benefit to coming here is that I have a renewed excitement for our project in South Africa. It really helps to have a reminder of why I want to do this work and why the benefits can balance the personal costs of being a nomad. (To a certain extent).

These small children, loved by their parents yet with so few opportunities... trying to help them is so important.

Hospital tours

Today was a true ‘medical tourism’ day; we visited 3 different health centres, each quite different. And driving around Port-au-Prince was fascinating.

Our first stop was the Grace Children’s Hospital, run by “ICC”, or International Child Care. (We are in Haiti for the 40th Anniversary of this faith-based NGO - in photo). For their anniversary, they are having “open house” days, where all consultations are free (rather than the usual $2 USD fee). The place was PACKED. They do have a mechanism for waiving fees for those “qui n’ont pas les moyens” (don’t have the means). But with how packed the clinic is today one wonders how many without the means just don’t attempt to go to the clinic (as is so often the case in Burkina Faso).

They have an inpatient ward, where the parents aren’t allowed to stay; it was the first time in my life that I saw a room full of kids with nary a parent in sight. There are enough nurses to do the care, and they are from the old school of believing that kids are better off with restricted visiting hours. One little marasmic girl with big wide eyes, a bit of papular pruritic eruption (an itchy, bumpy, common rash amongst HIV + kids)just held out her arms when we walked over. She didn’t make a sound but what she really wanted was to be held – even by a stranger. Some of the kids were very apprehensive of us but others were just curious and captivated by the white folks.

The hospital grounds are lovely and green, and there is even a playground!!

The second stop was GHESKIO, which is the oldest HIV treatment agency in Haiti – predates the more famous Partners in Health. We had a really lovely, comprehensive tour of an amazing research centre. They are an HIV vaccine trial study site, as well as being involved with a number of other research programs. It seems like a model of locally driven research done in partnership with a western university – and so it has all the funding that this implies. They have separate areas for each area of HIV care – testing counseling, lab (with phelebotomy), ARV treatment, pediatric HIV clinic, pediatric clinic, adherence, clinical trial clinic, STI clinic, family planning clinic, PMTCT clinic. It was crowded and chaotic but seems to be really well organized.
Finally we stopped at the government hospital. Typical for government hospitals, dark, crowded, not too clean. But still better organized and equipped than our hospital in Bobo. They have kids organized by both age and pathology to a certain extent (in Bobo they’re in two groups – older kids, and younger kids, regardless of what other infectious pathology they may have). There were more severely marasmic kids there, and the kids were very sick appearing. It was a odd to be there and not working.

This has been just a fascinating day – but I am sure exhausted! More tomorrow.
Take care
Laura

New country, new adventures!

Well, after a hiatus, I'm making an attempt to get back into blogging again. My impetus is the fact that I'm sitting in a hotel in Port-au-Prince, Haiti, on the first day of a week long trip to learn about pediatric HIV care in Haiti and speak in a conference on parasites & HIV in children.

After a journey that felt almost as long as that to Africa (though it was just two - 6 hour flights), I arrived this afternoon. The warmth was welcome as we climbed out of the airplane. There was a band in the entryway of the airport, like in Tahiti.
In fact at first glance, that's what this reminds me of - a cross between Africa (Burkina Faso) and Tahiti. Despite the higher ranking on the HDI - 154 vs Burkina's 174 of 177 countrires - things seem more run down here. A first example is that the urban roads are much worse - poorly maintained, more chaotic, slower.

Some things made me feel at home - reminding me of Burkina - the women selling deep fried beignettes on the side of the road, the vendors with second hand clothes, the warmth.
The vegetation and the ocean smells, and the cool ocean breeze.

I'm excited for the hospital visit tomorrow.

More later!
Laura

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.