learning patience

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

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

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

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

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

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

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

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

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