Saturday, March 29, 2008

"All fired up and ready to go". . .

This is one of Barack Obama's mantras and it can be mine too!

It's been a big week of pre-departure activity. I head off tonight for London and will be arriving in Freetown, Sierra Leone Monday night the 31st. The people at West Africa Fistula Foundation, WAFF (http://www.westafricafistulafoundation.org/), seem like very lovely people and I am already looking forward to new friendships.

Writer Nicholas Kristof's articles describe the plight of African women afflicted with obstetric fistulas so well, even though it describes events that took place in Ethiopia, the situation is the same all over Africa. Below is one of his New York Times pieces. Take the little time to read it and be inspired.

Thank you to everyone's love and support. I carry you all with me. Keep following the blog when you can. Robert's web expertise and map making certainly help make it happen.

Love,
Helen


The Illiterate Surgeon
Published in The New York Times: June 12, 2005
By NICHOLAS D. KRISTOF
nicholas@nytimes.com


Addis Ababa, Ethiopia

Just about the worst thing that can happen to a teenage girl in this world is to develop an obstetric fistula that leaves her trickling bodily wastes, stinking and shunned by everyone around her. That happened four decades ago to Mamitu Gashe.

But the most amazing thing about Ms. Mamitu is not what she endured but what she has become.

Ms. Mamitu's story begins when she was an illiterate 15-year-old in a remote Ethiopian village unreachable by road and with no doctor nearby. She married a local man, became pregnant and after three days of labor, she lapsed into unconsciousness and the baby was stillborn.

"After I woke up, the bed was wet" with urine, she remembers. "I thought I would get better after two or three days, but I didn't."

That's typically how an obstetric fistula arises: a teenage girl, often malnourished and with an immature pelvis, tries to deliver her first baby. The fetus gets stuck, and after several days of labor it is stillborn - but some of the mother's internal tissues have been damaged in that time, and so to her horror she finds herself constantly trickling urine or sometimes feces from her vagina.

Soon she stinks. Her husband normally abandons her, the constant trickle of urine leaves her with terrible sores on her legs, and if she survives at all she is told to build a hut away from the rest of the village and to stay away from the village well. Some girls die of infections or suicide, but many linger for decades as pariahs and hermits - their lives effectively over at the age of about 15.

Fistulas were common in America in the 19th century. But improved medical care means that they are now almost unknown in the West, while the United Nations has estimated that at least two million girls and women live with fistulas in the developing world, mostly in Africa.

This should be an international scandal, because a $300 operation can normally repair the injury. A major effort to improve maternal health in the developing world should be a no-brainer, for it could prevent most fistulas and reduce deaths in childbirth by half within a decade, saving 300,000 lives a year.

But maternal health is woefully neglected, and those suffering fistulas are completely voiceless - young, female, poor, rural and ostracized. They are the 21st century's lepers.

Ms. Mamitu was exceptionally lucky in that she was brought to a hospital here in Addis Ababa that offered free surgery by a saintly husband and wife pair of gynecologists from Australia, Reginald and Catherine Hamlin. Reg is now dead, while Catherine is the Mother Teresa of our time and is long overdue for a Nobel Peace Prize.

After that operation, 42 years ago, Ms. Mamitu was given a job making beds in the hospital. Then she began helping out during surgeries, and after a couple of years of watching she was asked by Dr. Reg Hamlin to cut some stitches. Eventually, Ms. Mamitu was routinely performing the entire fistula repair herself.

Over the decades, Ms. Mamitu has gradually become one of the world's most experienced fistula surgeons. Gynecologists from around the world go to the Addis Ababa Fistula Hospital to train in fistula repair, and typically their teacher is Ms. Mamitu.

Not bad for an illiterate Ethiopian peasant who as a child never went to a day of school.

A few years ago, Ms. Mamitu tired of being an illiterate master surgeon, and so she began night school. She's now in the third grade.

The Fistula Hospital where Ms. Mamitu works is nicknamed "puddle city" - because patients stroll around dripping urine - but it abounds with joy and hope.

President Bush has increased aid to the developing world generally and to Africa in particular, but a few days ago he rejected Tony Blair's appeal for a further dramatic increase in assistance for Africa. The real stakes in that rejection will be measured in lives like Ms. Mamitu's. I hope that Mr. Bush will reconsider - for the sake of people like those girls with fistula living in huts alone on the edges of hundreds of thousands of villages.

Ms. Mamitu shows us what a tragedy it would be to write them off. A couple of Australians once gave Ms. Mamitu a break, and so today Ms. Mamitu is not a victim at all, but an inspiration.

And, I hope, an inspiration to us to be more generous.

March 25, 2008

Pink Moon in Sierra Leone. . .

I have been marking the months and my recent travels with my whereabouts on the full moon. It’s a great way to keep track of my peripatetic existence. I have definitely covered some territory for the past 7 full moons …Maine, Ojai, Yungaburra (twice!), East Timor, Tuvalu and Vermont. Images of sparkles and moonbeams over the Damariscotta River, the Topa Topa Mountains, Lake Eacham, the Timor Sea, Funafuti Lagoon, and the snow covered pastures of Putney all swirl in my mind’s eye. Indeed, I feel very lucky.

Unfortunately my plans and hopes to return to Kashmir at the end of March were kyboshed due to increasing unrest and the bombing of a restaurant in Islamabad frequented by foreigners. My friend Todd Shea, CDRS director, made the decision to suspend volunteer activity until further notice. It’s very sad to think of all the people who continue to suffer as a result of the October 2005 earthquake and now they have these tumultuous times as a result of the elections and the aftermath of Bhutto’s assassination.
Our (Judy’s and mine) translator and surrogate son, Zubair, will be getting married (a “love” marriage) in April and I am very sorry not to be present for this momentous occasion.

In Dili, East Timor, I met Dara Cohen, a PhD candidate in political science from Stanford University in California. She told me about her experiences in Sierra Leone, in particular about the West Africa Fistula Foundation (www.westafricafistulafoundation.org), which were very intriguing. To make a longish story short, Freetown, Sierra Leone is my next destination.

I am excited and ready for this next challenge. Being able to communicate in English will definitely make things easier, though I can only speculate about all the other new challenges which will confront me. April’s “pink” moon will be spent somewhere in Sierra Leone. A wonderful way to celebrate my 54th birthday!

Love, Helen

Some facts about Sierra Leone:

Full name: Republic of Sierra Leone
Population: 5.9 million (UN, 2007)
Capital: Freetown
Area: 71,740 sq km (27,699 sq miles)
Major languages: English, Krio
(Creole language derived from English)
and range of African languages
Major religions: Islam, Christianity
Life expectancy: 41 years (men), 44 years (women) (UN)
Monetary unit: Leone
Main exports: Diamonds, rutile, cocoa, coffee, fish
GNI per capita: US $220 (World Bank, 2006)

Saturday, March 1, 2008







“Hi-bye, hi-bye” Tuvalu. . .

“Hi-Bye” is what all the small children say in their sing-songy voices as we walked to work every morning. The 12 days flew by when we were in Tuvalu, so it felt like…”hi-bye”, even though in some ways it felt as though we were there for a long duration since we did so much.










Now I am preparing to depart for the USA tonight…just enough time at home to have a bit of a catch up with Robert and friends, clear off the desk, tend to some business, have a few swims in Lake Eacham and mow!

The time in Tuvalu was a fantastic and new experience for me. It was a wonderful opportunity to get a good perspective on the research side of public health, as well as soak in a bit of the glorious South Pacific.

For those who are interested in more of the scientific and technical aspects of the project…read on…otherwise skip ahead…




Our team from James Cook University was in Tuvalu under the auspices of the Gates Foundation and the Task Force for Child Survival and Development, Emory University in Atlanta, Georgia who are coordinating the multi-centre, multi-country evaluation of lymphatic filariasis diagnostics. The mission had two objectives:

#1 To collect blood and urine samples and trap mosquitoes to compare detection methods for lymphatic filariasis in a low transmission setting.

#2 To help the Ministry of Health with a whole-population survey for lymphatic filariasis on Funafuti Island. The samples for objective 1 were collected from within this survey.

The community survey for the Gates Project comprised individuals from age 3 to 80 – totaling 1000 , as well as a survey of school children from age 6 to10 – totaling 350 children. Data was to be collected with the use of Personal Digital Assistants and training of locals to assist was all part of the project.

The diagnostic tests included:
Preparation of a “three line” blood slide for microfilaria.
ICT rapid filarial antigen test.
BMR1 rapid antibody test.
Filter paper samples prepared and stored for BM14 antibody and Og4C3 ELISA at JCU, and PCR in the USA.

Urine was collected from many participants and preserved for antibody testing in Japan.
Mosquitoes were collected using gravid and BG traps and sorted, stored, and transported. Mosquitoes were only being used as “de-facto blood collectors” or “flying syringes” and both the Aedes vector and the Culex non-vectors were suitable for analysis

Upon arrival our team of seven soon realized that those higher in the ranks than us had apparently had a few gaps in communication resulting in an overall lack of attention to details concerning the project and also enlisting the support from the people in Tuvala. We successfully met the challenge of pulling off the task at hand without alienating anyone in Tuvalu and potentially jeopardizing future collaborative projects. The whole situation was further complicated by two other projects requiring data collection being piggybacked onto the Gates Global Filariasis Project and the Tuvalu national survey. By the end of the 12 days it was apparent that we had been successful in laying the groundwork for the projects and progressing very well in the field and in the lab. Locally trained people became integral to the whole scheme and will be able to complete the work. It was a Herculean task requiring all of us to put in a succession of 14-18 hour days. Our team was very professional- competent, efficient, hardworking and good humoured throughout.

The best analogy I can conjure up is that it was like an enormous jigsaw puzzle which was dumped on the floor and we had to just hunker down and tackle it, but without having the edge pieces/framework available until the end.

We did manage a Sunday morning getaway to an islet, Tepuka, on the other side of the lagoon for a bit of R and R. Such a treat! I also managed to get in daily dawn and moonlit swims which definitely increased my level of productivity.

Our group all together.

Cultural anecdotes/observations about Tuvalu:

Global warming and the rising ocean are issues in the spotlight for Tuvalu, eventually making the people of Tuvalu environmental refugees (the island of Funafuti is only 800 meters wide at the widest point and 1+meters at the highest elevation). We were there during the highest tides of the year, king tides, and the water was coming up onto the runway.

Garbage issues are huge. They are running out of space to dump rubbish and the amount of plastic waste is horrendous. Very sad to see, as it seems that mostly the people have a tendency to be quite tidy…sweeping the breadfruit leaves assiduously every morning in front of their houses.

Owning land is a precious commodity. The houses are all very close together.
The people are generally all very overweight. Minimal exercise and high fat/sugar diet major contributing factors. Diabetes and hypertension must be huge problems. The people don’t squat, they lie down or just lean on one arm and rest.
Goods are never carried on heads, as in many other countries and babies are carried in the arms, not on backs.



4WD vehicles are prominent, despite the flat roads (only 8 km). Motorbikes/cycles too. Some ride bikes and few seem to walk.
It’s against the law to work or play on Sundays. They are a highly religious culture. Walking back from the lab at the hospital every night, we could hear the lovely singing in the churches.


The people are all very friendly, giggly and laid back, not appearing to have too many worldly worries. Despite being isolated they seem very happy and don’t appear to have conflicts amongst themselves.


The naming system is very complex. The first name of the father is generally the last name of the child. Wives keep their names, but then there seems to be other name switching too. This made data entry very challenging. Common names were along the lines of Fanoanoaga Patolo and Penielu Penitala…occasionally there was a “regular” name like Lolita or Honolulu and even a Snow White!



Extended families prevail. If one family member has an infertility issue, another family member will give a child over to that individual to be the parent. This can have serious health consequences as the child could miss out on being breast fed.
The dead are buried immediately as there is no refrigeration. Leo, the lab head at the hospital from the Philippines, has been asked to embalm people. He had to learn how to do it on the internet! The dead are buried in the front yards with elaborate graves.


The airport strip built during WWII by the US remains the central focus on the island. The incoming planes on Tuesdays and Fridays are major events. Otherwise the strip is the site for family picnics, walking, romantic rendezvous and sports.
The cargo ship arrives with goods about every 4-6 weeks


When a citizen is hospitalized they get a government subsidy of $15/day
In 2000 there was an agreement to lease the country’s national internet suffix “.tv” to a US company which generated enough funds for Tuvalu to join the UN. As a result of this agreement , the $45 million has been placed in a trust fund for the country and has been used for secondary school education, street lights and paving of roads.
The incredible turquoise colour of the ocean/lagoon is also the colour of their passports and school uniforms.


The jail doesn’t have walls or locks. There is a man who murdered someone on another island in the jail, he works during the day and goes to the jail at night. Lesser criminals are allowed to go home on weekends.

I hope that I can return someday. It would be a pleasure to work amongst these lovely people and try to assist them with some of their public health issues.

Blood samples on disks and strips (with ants checking them out).