helen weld public health: November 2009

Kigutu Reflections. . .

Yungaburra, Far North Queensland, Australia

The rain is pounding on the tin roof of our verandah here on the Atherton Tablelands, so welcome after a long, record breaking dry season. I listen to the inebriated chatter of the rainbow lorikeets as they feast on the nectar from the flowering black bean trees and watch the mists waft through in the valley below. A kookaburra hangs out in the bright red flame tree, so spectacular this time of year. He’s been waiting for a handout, coming to sit on the railing when Robert brings out a bit of fish for him. My jet lag haze laps at my psyche as I recover from the globe trotting marathon…I figure that I had 40 hours of time-in-the-planes since I left Bujumbura. My carbon footprint this week extends like deep mud around my knees, but nevertheless it is wonderful to be back in Australia after an 11 month hiatus.

My last week in Kigutu was full to the brim. According to Melino, the week was a record breaker in terms of number of patients seen... 321, compounded by the arrival of 363 local children under five coming in for polio vaccinations. The staffing was down too. Maneno was in Buj for a week of computer training, Orestine was off with a sick child and Sincerite on paternity leave. It felt good to be an integral part of the team; helping with triage, tending to patients in the ward (including a 2 year old with an infected uluva after he’d been taken to a traditional healer for a uluvaectomy, a commonly practiced procedure by traditional healers), helping with procedures, working in the pharmacy with Hilarie and caring for two newly admitted malnourished children (one quintessentially a marasmus case and the other quintessentially kwashiorkor). Marasmus is a form of malnutrition characterized by muscle wasting and loss of subcutaneous fat. Kwashiorkor is characterised by edema as a result of protein deficiency.

Felicia Price RN, the in-country director in Burundi for the Clinton Foundation, visited Kigutu for the week and it was great to glean more knowledge about malnutrition management from her. A few emergency cases arrived via stretcher too just to keep everyone on their toes, including a woman in labor who delivered precipitously in the hallway about 30 seconds after arrival! Never a dull moment. . .

A highlight of the week was a full in-costume performance of the local Kigutu drummers (including staff members Peter and Mandela) down on the small plateau by the farm with Lake Tanganyika as a backdrop. They are hoping to launch themselves on to wider horizons and use their drumming, song and dance as a means of health promotion. How terrific it would be to have this dream become a reality. Alex Goodell, computer whiz extraordinaire from Oregon, who has come to VHW to for a 6 month volunteer stint has edited some footage of their fantastic performance and has posted it on YouTube. Check it out at: http://www.youtube.com/watch?v=1m-2QP1x1hY

On Saturday, the day before my departure, I had the opportunity to walk down the road with community members (accompanied by army personnel as back up) to observe the community forces in action clearing the roadside where the ambush on the VHW vehicle occurred which resulted in Claude’s murder on July, 13, 2009. It is hard to fathom the horror and terror experienced by the staff that morning. You can read Tracy Kidder’s Opinion piece in the New York Times which reflects upon the events of that day at: http://www.nytimes.com/2009/07/22/opinion/22kidder.html

I was urged by the men to borrow a machete and spent a few minutes hacking at the brush which was obviously an attempt to symbolize solidarity, rather than to utilize muzungu muscle power. Nevertheless, I felt privileged to be part of their group and feel their spirit.

It’s amazing that it has been a week since I said my goodbyes in Kigutu and headed down the mountain to the airport in Bujumbura. My anticipated departure that evening was thwarted by a bird having been sucked into the plane’s engine in Belgium which dominoed to a 24 hour delay for me in Buj. I was able to use the extra day to catch my breath and reflect on my time in Kigutu. Also to write my epic report while sipping cappuccino and checking the internet on the wireless connections in the Buj “hotspots”; meet Alex; have a chance to debrief with Dziwe, and finally have a quick swirl through the local market with Peter and Prime before flying out to Nairobi, then Brussels and on to New York.

During my 24 hour stopover in New York, I loved having the opportunity to speak at an informal lunchtime gathering of employees from the TB Alliance www.tballiance.org , a not-for-profit development partnership accelerating the discovery and development of new tuberculosis drugs. I gave a short presentation about Village Health Works and how TB is dealt with out of “the Wall Street bubble” (as described by an employee). It was quite the contrast to be amongst the throngs walking down Wall Street after being in Kigutu watching the amazing sunset over Lake Tanganyika just 48 hours earlier. I felt as though I was the only one in New York NOT wearing a black coat!!

With this first stint in Kigutu, I think I have achieved my overall goal to become familiar with many aspects the VHW programme and establish a solid working rapport with the staff. More specifically, to assist the nursing staff, the community health workers, get the malnutrition ward more established and acquire a general appreciation of Burundi’s culture and its people. Though there is ALWAYS SO MUCH MORE to learn and knowledge to gain, I feel I have laid a good foundation in terms of achieving these general and specific goals. My learning curve continues from this experience in providing primary care, learning more about the realm of public health in a developing country and working with the local people.

Besides recharging my battery, during my ten weeks in Australia, I hope to procure some much needed items to bring back, practice my French and attempt to learn a bit more Kirundi. I am eager to return to Kigutu in mid January and see all the new developments and reunite with the tremendous staff, hoping that this trip to Kigutu will be the first of many to come.

Helen