Saturday, February 27, 2010

Bean Planting Week. . .

Planting the bean crop has been the major focus this week for the residents in our catchment area, therefore the week has been much slower in terms of numbers of patients coming to the clinic. Next week we are sure to have scores of people walking in.

Two highlights of this past week were to witness the incredible progress of two former patients. The first was Ed who was here for a long stretch when I was here in October. He had a very impressive orbital tumour and was started on treatment with steroids. When he came to visit he was so much improved we all gave hoots and hollers of delight. Ed was so happy and his vision is great. Secondly our little 5 year old burn patient ‘Muganga’ returned for a check up and he continues to improve dramatically. It is very rewarding to witness these impressive successes.

Sweet Bea, an almost 5 year old girl weighing 9.4 kg (20+lbs.), was transferred from the local government hospital in Bururi with severe malnutrition (marasmus). She also has extra pulmonary TB and some cardiac issues. Her father died in 2007 from probable TB. She is the youngest of six living children in the family (one child died and the mother also had a miscarriage). Her mother says that the family has no money and that their house is very old with many leaks in the roof which is particularly hard during these heavy rains. She is also very concerned no one is at home to take care of her other young children (14, 12, 9). Another big worry is that since this is the prime time to be planting the bean crops, she is missing the opportunity due to being here with Bea.

So far Bea is doing well with no fever, vomiting or diarrhea and she’s taking the prescribed first stage nutritional formula F75 without any complaints. It is a testament to VHW that the Bururi Hospital recognized that Bella would receive excellent care while here in the malnutrition ward. An advantage to having fewer patients this week was that there has been more time to get the whole story about Bea from the mother with the help of Melino and Gerard. I am sure many, if not all, the patients who come here have equally heart wrenching tales. I will be sure to continue to update her progress. I love the chance to really get to know patients like Bea. She is a real girl with an anguished mother in dire straits who has the chance to really get healthy.

I have been able to scrounge plastic bubble wrap and large plastic bags which came with some donations (Crate and Barrel!) for the mothers in the malnutrition ward to use to protect the bedding. I also made a spacer device out of a plastic drink bottle for a bronchodilator asthma treatment. Everything gets recycled if possible!

Will has planted a new bean crop with the agricultural team here at VHW for patients. The team has to take turns being ‘human scarecrows’, keeping watch over the seedlings as the raiding birds are wily and clever. He has also been working hard to organize collaborations with two community groups of women. Both groups are very excited to receive agricultural training and nutritional education from VHW. In exchange they will volunteer to do landscaping, gardening, and other duties at the clinic.

I
also plan to do some public health education with these women as they are highly motivated and all play pivotal roles in their communities. I look forward to more home visits too.

Today Will, Hilarie (one of our nurses), Peter and I hiked to the far ridge beyond Kigutu to Hilarie’s family home, nothing like a good Saturday morning workout with friends. It was lovely listening to the birds and the far away voices of children in the valley below.


“Kira”! Be healthy!

Helen



Close up of eye, post treatment


Eye miracle


Eye before treatment

Clovis three weeks post burn


Bea with mama


Bea 25-2-2010 front


Helen teaching spacer use with drink bottle


Will and Adonis human scarecrows guarding the beans


Peter, Will and Gerard speaking with Kigutu women


Hiking Hilarie


Hilarie


Hilarie and friend on the trail


Hilarie at home


Helen, Peter, Hilarie and Will



Helen with Naphtaly



Helen and Anne



Helen and Alex with kids



Helen almost finished with Alex's haircut


Chameleon





Sunday, February 21, 2010

Homecomings, Rewards & Gratitude. . .

The week began with the unexpected twist of Brad having to depart for the USA on Monday due to a family emergency. Since we have been working so closely, it was an adjustment for me. The void left by Connie was instantly doubled. (Connie was home in Flagstaff for four days and is now in Haiti for a week.) Both are missed greatly and we look forward to Brad’s return in March. We had been planning to work on some programs together, so I feel as though I am treading water a bit with this hiatus.

I was able to ensure that health promotion for the patients was done twice this week while they waited in triage. Elvis and I did a simple and basic power point on malaria. The feedback and questions from the patients was encouraging and our efforts seemed beneficial.
Working closely with the nurses this week in the wards has been a treat. I am continually impressed by their dedication and skills. Over my time here I have observed and worked with the nurses a great deal. I feel that I have their trust and respect and that they are willing to listen to my ideas. Now my suggestions and changes are being integrated and it is good to see that they are working well.

We have had some interesting clinical presentations, including a man severely jaundiced due to liver and kidney toxicity from herbs used by a traditional healer. Working in the malnutrition ward is very special. It’s very gratifying to watch these babes improve and gain strength.


Clovis has recovered remarkably well since his horrific burn on February 3rd. The wound has healed very well. He insists on doing much of the wound care himself and he does it very well. He has earned the nickname ‘Muganga’… ‘Doctor’, from all the staff. For a four year old, his resilience and courageous spirit is amazing and he has won all our hearts. Yesterday he was discharged and I had the idea of walking home with him to help his grandmother. Peter and Alex came too. It was only a “short” walk, just under two hours, up into the mountains behind Kigutu. Clovis was barefoot, running much of the way, wearing a large T shirt I had given him from Australia to keep the sun off his new skin. He never whinged at all which I found quite remarkable, though I wasn’t surprised. I puffed and panted in the rear as we gained more altitude up into the mist of the high hills. When we had arrived near to their home there were hoots and hollers of delight from their neighbours and relatives welcoming them. The tradition in Burundian culture is that when visitors come the hosts walk them part way home, so when we departed, Clovis, his grandmother and friends walked us back along the track until we reached the forest. Then it was goodbyes and hugs all around and we parted ways. It’s nice to have a happy ending and very rewarding to see good care truly making a difference.


Bazile has left for a two plus week trip home to Haiti to reunite with his family. He will be hugely missed. It’s hard to imagine how much worry and hardship he has endured since the January 12th earthquake. Despite this huge strain, he has always maintained a high standard of professionalism and compassion for others. He is a great source of strength and leadership for the staff here. Bon Voyage, Bazile!


It’s good having a quiet Sunday. The intensity of the work here is cushioned by the love and compassion of this lovely VHW family and the Kigutu community. I am always feeling grateful for this opportunity. I just wish I had the brain power to really learn Kirundi well as I would love to have “real” conversations with these friends….’buke buke’…I have a ‘little bit’.

Helen



Health promotion to patients


Jaundiced eyes


Clovis doing dressing with glove


Children breastfeeding, not twins


Maneno at new desk in malnutrition ward


Constantine 'Barack'


Constantine doing OB consults in OB room


Anne and Helen


Grandma and babe packed up


Stream crossing


On the track


Higher into the mist


Waiting for Helen to catch up


Home again


VHW staff...most, not all



Monday, February 15, 2010

The Beat Goes On. . .
Last Monday was relatively quiet as it was deemed a “spur of the moment” holiday by the Burundian President. This gave us some extra time for catching up and preparing for the anticipated hordes of patients for the rest of the week. We also had a full hospital and had to deal with the overflow of patients and space management.


Boohoo, Connie’s month here has gone by fast and she is all too soon heading home to Flagstaff, Arizona. Last Thursday evening we had a wonderful bon voyage soiree for her with lots of music and singing from the “local” talent. Fun!

After we arrived back in Kigutu from the weekend in Bujumbura, Brad received word from home about a death in his family. He has departed today for Baltimore and will return in March. Needless to say, there is a huge void having both of them gone. We will also miss Connie’s solar cakes. Fortunately we have some new Burundian nurses starting which is a godsend.


I am hoping in the next fortnight to launch my idea to get the community women trained to do some sewing. Surgical scrubs could be made from colorful Burundian fabric and then sold overseas to medical centers for health care personnel. The women would gain a skill, have an income and fundraising could be done for VHW, plus spread the word about what we’re doing here. Health care staff everywhere could be wearing great fabric in medical centers instead of the rather drab ones they currently use. It seems that through all the contacts VHW has in the USA and elsewhere, these colourful scrubs could become popular items.

Both of Kigutu’s community groups will be here this week. I look forward to meeting with them to present the scrubs idea and assess their enthusiasm and motivation. Details and fine tuning obviously need to be done, but it seems we are beginning to get the concept more in focus.

Clovis is healing so well. His wound care is down to one dressing change a day and it is looking good. He is certainly a feisty chap! One day he began heaving the gauze swabs across the room and later was acting like an drunken pterodactyl as he lunged at us with his arms out while standing on one leg.
Watching the sunsets from the top of the hill is a good way to wrap up the long days.

Last night there were a series of dramatic thunderbolts coming from the mountains over in the Congo across the lake, the 'Heart of Darkness' country. Nicholas Kristof’s chilling tales in his recent New York Times articles about what’s been happening in the Congo are hard to fathom, especially since it feels so close, just across Lake Tanganyika.


Another favorite pastime is watching the amazing Kigutu drummers practicing their routines. The little ones are simply adorable and eager to join in. Even the three year olds have the rhythm. Last week, as the sky was turning orange during the practice, there was a contrail from a high flying jet in the sky above catching the sun’s rays, which caused many to stop, point and exclaim. At times like this it makes one realize how this community has been insulated from some of our world’s realities, but definitely not in many other realms.


Helen


Moving beds in the overflowing ward


Bazile table drumming


Connie with solar oven


Connie's last supper in Bujumbura


Connie and Helen after a wonderful month’s reunion


Clovis heaving gauze across the room


Three vs Clovis doing his dressing


Ascaris worm which emerged from a child’s nose


Patient taking plant home


Peter drumming


Young drummer


Watching the drummers



Breakfast time


Helen on the water tower taking panorama photos


Sunset with Liesse and Esperance



Sunday, February 7, 2010

‘Our' Children of Kigutu. . .

Another full week! The patients continue to flock in for consultations and treatment once the ‘gate’ is opened for them to get in the queue. It is always mind boggling to realize how far people travel to get here. One young woman and her mother walked from Tanzania (over 100 km) for her delivery. Another arrived on the back of a bicycle sitting in a chair.

The plethora of children who come in daily for treatment of malaria and malnutrition are the ones that really wrench the heart.
The 'ambulance' (four strong men carrying a stretcher) arrived early Wednesday after a 4+hour trek from the farthest ridges. They lay it down and I peaked under the fabric to assess the transported bundle. An adorable four year old boy with burns over his torso, flank, left arm and hand stared up at me, exhibiting the quintessential Burundian stoic behavior, totally alert and nary a whimper.

After the hour it took for Connie, Brad and I to get him ‘settled’, cleaned and dress the burns, we already felt an attachment to this dear little guy named Clovis. His resilience and determination are astounding. Despite medication he was thrashing and he made it clear that he wanted to help clean the wounds. Brad gloved him and gave him a 4X4 gauze with saline and Clovis began deliberately and carefully cleaning his wounds. It really touched all of us simultaneously, we all had tears brimming!


We are into a routine now of doing his dressing twice a day with his mother. It will be a long haul, but we are confident that he will heal well. It’s awful to be involved with these tortuous sessions, but we do our best to keep him sedated with codeine and valium. He’s very special and we love him.


Two other boys, Ferdinand and Maombi, have chronic health issues and they spend a lot of time hanging out. Ferdinand has been here for about six months and Maombi about three. Last week I went to the Kigutu Primary School (next door to VHW) and spoke with teachers and the headmaster and now they are enrolled in the second grade. It’s definitely worth the effort to make sure they are fed, ready and delivered to school before we do rounds.

Brad and I felt very protective of them as they were quite the spectacle for the first few days, especially Maombi, who is in a wheelchair. Now they are integrating well.
Two babies from the malnutrition ward died over the weekend which was agonising. Both were admitted with multiple health issues.

The mother of one was a pregnant 18 year-old Muslim girl who was very upset (the most outward display of grief I have witnessed in Burundi). She explained that her husband’s father would blame the death on her and that the traditional healer had said that this pregnancy would be born as a rat or a stone. To help console her we took her into an exam room and used the Doppler on her so she could hear the reassuring galloping sound of the fetal heart tones. It was a relief to see her smile.
In the malnutrition ward the mothers seem to bond in almost a tribal manner. They all help look after each other’s children, truly conveying the feeling of “it takes a village to raise a child”. It’s very sweet to witness.

In the community of Kigutu, VHW staff members contribute their time to be with children. Pontien, our cook, coaches soccer. Peter (Information Technology) and Mandela (Laundry) do the amazing drumming and dancing. Claudine, the cleaner in the residence, leads a girls’ chorale group.

This past week I have had the opportunity to head to 'downtown' Kigutu every afternoon to do a dressing change for Stefan, our head housekeeper’s husband of 60 years. It’s great to have the little walk and witness all this community building in action.


This afternoon I walked to the top of the hill behind the clinic to watch the sunset. It’s good to feel so at home here, looking out to the verdant mountains beyond mountains on one side and out across Lake Tanganyika on the other.

Helen


Be sure to check out Brad’s blog too:
http://www.healthforhope.blogspot.com/


Patients waiting at the front of the queue

Bike ambulance

Clovis' burns

Clovis with dressing


First day of school for Maombi and Ferdinand

Brad and Maombi

Kigutu Primary

Classroom

Rounds in the malnutrition ward

Ponce playing soccer

Helen on home visit

Anna and Stefan, married for 60 years

Kigutu view panorama